Gail M. Basch M.D Department of Psychiatry Rush University Medical Center College Drinking 1© AMSP 2013

College Heavy Drinking Transitional time Heaviest drinking epoch Believe heavy drinking = norm 2© AMSP 2013

~2,000 ~700,000 ~80,000 ~2.8 million $62 billion Morbidity & Mortality 3© AMSP 2013 student deaths/yr assaults/yr sexual assaults/yr drove while intox /yr underage drinking

→ Drinking problems Clues for prevention Clues for Rx College Heavy Drinking 4© AMSP 2013

5 This Lecture Reviews: Definitions Campus drinking & problems Risk factors for heavy drinking Prevention efforts

6© AMSP 2013 Standard Drink

© AMSP Standard Drink in Solo Cup Beer (12 oz) Wine (5 oz) Spirits (1 oz)

/ 4+ ♀ ≥5 occas/month Heavy Episodic Drinking 8© AMSP ♂

9© AMSP 2013 Blood Alcohol Concentration Standard drink ~12 grams alcohol ↑ BAC with: ♀ ↓ Weight Drink w/out food 1 drink → BAC g/dl (~15 mg%)

10© AMSP 2013 BAC’s Effects ≤ 50 (1-3 drinks) BAC (mg%) Well-being, ↓ inhib ≤ 100Sleepiness, ↓ coordination ≤ 200Anger, moody, confusion ≤ 300Difficulty waking > 300 ↓Vital signs, coma, death Effects

Intox →forget events Remain consciousness Blackout 11© AMSP 2013

≥ 1 Role failure Risk of harm Legal problems Use despite problems  Dependence DSM IV Alcohol Use Disorders 12© AMSP 2013 ≥3 Tolerance Withdrawal Larger/longer Unable to cut down ↓ Time elsewhere Use despite problems AbuseDependence

Legal problems Cravings DSM 5 Alcohol Use Disorders 13© AMSP 2013 Tolerance Withdrawal Larger/longer Unable to cut down ↓ Time elsewhere AbuseDependence 2-3 mild, 4-5 mod, ≥6 severe Role failure Risk of harm Use despite problems

14© AMSP 2013 This Lecture Reviews: Definitions Campus drinking & problems Risk factors for heavy drinking Prevention efforts

heavy drinking/2 wks ♂ drink 10 drinks/occas ♀ drink 8 drinks/occas 1+ blackout/college 1+ alcohol problem prior yr students drink 72% of alcohol ~45% ~20% ~10% ~50% ~40 % ~20% Heavy Drinking Episodes 15© AMSP 2013

16© AMSP 2013 College vs Non-College

Single event/game day/holiday 21st birthday Fraternity/sorority Student athletes ↑Impulsivity AUD relative Low LR to alcohol 17© AMSP 2013 Risk Higher For:

18 © AMSP 2013 BAC ↑Drink Days

~83% ~25% ~40% ~50% ~72% drink to celebrate >21 b-day drinks blackouts highest ever drinks ↑ DWI risk 19© AMSP st Birthday

20© AMSP 2013 Game Day Drinking ~ 60% drink ~7 drinks/game ↑ Impulsive ↑ Expect drunk →↑ Drink

~ 60% prior heavy drinkers ~ 80% heavy episodic drinkers Greek peers = heavier drinkers Believe ↑ drink norms →↑ Drink 21© AMSP 2013 Fraternity/Sorority

Blackouts/Past 2 Weeks 22© AMSP 2013

~50% heavy episodic drinkers Leaders ↑ drink and set norms Athlete peers = heavier drinkers Athlete + Greek →↑ Drink 23© AMSP 2013 Student Athletes

24© AMSP 2013 Family History 4x ↑ AUD risk Even if adopted out

25© AMSP 2013 Impulsivity ↓Postpone reward ↑Risk taking ↑Urgency →↑ Drink

26© AMSP 2013 Level of Response ↑↑ Drinks/occas for effects →Join peers ↑↑ drinks/occas →Think everyone drinks ↑↑ →↑ Stress Use ↑ drinks to cope →↑ Drink

27© AMSP 2013 This Lecture Reviews: Definitions Campus drinking & problems Risk factors for heavy drinking Prevention efforts

28© AMSP 2013 Peer Influence Students fear rejection ~40% afraid to refuse Overest. peer/campus drink ↑ Drinking to match

29© AMSP 2013 Inaccurate Beliefs ~65% more fun ~55% better sex ↓Muscle tension Better sleep Other myths Alcohol OD Predict BAC Alcohol + Drugs False beliefs: Underinformed:

30© AMSP 2013 Alcohol to Cope Low doses → ↓ mild anxiety 2 or 3 drinks → ↑ anxiety Drink to Rx anxiety → ↑ Drink

31© AMSP 2013 Prevention Programs Orientation Student health Campus Life Dorm counselors Prevention campaigns

32© AMSP 2013 Prevention Videos Peer influence Accurate alcohol beliefs Actual campus drinking Healthy coping Can’t guess BAC Alcohol + drugs dangerous → ↓ Drink

33© AMSP 2013 This Lecture Reviewed: Definitions Campus drinking & problems Risk factors for heavy drinking Prevention efforts

© AMSP Acknowledgements Marc A. Schuckit, M.D. Department of Psychiatry University of California, San Diego Marcy Gregg AMSP Scholars