1. Department of Psychiatry Rush University Medical Center
College Drinking
Gail M. Basch M.D
Department of Psychiatry
Rush University Medical Center
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2. College Heavy Drinking
Transitional time Heaviest drinking epoch Believe heavy drinking = norm
Why is it that college is associated with some of the heaviest drinking years?
Students leave the stability of home transtioning into a much anticipated life of new peer groups and expected drinking behavior.
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3. This Lecture Reviews: Definitions Campus drinking & problems
Risk factors for heavy drinking
Prevention efforts
Review the outline of this talk by topic
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4. Morbidity & Mortality
~2,000 student deaths/yr ~700,000 assaults/yr ~80,000 sexual assaults/yr ~2.8 million drove while intox $62 billion/yr underage drinking
College HD is dangerous and deadly...let’s get some perspective quickly....
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5. Heavy Drinking Episodes
~45% heavy drinking/2 wks ~20% ♂ drank 10 drinks/occas ~10% ♀ drank 8 drinks/occas
Let’s briefly review how may students drink at high levels on campus today over any past 2 week period...
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6. College Heavy Drinking
→ drinking problems
Clues for prevention
Clues for Rx
Heavy drinking is a problem on campus today and will leads future AUD. Clinical example can be used here. The bottom line here is to identify students at risk and offer treatments that work. When students and health providers understand each other’s needs-result improve. What do college drinkers need?
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7. This Lecture Reviews: Definitions Campus drinking & problems
Risk factors for heavy drinking
Prevention efforts
In order to talk about heavy drinking on campus, let’s briefly review some definitions , terms, quantity standards
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8. Standard Drink
First, let's review what constitutes a std.drink…12 g of pure ethanol is our measurement of comparison… we observe that in 12 oz of beer, 4 oz of wine, of 1.5 oz of 80 proof liquor...
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9. Heavy Episodic Drinking
4+ ♀ / 5+ ♂ ≥5 occas/month
Now..at what level does drinking become problematic for college students?…. Episodic implies 5 or more episodes per month. Recall that heavy drinking for a woman is 4 or more drinks, for a man is 5 or more.
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10. Blood Alcohol Concentration
Standard drink ~12 grams alcohol
1 drink → BAC g/dl (~15 mg%)
Now…Let's now see how a standard drink containing 12 g of alcohol relates to BAC, 1 drink increases BAC about .015 g/dl or about 15mg% per hour. We use the term BAC often...a helpful thing to remember is
No two people are alike when it comes to BAC, BAC rises more rapidly with increasing # of drinks, female drinking, decreasing weight , and drinking without food.
↑ BAC with: ♀
↓ Weight
Drink w/out food
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11. BAC’s Effects Effects > 300 ↓Vital signs, coma, death ≤ 300
BAC (mg%)
> 300
↓Vital signs, coma, death
≤ 300
Difficulty waking
Here's what to expect when BAC rises
1-3-most report a feeling of well being and lowered inhibitions,
Even at low levels, stumbling and drowsiness may occur,
As levels rise, mood and concentration are effected, further increase will impact arousal, and further will impact vital functioning, can lead to coma/death.
≤ 200
Anger, moody, confusion
≤ 100
Sleepiness, ↓ coordination
≤ 50 (1-3 drinks)
Well-being, ↓ inhib
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12. Intox →forget events Not lose consciousness
Blackout
Intox →forget events Not lose consciousness
Blackout is another term that is used a lot...let’s review it quickly...
