The burden of alcohol use: excessive alcohol consumption and related consequences among college students

Aaron White, Ralph Hingson, Aaron White, Ralph Hingson

Abstract

Research shows that multiple factors influence college drinking, from an individual's genetic susceptibility to the positive and negative effects of alcohol, alcohol use during high school, campus norms related to drinking, expectations regarding the benefits and detrimental effects of drinking, penalties for underage drinking, parental attitudes about drinking while at college, whether one is member of a Greek organization or involved in athletics, and conditions within the larger community that determine how accessible and affordable alcohol is. Consequences of college drinking include missed classes and lower grades, injuries, sexual assaults, overdoses, memory blackouts, changes in brain function, lingering cognitive deficits, and death. This article examines recent findings about the causes and consequences of excessive drinking among college students relative to their non-college peers and many of the strategies used to collect and analyze relevant data, as well as the inherent hurdles and limitations of such strategies.

Figures

Figure 1
Figure 1
Alcohol: Trends in 30-day prevalence among college students vs. others 1 to 4 years beyond high school (twelfth graders included for comparision). SOURCE: The Monitoring the Future Study, the University of Michigan. NOTE: Others refers to high school graduates 1 to 4 years beyond high school not currently enrolled full time in college.
Figure 2
Figure 2
Binge alcohol use among adults aged 18 to 22, by college enrollment: 2002–2011. Survey years are shown on the horizontal axis, and the percentage using in the past month is shown on the vertical axis. For each college enrollment status (enrolled full time in college and not enrolled full time in college), there is a line showing use over the years 2002, 2003, 2004, 2005, 2006, 2007, 2008, 2009, 2010, and 2011. Tests of statistical significance at the .05 level were performed between 2011 and each of the previous years listed; significant results are indicated where appropriate. Among adults aged 18 to 22 enrolled full time in college, 44.4 percent were past-month binge alcohol users in 2002, 43.5 percent in 2003, 43.4 percent in 2004, 44.8 percent in 2005, 45.6 percent in 2006, 43.6 percent in 2007, 40.7 percent in 2008, 43.6 percent in 2009, 42.2 percent in 2010, and 39.1 percent in 2011. The differences between the 2011 estimate and the 2002, 2003, 2004, 2005, 2006, 2007, 2009, and 2010 estimates were statistically significant. Among adults aged 18 to 22 not enrolled full time in college, 38.9 percent were past-month binge alcohol users in 2002, 38.7 percent in 2003, 39.4 percent in 2004, 38.3 percent in 2005, 38.5 percent in 2006, 38.6 percent in 2007, 38.2 percent in 2008, 38.0 percent in 2009, 35.4 percent in 2010, and 35.4 percent in 2011. The differences between the 2011 estimate and the 2002 through 2009 estimates were statistically significant. SOURCE: Substance Abuse and Mental Health Services Administration. Results From the 2011 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H–44, HHS Publication No. (SMA) 12–4713. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012.
Figure 3
Figure 3
Alcohol: Trends in 2-week prevalence of consuming five or more drinks in a row among college students vs. others 1 to 4 years beyond high school (12th graders included for comparision). SOURCE: The Monitoring the Future study, the University of Michigan. NOTE: Others refers to high school graduates 1 to 4 years beyond high school not currently enrolled full time in college.
Figure 4
Figure 4
Drinking habits of college students from Harvard CAS. SOURCE: Johnston, L.D.; O’Malley, P.M.; Bachman, J.G.; and Schulenberg, J.E. Monitoring the Future National Survey Results on Drug Use, 1975–2011: Volume I: Secondary School Students. Ann Arbor, MI: Institute for Social Research, the University of Michigan.
Figure 5
Figure 5
Percent of 12th-grade male and female students who reported drinking at least once in the prior 2 weeks. SOURCE: Wechsler, H.; Lee, J.E.; Kuo, M., et al. Trends in college binge drinking during a period of increased prevention efforts: Findings from 4 Harvard School of Public health College alcohol study surveys: 1993–2001. Journal of American College Health 50(5):203–217, 2002. PMID: 11990979

References

    1. Abbey A. Alcohol-related sexual assault: A common problem among college students. Journal of Studies on Alcohol. 2002;(Suppl 14):118–128.
    1. Abbey A, Buck PO, Zawacki T, Saenz C. Alcohol’s effects on perceptions of a potential date rape. Journal of Studies on Alcohol. 2003;64(5):669–677.
    1. Alexander EN, Bowen AM. Excessive drinking in college: Behavioral outcome, not binge, as a basis for prevention. Addictive Behaviors. 2004;29(6):1199–1205.
    1. Blanco C, Okuda M, Wright C, et al. Mental health of college students and their non-college-attending peers: Results from the National Epidemiologic Study on Alcohol and Related Conditions. Archives of General Psychiatry. 2008;65(12):1429–1437.
    1. Boekeloo BO, Novik MG, Bush E. Drinking to get drunk among incoming freshmen college students. American Journal of Health Education. 2011;42(2):88–95.
    1. Boyer KK, Olson JR, Calatone RJ, Jackson EC. Print versus electronic surveys: A comparison of two data collection methodologies. Journal of Operations Management. 2002;20(4):357–373.
