Binge Drinking on American College Campuses: A New Look at an Old Problem, August 1995

INTRODUCTION

Binge Drinking in College: A Definitive Study

The Harvard School of Public Health College Alcohol Study examines the nature, extent, and associated problems of heavy episodic or "binge" drinking. In mounting this research effort, we sought answers to three core questions:

• How extensive is the problem of binge drinking among college students?
• Who is affected by binge drinking?
• What can be done about this problem?

A New Way of Looking at an Old Problem
Our findings show that the issue of heavy drinking by students can no longer be viewed solely from the standpoint of the problems binge drinkers cause for themselves. This study reveals that binging students are creating serious problems for students who do not binge drink - a phenomenon we are calling "secondhand binge" effects. These secondhand effects include physical assault, sexual harassment, and impaired sleep and study time - problems that threaten the quality and safety of the college experience for millions of non-binging students.

Learning From Successes
The demonstration of "secondhand binge" effects necessitates a new call to action for college administrators. To date, most college intervention efforts have focused on protecting binge drinkers from themselves. But binge drinkers harm others as well as t hemselves, and this impels us to refocus our efforts toward a concern about the damage binge drinkers do to others and to campus life.

Two examples from related areas offer reason for hope. Society's shift in attitude toward driving after drinking has led to a new range of options to intervene. Today, changes in tavern laws, the abandonment of "happy hour," the practice of using a des ignated driver, and stronger drunk driving laws serve to protect society from the documented impact of drunk driving on public safety. The anti-smoking movement in this country is another compelling example. As a society, we were once tolerant of other pe ople's cigarette smoking. When we learned of the health impact of secondhand smoke, we stopped allowing people to light up in our homes, workplaces, airplanes, and restaurants. In increasing numbers of social settings, it is no longer socially correct to smoke.

What Does This Mean For Colleges?
According to a 1989 Carnegie Foundation study, college presidents nationwide viewed alcohol abuse as their number one campus life problem. It still is. Binge drinking is associated with unplanned and unsafe sexual activity, physical and sexual assault, un intentional injuries, criminal victimization, interpersonal problems. physical or cognitive impairment, poor academic performance, automobile crash fatalities, and suicide. Colleges also pay significant costs for property damage, liability, health service s, and security.

Many colleges have worked hard at reducing binge drinking on their campuses. But while there has been an overall decline in drinking in American society as a whole, recent studies have shown no proportionate decline among college students. Nor have col lege students exhibited the rates of decline seen in other young populations. Between 1981 and 1993, binge drinking by high school seniors dropped by fourteen percent. Among 19-to-22-vear-olds not attending college, the rate dropped 9%. Among college stud ents, however, the decline in heavy drinking rings in at a paltry 2.6%.

Nearly five of six students in this study drank during the school year. The universal acceptance of drinking, and the easy availability of alcohol to college students regardless of age, is not news, or cause for panic. At most campuses it is not a prac tical goal to eliminate all drinking or reduce the proportion of students who drink. As a society, and on the campuses that reflect it, we have to make clear and consistent distinctions between drinking and alcohol abuse.

Our concern in the HSPH College Alcohol Study is alcohol abuse. The crux of alcohol abuse is in the behavior, not the quantity consumed. When people do dangerous, offensive, or obnoxious things when they drink, creating problems for themselves or for o thers around them, that's alcohol abuse.

Certainly, not all students who have ever binged have an alcohol problem-, but colleges with large numbers of binge drinkers do. This study strongly suggests that colleges create or perpetuate, through selection, tradition, policy, and other intended a nd unintended mechanisms, their own drinking cultures. In some of those cultures, behavior that would be considered alcohol abuse in other settings is becoming not just acceptable, but normative.

If You Take Away Only One Message From This Study
The key to this nation's intervention efforts may lie in the recognition of secondhand binge effects on college campuses. In a system with alcohol abuse, whether a family or a campus, the least effective intervention point is the abuser. By focusing on th ose who pay the price of binge drinking by suffering its secondhand effects, colleges could mobilize millions of students nationwide to assert their right to live free from the injury and harm created by the binge drinking of their peers.

