Gail M. Basch, M.D
Rush University Medical Center
March 2013
Alcohol Medical Scholars Program
Special Populations- College Drinking (Slide 1)
I.
Introduction.
College associated with heavy drinking. 1 2 3 (Slide 2)
A.
1.
Time of transition / exploration.
2.
Time of life with heaviest drinking.
3.
Incoming student believes heavy drinking = norm. 4,5
B.
This lecture reviews: (Slide 3)
1.
Definitions.
2.
Campus drinking & problems.
3.
Risk factors for heavy drinking.
4.
Prevention efforts.
Pattern → much morbidity and mortality. 6–9 (Slide 4)
C.
1.
2,000 student deaths / yr. from alcohol related causes. 9
2.
~700,000 assaults / yr.
3.
~80,000 sexual assaults / yr.
4.
~2.8 million drove while intoxicated.13
5.
U.S. spends $62 billion / yr underage drinking.
Students have heavy drinking episodes.14–16 (Slide 5)
D.
1.
~45% report heavy drinking / past 2 wks.
2.
~20% ♂drank 10 drinks / occasion.
3.
~10% ♀drank 8 drinks / occasion.
College heavy drinking → future drinking problems. 3 (Slide 6)
E.
1.
Clues for prevention efforts.
1
2.
Clues for Rx.
3.
Most clinicians learn little re: these issues.
F.
This lecture reviews: (Slide 7)
1.
Definitions.
2.
Campus drinking & problems.
3.
Risk factors for heavy drinking.
4.
Prevention efforts.
II.
Definitions.
Standard drink (10-12 g pure ethanol). 17 (Slide 8)
A.
1.
12 oz. beer.
2.
8 oz. malt liquor.
3.
4 oz. wine.
4.
1.5 oz. 80 proof liquor.
Heavy episodic drinking.17 (Slide 9)
B.
C.
1.
4+ std drinks for ♀.
2.
5+ std drinks for ♂.
3.
≥5 occasions during past month.
Blood alcohol concentration (BAC). 18 (Slide 10)
1.
Std. drink ~ 12 g alcohol.
2.
1 drink  BAC ~ ↑ 0.0.15g/dl ~15mg%.
3.
 BAC with
4.
a.
 Drinks.
b.
♀.
c.
↓ Weight.
d.
Drink without food.
BAC’s effects. 19 (Slide 11)
2
a. ≤ 50mg% (1-3 drinks) → Well-being, ↓ inhib.
b. ≤ 100 → Sleepiness, ↓ coordination.
c.
≤ 200 → Anger, moody, confusion.
d. ≤ 300 → Difficulty awakening.
e. > 300 → ↓ Vital signs, coma, death.
Blackout.20–22 (Slide 12)
D.
1.
Forget events that occurred when intox.
2.
No loss of consciousness.
Alcohol abuse & alcohol dependence = alcohol use disorders (AUDs). 23(Slide 13)
E.
Alcohol abuse: 1+ in same 12 mos (in absence of dep) of: 23
1.
a.
Role failure.
b.
Risk of harm.
c.
Legal problems.
d.
Use despite problems.
Alcohol dependence: 3+ in same 12 months of: 23
2.
III.
a.
Tolerance.
b.
Withdrawal.
c.
Unable to limit.
d.
Unable to cut down.
e.
Time w/ alcohol.
f.
↓Time elsewhere.
g.
Use despite problems.
Campus drinking and problems. (Slide 16)
Heavy drinking.3 24 (Slide 15)
A.
1.
45% 4+drinks / occas past 2 wks.10
3
2.
20% > 15 drinks / occas past 2 wks.
3.
50% ~1+ blackout / college.20,22
4.
40 % ~1+ alcohol problem prior yr.
5.
20% students drink 72% of all alcohol.
College students drink more than peers. 12,24–27 (Slide 16)
B.
1.
College drinking vs. non-college:
a.
Current drinkers / past yr: 63% vs 53%.
b.
Current heavy episodic drinking: 45% vs 38%.
c.
Current alcohol abuse / past yr: 18% vs 15%.
d.
DWI / 2 wks: 40% vs 25 %.
e.
Highlights college risk factors (some are mentioned below).
Risk factors: Some student subgroups have ↑ risk alcohol problems. (Slide 17)
C.
1.
~60% genetics & ~40% environment. (see pie chart).
a.
Environment: 21st b-day, game day, holidays, Greek, athletes.
b.
Genetics: Impulsivity, AUD, low level of response to alcohol (LR).
2.
Environmental risk factors (~40%). (Slide 16)
High-risk day/event → drink.
a.
1.
2.
At 21st birthday. 9,28 (Slide 18)
a'.
83% drink to celebrate.
b'.
~25 % >21 b-day drinks.
c'.
~40% report blackouts.
d'.
For 50% this is highest ever drinks.
e'.
