Alcohol Abuse among College Students:
The Failure of Prevention Programs
R. Wade Wheeler
Texas State University-San Marcos
Introduction
Alcohol abuse among college students and the negative consequences of binge drinking have been well documented (Wechsler, et al, 2000, Berkowitz and Perkins, 1986, O’Hare, 1990, Wechsler, et al, 1994). Survey research shows that 80 percent of college students drink alcohol (Presley, Meilman and Lyerla, 1994) and that average college students consume 9.6 drinks per week (Engs, Diebold, and Hanson, 1996).
January 1993, the Harvard School of Public Health alcohol study explained the extent of binge drinking in a nationally represented sample of college students. The results were disturbing. Heavy episodic (binge) drinking was found to be widespread. Forty-four percent of students surveyed were found to meet the widely accepted criterion necessary to be classified as binge drinkers (for men, the consumption of five or more drinks in a row and for women, the consumption of four or more drinks in a row at least once in the two weeks before the survey (Weschler, et al, 1994). Pledge members of fraternities and sororities have been found to have even higher rates of binge drinking: according to Engs, Diebold and Hanson (1996) “…almost twice as many drinks per week” than non-Greek members (p. 33). In follow-up surveys conducted in 1997, 1999 and 2001, similar results were reported (Weschler, et al 2001).
As one would expect, binge drinking has been linked to a number of negative consequences for college students, including alcohol-related driving injuries and fatalities (Baer, Kivlahan and Marlatt, 1995); unplanned sexual activity (Abbey, 1991, 2002); physical injury, criminal mischief, property damage, and trouble with law enforcement officers (Weschler, et al, 1995). According to the National Institute on Alcohol Abuse and Alcoholism (2002), every year over 1000 student deaths involve driving and drinking, 500,000 suffer serious injuries due to excessive drinking, and 400,000 college students have unprotected sex and 11 percent who drink cause property damage.
Alcohol abuse in the college population led Donna Shalala, the former Secretary of Health and Human Services to state “Even as college students discover the intricacies of quantum physics and American history, many do not grasp the enormous health problems on our college campuses” (National Institute on Alcohol Abuse and Alcoholism, 1995).
Research Methodology
Much of the data on alcohol abuse in the college population is based on student surveys. While there is evidence to support the accuracy of survey methods (Reinish, et al, 1991), self-report inventories are always subject to students’ capricious over or under reporting of their alcohol use. Moreover, the correlational nature of the vast majority of studies limits the dependence to which casual relationships can be established. Does binge drinking cause academic problems for students or do students who are experiencing academic problems drink excessively in response to their problems? What unknown variable can account for both? In addition, the extensive literature on alcohol abuse provides us with a better understanding of the complex set of social environmental, institutional, and to some degree, motivational factors related to heavy drinking, but it contributes little insight into the cognitive processes of students who engage in such behavior.
Prevention Programs
Almost 90 percent of colleges and universities have some type of prevention in place to address on-campus drinking (Berkowitz and Perkins, 1986). Existing literature on alcohol prevention programs indicates that methods employed vary widely in both design and application. The strategy most frequently used is primarily informational in nature (lectures, films, written-materials and media campaigns). Their objective is to provide students with corrective information about alcohol abuse and its negative consequences. Unfortunately, such strategies have been shown to be unsuccessful in the reduction of problem drinking (Rundall and Bruvold, 1998). Other programs concentrate their efforts on attitude change, using such techniques as values clarification sessions, non-drinking pledges, alcohol free activities and support groups for problem drinkers (Dodge, 1991, Kurtz, Irving and Block, 1993). Still others have developed special programs to treat students indentified as problem drinkers (Sadler and Scott, 1993).
Research has also indentified a number of environmental and social factors as important influences on drinking behavior: the presence of a Greek system (Lo and Globetti, 1993); student involvement in athletics (Leichliter et al, 1998); where students reside (on or off campus) (O’Hare, 1990); the size of the institution (Presley, et al, 1996); outlet density (Newman et al, 1991) and alcohol prices (Chaloupka, 1993). As a consequence some prevention programs advocate the difficult and perhaps impossible task of changing the broader social structure that shapes drinking attitudes, behaviors and conventional norms (Wagenaar and Perry, 1994). The basic objectives of these comprehensive and community wide approaches are to change as many social and cultural factors related to alcohol abuse as possible; this is a formidable task indeed when one considers the fact that people in the United States drink a considerable amount of alcohol. The annual average per-person consumption is 2.43 gallons of absolute alcohol (Franklin and Frances, 1999). To put this in perspective, “a standard drink is 0.5 ounces of alcohol, equivalent to 12 ounces of beer, 5 ounces of wine, or 1.5 ounces 80-proof distilled spirits” (Encyclopedia of Public Health, 2007, p.2). In addition, in the year 2002 alone, the alcohol industry spent an estimated 990 million dollars in advertising and young people between 12 and 20 years of age were exposed to approximately 66,000 alcohol ads (B.R.A.D, 2006). College administrators and health professional have little or no control over the cultural factors that promote the use of alcohol and should not be expected to develop policies that would negate the effects of massive advertising.
While they may vary widely, depending on the unique campus culture, geographic location, community support and a litany of other factors, alcohol prevention programs have two things in common: (1) their objective is to prevent alcohol abuse in young people, and (2) (as evidenced by the latest data available, CASA 2007) they are relatively ineffective. Following a recent review of the available literature on alcohol prevention efforts, Walters and Bennett (2000) concluded that, “Despite the many inferences of efficiency, empirical support for campus programs remains sparse” (p. 63).