    1. Brister HA, Wetherill RR, Fromme K. Anticipated versus actual alcohol consumption during 21st birthday celebrations. Journal of Studies on Alcohol and Drugs. 2010;71(2):180–183.
    1. Brown SA, Tapert SF, Granholm E, Delis DC. Neurocognitive functioning of adolescents: Effects of protracted alcohol use. Alcoholism: Clinical and Experimental Research. 2000;24(2):164–171.
    1. Butler LH, Correia CJ. Brief alcohol intervention with college student drinkers: Face-to face versus computerized feedback. Psychology of Addictive Behaviors. 2009;23(1):163–167.
    1. Campbell CA, Hahn RA, Elder R, et al. The effectiveness of limiting alcohol outlet density as a means of reducing excessive alcohol consumption and alcohol-related harms. American Journal of Preventive Medicine. 2009;37(6):556–569.
    1. Carey KB, Scott-Sheldon LA, Carey MP, DeMartini KS. Individual-level interventions to reduce college student drinking: A meta-analytic review. Addictive Behaviors. 2007;32(11):2469–2494.
    1. Carey KB, Scott-Sheldon LA, Elliott JC, et al. Face-to-face versus computer-delivered alcohol interventions for college drinkers: A meta-analytic review, 1998 to 2010. Clinical Psychology Review. 2012;32(8):690–703.
    1. Carpenter C, Dobkin C. The minimum legal drinking age and public health. Journal of Economic Perspectives. 2011;25(2):133–156.
    1. Chavez PR, Nelson DE, Naimi TS, Brewer RD. Impact of a new gender-specific definition for binge drinking on prevalence estimates for women. American Journal of Preventive Medicine. 2011;40(4):468–471.
    1. Clapp JD, Johnson M, Voas RB, et al. Reducing DUI among US college students: Results of an environmental prevention trial. Addiction. 2005;100(3):327–334.
    1. Clapp JD, Min JW, Trim RS, et al. Predictors of error in estimates of blood alcohol concentration: A replication. Journal of Studies on Alcohol and Drugs. 2009;70(5):683–688.
    1. Crego A, Rodriguez-Holguin S, Parada M, et al. Reduced anterior prefrontal cortex activation in young binge drinkers during a visual working memory task. Drug and Alcohol Dependence. 2010;109(1–3):45–56.
    1. DeJong W, Schneider SK, Towvim LG, et al. A multisite randomized trial of social norms marketing campaigns to reduce college student drinking. Journal of Studies on Alcohol. 2006;67(6):868–879.
    1. DeJong W, Schneider SK, Towvim LG, et al. A multisite randomized trial of social norms marketing campaigns to reduce college student drinking: A replication failure. Substance Abuse. 2009;30(2):127–140.
    1. Devos-Comby L, Lange JJE. “My drink is larger than yours”? A literature review of self-defined drink sizes and standard drinks. Current Drug Abuse Reviews. 2008;1(2):162–176.
    1. Elder RW, Lawrence B, Ferguson A, et al. The effectiveness of tax policy interventions for reducing excessive alcohol consumption and related harms. American Journal of Preventive Medicine. 2010;38(2):217–229.
    1. Elliott JC, Carey KB, Bolles JR. Computer-based interventions for college drinking: A qualitative review. Addictive Behaviors. 2008;33(8):994–1005.
    1. Engs RC, Diebold BA, Hanson DJ. The drinking patterns and problems of a national sample of college students, 1994. Journal of Alcohol and Drug Education. 1996;41:13–33.
    1. Fell JC, Fisher DA, Voas RB, et al. The impact of underage drinking laws on alcohol-related fatal crashes of young drivers. Alcoholism: Clinical and Experimental Research. 2009;33(7):1208–1219.
    1. Fleming MF, Balousek SL, Grossberg PM, et al. Brief physician advice for heavy drinking college students: A randomized controlled trial in college health clinics. Journal of Studies on Alcohol and Drugs. 2010;71(1):23–31.
    1. Giles SM, Champion H, Sutfin EL, et al. Calorie restriction on drinking days: An examination of drinking consequences among college students. Journal of American College Health. 2009;57(6):603–609.
    1. Gill JS. Reported levels of alcohol consumption and binge drinking within the UK undergraduate student population over the last 25 years. Alcohol and Alcoholism. 2002;37(2):109–120.
    1. Goodwin DW. Alcohol amnesia. Addiction. 1995;90(3):315–317.
    1. Hanson KL, Medina KL, Padula CB, et al. Impact of adolescent alcohol and drug use on neuropsychological functioning in young adulthood: 10-year outcomes. Journal of Child & Adolescent Substance Abuse. 2011;20(2):135–154.
    1. Hartzler B, Fromme K. Fragmentary and en bloc blackouts: Similarity and distinction among episodes of alcohol-induced memory loss. Journal of Studies on Alcohol. 2003a;64(4):547–550.
    1. Hartzler B, Fromme K. Fragmentary blackouts: Their etiology and effect on alcohol expectancies. Alcoholism: Clinical and Experimental Research. 2003b;27(4):628–637.
    1. Hingson RW, Heeren T, Edwards EM, Saitz R. Young adults at risk for excess alcohol consumption are often not asked or counseled about drinking alcohol. Journal of General Internal Medicine. 2012;27(2):179–184.
