Alcohol Consumption, Alcohol-Related Problems, and Quality of Life Among College Students

College student alcohol abuse is now recognized as a substantial public health problem rather than a harmless right of passage (Hingson, Heeren, Zakocs, Kopstein, & Wechsler, 2002; O'Malley & Johnston, 2002; Perkins, 2002; Wechsler et al., 2002). Although most students do not drink on a daily basis or meet criteria for alcohol dependence (Clements, 1999), large numbers of college students drink frequently and in a manner that often results in pernicious outcomes both for the drinker and for the larger college community (Ham & Hope, 2003). However, the net or global impact of drinking for individual college students is more difficult to quantify (Murphy, McDevitt-Murphy, & Barnett, 2005). Presumably, alcohol's global impact or value for any individual is a function of the sum of the net negative impact of drinking (e.g., specific alcohol-related problems, impact on academics, health, relationships, etc.) and the net positive impact of drinking (e.g., social enhancement, alleviation of boredom, enjoyment, etc.). A behavioral economic or choice perspective (Tucker, Vuchinich, & Rippins, 2002; Vuchinich & Heather, 2003; Vuchinich & Tucker, 1988) posits that a student's decisions about how often and how much to drink will be related to the value of alcohol use relative to the value of other available activities. Thus, quantifying the net impact of alcohol use could shed light on why students increase or decrease their drinking (Murphy, Correia, Colby, & Vuchinich, 2005).

College Student Alcohol Use and Negative Outcomes

Adverse proximal outcomes associated with college student drinking are well-documented and include large numbers of past-year injuries (500,000), unprotected sexual encounters (399,725), physical assaults (632,899), sexual assaults or date rapes (71,379), and unintentional alcohol-related fatalities (1,445; Hingson et al., 2002). Alcohol has also been implicated in two thirds of college student suicides and 95% of all violent crimes on campus (Commission on Substance Abuse at Colleges and Universities, 1994). Wechsler, Lee, Kue, and Lee (2000) found that frequent heavy drinkers were 21 times more likely to experience 5 or more different alcohol-related problems than were students who were light or moderate drinkers. However, alcohol use during college does not appear to be causally related to more global adverse outcomes such as academic impairment (Paschall & Freisthler, 2003; Wood, Sher, & McGowan, 2000), failure to achieve developmental milestones such as graduating college, marriage, and full-time employment (Gotham, Sher, & Wood, 2003), or to persistent psychological difficulties such as depression, anxiety, or low self-esteem (Camatta & Nagoshi, 1995; Nystrom, 1992).

It appears that adverse consequences, rather than alcohol use per se, are most associated with negative outcomes. For example, several studies suggest that students with high levels of alcohol-related problems show increased levels of stress and depression, social anxiety, and low self-esteem (Camatta & Nagoshi, 1995; Hutchinson, Patock, Cheong, & Nagoshi, 1998; Kassel, Jackson, & Unrod, 2000; Lewis & O'Neill, 2000). Although alcohol-related problems are by definition related to alcohol consumption, they actually occur rather infrequently for most individual drinkers. Gruenewald and associates (2003) found a dose-response relation between drinking and some alcohol-related consequences, but the prevalence of these outcomes was low even on heavy drinking nights. Other "alcohol-related" problems did not show the expected linear relation to drinking level (e.g., unprotected sex, performing poorly on a test), which is consistent with previous research showing that a significant amount of variance in alcohol-related problems is not accounted for by alcohol consumption (Borsari, Neal, Collins, & Carey, 2001). It is also likely that some behaviors that are classified as alcohol problems, such as missing class, damaging property, and having unplanned sex, only occasionally result in negative outcomes for the student drinker (e.g., when a student is arrested for damaging property). Therefore, the differential impact of alcohol use and alcohol-related consequences on everyday functioning has...