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Lifetime consumption of alcohol typically reaches its highest levels during an individual's late teens and early 20s. Numerous studies document a range of negative consequences of high levels of alcohol consumption, including violence, date rape, accidents, academic problems, and family conflict. The college campus is one setting where the pattern of youthful heavy drinking is felt acutely. College students, on average, drink more than their noncollege peers of the same age and routinely report negative consequences from both their own and others' drinking. While heavy drinking in college is associated with personality factors such as impulsivity, noncomformity, and depression, contextual factors such as distance from parents, close association with peers, dormitory residence, association with fraternities and sororities, large-group social events, and athletics appear to support and exacerbate heavy drinking as well.
Heavy drinking in college should not be confused with dependent drinking in later life, however. Several studies note significant reductions in heavy drinking in the 20s. At the individual level, Schulenberg and colleagues followed the drinking patterns of high school seniors for at least 6 years and noted that a subset of individuals (17%) reported more than isolated patterns of heavy drinking over time. Thus, college administration and health officials, who are under increasing pressure to provide both preventive and treatment services as a public health service for college students, are faced with a multifaceted social problem that is common, risky, and limited in time for most but chronic for some.
During the winter term of their second year in college, participants randomized into the prevention condition were mailed feedback results comparing their drinking and its consequences with the norms of their college peers. The summary sheets contained bar graph results from 3 assessments (baseline, spring of the freshman year, and fall quarter of the sophomore year) and concluded with a paragraph that personalized the feedback for each participant. After the mailing, we also phoned prevention group participants in the highest-risk categories (n=56) to express concern about risk and offer additional feedback sessions. Thirty-four motivational interviews were conducted in the second year, most over the phone (n=26).
Central findings suggest that much heavy drinking among college students is transitory, despite some students who report a pattern of continued or worsening consequences over time. Changes in drinking are reflected in specific dimensions of drinking behavior, Compared with a high-risk control sample, in this randomized trial, participants receiving a brief individual preventive intervention had significantly greater reductions in negative consequences that persisted over a 4-year period. Individual change analyses suggest that the dependence symptoms of those receiving the brief intervention are more likely to decrease and less likely to increase.
Mean drinking quantity end negative consequences increased only marginally within our normative comparison group, suggesting that students in general do not commonly or routinely develop drinking problems during the college years. However, drinking quantity and associated problems declined steadily over time for high-risk students who entered college with a history of heavy drinking. Recruitment of high-risk students was based on drinking during high school, and thus both developmental and statistical trends probably move toward less extreme behavior (but these same individuals reported mean increases drinking upon entry into college. Four years after matriculation, our high-risk control students continued to drink more frequently than the normative comparison students, but their problem scores had markedly decreased and, although still above those of the comparison group, were much less elevated (standardized difference about 0.62) than they were at baseline (standardized difference about 1.40). This pattern of data is consistent with other longitudinal studies showing that adolescents with problem behaviors (including heavy drinking) remain less conventional than others as they age into adulthood, but do not have worse psychosocial adjustment.
Prevention effects were observed for only some dimensions of drinking behavior, The dimension of greatest interest, negative consequences of drinking, shows the greatest effects. This is important not only because negative consequences measure the degree to which individuals may be harmed as a result of drinking, but also because the preventive intervention targeted individual choices and reduction of risk, rather than drinking rates per se. Our findings are consistent with the goals of harm reduction interventions, approaches that focus on minimizing the harmful effects of high-risk drinking. The duration of our prevention effects is also noteworthy. Modest differential changes in drinking quantity and frequency, described in our earlier report of 2-year outcomes, do not appear to persist for longer periods of time, yet we found significantly reduced negative consequences 3 1/2 years after the preventive intervention. We are unaware of other studies (much less randomized trials) of prevention efforts among college students that demonstrate such long-lasting effects.
Reflection Exercise #3