High-Risk Drinking in College: What We Know and What We Need To Learn

Surveying the Damage: Consequences of College Student Alcohol Abuse Consumption

College students who use alcohol excessively experience numerous harmful consequences. However, the literature on the epidemiology of those consequences is of mixed quality. It is typically based on self-report methodology and is not as comprehensive or complete as might be wished. Evidence suggests that there is only a modest correlation between college students’ self-perception of having a drinking problem and the many negative consequences of drinking that they report (Perkins, 2002).

Damage to Self

Students who engage in risky drinking may experience blackouts (i.e., memory loss during periods of heavy drinking); fatal and nonfatal injuries, including falls, drownings, and automobile crashes; illnesses; missed classes; unprotected sex that could lead to a sexually transmitted disease or an unwanted pregnancy; falling grades and academic failure; an arrest record; accidental death; and death by suicide. In addition, college students who drink to excess may miss opportunities to participate in the social, athletic, and cultural activities that are part of college life.

Academic impairment. Data from several national studies indicate that drinking and academic impairment are associated (Engs et al., 1996; Perkins, 1992; Presley et al., 1996a,b; Wechsler et al., 1994, 1998, 2000b). In addition to students’ own perceptions that alcohol use has produced academic impairment, several studies have revealed a consistent association between lower self-reported grade averages and higher levels of alcohol consumption (Engs et al., 1996; Presley et al., 1996a,b). However, it cannot be determined from these studies whether heavier drinking per se is responsible for lower grades. This is because they have generally relied on cross-sectional designs, self-reported grades, and self-reported academic failure due to drinking, and have not taken into account other variables—such as college students’ aptitude, high school achievement, and other drug use—that could account for the observed association.

Several studies, however, have specifically accounted for those limitations and have attempted to correct for them in their study designs. One such study of 429 students at a large midwestern university found only a modest role for alcohol involvement in negative educational outcomes (Wood MD et al., 2000). The negative effect of alcohol consumption was most pronounced on educational attainment in college among those students who ranked as high academic performers during their high school years. Another study, a longitudinal investigation of alcohol use by 444 college students recruited as freshmen, found that much of the association between alcohol use and academic problems during college appeared to be due to student differences that predated college admission (Wood PK et al., 1997).

Memory loss. Memory loss during periods of heavy drinking, a common occurrence among alcoholics, is also reported by a significant number of students who drink. In CAS, 10 percent of nonbinge drinkers, 27 percent of occasional binge drinkers, and 54 percent of frequent binge drinkers reported at least one incident in the past year of having forgotten where they were or what they did while drinking (Wechsler et al., 2000b). Other studies have also documented blackouts among college students who drink to excess (Buelow and Koeppel, 1995; Presley et al., 1996a,b; Sarvela et al., 1988).

Injuries, alcohol poisoning, and other fatalities. Students who misuse alcohol also risk personal injury and even death. Although it is difficult to unambiguously attribute injuries to drinking in some studies, personal injuries to students as a result of heavy drinking have been documented (Perkins, 1992; Presley et al., 1996a,b; Wechsler et al., 1998, 2000a). The U.S. Department of Education has evidence that at least 84 college students have died since 1996 due to alcohol poisoning or alcohol-related injury. However, it is believed that the total is much greater, since reporting is incomplete. Certainly when alcohol-related traffic crashes are taken into consideration, estimates are much higher. A recent study estimates that more than 1,400 college students between the ages of 18 and 24 die each year from alcohol-related unintentional injuries and 500,000 students between the ages of 18 and 24 sustain unintentional alcohol-related injuries each year (Hingson et al., 2002). Traffic crash data provide additional insight about injuries related to drinking and driving (see Alcohol Use and Driving by College Students).

Likewise, few empirical data are available on the association of alcohol use and suicide in the college student population. Although there appears to be an association, the nature of the underlying relationship has yet to be resolved. There is documented evidence that alcohol misuse may potentially lead to thoughts of suicide and suicide attempts among college students (Presley, 1996a, 1996b, 1998), but it is also plausible that suicidal thoughts may lead to increased drinking since, for some, depression increases the tendency to drink heavily.

Many college students who drink heavily experience negative short-term health consequences such as hangovers, nausea, and vomiting. Longer-term health consequences of heavy alcohol use may include reduced resistance to infection (Engs and Aldo-Benson, 1995) and increased vulnerability to lifelong alcohol problems and its attendant physical consequences such as cirrhosis of the liver (Vaillant, 1996). However, heavy drinking in college does not necessarily continue after students graduate. A recent study examining college students’ drinking behavior, Greek membership, and postcollege drinking patterns indicates that heavy drinking among members of Greek organizations does not generally lead to increased alcohol use later in life (Sher et al., 2001).