    1. Hingson R, Heeren T, Winter M. Lower legal blood-alcohol limits for young drivers. Public Health Reports. 1994;109(6):738–744.
    1. Hingson R, Heeren T, Winter MR, Wechsler H. Early age of first drunkenness as a factor in college students’ unplanned and unprotected sex attributable to drinking. Pediatrics. 2003a;111(1):34–41.
    1. Hingson R, Heeren T, Winter M, Wechsler H. Magnitude of alcohol-related mortality and morbidity among U.S. college students ages 18–24: Changes from 1998 to 2001. Annual Review of Public Health. 2005a;26:259–279.
    1. Hingson R, Heeren T, Zakocs R, et al. Age of first intoxication, heavy drinking, driving after drinking and risk of unintentional injury among U.S. college students. Journal of Studies on Alcohol. 2003b;64(1):23–31.
    1. Hingson R, Heeren T, Zakocs R, et al. Magnitude of alcohol-related mortality and morbidity among U.S. college students ages 18–24. Journal of Studies on Alcohol. 2002;63(2):136–144.
    1. Hingson R, McGovern T, Howland J, et al. Reducing alcohol-impaired driving in Massachusetts: The Saving Lives Program. American Journal of Public Health. 1996;86(6):791–797.
    1. Hingson R, White A. Magnitude and prevention of college alcohol and drug misuse: U.S. college students ages 18–24. In: Kay J, Schwartz V, editors. Mental Health Care in the College Community. London: John Wiley & Sons; 2010. pp. 289–324.
    1. Hingson RW, Zakocs RC, Heeren T, et al. Effects on alcohol related fatal crashes of a community based initiative to increase substance abuse treatment and reduce alcohol availability. Injury Prevention. 2005b;11(2):84–90.
    1. Hingson R, Zha W, Weitzman ER. Magnitude of and trends in alcohol-related mortality and morbidity among U.S. college students ages 18–24, 1998–2005. Journal of Studies on Alcohol and Drugs. 2009;(Suppl. 16):12–20.
    1. Holder HD, Gruenewald PJ, Ponicki WR, et al. Effect of community-based interventions on high-risk drinking and alcohol-related injuries. JAMA: Journal of the American Medical Association. 2000;284(18):2341–2347.
    1. Howland J, Rohsenow DJ, Greece JA, et al. The effects of binge drinking on college students’ next-day academic test-taking performance and mood state. Addiction. 2010;105(4):655–665.
    1. Ichiyama MA, Fairlie AM, Wood MD, et al. A randomized trial of a parent-based intervention on drinking behavior among incoming college freshmen. Journal of Studies on Alcohol and Drugs. 2009;(Suppl. 16):67–76.
    1. Jennison KM. The short-term effects and unintended long-term consequences of binge drinking in college: A 10-year follow-up study. American Journal of Drug and Alcohol Abuse. 2004;30(3):659–684.
    1. Johnston LD, O’Malley PM, Bachman JG. Monitoring the Future National Survey Results on Drug Use, 1975–2000. Volume I: Secondary School Students. Bethesda, MD: National Institute on Drug Abuse; 2001a. NIH Publication No. 01–4924.
    1. Johnston LD, O’Malley PM, Bachman JG. Monitoring the Future National Survey Results on Drug Use, 1975–2000. Volume II: College Students and Adults Ages 19–40. Bethesda, MD: National Institute on Drug Abuse; 2001b. NIH Publication No. 01–4925.
    1. Johnston LD, O’Malley PM, Bachman JG, Schulenberg JE. Monitoring the Future National Survey Results on Drug Use, 1975–2006 Volume II: College Students and Adults Ages 19–45. Bethesda, MD: National Institute on Drug Abuse; 2007. NIH Publication No. 07–6206.
    1. Johnston LD, O’Malley PM, Bachman JG, Schulenberg JE. Monitoring the Future National Survey Results on Drug Use, 1975–2011. Volume II: College Students and Adults Ages 19–50. Ann Arbor: Institute for Social Research, the University of Michigan; 2012.
    1. Jones R, Lacey J. Alcohol and Highway Safety 2001: A Review of the State of Knowledge. Washington, D.C.: National Highway Traffic Safety Administration; 2001. Report No. DOT HS–809–383.
    1. Jones R, Pitt N. Health surveys in the workplace: Comparison of postal, email and World Wide Web methods. Occupational Medicine (London) 1999;49(8):556–558.
    1. Kaysen D, Neighbors C, Martell J, et al. Incapacitated rape and alcohol use: A prospective analysis. Addictive Behaviors. 2006;31(10):1820–1832.
    1. Kerr WC, Stockwell T. Understanding standard drinks and drinking guidelines. Drug and Alcohol Review. 2012;31(2):200–205.
    1. Knight JR, Wechsler H, Kuo M, et al. Alcohol abuse and dependence among U.S. college students. Journal of Studies on Alcohol. 2002;63(3):263–270.
    1. Koski A, Ojanperä I, Vuori E. Interaction of alcohol and drugs in fatal poisonings. Human & Experimental Toxicology. 2003;22(5):281–287.
    1. Koski A, Vuroi E, Ojanperä I. Relation of postmortem blood alcohol and drug concentrations in fatal poisonings involving amitriptyline, propoxyphene and promazine. Human & Experimental Toxicology. 2005;24(8):389–396.
