Concerted Efforts Needed to Address College-Age and Underage Drinking
by Marlene Busko
April 28, 2008 (Toronto, Ontario) — "Problems related to college drinking have been going on year after year on American college campuses, and we're only now just beginning to fully appreciate the magnitude of it," said Ralph W. Hingson, SCD, director of the division of epidemiology and prevention research at the National Institute on Alcohol Abuse and Alcoholism (NIAAA). "The good news is that there is evidence that one can intervene to reduce these problems."
Dr. Hingson was speaking at the Distinguished Scientist Lecture at the American Society of Addiction Medicine 39th Annual Medical-Scientific Conference.
Death and Injury to Selves and Others
A study by Dr. Hingson and colleagues commissioned by the NIAAA national Task Force to assess the magnitude of underage drinking problems in the United States reported that, based on 1998 data, drinking by college students aged 18 to 24 years contributes to an estimated 1400 student deaths, 500,000 injuries, and 70,000 cases of sexual assault or date rape each year (Hingson RW et al. J Stud Alcohol. 2002;63:136-144).
An updated study based on 2001 data showed that drinking by college students is now estimated to contribute to 1700 alcohol-related unintentional injury deaths (mostly traffic crash deaths), nearly 600,000 nonfatal injuries, 690,000 assaults, and 100,000 sexual assaults/date rapes every year.
It is important to note that half of the people who die in traffic crashes caused by young drunk drivers are passengers, pedestrians, or people in other vehicles, Dr. Hingson stressed. "Clearly, many people, not only the drinkers, are negatively affected by these behaviors, and it underscores that colleges have a responsibility to try to do something about it," he said.
Binge Drinking Has Broad Impact
Drinking to get drunk, or binge drinking — defined as 5 or more drinks on 1 occasion for men and 4 or more drinks on 1 occasion for women — is clearly a problem in this college-age group (age 18 to 24 years), said Dr. Hingson.
A recent survey reported that, among 18- to 24-year-olds, 4.4 million college students (or 45% of the college students) and 7.9 million who were not in college (or 40% of those who were not in college) engaged in binge drinking. In addition, 2.8 million college students and 4.5 million of the young adults who were not college students reported driving under the influence of alcohol.
Alcohol-related unintentional injuries are estimated to lead to about 5500 deaths among all 18- to 24-year-olds each year in the United States.
"The problem begins before people get into college," Dr. Hingson noted. National surveys show that the younger people are when they first become intoxicated, the greater the likelihood that they will have alcohol dependence while in college and will engage in risky behaviors such as driving after drinking, riding with drunk drivers, or having unplanned, unprotected sex after drinking.
In the United States, an estimated 1 million high school students engage in binge drinking at least 6 times a month. A national survey by the Substance Abuse and Mental Health Services Administration (SAMHSA) found that 2 million 12- to 20-year-olds reported that they frequently drank to get drunk; compared with nondrinkers, these young people were much more likely to take part in risky behaviors such as driving after drinking, riding with drunk drivers, carrying a gun, having unprotected sex, and using psychoactive drugs. Nearly a third of these children and adolescents reported that they consumed drugs and drank alcohol at school.
There are opportunities to intervene at the level of the individual, the school, and the environment, said Dr. Hingson. A multipronged approach is more effective than a single approach, and intervention strategies need to involve young people, he said, noting that the majority of young people do not abuse alcohol.
Individual Intervention: "Teachable Moments"
A study at a level-1 trauma center in Seattle, Washington found that 46% of the patients there had been injured while under the influence of alcohol (Gentilello LM et al. Ann Surg.1999;230:473-480). The study randomized 396 patients to a control group and 336 patients to an intervention consisting of 30 minutes of counseling. A year later, compared with individuals in the control group, people in the brief counseling group were, on average, drinking 21 fewer drinks per week and had a 23% reduction in drinking and driving, a 47% reduction in injuries requiring emergency room admission, and a 48% reduction in injuries requiring hospital admission.
