Mental Health Issues and the University Student

6. Alcohol on Campus

Juan, an 18-year-old Hispanic freshman from North Carolina, avoids eye contact and squirms in his seat. His left ankle is bandaged. He’s been mandated to come for an assessment following an emergency department evaluation over the weekend. He explains that he got drunk at a fraternity party, at which he’d hoped to “hook up” with a classmate. When he saw her leave with another guy, he tried to follow but fell down a half-flight of stairs and sustained an ankle sprain, as well as multiple abrasions. He admits to drinking six to seven drinks, two to three nights a week, but thinks his peers drink as much. He has had one blackout, but denies DWI charges or other consequences. “I can stop anytime I want to—but then I wouldn’t have any fun at college,” he says, adding that he plans to rush this particular fraternity. He’s ashamed of the events of the weekend but chalks it up to frustrated love rather than alcohol, saying he’s never had a girlfriend, and he can’t even approach girls he likes without drinking first. Although he began drinking his senior year of high school, he never got drunk or threw up until he arrived at college. He denies tremors, cravings, or other withdrawal symptoms. Chapter 6 Alcohol on Campus Alcohol on Campus  45 Drinking on Campus: What’s “Normal”? Most college students are legally underage for drinking alcohol, yet most do drink at least occasionally, and many drink heavily enough to make alcohol abuse a major health problem on campus. This is not a new phenomenon, but the extent of college drinking has crept up since the 1940s, and it’s more concerning now that we better understand the relationship between age and alcohol use. Recent research shows that the developing brain is much more susceptible to the effects of addicting substances than the older brain. In a large, national epidemiological study of alcohol-dependent adults, 15% were diagnosable before age 18, 47% before age 21, and a full 69% of them were diagnosable before age 25.1 Furthermore, among that majority whose addiction began before age 25, the odds for seeking help were lower than for those addicted after age 30, and the frequency, duration, and severity of alcohol dependence episodes was worse in the younger drinkers. Thus, the university setting provides a unique and critical opportunity to create positive change that can be immediate and long lasting. Juan’s drinking pattern meets the definition of binge drinking: five or more drinks in a row for men and four or more for women. The majority of accidents , injuries, and sexual mishaps related to alcohol occur among students who binge drink. Juan’s impression that “everyone” drinks as much is wrong, but the numbers are in fact quite high. At four-year colleges across the country, about two in five students drink at this level, a prevalence that has remained stable over the past decade.2 The negative consequences of drinking appear to be on the rise. Certainly, there’s greater recognition of the enormous public health burden of college drinking. Alcohol-related deaths due to unintended injury rose 3% per 100,000 between 1998 and 2005, to 1,825; this is higher than the number of student deaths due to suicide.3 More and more students are driving while intoxicated, and in 2001, 599,000 sustained injuries related to alcohol. There’s growing awareness too of just how much collateral damage is due to drinking. In 2001 nearly 700,000 students were assaulted by a drunk student, and 97,000 suffered a sexual assault or rape due to alcohol.4 Finding an effective way to treat students like Juan is therefore critical. Concerns about all this led the National Institute on Alcohol Abuse and Alcoholism (NIAAA) to create a Task Force on College Drinking in 1998, and since then, mounting data have prompted universities to take a more proactive stance toward dealing with alcohol misuse on campus. Research has prolifer- 46  Clinical Challenges ated on treatment and prevention strategies that might be most effective, and growing evidence supports early intervention. Although heavy drinking is more common in emerging adulthood than in other stages of life, the college environment itself seems to lead to heavier and more problematic drinking. Longitudinal studies show, for example, that high school students who are college bound...