What Is "Binge Drinking"?
In this study, binge drinking is defined as five or more drinks in a row one or more times during a two week period for men, and four or more drinks in a row one or more times during the same period for women - a gender specific modification to a national standard measure. Our research documents that it takes four drinks for women to run the same risk of various alcohol-related health and behavior problems as men who have had five drinks. These problems include getting into arguments, getting injured, for getting where they were or what they did, and engaging in unplanned or unprotected sex. A drink is defined as a 12-ounce can or bottle of beer, a four-ounce glass of wine, a 12-ounce bottle or can of wine cooler. or a shot of liquor taken straight or in a mixed drink. Some may say, "Four or five drinks? That's not much." What this study demonstrates is that, in many students, this benchmark is indicative of a heavy drinking lifestyle. In reality, many students in this study report drinking far more than t his, often with the specific intention of getting drunk. But the data show that students who drink in these or greater amounts differ from other students by the frequency and severity of their alcohol-related problems.

"I was having a great night. I drank at least 15 beers. Then I blanked out. This is not unusual for me. Another time, I became violent, smashed bottles, pushed RAs, and got in tons of trouble."

Figure 1. Distribution of 140 Colleges by Percent of Binging Students

Rates of Binging Vary Widely From School To School
Binging rates vary dramatically from campus to campus. At its lowest, the binge drinking rate was I% of the student population. At its highest, the rate was a staggering 70% of students. At nearly one-third of the schools, more than half of the responding students were binge drinkers. We classify these schools as high-binge colleges.

The Extent of Binge Drinking By Students Is Alarming
Fully 84% of all students drank during the school year. Nearly half (44%) of all students were binge drinkers, and 19% were frequent binge drinkers (binged three or more times in the past two weeks). But even these averages conceal the extent of binge dri nking on high-binge campuses.

Figure 2. % of Students at High and Low Binge Colleges

"My roommate came home very drunk. I didn't want to deal with it. I had three tests the next day and had planned to study instead of playing 'mom.' I was really scared though. She was throwing things everywhere and crying. She really stunk and was disgusting. I especially didn't want her to puke in my room. I flunked one test and skipped another; I was so drained. I didn't speak with her all the next day."

STUDY DESIGN

The College
A national representative sample of 195 colleges was selected from the American Council on Education's list of four-year colleges and universities accredited by one of the six regional bodies covering the United States. One hundred forty accredited four-y ear colleges participated in the study. These colleges are located in 40 states and the District of Columbia. They represent a cross-section of American higher education. Two-thirds are public, and one-third are private. Approximately two-thirds are locat ed in suburban/urban settings and one-third in small town/rural settings. Four percent are women-only colleges, and four percent are historically black institutions.

The Questionnaire
Our 20-page survey instrument asked students a variety of questions about their drinking behavior and explored problems they experienced as a result of their own drinking and the drinking of others. Most of the measures and questions had been previously s tandardized in other national or large scale studies. Four separate mailings were sent to students at each college. Responses were voluntary and anonymous.

The Response Rate
A sample of 25,627 students received questionnaires. A total of 17,592 students responded, for an overall response rate of 69%. This is considered a good response rate for mailed questionnaires with college populations. Comparisons of early and late respo nders and a survey of non-responders to the regular questionnaire were used to rule out possible response bias. Only statistically significant comparisons are presented in this report.

Figure 3. Distribution of the 140 Colleges Included in the Study

THE PRICE THE BINGER PAYS: WHAT BINGERS DO TO THEMSELVES
The numbers in the chart below illustrate the strong, positive relationship between the frequency of binge drinking and the variety of alcohol-related health, social and academic problems. Nearly half of frequent binge drinkers (47% ) experience five or m ore different problems as a result of their own drinking since the beginning of the school year. In contrast, 14% of binge drinkers and only 3% of students who drink but do not binge experience five or more drinking-related problems .

Figure 4. Alcohol-related Health, Social and Academic Problems

"I went to three different frats during pledge week, got drunk, and was almost run over by a car. I didn't realize how close [I came] until the next day. However, overall I had a great time."

SECONDHAND BINGE EFFECTS: WHAT BINGERS DO TO OTHERS
The most troubling findings of this study reveal the impact of binge drinking on students who do not binge. We call it "secondhand binge" effects. It is no longer possible to view binging solely as the binger's problem: n on-binging students are paying to o steep a price.

"In a crowded bar I accidentally nudged someone. I apologized, but the guy hit me anyway with my pitcher of beer, dousing me with beer and making my mouth bleed."

Comparing the prevalence of problems experienced by students at low-binging and high binging schools brings the issue into sharp focus. On campuses where more than half the students are binge drinkers, the vast majority or students (87%) who live on ca mpus have experienced one or more problems as a result of others' binge drinking. Even at schools where binge drinking rates are below 35% of the student population, 62% of students who live on campus have been victims of secondhand binge effects.