Not to be confused with passing out…an alcoholic blackout involves amnesia while awake, new memories are made and then forgotten within minutes, a typical example of a blackout on campus may be a student returning home from a party, but unclear on how he got there…
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13. Alcohol Use Disorders Abuse Dependence ≥3 ≥ 1 Tolerance Role failure
Withdrawal
Unable to limit
Unable to cut down
 Time w/alcohol
↓ Time elsewhere
Use despite problems
≥ 1
Role failure
Risk of harm
Legal problems
Use despite problems
 Dependence
Let's quickly review the major AUDs….Dep indicates repeated problems interfering w fxning during the same yr, look for at least 3 items of 7 items including tol (repeated intake leads to more being needed for same effect) &/or withdrawal(opposite effect of intox when alcohol is stopped)
Alc Ab is dx'd in the absence of Dep and indicates repeated use despite problems, requiring 1+ of 4 items during the same year. The 4 items include…
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14. This Lecture Reviews: Definitions Campus drinking & problems
Risk factors for heavy drinking
Prevention efforts
Recap you reviewed some serious statistics during this heavy drinking time for college students, recall that you gave definitions of heavy episodic drinking, Std drink, BAC, Blackout, AUDs
... now introduce topic of campus drinking and problems
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15. Heavy Drinking
45% 4+ drinks/occas past 2 wks 20% > 15 drinks/occas past 2 wks 50% ~ 1+ blackout/college 40 % ~ 1+ alcohol problem prior yr 20% students drink 72% of alcohol
let’s get down to the nitty gritty…..How much are students drinking?
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16. College Students vs Peers
College students drink differently from their non-college peers
In all four categories, current drinking, heavy episodic, current alc ab, and DWI, college students outdrink their peers.
(note that stats are % student drinkers over the past year, Dwi % student drinkers/past two wks)
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17. Specific Vulnerabilities
CAMPUS DRINKING AND PROBLEMS…What do students inherit, what is risky on campus? Is there interplay between the two?
...specific risk factors itemized in next slide and pie chart available again
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18. Risk Higher For:
21st birthday Single event/game day/holiday Fraternity/sorority Student athletes ↑Impulsivity AUD relative Low LR to alcohol
I will explain each one individually in a moment, let’s take a look at them as a group now….
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19. BAC ↑Drink Days
The bottom line here is, even for a student who does not drink regularly, one heavy drinking day can be risky with high BAC and related consequences...
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20. Next: 21st Birthday
83% drink to celebrate ~25% >21 b-day drinks ~40% blackouts ~50% highest ever drinks
This is an example of an environmental risk factor for heavy drinking….
A 21st birthday can be a dangerous milestone…
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21. Next: Game Day Drinking
~7 drinks/game
↑ Impulsive
↑ Expect drunk
This is another example of an environmental risk factor on campus.
60% of students report drinking on game days, at an average of 7 drinks per game.
Students report higher feelings of impulsivity and higher expectations of drinking and drunkeness on game day. Consequences such as liquor violations, assaults, DWI, are shown to correlate with these expectations.
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22. Next: Fraternity/Sorority
~ 60% prior heavy drinkers ~ 80% heavy episodic drinkers Greeks = heavier drink peers Believe ↑ drink norms
Joining a heavy drinking peer group with even heavier drinking peer leaders sets higher norms for fraternity and sorority members is another example of a risk factor for college heavy drinking . 60% of students were heavy dri in High School before pledging membership, 80 % report heavy episodic drinking once in Greek life.
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23. Fraternity/Sorority Blackouts/Past 2 Weeks
We see that blackouts reported over the past two weeks almost double once in Greek life as shown by the higher blue bars for both fraternities on your left and sororites on your right, when compared to non-Greek college peers.
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24. Next: Student Athletes
~50% heavy episodic drinkers
Leaders ↑ drink and set norms
↑↑ Drink peer group
Athlete + Greek =↑↑ drink
Again, here we are taking a look at environmental risk factors for college heavy drinking...
50% student athletes report heavy episodic drinking , student athlete leaders drink more and set new norms. A student in this high risk group who also belongs to a Greek organization will have an even greater risk for heavy drinking.
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25. Next: Impulsivity ↓Postpone reward ↑Risk taking ↓Urgency © AMSP 2013
Now, let’s layer on genetic risk factors, Whether on a 21° birthday, in a frat/sor, or on a game day-impulsivity will increaase HD….