    1. Kraus CL, Salazar NC, Mitchell JR, et al. Inconsistencies between actual and estimated blood alcohol concentrations in a field study of college students: Do students really know how much they drink? Alcoholism: Clinical and Experimental Research. 2005;29(9):1672–1676.
    1. Krebs CP, Lindquist CH, Warner TD, et al. College women’s experiences with physically forced, alcohol- or drug-enabled, and drug-facilitated sexual assault before and since entering college. Journal of American College Health. 2009;57(6):639–647.
    1. LaBrie J, Earleywine M, Lamb T, Shelesky K. Comparing electronic-keypad responses to paper-and-pencil questionnaires in group assessments of alcohol consumption and related attitudes. Addictive Behaviors. 2006;31(12):2334–2338.
    1. LaBrie JW, Huchting K, Tawalbeh S, et al. A randomized motivational enhancement prevention group reduces drinking and alcohol consequences in first-year college women. Psychology of Addictive Behaviors. 2008;22(1):149–155.
    1. LaBrie JW, Hummer J, Kenney S, et al. Identifying factors that increase the likelihood for alcohol-induced blackouts in the prepartying context. Substance Use & Misuse. 2011;46(8):992–1002.
    1. Larimer ME, Cronce JM. Identification, prevention and treatment: A review of individual-focused strategies to reduce problematic alcohol consumption by college students. Journal of Studies on Alcohol. 2002;(Suppl. 14):148–163.
    1. Larimer ME, Cronce JM. Identification, prevention, and treatment revisited: Individual-focused college drinking prevention strategies 1999–2006. Addictive Behaviors. 2007;32(11):2439–2468.
    1. Lee CM, Lewis MA, Neighbors C. Preliminary examination of spring break alcohol use and related consequences. Psychology of Addictive Behaviors. 2009;23(4):689–694.
    1. Liang L, Huang J. Go out or stay in? The effects of zero tolerance laws on alcohol use and drinking and driving patterns among college students. Health Economics. 2008;17(11):1261–1275.
    1. Litt DM, Lewis MA, Patrick ME, et al. Spring break versus spring broken: Predictive utility of spring break alcohol intentions and willingness at varying levels of extremity. Prevention Science. 2013 Feb 13; [Epub ahead of print]
    1. Luczak SE, Shea SH, Hsueh AC, et al. ALDH2*2 is associated with a decreased likelihood of alcohol-induced blackouts in Asian American college students. Journal of Studies on Alcohol. 2006;67(3):349–353.
    1. Lygidakis C, Rigon S, Cambiaso S, et al. A Web-based versus paper questionnaire on alcohol and tobacco in adolescents. Telemedicine Journal and E-Health. 2010;16(9):925–930.
    1. Mallett KA, Varvil-Weld L, Borsari B, et al. An update of research examining college student alcohol-related consequences: New perspectives and implications for interventions. Alcoholism: Clinical and Experimental Research. 2013;37(5):709–716.
    1. McCabe SE, Cranford JA, Boyd CJ. The relationship between past-year drinking behaviors and nonmedical use of prescription drugs: Prevalence of co-occurrence in a national sample. Drug and Alcohol Dependence. 2006;84(3):281–288.
    1. McCartt AT, Hellinga LA, Wells JK. Effects of a college community campaign on drinking and driving with a strong enforcement component. Traffic Injury Prevention. 2009;10(2):141–147.
    1. McCauley JL, Calhoun KS, Gidycz CA. Binge drinking and rape: A prospective examination of college women with a history of previous sexual victimization. Journal of Interpersonal Violence. 2010;25(9):1655–1668.
    1. Medina KL, McQueeny T, Nagel BJ, et al. Prefrontal cortex volumes in adolescents with alcohol use disorders: Unique gender effects. Alcoholism: Clinical and Experimental Research. 2008;32(3):386–394.
    1. Meilman PW, Leichliter JS, Presley CA. Greeks and athletes: Who drinks more? Journal of American College Health. 1999;47(4):187–190.
    1. Meilman PW, Presley CA, Cashin JR. The sober life at the historically black colleges. Journal of Blacks in Higher Education. 1995;9:98–100.
    1. Meilman PW, Presley CA, Lyerla R. Black college students and binge drinking. Journal of Blacks in Higher Education. 1994;8:70–71.
    1. Miller NS, Gold MS. Alcohol. New York: Plenum Publishing Company; 1991.
    1. Miron JA, Tetelbaum E. Does the minimum legal drinking age save lives? Economic Inquiry. 2009;47(2):317–336.
    1. Mohler-Kuo M, Dowdall GB, Koss MP, Wechsler H. Correlates of rape while intoxicated in a national sample of college women. Journal of Studies on Alcohol. 2004;65(1):37–45.
    1. Moreira MT, Smith LA, Foxcroft D. Social norms interventions to reduce alcohol misuse in university or college students. Cochrane Database of Systematic Reviews (Online) 2009;(3):CD006748.
    1. Mundt MP, Zakletskaia LI. Prevention for college students who suffer alcohol-induced blackouts could deter high-cost emergency department visits. Health Affairs (Millwood) 2012;31(4):863–870.