Secondhand Binge Effects
Percentage of students residing at low-binge and high-binge colleges who reported the following alcohol-related experiences:

Figure 5. Secondhand Binge Effects

Binge Drinkers Underestimate Their Behavior
Relatively few binge drinkers consider themselves to be heavy or problem drinkers. Whether they attend a high-binging school or a low-binging school, most binge drinkers compare their drinking to that of their friends and the people with whom they party. Women who compare their drinking to men's drinking are especially apt to underestimate their drinking. Our study found that 91% of the women who were frequent binge drinkers, and 78% of the me, considered themselves to be moderate or light drinkers. Thus, even the heaviest drinkers on low-binge campuses perceive their drinking to be within acceptable limits, seriously compromising outreach efforts targeted at this population

Women, Binging, and Secondhand Binge Effects
A post-World War II study of college drinking viewed drinking by women to be such a minor problem that the researchers defined five different levels of quantity and frequency for men but only two for women. Today, while women are still less often binge dr inkers than men, the gender gap has closed, and the risks to women are even more pronounced.

"I went to a fraternity party off campus. I had at least 12 shots of liquor and two mixed drinks. That night I went home with this guy that I did not know and had sex with him...the guy and his roommates carried me home to my dorm where two RAs caught me. I went to the hospital for alcohol poisoning and rape. I blacked out. I never pressed charges because he used the condom in my wallet."

Their own abuse of alcohol increases their risk of being victimized by unwanted or unprotected sex. Female students are also especially at risk for serious secondhand binge effects. At high-binge colleges, 26% of women report an unwanted sexual advance , compared to 15% of women at low-binge campuses.

"A girl I know, who has a very low alcohol tolerance, got so drunk that a friend and I had to carry her for several blocks, trying to keep her from burning us with a cigarette. Since then she has gotten as, or nearly as, drunk every weekend. It has gotten her into some very bad situations and made things very difficult for her roommate and friends who won't confront her forcefully or let me confront her."

SNAPSHOTS: WHO IS BINGE DRINKING ON CAMPUS IN AMERICA?
The highest binge rate was for white males (54%); the lowest was black/African American female (12%). Women attending women's colleges were less likely to binge than women at coeducational institutions (29% v. 39%, respectively).

Figure 6. Who is Binge Drinking

"My roommate had a drinking contest with her boyfriend. They each had five shots of Wild Turkey, two beers, and then started a "power hour" -- one shot of beer per minute for 60 minutes. My roommate began falling down and looked ill. She laid down to go to sleep and began throwing up for two hours straight. She rolled over and almost choked on her own vomit."

Change in Binging Trends From High School to College
Half (50%) of the binge drinkers in the colleges in this study had already binges when they were seniors in high school, but campus binging rates also influence the drinking behavior of students once they arrive at college.

At high-binge colleges -- where more than half of students are binge drinkers -- nearly two of five students who did not binge in high school reported binge drinking as college students. In contrast, at low-binge colleges nearly half of the students wh o were binge drinkers in high school gave up this behavioral as college students.

Colleges with high binge rates were much more likely to attract students who were binge drinkers in high school, compared with low-binge colleges (38%, compared with 24% of students at low-binge colleges who previously binged in high school).

Figure 7. High School Drinking Changes in College

Binging and Fraternities and Sororities
Sorority members are nearly twice as likely to be binge drinkers compared to other female students (62% vs. 35%, respectively). Among women who live in sorority houses, an astonishing 80% are binge drinkers. Similarly, fraternity m embers binge more than other male students (75% vs. 45%, respectively), and 86% of fraternity house residents binge. This raises the question of whether Greek societies attract or create binge drinkers. Our data indicate that both dynamics are at work. Sixty percent of those wh o lived in fraternity houses had been binge drinkers in high school; and over three-fourths of fraternity residents who had not binged in high school became binge drinkers in college.

Conversely, sororities do not seem so much to attract binge drinkers; one in three women who lived in sororities had binged in high school, only slightly higher than the proportion among other students. But three out of every four women who had not bin ge d in high school became binge drinkers while in residence in sororities.