Damage to Others

When college students misuse alcohol, damage to the campus environment or residence hall—including vomit and litter—are common aftereffects. In one national study, 8 percent of all students (11 percent of drinkers) admitted damaging property or pulling a fire alarm in connection with their drinking (Engs and Hanson, 1994). Findings from the CAS and Core studies were similar. Occasional binge drinkers were almost 3 times more likely and frequent binge drinkers nearly 10 times more likely to report having damaged property when compared with students who do not binge drink (Wechsler et al., 2000b). Excessive drinking is also a contributor to fights and interpersonal and sexual violence. It is estimated that each year 600,000 college students aged 18 to 24 are assaulted by another student who has been drinking and 70,000 college students aged 18 to 24 are victims of alcohol-related sexual assault or date rape (Hingson et al., 2002). Sleep loss and interrupted study time on the part of students affected by others’ drinking are common. In CAS, 61 percent of nonbingeing students living on campus said they had experienced sleep or study disturbances due to someone else’s drinking (Wechsler et al., 1998). In the same study, 50 percent of nonbingeing students living on campus also said that at least once during the past year they had to “babysit” another student who drank too much (Wechsler et al., 1998).

Damage to the Institution

More than 25 percent of college administrators from schools with relatively low drinking levels and more than half of administrators from schools with high drinking levels reported that their campuses have a “moderate” or “major” problem with vandalism and property damage (Wechsler, et al., 1995c). Strains in “town/gown” relations (i.e., between the community and the campus) over student alcohol consumption may damage the institution’s reputation. Similarly, failure and dropout rates due to student alcohol misuse can damage a college’s academic image, resulting in the loss of tuition and the capacity to attract high-caliber students. Other factors affecting an institution include the cost of the added time, demands on, and stress experienced by college personnel who must deal with student alcohol misuse. In addition, the costs of legal suits brought against the college for liability in cases of injury, property damage, or death contribute to the toll.

Alcohol Use and Driving by College Students

According to CAS, fully 30 percent of students who drank in the past year said they had driven after drinking alcohol during the past 30 days (Wechsler et al., 2000b). In the Core survey, one-third of students (39 percent of drinkers) admitted driving while under the influence of alcohol or other drugs within the past year (Presley et al., 1996a,b).

About one-half of all fatal traffic crashes among 18- to 24-year-olds involve alcohol, and many of those killed are college students (Chassin and DeLucia, 1996). Further, data from SAMHSA show that an estimated 18 percent of drivers age 16 to 20—about 2.5 million adolescents—drive under the influence of alcohol (Center for Substance Abuse Treatment, 1999).

Recent data from the National Highway Traffic Safety Administration (NHTSA) show that motor vehicle crashes are the leading cause of death for young people, 15 to 20 years of age, and that the severity of traffic crashes increases with alcohol involvement. In 1998, 21 percent of the drivers aged 15 to 20 who were killed in crashes were intoxicated (blood alcohol concentration > 0.10), and 21 percent of drivers in this age group who were involved in fatal crashes (i.e., one in which someone, not necessarily the driver, dies) were intoxicated (NHTSA, 2000). NHTSA does not break down statistics for this age group into college and noncollege students. Nonetheless, many of the young drivers and passengers killed—like Jon Levy from Radford University—were college students.

Alcohol and High-Risk Sexual Behavior

Unintended and unprotected sexual activity is another possible consequence of heavy drinking. In general, studies have shown that college students who drink heavily are more likely to engage in unplanned sexual activity than students who do not drink heavily (Anderson and Mathieu, 1996; Cooper et al., 1994, 1998; Meilman, 1993; Perkins, 1992; Wechsler et al., 1998, 2000b). Data from CAS provide information about the percentage of nonbinge drinkers, occasional binge drinkers, and frequent binge drinkers who engage in unplanned sexual activity or do not use protection when having sex. For unplanned sexual activity, the percentage increases from 8 percent for nonbinge drinkers to 22 percent for occasional binge drinkers to 42 percent for frequent binge drinkers. For unprotected sex, the percentage increases from 4 percent for nonbinge drinkers to 10 percent for occasional binge drinkers and 20 percent for frequent binge drinkers (Wechsler et al., 2000b).

Eight in 10 college students report that they are sexually experienced, 1 in 3 reports having had 5 or more lifetime sexual partners, and 6 in 10 report inconsistent condom use (CDC, 1997; Douglas et al., 1997). As already stated, about four in five drink and two in five binge drink. Given the frequent occurrence of drinking and sexual activity among college students, a substantial proportion would be expected to engage in both behaviors by chance alone. Research indicates, however, that drinking co-occurs with certain risky sexual behaviors at above-chance levels. For example, students who engage in heavy episodic drinking are about twice as likely to have had multiple sexual partners in the past month than nonbinge drinkers (Wechsler, 1995a).