BAC~0.186 g/dl.9
Next: other high-risk events.9 28–29 (Slide19)
a'.
New Year’s Eve: BAC~0.126 g/dl.
b'.
Spring Break: BAC~0.107 g/dl.
c'.
Graduation: BAC~0.093 g/dl.
d'.
Valentine’s Day: BAC~0.076 g/dl.
e'.
Weekday: BAC~0.076g/dl (see bar graph).
4
3.
Next: Game day drinking. (Slide 21)
a'.
~60% drink on game day.
b'.
~7drinks/game.
c'.
↑ Impulsivity.
d'.
↑ Expectations.
Next: Members of fraternity/sorority. 30–33 (Slide 22)
b.
1.
2.
3.
Greek members drink  with alcohol related conseq.
a'.
~60% heavy drinkers in high school.
b'.
~80% heavy episodic drinkers currently.
↑ drinker peer groups.
a'.
Leaders drink 
b'.
Set drinking norms.
c'.
→ drink.
Fraternity/Sorority Blackouts: (Slide 23)
a'.
Members vs. non-members.
b'.
Blackouts / past 2 wks:
1. ♂:
45% vs 23%.
2. ♀:
42% vs 20%.
Next: Student athletes.34–37 (Slide 25)
c.
1.
2.
Athletes drink  with  alcohol related conseq.
a'.
~50% heavy episodic drinkers.
b'.
If athlete and in Greek system → drinks .
↑ Drinker peer groups.
a'.
Team leaders drink 
b'.
Set drinking norms.
c'.
→ drink.
Genetic risk factors (~60%). 2 (Slide 17)
3.
a.
Next: ↑ Impulsivity. 7,38–44 (Slide 25)
5
1.
Example of genetic factor.
2.
↓ Ability to postpone reward.
3.
↑ Risk taking.
4.
↑ Urgency.
5.
→ drink.
b.
Next: Students with alcohol dependent relatives. (Slide 26)
1.
Another example of inherited genetic risk factor.
2.
4x ↑ risk AUDs.45,46
3.
Even if adopted out.
4.
→ drink.
Next: Low sensitivity (low level of response).45,47–52 (Slide 27)
c.
IV.
1.
Well studied genetic risk factor.
2.
Need  drinks for effects (can “drink others under table”).
3.
So  drinks /occasion.
4.
Join peers who  drinks /occasion.
5.
Think everyone drinks .
6.
Stress from heavy drinking.
7.
Use drinks to cope.
8.
→ drink.
Prevention efforts. (Slide 28)
Heavy drinking peers influence drinking. (Slide 29) 45,53–56 57
A.
Offer ↑↑ number of drinks.
1.
2.
a.
Students fear rejection if refuse drink.
b.
~40% afraid to refuse.
c.
Lack skills to say no.
Also overestimate peer/campus support of heavy drinking. 40 58–63 57
6
a.
↑ drinking to match estimation.
b.
Think heavy drinking desirable.
c.
 Drink/occasion.
d.
If teach students about peer pressure → ↓ drink.
3.
B.
Next: Inaccurate beliefs. (Slide 30)
1.
Re: benefits of heavy drinking.
a.
~65% believe alcohol → more fun.
b.
~55% believe alcohol → better sex.
2.
Re : alcohol used incorrectly for:
3.
Muscle tension relief.
2.
Better sleep.
Re: mis / under-informed on dangers of heavy drinking.
a.
Believe can guess BAC.
b.
Minimize alcohol overdose dangers.
c.
Alcohol + other drugs dangers.
Educate students about alcohol and real effects → ↓ drink.
4.
C.
Next: Alcohol to cope.
57 63,64
(Slide 31)
1.
Students falsely believe alcohol ↓ stress.
2.
Low doses → ↓ mild anxiety.
3.
2 or 3 drinks → ↑ anxiety.
a.
Later in evening.
b.
Next morning.
4.
5.
D.
1.
Drink to treat alcohol-induced anxiety.
a.
Can interfere with searching for better ways to handle stress.
b.
Drinking takes place of healthy coping skills.
Correct false belief and teach student healthy coping skill → ↓ drink.
Key elements of campus drinking prevention programs include.45,49,50,52 (Slide 32)
7
1.
Student health.
2.
Dorm counselors.
3.
Orientation.
4.
Prevention campaigns.
Prevention videos taught about : 44,48 49 ,51 (Slide 33)
E.
1.
Peer influence.
2.
Accurate alcohol beliefs.
3.
Actual campus drinking patterns.
4.
New coping skills.
5.
Info: can't guess BAC.
6.
Info: dangers of alcohol + drugs.
Tailoring prevention to risk → ↓ heavy drinking/problems.
F.
V.
Conclusion. (Slide 34)
A.
This lecture reviewed:
1.
Definitions of alcohol use and problems.
2.
Campus drinking & problems.
3.
Risk factors for heavy drinking.
4.
Prevention efforts.
8
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