DRUNK DRIVING: DO STUDENTS STILL DRINK AND DRIVE?
Don't drink and drive and "Friends don't let friends drive drunk" have not yet become meaningful slogans among college binge drinkers, despite the investment of advertising public education dollars in these messages. In its 1993 report entitled: Substance Abuse: The Nation's Number One Health Problem, the Robert Wood Johnson Foundation documented that alcohol abuse contributes to nearly half of motor vehicle fatalities, the leading cause of death among young Americans. Our study confirms that college stud ents remain at high risk: fifty percent of frequent binge drinkers in this study reported riding with a driver that was drunk or high, and 40% of the males who binged frequently reported that they had driven a car after having consumed five or drinks.

Figure 8. College Student Drinking and Driving

"We were [driving] to a party and we were following another friend because we didn't know the way. The person we were following was driving crazy, driving on top of the line of the highway. We didn't know whether he was changing lanes or just playing around. Then, going around a sharp bend, he turned on two wheels and lost control and crashed into another car. The driver was drunk and four of my friends were hospitalized."

NATIONAL TRENDS: STUDENTS' USE OF ALCOHOL FAR OUT-DISTANCE ILLEGAL DRUG AND TOBACCO USE
Shifts in societal attitudes have played a tremendous note in reducing the use of illegal drugs and tobacco products by college students. Often fueled by the nature and scope of the impact of substance abuse on others, changing attitudes led to more effec tive intervention strategies. These included smoke-free work place policies, taxes that price cigarettes beyond the means of most teenagers, and stiffer illegal drug and drunk driving laws. Spreading information about the prevalence of secondhand binge ef fects could mobilize non-binging students in a groundswell of support to reduce binge drinking on college campuses.

Figure 9. Alcohol and Other Drug Use

WHAT COLLEGES CAN DO: A NEW APPROACH TO AN OLD PROBLEM

All colleges are unique; each has its own culture and traditions, resources and priorities, and relationship with the community. But every college with a substantial proportion of binge drinkers must begin with the question: "Can we accomplish our miss ion, and fulfill our students' goals, if we tolerate behavior that compromises the quality of students' educational and social lives, as well as their health and safety?" If that question leads to a commitment to act vigorously and systemically against ca mpus alcohol abuse, multiple approaches tailored to conditions on each campus will certainly be needed.

Understanding the Problem
Everyone, from the college president down, is susceptible to denial about the extent of the alcohol abuse problem and its impact on the life of the campus. To begin to assess the extent of the problem on a campus, consider a weekend tour, beginning on Thu rsday night. Take a drive around the campus with the security guards; observe the clubs on its outskirts. Drop in on the health service. On Friday, see how many classes are offered and how many students attend. Observe the fraternity houses and dorm's lat e at night; station yourself outside of the residence halls and sorority houses Sunday morning and witness the "walk of shame" a phrase that students use to describe women returning from a night of unplanned, and often unprotected, sex. Above all, fight t he temptation to think of the alcohol abuse you see as merely the problem of "troubled" individuals. When the faces change but the numbers do not, something much more powerful and institutional is happening.

A Systematic Effort Begins With The President
Commitment and leadership at the top is vital to assure that consistent, long-term prevention and intervention strategies are reflected not just in speeches but in budgets. Over the years, many administrations have opted to keep a low profile on preventio n efforts. Denial, a sense of futility, and lack of resources may be at play, but there are other reasons as well. Some administrators fear that a more visible, university-wide stance might create the appearance that alcohol abuse is unusually severe at t heir school, rather than that the school chooses to mount a realistic, systemic response to a common problem other colleges prefer to sweep under the rug. Some administrators may be advised by their legal institution's counsel to do as little as possible that might suggest knowledge of an alcohol problem on campus and acceptance of any responsibility for the environment that encourages or discourages it. But the prevalence of binge drinking on campus is no secret, and it is difficult to see how a college administrator could successfully claim not to know it exists.

Expect Everyone to Play an Important Role
Colleges and universities offer our most formidable aggregations of specialists in human and organizational behavior, including psychologists, sociologists and anthropologists, linguists, and lawyers, teachers and marketing strategists, experts in health and addictions, policy analysts and security specialists, community organizers, family therapists, and systems analysts. Yet it is the rare institution that convenes a working group of appropriately diverse problem solvers to address alcohol abuse in its midst. These faculty members can be asked to play a limited but meaningful role in planning and assessment, supporting students and administrators in a campus-wide effort. Athletic directors and coaches can have enormous influence on the drinking culture of a campus, but they are rarely pressed to use it. The very visible example set by athletes, the drinking policy at games, the money showered on campus by the beer industry -- these are forces that make some student affairs directors feel they are bailin g water with a spoon.

