From Knowledge To Action

From Knowledge To Action – other colleges can use findings of Harvard’s College Alcohol Study to fight against student alcohol abuse

Henry Wechsler

How Harvard’s College Alcohol Study Can Help Your Campus Design a Campaign Against Student Alcohol Abuse

Since results from our first survey were published five years ago, heavy episodic alcohol use or “binge drinking” among college students has become a nationally recognized problem. Seventy percent of college presidents consider binge drinking a problem for their institutions, but they don’t know how to counteract it. This is no surprise, since there has not, up to now, been sufficient, scientifically credible information about what is effective. Some approaches seem promising, but they usually have been evaluated on a single campus only, often without control groups.

In this article, we are now able to offer selected findings from our College Alcohol Study (CAS) that can be used to shape intervention campaigns to address the problem of binge drinking. Since 1993, over 50,000 students in a nationally representative sample of 140 colleges in 39 states have responded to our three surveys. We’ve asked questions about alcohol use and abuse, experience with prevention programs, encounters with enforcement or control policies, and attitudes toward school initiatives. We’ve learned a number of important lessons to guide college responses to student alcohol abuse.

COLLEGES MUST ACT

There is general agreement today about the nature of the problem. The CAS national findings clearly demonstrate that binge drinking is prevalent on most college campuses. Nationally, two in five students binge drink–defined as consuming five or more drinks in a row for men and four for women–at least once in a two-week period. These students experience a higher rate of various educational, social, and health problems than their non-binging peers. Half of the students who binge drink do so more than once a week. Half of these frequent binge drinkers report having five or more different alcohol-related problems during the school year. This rate is 20 times greater than that for students who drink but do not binge.

Beyond the harm they cause for themselves, binge drinkers affect others on campus. Non-binging students who attend schools in which more than half of the students binge drink are more than twice as likely to report such secondhand effects as insults and arguments, vandalism, physical assaults, or unwanted sexual advances than are students in schools with fewer binge drinkers.

At most campuses, these problems are just too severe to ignore. While deaths are relatively rare, most large colleges report numerous overdoses–admissions for acute alcoholic poisonings–in their student health centers or community emergency rooms. In our survey, 0.6 percent of students report needing treatment for alcohol overdose. While this seems like a small number, projected nationally it could add up to over 30,000 students a year. Each year, one in eight students reports injuries resulting from alcohol use, and one in 20 reports injuries severe enough to require medical treatment.

Binge drinking also affects students’ academic performance, with half of binge drinkers reporting that they missed at least one class as a result of their alcohol use, and more than a third saying they fell behind in their schoolwork due to drinking. Binge drinkers are also more likely to report lower grades than non-bingers.

Colleges must protect their students from these negative effects of alcohol. One in eight non-binge-drinking students nationwide reported being assaulted physically or having personal property vandalized due to another student’s alcohol use. The everyday effects of binge drinking disrupt the process of higher education. Taking care of drunks, having sleep and study disturbed, and worrying about one’s physical safety are incompatible with the atmosphere required for optimal learning to take place.

ONE SIZE DOES NOT FIT ALL

Binge drinking rates at different colleges range from one to 80 percent of students. This variation suggests that institutional approaches should be shaped by the particular conditions of a given campus. Many factors–the attitudes and experiences students bring to school, social and institutional features of the college, and characteristics of the adjoining community–contribute to student alcohol problems. Colleges vary with respect to each of these factors, including for example, the levels of drinking during high school by their incoming freshman, the size and status of their fraternities and sororities, and the number and political strength of local alcohol outlets. The response of colleges must take these variations into account; there are no “one-size-fits-all” solutions. While we here offer national statistics that can be used in shaping campaigns, each college needs to take stock of its own particular situation. A comprehensive self-diagnosis is the necessary first step.

ALCOHOL EDUCATION Is NOT ENOUGH

A natural response for colleges wishing to address binge drinking is to educate students about the problems of alcohol use. Results from our surveys of college administrators indicate that curriculum infusion, dedicated classes, and poster or communications campaigns are a regular part of most school efforts. Student reports reflect this educational emphasis. Four of five students have been exposed to some alcohol education effort. Two of three students have seen posters or signs and report having read announcements or articles.

The problem, however, is that most of the heaviest drinkers too easily ignore all this; indeed, they do not view their drinking as a problem. Only one-quarter of the frequent binge drinkers say they ever had a drinking problem; two of three students who drink that way consider themselves “moderate drinkers.”

While education is needed, by itself it will not solve the problem. Binge drinkers, in fact, are more likely than non-binge drinkers to report they have received information from the school. Moreover, the most at-risk groups on campus–members of Greek organizations and athletes–are already targeted for educational interventions in an overwhelming majority of survey schools. Eighty percent of schools report offering special educational programs for athletes, while two-thirds offer programs for fraternity members and 60 percent for sorority members.

