College Binge Drinking Still on the Rise

Despite efforts at prevention, the prevalence of binge drinking among college students is continuing to rise, and so are the harms associated with it.

Researchers with the National Institute on Alcohol Abuse and Alcoholism (NIAAA) said the proportion of college students aged 18 to 24 years who engaged in binge drinking (defined as having 5 or more drinks on an occasion in the previous 30 days) increased from 41.7% in 1998 to 44.7% in 2005. At the same time, the number of deaths from unintentional alcohol-related injury increased from 1440 in 1998 to 1825 in 2005, or 18.5 to 19.0 per 100 000 students (a 3% increase, although the increase was not statistically significant). Also, the proportion of those who reported driving under the influence of alcohol in the past year increased from 26.5% to 28.9% (Hingson RW et al. J Stud Alcohol Drugs Suppl. 2009;[16]:12-20).

The analysis integrated data from the National Highway Traffic Safety Administration's Fatality Analysis Reporting System, the Centers for Disease Control and Prevention's injury mortality data, national coroner studies, census and college enrollment data, the National Household Survey on Drug Use and Health, and the Harvard School of Public Health's College Alcohol Study (CAS). The findings appear in the July supplement of the Journal of Studies on Alcohol and Drugs, which published 14 articles reporting results of projects associated with the Rapid Response to College Drinking Problems Initiative, a grant program funded by the NIAAA.

Ralph W. Hingson, ScD, MPH, lead author and director of the NIAAA's Division of Epidemiology and Prevention Research, said his study's findings show that colleges and communities are not taking the necessary steps to implement effective alcohol abuse prevention and intervention programs, and by not doing so, they are putting the students who drink at risk for long-term medical problems, injury, and legal troubles.

“Most college students engaging in drinking do not think they have a drinking problem, and yet maybe 1 in 5 are drinking at a level that would be diagnosed as alcohol dependent. So we have to ramp up the screening to reduce population effects,” Hingson said. “The challenge is to persuade not only the colleges, but also the communities to work collectively to reduce the problems and implement the interventions.”

To bolster this argument, Hingson and colleagues showed that in 1998 and 2001, of the students who were under the influence of alcohol, 10.5% of these students were injured, 12% were assaulted, and 2% experienced sexual assault or date rape by another college student who had been drinking. And the student who drinks is not the only one affected by alcohol. “Nearly half of people who die in traffic crashes under the age of 25 are those who were not the drinking drivers,” Hingson said.

William DeJong, PhD, who served as special editor of the supplement and is a professor in the Department of Social and Behavioral Sciences at Boston University's School of Public Health, attributed the persistently high binge drinking percentages on societal factors. “Many students come into college believing that heavy drinking is the norm, when it is not. And many of them think of their college years as a respite from the ‘real world,’ when it should be a time when they work hard to prepare for their future,” DeJong said. “This mindset is coupled with ready access to free or inexpensive alcohol, plus a lack of consistent enforcement of school rules and local and state law.”

A closer look at the data reveals some possibly encouraging developments. While binge drinking rose from 1998 to 2005, most of the increase during that time did not involve students younger than 21 years of age. And although the percentage of students reporting driving under the influence of alcohol was higher in 2005 compared with 1998, that percentage represented a decline from 31.4% in 2002.

Hingson credits that later decline to federal legislation passed in 2000 that threatened to withhold highway funds from states that did not define driver intoxication as a blood alcohol concentration of 0.08% or higher. At the time of the legislation's passage, only 17 states had such a definition, but by 2005, all did, Hingson said. “It shows we can make a difference if society decides certain levels of alcohol are too high when driving,” Hingson said. “The legislation passed, and there was a reduction in students driving under the influence of alcohol.”

Hingson was also critical of the Amethyst Initiative, an effort signed on by 135 university and college presidents and chancellors calling for a public debate on the merits of the 21-year-old minimum drinking age and the possible positive consequences that would result if the minimum age was lowered. To bolster his concern, Hingson noted his study found that for each year they studied, a greater percentage of 21- to 24-year olds than 18- to 20-year olds engaged in binge drinking and driving under the influence of alcohol.