    1. Mundt MP, Zakletskaia LI, Brown DD, Fleming MF. Alcohol-induced memory blackouts as an indicator of injury risk among college drinkers. Injury Prevention. 2012;18(1):44–49.
    1. Naimi TS, Nelson DE, Brewer RD. The intensity of binge alcohol consumption among U.S. adults. American Journal of Preventive Medicine. 2010;38(2):201–207.
    1. Nash RA, Takarangi MK. Reconstructing alcohol-induced memory blackouts. Memory. 2011;19(6):566–573.
    1. National Institute on Alcohol Abuse and Alcoholism (NIAAA) Alcohol Policy Information System. 2010. Available at . Accessed February 16, 2010.
    1. NIAAA . NIAAA Newsletter, Winter 2004, Number 3. Bethesda, MD: National Institutes of Health, U.S. Department of Health and Human Services (DHHS); 2004. Available at: .
    1. NIAAA . Harmful Interactions: Mixing Alcohol with Medicines. Bethesda, MD: National Institutes of Health, U.S. Department of Health and Human Services (DHHS); revised 2007a (NIH Publication No. 07-5329). Available at: .
    1. NIAAA . Parents – Spring Break Is Another Important Time to Discuss College Drinking. Bethesda, MD: National Institutes of Health, DHHS; 2007b. (NIH Publication No. 05-5642)
    1. NIAAA . A Call to Action: Changing the Culture of Drinking at US Colleges. Bethesda, MD: National Institutes of Health, U.S. Department of Health and Human Services (DHHS); Task Force of the National Advisory Council on Alcohol Abuse and Alcoholism. 2002 (NIH Publication No. 02–5010)
    1. NIAAA . What Colleges Need to Know Now: An Update on College Drinking Research. Bethesda, MD: National Institutes of Health, U.S. Department of Health and Human Services (DHHS); 2007c. (NIH Publication No. 07–5010)
    1. National Research Council Institute of Medicine of the National Academies . Reducing Underage Drinking: A Collective Responsibility. Washington, DC: The National Academies Press; 2004.
    1. Neighbors C, Lee CM, Lewis MA, et al. Internet-based personalized feedback to reduce 21st-birthday drinking: A randomized controlled trial of an event-specific prevention intervention. Journal of Consulting and Clinical Psychology. 2009;77(1):51–63.
    1. Neighbors C, Lee CM, Atkins DC, et al. A randomized controlled trial of event-specific prevention strategies for reducing problematic drinking associated with 21st birthday celebrations. Journal of Consulting and Clinical Psychology. 2012;80(5):850–862.
    1. Nelson EC, Heath AC, Bucholz KK, et al. Genetic epidemiology of alcohol-induced blackouts. Archives of General Psychiatry. 2004;61(3):257–263.
    1. Norberg KE, Bierut LJ, Grucza RA. Long-term effects of minimum drinking age laws on past-year alcohol and drug use disorders. Alcoholism: Clinical and Experimental Research. 2009;33(12):2180–2190.
    1. Northcote J, Livingston M. Accuracy of self-reported drinking: Observational verification of ‘last occasion’ drink estimates of young adults. Alcohol and Alcoholism. 2011;46(6):709–713.
    1. O’Brien MC, McCoy TP, Champion H, et al. Single question about drunkenness to detect college students at risk for injury. Academic Emergency Medicine. 2006;13(6):629–636.
    1. O’hare TM. Drinking in college: Consumption patterns, problems, sex differences and legal drinking age. Journal of Studies on Alcohol. 1990;51(6):536–541.
    1. Oster-Aaland L, Lewis MA, Neighbors C, et al. Alcohol poisoning among college students turning 21: Do they recognize the symptoms and how do they help? Journal of Studies on Alcohol and Drugs. 2009;(Suppl 16):122–130.
    1. Parada M, Corral M, Caamaño-Isorna F, et al. Binge drinking and declarative memory in university students. Alcoholism: Clinical and Experimental Research. 2011;35(8):1475–1484.
    1. Parada M, Corral M, Mota N, et al. Executive functioning and alcohol binge drinking in university students. Addictive Behaviors. 2012;37(2):167–172.
    1. Paschall MJ, Antin T, Ringwalt CL, Saltz RF. Effects of AlcoholEdu for College on alcohol-related problems among freshmen: A randomized multicampus trial. Journal of Studies on Alcohol and Drugs. 2011a;72(4):642–650.
    1. Paschall MJ, Antin T, Ringwalt CL, Saltz RF. Evaluation of an internet-based alcohol misuse prevention course for college freshmen: Findings of a randomized multi-campus trial. American Journal of Preventive Medicine. 2011b;41(3):300–308.
    1. Paschall MJ, Freisthler B. Does heavy drinking affect academic performance in college? Findings from a prospective study of high achievers. Journal of Studies on Alcohol. 2003;64(4):515–519.
    1. Patrick ME, Lewis MA, Lee CM, Maggs JL. Semester and event-specific motives for alcohol use during Spring Break: Associated protective strategies and negative consequences. Addictive Behaviors. 2013;38(4):1980–1987.
    1. Perry PJ, Argo TR, Barnett MJ, et al. The association of alcohol-induced blackouts and grayouts to blood alcohol concentrations. Journal of Forensic Sciences. 2006;51(4):896–899.