In other words, college students have been told about the risks of alcohol use, yet they continue to binge drink. While our evidence demonstrates that schools are targeting the right audiences for their interventions, it suggests that the impact is limited. Reliance solely on educational interventions to reduce alcohol use is an inadequate response. Colleges need to move beyond a simple didactic model.

STUDENT SUPPORT FOR TOUGHER POLICIES

Many colleges are considering an increase in controls over alcohol; pressures to do so have risen in the wake of a number of highly visible deaths on college campuses in the past two years. Administrators are caught between the fear that a tragic event will occur if they don’t tighten controls over alcohol and the threat of student protests and potential riots if they do. While our results indicate that colleges that ban alcohol for everyone on campus-including of-age students-have lower rates of binge drinking and associated problems, the causal direction of this relationship is not clear. It may be that it is easier to ban alcohol at colleges with low binge rates, or that a third factor–such as a shared concern among students and administrators over the negative effects of heavy drinking–is responsible for both the lower rates and the strict policy.

When considering whether to adopt tougher control measures, it should not be a foregone conclusion that students will strongly oppose such a change. Some will, as the still vivid memories of students throwing debris at police or burning furniture in protest suggest. However, our data indicate that many students are concerned about the role alcohol plays in their life at college. Half of all students nationally believe that alcohol is a problem on their campus; considerable support exists for a wide array of possible policy controls. Among colleges that strengthened their alcohol policies between 1993 and 1997, nearly one-quarter did so in response to pressure from students.

College administrators should realize that they have a lot more support to implement policy changes than they think they do. Although this may come as a surprise to administrators confronted by angry students demanding the “right” to drink as much as they want, more than half of all students nationally favor more college intervention. As Table 1 shows, there is considerable student support for a wide array of possible policy controls that may help impact binge drinking and related harms.

MARGINALIZING THE HEAVIEST DRINKERS

Frequent binge drinkers are out of touch with the way alcohol problems are perceived by others on campus. Only one in five students engages in this type of drinking, yet this group accounts for two-thirds of all the alcohol consumed by college students; more than half of all the alcohol-related problems students experience; and over 60 percent of all the reported injuries, vandalism, and problems with the police.

While most of these students don’t think they have a problem with alcohol, their schools have a problem with them. Frequent binge drinkers oppose efforts by college administrators to reduce levels of problem drinking and related harms. These are the students most likely to protest, not always peacefully, in support of the item most important to them: beer. But in this stance, they are out of step with most other students, even the occasional binge drinkers. A look at support of tougher control measures by type of drinker (Table 2) reveals how out of touch frequent binge drinkers are.

Administrators and students need to appreciate that the heaviest drinkers are a vocal, highly visible, but relatively small minority. Up to now, given peer-pressure to drink, non-bingers have often felt marginalized, with the best they could ask for being separate, alcohol-free dorms. The segregation should work the other way, with students who disturb the peace moved to dorms for people whose behaviors indicate they need extra supervision.

LOW-COST ALCOHOL IS A HIGH-COST PROBLEM

When students are looking for social activities, few alternatives can compete with the low cost of alcohol. A recent survey of bars and retail liquor outlets in 10 college communities makes this point very clearly. (See Table 3.)

Social activities that involve alcohol appeal to students on a cost basis. Alcohol is cheap, plentiful, and easy to get. For the price of one movie ticket (not including concessions), a student could buy eight drinks at a bar, 15 cans of beer, or entrance for three people to an “all-you-can-drink-party.” On all of these campuses, students can find a way to binge drink for less than five dollars. Students who pay less than a dollar per drink, or who pay a set fee for “all-you-can-drink,” are more likely to drink at binge levels than students who have to pay more. Econometric analyses of alcohol use have shown that price does play a role in binge drinking, particularly among women.

A high density of alcohol outlets surrounds most larger campuses. Establishments cater to college students and compete with each other to draw business. Frequently this competition translates into price wars: local outlets undercut each other and make up the difference by selling large volumes. College communities can examine the distribution of liquor outlets and the pricing practices in the neighborhoods around them. They can then begin a process of dialogue and concerted action with community leaders to solve these problems.

DESIGNATED HELPERS

College students are motivated by positive messages that align with their values. They tend to be less responsive to rule-based approaches than to positive visions of their role. Indeed, social factors–like the number of close friends and hours spent socializing with friends–are important predictors of binge drinking, independent of age, religion, personal and family alcohol history, and other substance use.

One norm among students that can be a very powerful motivator is their desire to see that their friends are safe. Half of students nationally report that they have taken care of another student who was drunk, an important indicator of student values. Positive messages can capitalize on these existing motivations and reinforce safe behaviors.

