This section estimates the frequency of alcohol-related problems among college students. Individual problems include:
Using a number of national data sets, Hingson, Heeren, Zakos, Kopstein & Wechsler (2002) estimated that 1,400 U.S. college students aged 18-24 died from alcohol-related unintentional injuries in 1998. Of the 1,400 deaths, 307 were unintentional non-traffic deaths. These deaths were related to falls, burns, drowning, alcohol poisoning, and other accidents. Mortality rates due to suicide or other related medical problems are not available. College student status is not included on death certificates or other fatality data sets.
Hingson et al. (2002) also estimated that 600,000 students were assaulted by other students who were drinking alcohol, and 500,000 students were injured as a result of their drinking. Estimates suggest that one in four college students (approximately two million students) drove a car under the influence of alcohol in the previous 12 months. One in three students reported getting in a car driven by someone who had been drinking alcohol.
Self-report surveys provide additional evidence of the multiple adverse effects of alcohol use among college students. Blackouts are one of the most common effects of heavy alcohol use, with a number of surveys finding that 25% of students report memory loss on at least one occasion after drinking (Perkins, 2002). Alcohol-related personal injuries are reported by 9-15% of students in the College Alcohol Study (Wechsler, 1998) and the Core Survey (Presley et al., 1996). Nearly 50% of college students who use alcohol report hangovers, abdominal pain, and vomiting during heavy drinking episodes (Presley et al., 1996).
Unintended and unprotected sexual activity are of great concern. HIV infection continues to occur at an alarming rate among various U.S. populations, including college students. While more effective treatment is available, HIV infection is a serious life- threatening illness. The social stigma associated with HIV infection, as well as its possible effect on future children, are other components that impact affected individuals. Self-report surveys (Weschler, 1999; Anderson, 1996) have found that as many as 10% of students report having unprotected sex as a result of alcohol use. These surveys also suggest that 20-40% of women report unintended sex associated with alcohol use (Mielman, 1993; Wechsler, 1998; Gross & Billingham, 1998; Fisher, Cullen & Turner, 2000).
The effect of high-risk alcohol use on roommates and other members of a college community is another aspect of alcohol use on college campuses (Fisher, Sloan, Cullen & Lu, 1998). Nearly 30% of students report being involved in a fight or argument while drinking in the previous 12 months. Data collected from the College Drinking Survey (Wechsler, 1998) found that 13 to 27% of students reported being assaulted, hit or pushed by another student who was drinking. In the same study, 8% reported damaging university property or setting off a fire alarm. Five to ten percent of the students reported being involved with campus or community police for incidents involving alcohol.
In summary, alcohol problems among college students are common. These problems are serious and can result in death and serious injury. The study conducted by Hingson and colleagues suggests that 14,000 students have died in the past 10 years as a result of their drinking. Interpersonal violence and high-risk sexual behavior are strongly associated with alcohol use. Alcohol use is also strongly associated with tobacco and other drug use.
Clinicians may want to consider a number of factors that contribute to high-risk alcohol use and alcohol-related adverse events. Some of these factors can be modified or changed. Others are more resistant to prevention efforts.
Individual factors that may play an important role in alcohol use and risk-taking behavior include a number of pre-college variables. These include
(Baer, 2002; Dowdall & Weschler, 2002; Clapper, Martin & Clifford, 1994; Corbin, McNair & Carter, 1996).
Individual risk factors that can be addressed by clinicians include:
(Haines, 1996; Dowdall & Weschler, 2002).
Clinicians may want to use these individual risk factors to screen, assess, and develop a plan for each student they encounter at the student health center. For example, students who have a strong family history of alcohol problems, a history of impulsive or deviant behavior, or chronic depression should be counseled to be abstinent from alcohol use. Others with less immediately threatening risk factors should be informed about low-risk drinking limits and how to avoid alcohol use in high-risk situations.
Modules 2, 3 and 4 are designed to provide clinicians with methods to screen, assess, and intervene with individual students.
What follows is a list of interventions that have been tested and evaluated in research studies. While many of these interventions are beyond the immediate scope of work of clinic-based health care professionals, providers may want to volunteer time and expertise to work with campus and community groups who are involved in broader-based efforts.
Interventions That Seem to Work to Reduce Alcohol Use and Alcohol-Related Problems
Interventions That May Work
Some strategies have been shown in research studies to be ineffective. Health care professionals need to be aware of them in order to insure that time, energy, and funding are directed to more promising approaches.
Interventions That Don't Work
One strategy that is within the scope of work of most student health clinicians is to promote healthy behaviors through individual and group interventions. Module 2 of this curriculum describes the role of the college health clinic in screening students for at- risk and problem drinking in order to discern who needs what type of health message and to identify the small percentage of students who should be referred to an addiction treatment program. Modules 3 and 4 focus on the skills needed to deliver effective office-based brief interventions for those students who would benefit from reducing their drinking.
It is important to have screening and outreach programs on campus that identify those students who may not seek care in student health centers. Opportunities include dormitories, the Greek system, student unions, or student health fairs. Having incoming students complete a health habit survey that includes alcohol use is a system-wide screening method that has worked in some campus settings (Marlatt et al., 1998). Another option is National Alcohol Screening Day, an annual event sponsored by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the Substance Abuse and Mental Health Services Administration (SAMHSA). The program provides free, anonymous screening, alcohol and health information, and the opportunity to speak with a health professional about alcohol concerns. It takes place every April on college campuses and in community and private practice settings around the country. (For more information go to www.niaaa.nih.gov.)
High-risk alcohol use among college students is a major problem. There are many adverse effects with high levels of mortality and serious morbidity. While we need additional research, there are a number of proven prevention strategies that can be implemented immediately. In addition to implementing screening and intervention protocols in student health centers, clinicians have the opportunity to participate in a variety of campus and community intervention activities. The key is to base all interventions on proven and tested strategies
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Last reviewed: 9/23/2005