    1. Powell LA, Williams J, Wechsler H. Study habits and the level of alcohol use among college students. Education Economics. 2004;12(2):135–149.
    1. Presley CA, Leichliter JS, Meilman PW. Alcohol and Drugs on American College Campuses: A Report to College Presidents. Third in a Series: 1995, 1996, and 1997. Carbondale, IL: Core Institute, Southern Illinois University; 1998.
    1. Presley CA, Meilman PW, Cashin JR. Alcohol and Drugs on American College Campuses: Use, Consequences, and Perceptions of the Campus Environment. Volume IV: 1992–94. Carbondale, IL: The Core Institute; 1996a.
    1. Presley CA, Meilman PW, Cashin JR, Lyera R. Alcohol and Drugs on American College Campuses: Use, Consequences, and Perceptions of the Campus Environment. Volume III: 1991–93. Carbondale, IL: The Core Institute; 1996b.
    1. Presley CA, Meilman PW, Leichliter JS. College factors that influence drinking. Journal of Studies on Alcohol. 2002;(Suppl 14):82–90.
    1. Presley CA, Pimentel ER. The introduction of the heavy and frequent drinker: A proposed classification to increase accuracy of alcohol assessments in postsecondary educational settings. Journal of Studies on Alcohol. 2006;67(2):324–331.
    1. Preusser D, Ulmer R, Preisser C. Obstacles to Enforcement of Youthful (Under 21) Impaired Driving. Washington, DC: National Highway Traffic Safety Administration; 1992. (DOT HS 807–878)
    1. Read JP, Beattie M, Chamberlain R, Merrill JE. Beyond the “Binge” threshold: Heavy drinking patterns and their association with alcohol involvement indices in college students. Addictive Behaviors. 2008;33(2):225–234.
    1. Reboussin BA, Song EY, Wolfson M. The impact of alcohol outlet density on the geographic clustering of underage drinking behaviors within census tracts. Alcoholism: Clinical and Experimental Research. 2011;35(8):1541–1549.
    1. Rutledge PC, Park A, Sher KJ. 21st birthday drinking: Extremely extreme. Journal of Consulting and Clinical Psychology. 2008;76(3):511–516.
    1. Saltz RF, Welker LR, Paschall MJ, et al. Evaluating a comprehensive campus-community prevention intervention to reduce alcohol-related problems in a college population. Journal of Studies on Alcohol and Drugs. 2009;(Suppl. 16):21–27.
    1. Schaus JF, Sole ML, McCoy TP, et al. Alcohol screening and brief intervention in a college student health center: A randomized controlled trial. Journal of Studies on Alcohol and Drugs. 2009;(Suppl. 16):131–141.
    1. Schulenberg J, Maggs JL, Long SW, et al. The problem of college drinking: Insights from a developmental perspective. Alcoholism: Clinical and Experimental Research. 2001;25(3):473–477.
    1. Schweinsburg AD, McQueeny T, Nagel BJ, et al. A preliminary study of functional magnetic resonance imaging response during verbal encoding among adolescent binge drinkers. Alcohol. 2010;44(1):111–117.
    1. Scribner RA, Mason KE, Simonsen NR, et al. An ecological analysis of alcohol outlet density and campus-reported violence at 32 U.S. colleges. Journal of Studies on Alcohol and Drugs. 2010;71(2):184–191.
    1. Scribner R, Mason K, Theall K, et al. The contextual role of alcohol outlet density in college drinking. Journal of Studies on Alcohol and Drugs. 2008;69(1):112–120.
    1. Scribner RA, Theall KP, Mason K, et al. Alcohol prevention on college campuses: The moderating effect of the alcohol environment on the effectiveness of social norms marketing campaigns. Journal of Studies on Alcohol and Drugs. 2011;72(2):232–239.
    1. Shults RA, Elder RW, Sleet DA, et al. Reviews of evidence regarding interventions to reduce alcohol-impaired driving. American Journal of Preventive Medicine. 2001;21(Suppl. 4):66–88.
    1. Singleton RA. Collegiate alcohol consumption and academic performance. Journal of Studies on Alcohol and Drugs. 2007;68(4):548–555.
    1. Singleton RA, Jr, Wolfson AR. Alcohol consumption, sleep, and academic performance among college students. Journal of Studies on Alcohol and Drugs. 2009;70(3):355–363.
    1. Smith GS, Branas CC, Miller TR. Fatal nontraffic injuries involving alcohol: A metaanalysis. Annals of Emergency Medicine. 1999;33(6):659–668.
    1. Squeglia LM, Spadoni AD, Infante MA, et al. Initiating moderate to heavy alcohol use predicts changes in neuropsychological functioning for adolescent girls and boys. Psychology of Addictive Behaviors. 2009;23(4):715–722.
    1. Squeglia LM, Sorg SF, Schweinsburg AD, et al. Binge drinking differentially affects adolescent male and female brain morphometry. Psychopharmacology (Berlin) 2012;220(3):529–539.
    1. Straus R, Bacon SD. Drinking in college. New Haven, CT: Yale University Press; 1953.
    1. Substance Abuse and Mental Health Services Administration (SAMHSA) The DAWN Report: Trends in Emergency Department Visits Involving Underage Alcohol Use: 2005 to 2009. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2011. (Accessed September 13, 2011). .