Anti-drunk-driving campaigns have profited from similar messages promoting informal controls of drinking behavior among friends. This approach may hold even more promise for college students: messages can appeal to their desire to protect their friends. “Friends don’t let friends drive drunk” is a message that resonates with a highly social group. Similar messages aimed at students can enhance peer support for discouraging others from getting drunk, acting irresponsibly, having sex when they are drunk, or burdening their friends with unsafe behavior. “Friends don’t let friends lose control” may be an appropriate message for students who fear the secondhand effects of alcohol or the increasingly litigious repercussions of going out or hooking up while under the influence.

Another message that can resonate is that in group situations, some students owe it to others to abstain. In some of the recent, highly publicized overdose deaths, the people who were taking care of the student who died were also intoxicated and unable to recognize the seriousness of the situation.

BINGE DRINKING IS A WOMEN’S HEALTH ISSUE

Women are affected at lower dosage levels of alcohol than men. In our survey, we employed a gender-specific measure of binge drinking to account for the greater number of problems women experience at the same consumption rate as men. Women who join sororities have had fewer binge-drinking experiences in high school than men who join fraternities, yet in college they binge drink at the same rate as men. The mix of alcohol and inexperience puts them in grave jeopardy for sexual assault. Acquaintance rape is one of the most salient health issues for women on college campuses. Nationally, one of 10 female frequent binge drinkers reported engaging in non-consensual sex while under the influence of alcohol.

Female students are an important target group for promoting mutual caretaking messages. Informally today we already see women designated to stay sober and watch out for their friends at heavy drinking parties.

Many college campuses have well-established women’s centers that are credible and effective advocates for women’s health and status. The staff of these centers need to be concerned about the ways in which binge drinking and alcohol abuse are women’s health issues. Women’s centers on colleges should be partners in efforts to reduce binge drinking and related harms.

ENABLERS MAY DISABLE

It is especially important to pay attention to mutual caretaking motives in light of the evidence on how underage students obtain alcohol.

A great deal of collegiate energy and prevention resources are spent on combating fake IDs. Yet this technique for obtaining alcohol is used by only one in five underage students. How do they get alcohol? Four of five underage drinkers get their alcohol from older students. One-third of older students have been asked by underage students to provide them with alcohol, and almost all complied. This is one student norm that needs to be challenged!

Of-age students view providing alcohol to minors as a gesture of friendship and don’t consider the potential for harm. To them, this form of sharing is a positive act. We need to make a clear distinction for these students between positive and negative acts of “sharing” alcohol. What kind of “friendship” would enable heavy drinking?

STUDENT RIGHTS

While we hear from students demanding a right to drink, there have been few public demonstrations for a binge-free college environment. According to our data, most college students have experienced secondhand effects of binge drinking, but few complain about it. Seven in eight non-binge-drinking students have been affected negatively by the drinking of others, yet only one of seven students living in dormitories reports having complained to a resident advisor about other students’ drinking. Students may choose not to complain due to social pressure or fear of retaliation.

The change needed is for all students to understand that they have far more fundamental rights as students than any claimed “right” of a few to drink. The rights of all students to live and learn in a habitable dormitory environment need to be reestablished as a part of college policy addressing binge drinking. A campaign that informs students of their basic right to a quality of campus life free from the secondhand effects of binge drinking is needed. Agreement with student governments about unacceptable behavior in a group living situation, and enforcement of the resulting code of conduct, is an important step toward reducing the harms of excessive alcohol use.

Students almost universally support alcohol-free living environments. Nearly nine out of every 10 students support a policy by colleges that would provide alcohol-free dormitories on campus. Some have voted already with their feet. Eighteen percent of students report that they already live in an alcohol-free dorm; 24 percent more say they would like to live in one. Altogether, three of five non-bingers either live in–or want to live in–an alcohol-free dorm.

SUMMING UP

Binge drinking is the most serious problem affecting social life, health, and education on college campuses today. Colleges should develop campaigns specifically tailored for their campuses, using our survey data as a start, and using what they know about local problems and resources. On a national level, our overall recommendations point to issues that deserve attention. These issues lend themselves to local campaigns undertaken by college administrators, communications experts, and prevention specialists.

For more information on the materials presented here, the Harvard College Alcohol Study (CAS), or the Matter of Degree Program Evaluation, visit our Web page: http://www.hsph.harvard.edu/cas. The authors are grateful to Kathleen McCabe and Julie Kearney for providing information used in this report. The College Alcohol Study has been supported by grants from the Robert Wood Johnson Foundation. Publications of the CAS include “Health and Behavioral Consequences of Binge Drinking in College–A National Survey of Students in 140 Campuses,” JAMA 1994, Vol. 272, pp. 1,672-77, and “Changes in Binge Drinking and Related Problems Among American College Students Between 1993 and 1997,” JACH 1998, Vol. 7, pp. 57-68.