Resident advisors (RAs)and academic and retention counselors have been under utilized. They could enhance both prevention and early intervention efforts, but they each need clear roles. RAs cannot be expected to be both monitors and confidants. They ne ed much better sustained training and supervision than they typically receive, and better support, including the sure protection of explicit policy.

Security officers should also benefit from dedicated training and regular consultation around alcohol-related issues and infractions. It's easy for them to lapse into feeling like they are hurting rather than helping students whose abusive drinking the y call to authorities' attention. Students themselves must carry much of the responsibility for campus change. Student government, peer educators, and campus media can all agree that students are in favor of good times but not in favor of drunkenness.

Change Expectations of Incoming Freshmen Before They Arrive on Campus
Half of college bingers began binging in high school or earlier. Many colleges (larger state universities and elite institutions, for example) may be in a position to encourage high schools to strengthen their health education programs. Colleges also need to examine the expectations they are planting, or failing to plant, in applicants and entering students. Their promotional material should not reflect just the educational and athletic achievements of the school, but the quality of student life, includin g the measures they are willing to take to safeguard it. Recruiters can be trained to describe an institution where there are a great many ways to have a good time, and where drunken behavior is decidedly unwelcome. By discouraging applicants who intend t o major in binge drinking, the institution can be expected eventually to improve its drinking culture, probably upgrade its academic standing, and save some of the costs associated with alcohol abuse.

At some campuses freshman orientation is something between a lost opportunity and a week-long drunk. When they first arrive on campus, usually before other students, many freshmen will respond positively to intiatives they will later spurn, particularl y if they represent opportunity to meet their classmates under relatively natural conditions.

First-year women need special attention. Many have had little experience with alcohol abuse in high school, and need to understand that because of differences in metabolism women cannot drink equally with men. It only takes four drinks for a woman to b egin having the same alcohol-related problems as a man who has five drinks. And their risk of sexual assault, unwanted pregnancy, and exposure to HIV and other sexually transmitted diseases is dramatically increased by their own alcohol abuse and by that of their companions.

Challenge the Greeks
Many fraternities and sororities are functional saloons. Fully 86% of men and 80% of women who live in fraternities and sororities are binge drinkers. The rare president or dean who tells the Greeks to "shape up or ship out," and then keeps his or her wor d, earns the respect of many. The national organizations must be held accountable for serving underage students in their frat houses and providing an environment where binge drinking is the norm.

Campus and Community Must Cooperate
Town/gown relationships are important for both parties. State and local officials need to enforce underage drinking laws and strengthen others to help limit supply. Even more important are the bars and clubs that encourage drunkenness through promotion of discount drinks and contests. Presently, these clubs often form the nucleus of the advertising account for campus newspapers. Colleges will have to confront their own power to influence the way these clubs operate and are regulated; they are far for help less or ignorant in these matters. If they want to target heavy drinking, drunkenness, and in particular the antisocial behaviors this form of drinking causes, campus security and town police should be on the same team, working together. In return, colleg es can help local law enforcement agencies through more consistent disciplinary policies for students whose drunken behavior violates the law.

Most of All, Empower Students to Take the Lead
A successful and sustainable campus-wide effort depends upon the extent to which students are seen as leaders and impetus of their own self-generated code of respectful community behavior, or only the targets of it. Process is not just important, but cruc ial. It requires patience, persistence, and humility to enable students to take the lead in making drunkenness an unacceptable excuse for violent and disruptive behavior that violates other students' rights. But a set of policies and exhortations from abo ve will simply not suffice. Students bothered by the secondhand binge effects of binging students will gradually feel empowered to speak up without feeling humiliated themselves. It will be the students standing at their sides, more than the administrator s standing behind them, who most contribute to that feeling.

Whatever alcohol policies are developed by and for students must be brief and comprehensible enough to be effectively publicized, and must be vigorously enforced. It's better to have a few well-specified rules, with teeth, about the critical issues (su ch as how students behave), than many intricate rules which students do not read and know will not be enforced.

If colleges really aspire to be civil communities, prevention efforts must empower those students adversely affected by binge drinking of others. We once thought drunk drivers were part of life, and smokers had to be tolerated. Today people feel comfor table speaking out against drunk drivers and smokers because we now know the harm they cause others is not an acceptable price to pay for their behavior. The same lessons can help lend a voice to students affected by the second hand binge problems of othe r student's drinking.

Quotes used in this report are drawn from student responses to open-ended questions in our survey