"I think what happened is [the clinicians] caught these people at a 'teachable moment,' " said Dr. Hingson. The patients had just had been so seriously injured as a result of their drinking that they ended up on life support in a hospital, when they would be most receptive to counseling.
"In the United States, we have 8 million emergency room visits each year . . . which represents 8 million 'teachable moments' where we have an opportunity to intervene," he noted.
Unfortunately, there is an implementation gap, said Dr. Hingson. Most young people who meet alcohol-use disorder criteria do not think they have a problem. A recent study found that 19% of college students met alcohol-use disorder criteria, but only 5% had received any counseling.
School-Based Intervention: Addressing Peer Pressure
Schoolchildren form a captive audience, but "just telling them about the associated harms of alcohol might increase their knowledge level, but it doesn't do much about changing behaviors," said Dr. Hingson.
The most effective school-based programs are those that address social pressures that young people face to drink (and teach developmentally appropriate resistance skills), provide teacher training, are interactive, and perhaps most important, include a family component.
Environmental Intervention: Setting a Higher vs Lower Drinking Age
Raising the drinking age to 21 years, increasing the price of alcohol, and reducing alcohol outlet density are ways to intervene on an environmental level.
The younger people are when they begin to drink, the more likely they are to develop dependence. In a study that looked at alcohol-consumption onset, Dr. Hingson and colleagues found that compared with people who started to drink alcohol only after age 25 years, those who started earlier were more likely to become dependent on alcohol before the age of 25 years and to have multiple and longer episodes of alcohol dependence (Hingson RW et al. Pediatrics. 2006;118:e755-e763).
Another recent study found that preteen drinkers are 3 times more likely to attempt suicide.
"Leading Contributor to the Leading Cause of Death"
In the United States, injuries are the leading cause of death in people age 1 to 44 years, and there are over 50,000 alcohol-related injury deaths each year, said Dr. Hingson.
"Alcohol is the leading contributor to the leading cause of death among young people in the United States . . . that's why it's so important that we need to try to intervene to address these problems," he concluded.
American Society of Addiction Medicine 39th Annual Medical-Scientific Conference. April 10-13, 2008.
by Marlene Busko
April 28, 2008 (Toronto, Ontario) — "Problems related to college drinking have been going on year after year on American college campuses, and we're only now just beginning to fully appreciate the magnitude of it," said Ralph W. Hingson, SCD, director of the division of epidemiology and prevention research at the National Institute on Alcohol Abuse and Alcoholism (NIAAA). "The good news is that there is evidence that one can intervene to reduce these problems."
Dr. Hingson was speaking at the Distinguished Scientist Lecture at the American Society of Addiction Medicine 39th Annual Medical-Scientific Conference.
Death and Injury to Selves and Others
A study by Dr. Hingson and colleagues commissioned by the NIAAA national Task Force to assess the magnitude of underage drinking problems in the United States reported that, based on 1998 data, drinking by college students aged 18 to 24 years contributes to an estimated 1400 student deaths, 500,000 injuries, and 70,000 cases of sexual assault or date rape each year (Hingson RW et al. J Stud Alcohol. 2002;63:136-144).
An updated study based on 2001 data showed that drinking by college students is now estimated to contribute to 1700 alcohol-related unintentional injury deaths (mostly traffic crash deaths), nearly 600,000 nonfatal injuries, 690,000 assaults, and 100,000 sexual assaults/date rapes every year.
It is important to note that half of the people who die in traffic crashes caused by young drunk drivers are passengers, pedestrians, or people in other vehicles, Dr. Hingson stressed. "Clearly, many people, not only the drinkers, are negatively affected by these behaviors, and it underscores that colleges have a responsibility to try to do something about it," he said.
Binge Drinking Has Broad Impact
Drinking to get drunk, or binge drinking — defined as 5 or more drinks on 1 occasion for men and 4 or more drinks on 1 occasion for women — is clearly a problem in this college-age group (age 18 to 24 years), said Dr. Hingson.