While Hingson's article presents the data defining the scope of the binge drinking problem on college campuses, the other articles in the supplement look at the efforts of the Rapid Response to College Drinking Problems Initiative. The initiative invited college administrators to propose interventions to address alcohol-related problems at their campuses. Between September 2004 and September 2005, the NIAAA selected 15 colleges and paired each with a multidisciplinary team of experts in prevention and intervention.

In one study of 265 mandated students (those with alcohol and drug policy violations), researchers compared those who went through a brief one-on-one counseling program with those who did not receive the therapy. The students who underwent counseling did better at reducing past 90-day weekday alcohol consumption and the number of alcohol-related consequences, while increasing past 90-day use of protective behaviors and coping skills (Amaro H et al. J Stud Alcohol Drugs Suppl. 2009;[16]:45-56).

Another study involved 363 students at a large public university who presented as new patients to the campus health service, screened positive for high-risk drinking, and agreed to participate in the trial. Researchers found that at 6 months, those students randomized to receive 2 brief intervention sessions delivered by 4 health care workers trained in motivational interviewing techniques were having fewer drinks on average per week compared with those in the control group (6.16 vs 8.90) and reported a lower peak number of drinks per sitting, 6.52 drinks consumed compared with 7.98 drinks consumed by the control group (Schaus JF et al. J Stud Alcohol Drugs Suppl. 2009;[16]:131-141).

A third study looked at a comprehensive strategy to decrease disruptive off-campus parties by promoting student integration into the neighborhoods in which they live. The intervention included, in part, increasing police patrols of off-campus parties and expanding campus-based late-night programming. The researchers said they found that the prevalence of heavy episodic drinking was significantly lower at the 2 schools studied with these intervention programs compared with a control college located in the same part of the state (Saltz RF et al. J Stud Alcohol Drugs Suppl. 2009;[16]:21-27).

But while these studies illustrate programs that may help reduce problem drinking on campus, the consumption of alcohol by some students remains a fact of life, especially because the current culture accepts it in most segments of adult society. So what maximum level of alcohol consumption by students would Hingson consider a feasible goal? “Try to look at drinking patterns that are a risk to health and establish daily levels that should not be exceeded,” said Hingson, who recommended that men have no more than 4 drinks in a single day and no more than 14 drinks over a 7-day period and that women have no more than 3 drinks in a single day and no more than 7 drinks over a 7-day period.

The articles in the Journal of Studies on Alcohol and Drugs supplement may provide evidence that certain techniques in prevention and intervention can work, but Henry Wechsler, PhD, principal investigator of the Harvard School of Public Health's CAS, wonders why college binge drinking prevalence remained so high. “You almost get this feeling that a lot of people are claiming success, but why then are we not doing better?” Wechsler asked.

Wechsler, who is also a lecturer at the Harvard School of Public Health in Boston, said he believes campus alcohol-control programs are too often incorrectly focused. “Most of the approaches are based on the individual, and that is fine; it certainly has a place in prevention efforts. But what is missing are the efforts to change the environment,” Wechsler said. “You can change students 1 by 1, but every year new students come and then you have to change them. Change the environment; it lasts and it does not need to change every year.”

Wechsler said the articles from the Rapid Response to College Drinking Problems Initiative mirrored much of the findings he and colleagues uncovered while running the CAS. That effort, which ran from 1992 to 2006, used 4 national surveys involving more than 50 000 students at 120 colleges.

Wechsler said that changing the campus environment to downplay the significance of alcohol would be effective, but very difficult to achieve, especially because it requires the effort of the college and the surrounding community. “College administrations are not in the community, and it requires input from the community because that is where alcohol is marketed and sold,” Wechsler said. “You also have hesitant administrators who feel like they are the bad guys on campuses with regard to fraternities and athletic programs. They have to enforce rules, which makes a college administrator feel like a police officer, and it is something they are not trained for.”

DeJong basically agreed. “I think what I find most discouraging is that many campus administrators have concluded that very little can be done to address this problem, even though there are several examples of colleges and universities that have seen dramatic reductions in problem drinking and its negative consequences,” he said. “We need to find more effective ways of getting out the message that progress is possible.”