    1. Substance Abuse and Mental Health Services Administration (SAMHSA) Results from the 2001 National Household Survey on Drug Abuse: Volume 1: Summary of National Findings. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2002. (DHHS Publication No. SMA 02–3758, 2002)
    1. Substance Abuse and Mental Health Services Administration (SAMHSA) Results from the 2005 National Survey on Drug Use and Health: National Findings. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2006. (DHHS Publication No. SMA 06–4194)
    1. Substance Abuse and Mental Health Services Administration (SAMHSA) Results from the 2007 National Survey on Drug Use and Health: National Findings. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2008. (NSDUH Series H-34, DHHS Publication No. SMA 08–4343)
    1. Substance Abuse and Mental Health Services Administration (SAMHSA) Summary of Findings of the 1999 National Household Survey on Drug Abuse. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2000. (DHHS Publication No. SMA 00–3466)
    1. Tanaka E. Toxicological interactions between alcohol and benzodiazepines. Journal of Toxicology Clinical Toxicology. 2002;40(1):69–75.
    1. Testa M, Livingston JA. Alcohol consumption and women’s vulnerability to sexual victimization: Can reducing women’s drinking prevent rape? Substance Use & Misuse. 2009;44(9–10):1349–1376.
    1. Thombs DL, Olds RS, Bondy SJ, et al. Undergraduate drinking and academic performance: A prospective investigation with objective measures. Journal of Studies on Alcohol and Drugs. 2009;70(5):776–785.
    1. Timberlake DS, Hopfer CJ, Rhee SH, et al. College attendance and its effect on drinking behaviors in a longitudinal study of adolescents. Alcoholism: Clinical and Experimental Research. 2007;31(6):1020–1030.
    1. Treno AJ, Gruenewald PJ, Lee JP, Remer LG. The Sacramento Neighborhood Alcohol Prevention Project: Outcomes from a community prevention trial. Journal of Studies on Alcohol and Drugs. 2007;68(2):197–207.
    1. Turner CF, Ku L, Rogers SM, et al. Adolescent sexual behavior, drug use, and violence: Increased reporting with computer survey technology. Science. 1998;280(5365):867–873.
    1. Turrisi R, Larimer ME, Mallett KA, et al. A randomized clinical trial evaluating a combined alcohol intervention for high-risk college students. Journal of Studies on Alcohol and Drugs. 2009;70(4):555–567.
    1. Upcraft ML. Today’s First-Year Students and Alcohol. Paper prepared for the Task Force on College Drinking, National Advisory Council on Alcohol Abuse and Alcoholism; Bethesda, MD. 2000.
    1. Varvil-Weld L, Mallett KA, Turrisi R, et al. Are certain college students prone to experiencing excessive alcohol-related consequences? Predicting membership in a high-risk subgroup using pre-college profiles. Journal of Studies on Alcohol and Drugs. 2013;74(4):542–551.
    1. Voas RB, Williams AF. Age differences of arrested and crash-involved drinking drivers. Journal of Studies on Alcohol. 1986;47(3):244–248.
    1. Voas RB, Tippetts AS, Fell J. The relationship of alcohol safety laws to drinking drivers in fatal crashes. Accident Analysis and Prevention. 2000;32(4):483–492.
    1. Wagenaar AC, Toomey TL. Effects of minimum drinking age laws: Review and analyses of the literature from 1960 to 2000. Journal of Studies on Alcohol. 2002;(Suppl. 14):206–225.
    1. Wagenaar AC, Murray DM, Toomey TL. Communities Mobilizing for Change on Alcohol (CMCA): Effects of a randomized trial on arrests and traffic crashes. Addiction. 2000;95(2):209–217.
    1. Wagenaar AC, O’Malley PM, LaFond C. Lowered legal blood alcohol limits for young drivers: Effects on drinking, driving, and driving-after-drinking behaviors in 30 states. American Journal of Public Health. 2001;91(5):801–804.
    1. Wagenaar AC, Salois MJ, Komro KA. Effects of beverage alcohol price and tax levels on drinking: A meta-analysis of 1003 estimates from 112 studies. Addiction. 2009;104(2):179–190.
    1. Wagenaar AC, Erickson DJ, Harwood EM, O’Malley PM. Effects of state coalitions to reduce underage drinking: A national evaluation. American Journal of Preventive Medicine. 2006;31(4):307–315.
    1. Wang YC, Lee CM, Lew-Ting CY, et al. Survey of substance use among high school students in Taipei: Web-based questionnaire versus paper-and-pencil questionnaire. Journal of Adolescent Health. 2005;37(4):289–295.
    1. Wechsler H, Davenport A, Dowdall G, et al. Health and behavioral consequences of binge drinking in college: A national survey of students at 140 campuses. JAMA: Journal of the American Medical Association. 1994;272(21):1672–1677.
    1. Wechsler H, Davenport AE, Dowdall GW, et al. Binge drinking, tobacco, and illicit drug use and involvement in college athletics. A survey of students at 140 American colleges. Journal of American College Health. 1997;45(5):195–200.
    1. Wechsler H, Dowdall GW, Davenport A, Castillo S. Correlates of college student binge drinking. American Journal of Public Health. 1995;85(7):921–926.
    1. Wechsler H, Dowdall GW, Davenport A, Rimm EB. A gender-specific measure of binge drinking among college students. American Journal of Public Health. 1995;85(7):982–985.