Attitudes and Motives for Student Drinking
If alcohol abuse in the college population is the serious health problem many believe it to be, the essential question is: Why do students engage in such self-destructive, irrational and unhealthy behavior? What are they thinking? Part of the answer may be that young people simply do not view binge drinking as a major problem (Broadbent, 1994), fail to consider the long term risk for heavy episodic drinking, and tend to indentify hangovers as the most serious consequence of such activity (Crundall, 1995). Moreover, not all students who binge drink suffer negative consequences. As Weitzman and Nelson (2004) have suggested “While the heaviest drinkers are at greater risk for harm, they are relatively few and generate proportionally small amounts of all drinking harms” (p. 247). In addition a report by Weschler, et al, 1999) indicates that the top 17 percent of students in the sample who drank heavily and frequently consumed 68 percent of the alcohol drunk by college students.
Researchers have identified a number of specific motives underlying student drinking: Drinking to socialize and drinking to relieve stress (Brennan, et al, 1986); to get drunk (Weschler, et al, 2000; and Sobel and Sobel, 1993) were so bold to suggest that “alcohol intoxication is socially acceptable as an excuse for engaging in certain otherwise inappropriate behaviors (in Lilenfield, Seeing Both Sides, 1995, p. 331). Unfortunately, the literature on student motivation to drink is not as straight-forward as one may expect. For example, consider the words of Read et al (2003) following a review of the available literature on drinking motives “…measures of drinking motives and alcohol problems have varied across studies creating a challenge in the comparison disparate findings.” Still it is worth considering that drinking to cope may be a less salient predictor of drinking while in college, during which time social factors and positive affect enhancement play a greater role (p. 21).
The identification of the motives for student drinking is necessary but insufficient for a better understanding of binge drinking. Research has also shown that one’s attitudes and expectancies about the effects of alcohol determines one’s decision to drink or not to drink (Darkes and Goldman, 1993). Alcohol prevention programs whose primary objective is to change attitudes may not be effective because attitudes have proven to be quite difficult to change (Rundall and Bruvold, 1988). This is especially true of those attitudes that were formed as a result of direct experience (Baron and Byrne, 2000, p. 125). What’s more, strong attitudes have a greater impact on behavior than do attitudes that are weak or ambivalent (Petkova, Ajzen and Driver, 1995). The reality is that most college students express strong, positive, and unambiguous attitudes toward “partying” (a euphemism for heavy drinking and sexual activity), and as Leigh and Stacey (1993) have found, positive expectancy on the part of students was a stronger predictor of rates of drinking than was negative expectancy. Furthermore, Weschler and Rohman’s (1981) earlier study showed that binge drinkers viewed all the reasons for drinking (to relax, to forget problems or to change one’s mood) as significantly more important than did other drinkers.
College students tend to associate heavy alcohol consumption with fun, laughter, relaxation, feelings of euphoria, and sex. If indeed behavior is shaped by its consequences (B. F. Skinner, 1953) “partying behavior” followed by positive outcomes strengthens the behavior and is more likely to be repeated. In this context the findings of Lynn Cooper (2002) are especially relevant. She states that “not only does the likelihood he or she has ever had sex, but the level of alcohol involvement also predicts level of sexual activity” (p. 111), and that on average college students “have more than 8 new sex partners in their four years in college” (p. 115).
The absence of negative consequences also serves to reinforce inappropriate drinking behavior. As Wesley Perkins (2002) has observed “an intoxicated student who behaves obnoxiously in public may feel no embarrassment or condemnation at all if the student’s peers complacently ignore him or her or if this student and the student’s peers simply think of the student’s actions as typical of most students” (p.99). This scenario is consistent with research findings which suggest that “Drinking is perceived as part of the college experience by most students” (Engs, Diebold & Hanson, 1996, p.28).
The reinforcing properties associated with heavy drinking raises the possibility that researchers may have discounted the notion that episodes of heavy drinking have simply been reinforced by its satisfaction of a variety of needs. As cited throughout this paper, there is a plethora of data available on the negative consequences, but the emphasis placed on the positive outcomes of binge drinking is rather meager. For example, the link between alcohol use and sexual aggression or unprotected sex has been well documented (Abby, 2002; Steel and Josephs, 1990). On the other hand data on the incidence of satisfying, consensual sexual activity associated with binge drinking is rather sparse. In fairness, it should be noted that more than 100,000 students between the ages of 18 and 24 report having been too drunk to know if they consented to sex or not (Hingston et al, 2002).
Concluding Comment
Despite the best efforts of college administrators and health professionals, the effectiveness of alcohol prevention programs, based on research of a correlational and demographic nature, has not been demonstrated. Prevention programs advocated by government and health organizations have been criticized as too simplistic (Wood, 1996). University policies designed to control environmental factors or those designed to limit or regulate how, where and when alcohol is consumed, such as, banning alcohol on campus or creating alcohol-free dormitories (Frahm, 1991) have also been ineffective. As Presley, Meilman and Leichliter (2002) have concluded “confounding the environmental issue each college attracts students who choose on an individual basis to drink or not to drink for a variety of reasons that have no relation to the collegiate environment” (p.87).
Perhaps more useful information about binge drinking can be obtained if future research focuses more attention on positive outcomes related to heavy drinking and efforts to learn more about how students who binge drink interpret, remember, feel and use information about situations in which heavy drinking occurs. Such an emphasis may provide data which will allow us to design more effective communication techniques necessary to change individual perceptions about alcohol abuse. Behavioral changes in the student population are not likely to occur by continuing unsuccessful attempts to manage the broader social and cultural factors that influence the excessive use of alcohol.
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