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 other 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. (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 binged 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 nonconsensual 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 or 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.
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.
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.
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