A recent survey reported that, among 18- to 24-year-olds, 4.4 million college students (or 45% of the college students) and 7.9 million who were not in college (or 40% of those who were not in college) engaged in binge drinking. In addition, 2.8 million college students and 4.5 million of the young adults who were not college students reported driving under the influence of alcohol.
Alcohol-related unintentional injuries are estimated to lead to about 5500 deaths among all 18- to 24-year-olds each year in the United States.
"The problem begins before people get into college," Dr. Hingson noted. National surveys show that the younger people are when they first become intoxicated, the greater the likelihood that they will have alcohol dependence while in college and will engage in risky behaviors such as driving after drinking, riding with drunk drivers, or having unplanned, unprotected sex after drinking.
In the United States, an estimated 1 million high school students engage in binge drinking at least 6 times a month. A national survey by the Substance Abuse and Mental Health Services Administration (SAMHSA) found that 2 million 12- to 20-year-olds reported that they frequently drank to get drunk; compared with nondrinkers, these young people were much more likely to take part in risky behaviors such as driving after drinking, riding with drunk drivers, carrying a gun, having unprotected sex, and using psychoactive drugs. Nearly a third of these children and adolescents reported that they consumed drugs and drank alcohol at school.
There are opportunities to intervene at the level of the individual, the school, and the environment, said Dr. Hingson. A multipronged approach is more effective than a single approach, and intervention strategies need to involve young people, he said, noting that the majority of young people do not abuse alcohol.
Individual Intervention: "Teachable Moments"
A study at a level-1 trauma center in Seattle, Washington found that 46% of the patients there had been injured while under the influence of alcohol (Gentilello LM et al. Ann Surg.1999;230:473-480). The study randomized 396 patients to a control group and 336 patients to an intervention consisting of 30 minutes of counseling. A year later, compared with individuals in the control group, people in the brief counseling group were, on average, drinking 21 fewer drinks per week and had a 23% reduction in drinking and driving, a 47% reduction in injuries requiring emergency room admission, and a 48% reduction in injuries requiring hospital admission.
"I think what happened is [the clinicians] caught these people at a 'teachable moment,' " said Dr. Hingson. The patients had just had been so seriously injured as a result of their drinking that they ended up on life support in a hospital, when they would be most receptive to counseling.
"In the United States, we have 8 million emergency room visits each year . . . which represents 8 million 'teachable moments' where we have an opportunity to intervene," he noted.
Unfortunately, there is an implementation gap, said Dr. Hingson. Most young people who meet alcohol-use disorder criteria do not think they have a problem. A recent study found that 19% of college students met alcohol-use disorder criteria, but only 5% had received any counseling.
School-Based Intervention: Addressing Peer Pressure
Schoolchildren form a captive audience, but "just telling them about the associated harms of alcohol might increase their knowledge level, but it doesn't do much about changing behaviors," said Dr. Hingson.
The most effective school-based programs are those that address social pressures that young people face to drink (and teach developmentally appropriate resistance skills), provide teacher training, are interactive, and perhaps most important, include a family component.
Environmental Intervention: Setting a Higher vs Lower Drinking Age
Raising the drinking age to 21 years, increasing the price of alcohol, and reducing alcohol outlet density are ways to intervene on an environmental level.
The younger people are when they begin to drink, the more likely they are to develop dependence. In a study that looked at alcohol-consumption onset, Dr. Hingson and colleagues found that compared with people who started to drink alcohol only after age 25 years, those who started earlier were more likely to become dependent on alcohol before the age of 25 years and to have multiple and longer episodes of alcohol dependence (Hingson RW et al. Pediatrics. 2006;118:e755-e763).
Another recent study found that preteen drinkers are 3 times more likely to attempt suicide.
"Leading Contributor to the Leading Cause of Death"
In the United States, injuries are the leading cause of death in people age 1 to 44 years, and there are over 50,000 alcohol-related injury deaths each year, said Dr. Hingson.
"Alcohol is the leading contributor to the leading cause of death among young people in the United States . . . that's why it's so important that we need to try to intervene to address these problems," he concluded.
American Society of Addiction Medicine 39th Annual Medical-Scientific Conference. April 10-13, 2008.