    1. Wechsler H, Dowdall GW, Maenner G, et al. Changes in binge drinking and related problems among American college students between 1993 and 1997. Results of the Harvard School of Public Health College Alcohol Study. Journal of American College Health. 1998;47(2):57–68.
    1. Wechsler H, Kuo M. Watering down the drinks: The moderating effect of college demographics on alcohol use of high-risk groups. American Journal of Public Health. 2003;93(11):1929–1933.
    1. Wechsler H, Kuh G, Davenport AE. Fraternities, sororities and binge drinking: Results from a national study of American colleges. NASPA Journal. 2009;46(3):395–416.
    1. Wechsler H, Lee JE, Kuo M, et al. Trends in college binge drinking during a period of increased prevention efforts Findings from 4 Harvard School of Public Health College Alcohol Study surveys: 1993–2001. Journal of American College Health. 2002;50(5):203–217.
    1. Wechsler H, Lee JE, Kuo M, Lee H. College binge drinking in the 1990s: A continuing problem Results of the Harvard School of Public health 1999 College Alcohol Survey. Journal of American College Health. 2000;48(5):199–210.
    1. Wechsler H, Nelson TF. What we have learned from the Harvard School of Public Health College Alcohol Study: Focusing attention on college student alcohol consumption and the environmental conditions that promote it. Journal of Studies on Alcohol and Drugs. 2008;69(4):481–490.
    1. Wechsler H, Nelson TF. Binge drinking and the American college students: What’s five drinks? Psychology of Addictive Behaviors. 2001;15(4):287–291.
    1. Weitzman ER, Folkman A, Folkman MP, Wechsler H. The relationship of alcohol outlet density to heavy and frequent drinking and drinking-related problems among college students at eight universities. Health & Place. 2003;9(1):1–6.
    1. Wetherill RR, Fromme K. Acute alcohol effects on narrative recall and contextual memory: An examination of fragmentary blackouts. Addictive Behaviors. 2011;36(8):886–889.
    1. Wetherill RR, Schnyer DM, Fromme K. Acute alcohol effects on contextual memory BOLD response: Differences based on fragmentary blackout history. Alcoholism: Clinical and Experimental Research. 2012;36(6):1108–1115.
    1. White AM. What happened? Alcohol, memory blackouts, and the brain. Alcohol Research & Health. 2003;27(2):186–196.
    1. White AM, Hingson RW, Pan IJ, Yi HY. Hospitalizations for alcohol and drug overdoses in young adults ages 18–24 in the United States, 1999–2008: Results from the Nationwide Inpatient Sample. Journal of Studies on Alcohol and Drugs. 2011;72(5):774–786.
    1. White AM, Jamieson–Drake DW, Swartzwelder HS. Prevalence and correlates of alcohol–induced blackouts among college students: Results of an e–mail survey. Journal of American College Health. 2002;51(3):117–119. 122–131.
    1. White AM, Kraus CL, Flom JD, et al. College students lack knowledge of standard drink volumes: Implications for definitions of risky drinking based on survey data. Alcoholism: Clinical and Experimental Research. 2005;29(4):631–638.
    1. White AM, Kraus CL, McCracken LA, Swartzwelder HS. Do college students drink more than they think? Use of a free-pour paradigm to determine how college students define standard drinks. Alcoholism: Clinical and Experimental Research. 2003;27(11):1750–1756.
    1. White AM, Kraus CL, Swartzwelder H. Many college freshmen drink at levels far beyond the binge threshold. Alcoholism: Clinical and Experimental Research. 2006;30(6):1006–1010.
    1. White AM, Signer ML, Kraus CL, Swartzwelder HS. Experiential aspects of alcohol–induced blackouts among college students. American Journal of Drug and Alcohol Abuse. 2004;30(1):205–224.
    1. White AM, Swartzwelder HS. Inbound college students drink heavily during the summer before their freshman year: Implications for education and prevention efforts. American Journal of Health Education. 2009;40:909–96.
    1. Williams J, Powell LM, Weschler H. Does alcohol consumption reduce human capital accumulation? Evidence from the College Alcohol Study. Applied Economics. 2003;35(10):1227–1245.
    1. Wolfson M, Champion H, McCoy TP, et al. Impact of a randomized campus/community trial to prevent high-risk drinking among college students. Alcoholism: Clinical and Experimental Research. 2012;36(10):1767–1778.
    1. Wood PK, Sher KJ, Erickson DJ, DeBord KA. Predicting academic problems in college from freshman alcohol involvement. Journal of Studies on Alcohol. 1997;58(2):200–210.
    1. Wood MD, Sher KJ, McGowan AK. Collegiate alcohol involvement and role attainment in early adulthood: Findings from a prospective high-risk study. Journal of Studies on Alcohol. 2000;61(2):278–289.
    1. World Health Organization (WHO) Alcohol and Injuries: Emergency Department Studies in an International Perspective. Geneva: World Health Organization; 2009.
    1. Zagrosek A, Messroghli D, Schulz O, et al. Effect of binge drinking on the heart as assessed by cardiac magnetic resonance imaging. JAMA: Journal of the American Medical Association. 2010;304(12):1328–1330.

Source: PubMed

3
Tilaa