Henry Wechsler is Principal Investigator, and Toben Nelson is Research Associate, for the Harvard School of Public Health College Alcohol Study (CAS). Elissa Weitzman is Director of the Matter of Degree Program Evaluation at the Harvard School of Public Health and Senior Scientist with the CAS.

STUDENT SUPPORT FOR TOUGHER MEASURES TO

REDUCE BINGE DRINKING

Possible Policy Controls Percentage Support

Crack down on underage drinking 67

Enforce rules strictly 65

Prohibit kegs on campus 60

Crack down on Greeks 60

Hold hosts responsible 55

Ban ads from local outlets 52

NATIONAL-LEVEL STUDENT SUPPORT FOR TOUGHER POLICIES (PERCENTAGES)

Policy Non-drinkers Drinkers, Occasional Frequent

Non-bingers Bingers Ringers

Prohibit kegs on campus 86.4 67.7 48.6 34.6

Enforce rules strictly 93.2 75.0 54.2 35.2

Crack down on Greeks 90.1 69.5 47.1 28.2

Hold hosts responsible 81.1 59.9 45.3 33.3

Crack down on underage drinkers 93.5 76.9 56.6 37.1

COST OF ALCOHOL COMPARED WITH OTHER STUDENT

ACTIVITIES AT 10 HIGH-BINGE UNIVERSITIES

Social Activities Average Price

Beer from a keg $0.25

Beer from a can $0.37

Drink special at bars/clubs $0.75

Admission, all-you-can-drink party $1.50

Cup of coffee (off-campus) $1.09

Movie ticket $5.86

Concert $27.33

STUDENT ALCOHOL ABUSE: MAKING PREVENTION A TOP PRIORITY

In 1998, six university presidents wrote an open letter–excerpted below–to all their presidential colleagues, urging their personal involvement in combating alcohol abuse. (EDITOR’S NOTE: The Harvard School of Public Health College Alcohol Study is not affiliated with the Higher Education Center for Alcohol and Other Drug Prevention.)

College and university presidents must address the problems caused by student alcohol use. Student high-risk drinking and the many problems that arise from it are among the most serious threats faced by our nation’s institutions of higher education. Many of the things we worry about–student death and injury, weak academic performance, property damage and vandalism, strained town-gown relations, negative publicity–are linked to student alcohol abuse.

Our primary interest in serving on the Presidents Leadership Group of the Higher Education Center for Alcohol and Other Drug Prevention was to underscore the seriousness of this problem and to help embolden our presidential colleagues to make the fight against student alcohol abuse a top priority. Stemming alcohol abuse is not something that college and university presidents can do alone, but their active leadership is essential.

With support from the Robert Wood Johnson Foundation, we have issued our recommendations in a report that has been mailed to all four-year college and university presidents in the United States. Our recommendations are built around three core ideas:

1) Be Vocal. College presidents should openly and publicly acknowledge that alcohol and other drug problems exist and then reach out to campus, community, and state-level groups to develop and implement a comprehensive strategy for prevention.

2) Be Visible. College presidents should take an active stand on alcohol and other drug issues, convey clear expectations and standards, and serve as a role model to other senior administrators, faculty, and students.

3) Be Visionary. College presidents should make alcohol and other drug prevention a priority in their strategic plan for the school.

The recommendations should be considered with these thoughts in mind. First, student alcohol abuse is a problem shared by all institutions of higher education. Clearly, high-risk drinking is more prevalent at some schools than others, but no school is immune from the problem. Acknowledging that fact is a healthy first step.

Second, student alcohol abuse is not a problem of the campus alone, but of the entire community. It is impossible for college and university officials to succeed in reducing the scope of this problem if they fail to work in partnership with local and state government officials, law enforcement agencies, community prevention advocates, and the owners of local bars and restaurants.

Third, although we believe that college and university presidents can make great strides in addressing this problem, we also recognize that student alcohol abuse is a problem that will never entirely go away. That means that campus-based programs and policies, plus coalition work at the local and state level, must become a permanent part of college and university operations.

ROBERT L. CAROTHERS

President, University of Rhode Island

MARY SUE COLEMAN

President, University of Iowa

B. JAMES DAWSON

President, Tennessee Wesleyan College

E. GORDON GEE

President, Brown University

CHARLES A. HINES

President, Prairie View A&M University

MANUEL T. PACHECO

President, University of Missouri

WILLIAM DEJONG

Director, Higher Education Center for Alcohol and Other Drug Prevention

The Higher Education Center, established in 1993 by the U.S. Department of Education, is a primary resource center for assisting institutions of higher education with alcohol and other drug prevention programs. Copies of the Presidents Leadership Group report are available from the Higher Education Center for Alcohol and Other Drug Prevention, Education Development Center, Inc., 55 Chapel St., Newton, MA 02158. Phone: 800-676-1730; Web site: http://www.edc.org/hec/

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