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Gail M. Basch M.DDepartment of Psychiatry
Rush University Medical Center
College Drinking
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College Heavy Drinking
Transitional time
Heaviest drinking epoch
Believe heavy drinking = norm
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~2,000
~700,000
~80,000
~2.8 million
$62 billion
Morbidity & Mortality
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student deaths/yr
assaults/yr
sexual assaults/yr
drove while intox
/yr underage drinking
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→ Drinking problems
Clues for prevention
Clues for Rx
College Heavy Drinking
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This Lecture Reviews:
• Definitions
• Campus drinking & problems
• Risk factors for heavy drinking
• Prevention efforts
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Standard Drink
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Standard Drink in Solo Cup
Beer (12 oz)
Wine (5 oz)
Spirits (1 oz)
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/ 4+ ♀
≥5 occas/month
Heavy Episodic Drinking
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5+ ♂
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Blood Alcohol Concentration
Standard drink ~12 grams alcohol
1 drink → BAC 0.015 g/dl (~15 mg%)
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BAC’s Effects
≤ 50 (1-3 drinks)
BAC (mg%)
Well-being, ↓ inhib
≤ 100 Sleepiness, ↓ coordination
≤ 200 Anger, moody, confusion
≤ 300 Difficulty waking
> 300 ↓Vital signs, coma, death
Effects
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Intox →forget events
Remain consciousness
Blackout
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≥ 1
Role failure
Risk of harm
Legal problems
Use despite problems
Dependence
DSM IV Alcohol Use Disorders
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≥3
Tolerance
Withdrawal
Larger/longer
Unable to cut down
↓ Time elsewhere
Use despite problems
Abuse Dependence
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Legal problems
Cravings
DSM 5 Alcohol Use Disorders
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Tolerance
Withdrawal
Larger/longer
Unable to cut down
↓ Time elsewhere
Abuse Dependence2-3 mild, 4-5 mod, ≥6 severe
Role failureRisk of harmUse despite problems
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This Lecture Reviews:
• Definitions
• Campus drinking & problems
• Risk factors for heavy drinking
• Prevention efforts
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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
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College vs Non-College
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Single event/game day/holiday
21st birthday
Fraternity/sorority
Student athletes
↑Impulsivity
AUD relative
Low LR to alcohol17© AMSP 2013
Risk Higher For:
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BAC ↑Drink Days
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~83%
~25%
~40%
~50%
~72%
drink to celebrate
>21 b-day drinks
blackouts
highest ever drinks
↑ DWI risk
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21st Birthday
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Game Day Drinking
~60% drink
~7 drinks/game
↑ Impulsive
↑ Expect drunk
→↑ Drink
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~ 60% prior heavy drinkers
~ 80% heavy episodic drinkers
Greek peers = heavier drinkers
Believe ↑ drink norms
→↑ Drink
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Fraternity/Sorority
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Fraternity/Sorority
Blackouts/Past 2 Weeks
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~50% heavy episodic drinkers
Leaders ↑ drink and set norms
Athlete peers = heavier drinkers
Athlete + Greek →↑ Drink
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Student Athletes
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Family History
4x ↑ AUD risk
Even if adopted out
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Impulsivity
↓Postpone reward↑Risk taking↑Urgency→↑ Drink
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Level of Response
↑↑ Drinks/occas for effects
→Join peers ↑↑ drinks/occas
→Think everyone drinks ↑↑
→↑ Stress
Use ↑ drinks to cope
→↑ Drink
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This Lecture Reviews:
• Definitions
• Campus drinking & problems
• Risk factors for heavy drinking
• Prevention efforts
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Peer Influence
Students fear rejection
~40% afraid to refuse
Overest. peer/campus drink
↑ Drinking to match
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Inaccurate Beliefs
~65% more fun~55% better sex↓Muscle tensionBetter sleepOther myths
Alcohol ODPredict BACAlcohol + Drugs
False beliefs: Underinformed:
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Alcohol to Cope
Low doses → ↓ mild anxiety
2 or 3 drinks → ↑ anxiety
Drink to Rx anxiety
→ ↑ Drink
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Prevention Programs
OrientationStudent healthCampus LifeDorm counselorsPrevention campaigns
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Prevention VideosPeer influence Accurate alcohol beliefsActual campus drinkingHealthy copingCan’t guess BACAlcohol + drugs dangerous→ ↓ Drink
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This Lecture Reviewed:
• Definitions
• Campus drinking & problems
• Risk factors for heavy drinking
• Prevention efforts
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Acknowledgements
Marc A. Schuckit, M.D.Department of Psychiatry
University of California, San Diego
Marcy Gregg
AMSP Scholarswww.alcoholmedicalscholars.org