Students who have inherited traits of impulsivity are at higher risk for college drinking- they can not postpone rewards, take higher risks and have a greater sense of urgency.
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26. Family History 4x ↑ AUD risk Even if adopted out © AMSP 2013
Having a biological parent with alcoholism increases risk for alcoholism by 4x (genes), even if student has been adopted away from birth parents .
On campus, these students have a genetic risk for heavy drinking….
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27. ↑↑ Drinks/occas for effects →Join peers ↑↑ drinks/occas
Level of Response
↑↑ Drinks/occas for effects
→Join peers ↑↑ drinks/occas
→Think everyone drinks ↑↑
→↑ Stress
Use ↑ drinks to cope
-One of the most studied genetically influenced risk factors for heavy drinking is Level of Response. In this case….the student needs more drinks for intox, in other words he can drink his classmates under the table. This results in more drinks ea. time. He finds a heavier drinking peer group. A new normal is now established. Chances are stressful situations result. In turn, he may use more alcohol to cope with stress. I will use Level of Response when I discuss a successful prevention approach later in this lecture…..
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28. This Lecture Reviews: Definitions Campus drinking & problems
Risk factors for heavy drinking
Prevention efforts
I have now told you what a drink is. How many drinks are too many,
I have now told you how drinks can get you in to trouble when BAC is high, we have reviewed blackouts and other definitions....
I’ve told you about many high risk factors, including holidays, groups on campus, impulsivity , family history, a low sensitivity to alcohol.
How might these high risk factors be used to prevent heavy drinking on college campuses?
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29. Peer Influence Students fear rejection ~40% afraid to refuse
Overestimate peer/campus
↑ Drinking to match
We can teach students how to cope with peer pressure....how to say no and how to understand peer influence on campus....
Peer pressure works in several ways…Friends offer higher # of drinks, additionally- students worry about rejection if they refuse that drink…don’t know how to say no, 40% believe refusing to drink needs an excuse,
also they overestimate campus drinking patterns and drinking approval ...often say everyone drinks as much as I do
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30. Inaccurate Beliefs ~65% more fun ~55% better sex ↓Muscle tension
Better Sleep
Alcohol OD
Predict BAC
Alcohol + Drugs
We can educate students about alcohol and it’s real effects….
Students often have an inaccurate expectation of what happens when they drink-
65% count on alcohol to improve mood, 55% to enhance sex, handle stress, decrease muscle tension …..also false and misperceptions ie alcohol posioning, caffeine and alcohol
Good spot to educate audience on alcohol’s poor effects on sleep
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31. Alcohol to Cope Low doses → ↓ mild anxiety 2 or 3 drinks → ↑ anxiety
Drink to Rx anxiety
→ ↑↑ drink
Heavy drinking is sometimes misunderstood as a way to cope with stress. We can correct this belief and teach student healthy coping skills….
1-2 drinks may decrease anxiety,, but more can actually have the opposite effect. If this becomes a pattern, drinking to treat anxiety substiutes for development of healthy coping skills.
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32. Prevention Programs Student health Dorm counselors Orientation
Prevention campaigns
Prevention programs on campus take advantage of various entry points to educate students, ie student health…..
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33. Prevention Videos Peer influence Accurate alcohol beliefs
Actual campus drinking
Healthy coping
Can’t guess BAC
Alcohol + drugs dangerous
e.g.,, at UCSD, a low cost effective prevention campaign uses videos to educate- videos worked, espeically in students wtih low level of response genetic risk factor
The bottom line is tailoring prevention to risk decreases heavy drinking!
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34. This Lecture Reviewed:
Definitions
Campus drinking & problems
Risk factors for heavy drinking
Prevention efforts
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35. Acknowledgements Marc A. Schuckit, M.D. Marcy Gregg AMSP Scholars
Department of Psychiatry
University of California, San Diego
Marcy Gregg
AMSP Scholars
Thank you Dr. Schuckit for your supervision on this project and for your extensive research in this area, thanks to Marcy and AMSP!!
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