Although research indicates that the relationship between alcohol use and risky sexual behavior is complex, it also suggests that when alcohol is used in the context of a sexual or potential sexual situation such as a date, it is associated with increased sexual risk-taking under some circumstances. Alcohol use appears to be more likely to promote sexual intercourse when the male partner drinks and in situations involving new or occasional sex partners. Drinking prior to intercourse has been consistently related to casual sex as well as to a failure to discuss risk-related topics before having sex (Cooper, 2002).

The disinhibiting effects of consuming alcohol may help explain the relationship between drinking and risky sexual behavior. Alcohol appears to disinhibit behavior primarily as a result of its pharmacologic effects on information processing (Steele and Josephs, 1992). By reducing the scope and efficiency of information processing, alcohol allows simple, salient cues that instigate behavior—such as sexual arousal—to be processed, while blunting the processing of more distal and complex cues, such as the possibility of contracting a sexually transmitted disease, including HIV/AIDS.

Expectancy also plays a role in risky sexual behavior. Preexisting beliefs about alcohol’s effects on behavior influence an individual’s behavior after drinking (Lang, 1985). Among adolescents and young adults, prior patterns of alcohol use have also been shown to predict the onset of sexual behavior and of risky sexual behavior 6 months to 4 years later. However, existing data do not support inferences of a simple one-way causal influence from drinking to risky sexual activity (Cooper and Orcutt, 2000; Newcomb, 1994). Drinking and sex may covary in part because the opportunity to meet potential new sex partners commonly occurs in settings where people drink, such as bars. It is likely that multiple causal processes operate together to create the patterns of association observed between alcohol use and risky sex.

Alcohol and Physical and Sexual Aggression

Research shows that alcohol consumption is associated with aggressive behavior (Chermack and Giancola, 1997; Roizen, 1993). Although there is little research on this issue as it affects college students specifically, studies show that a substantial proportion of young adults engage in fighting while intoxicated (Wechsler et al., 1995c). Alcohol-related aggression is a serious problem on college campuses, but it is not clear whether alcohol promotes aggressive behavior in some people or whether individuals who are more aggressive tend to drink more (Giancola, 2002).

Because not all people become aggressive when they drink, it can be argued that alcohol does not cause aggression directly through its pharmacological effects alone (Bushman and Cooper, 1990). Rather, intoxicated aggression appears to be the product of individual differences and contextual variables interacting with pharmacodynamics (Chermack and Giancola, 1997). Evidence from both animal and human research indicates that there is a positive relationship between levels of the male hormone testosterone and physical aggression (Volavka, 1995). A recent study found that healthy male college students with high levels of testosterone, measured in saliva, were more aggressive on the Taylor Aggression Paradigm—a behavioral measure of aggression—than those with low levels (Berman et al., 1993). Heightened aggression has also been associated with low levels of the brain neurotransmitter serotonin (Berman et al., 1997). It may be that the aggression-enhancing effects of alcohol are more likely to occur in people with higher baseline levels of testosterone and lower levels of serotonin.

Incidence on campus. Alcohol-related sexual assault is a common occurrence on college campuses. Although estimates of the incidence and prevalence vary dramatically because different sources use different definitions and many victims are unwilling to report sexual assaults to the police or other authorities, at least 50 percent of college student sexual assaults are associated with alcohol use (Abbey, 1991, 2002; Abbey et al., 1996, 1998; Copenhaver and Grauerholz, 1991; Harrington and Leitenberg, 1994; Koss, 1992; Koss et al., 1987; Miller and Marshall, 1987; Muehlenhard and Linton, 1987; Presley et al., 1997; Tyler et al., 1998). Further, when alcohol is involved, acts meeting the legal definition of rape appear more likely to occur (Ullman et al., 1999).

Typically, if either the victim or the perpetrator is drinking alcohol, then both are (Abbey et al., 1998). In one study, both the victim and the perpetrator had been drinking in 97 percent of sexual assaults involving alcohol (Harrington and Leitenberg, 1994). In another study the rate was 81 percent (Abbey et al., 1998). Because rates of alcohol consumption are higher among White college students than among their African-American peers, it is not surprising that alcohol-related sexual assaults appear to be more common among White college students than among African-American college students (Abbey et al., 1996; Harrington and Leitenberg, 1994). Rates of alcohol-related sexual assault have not been examined in other ethnic groups.

Targets of sexual assault. Sexual assaults most frequently occur among individuals who know each other, in the context of a date or party at the woman’s or man’s home (e.g., residence hall, apartment, fraternity, sorority, and parents’ homes). In a sample of 416 college women who had experienced sexual assault, those involving alcohol were more likely to be perpetrated by a nonromantic friend or acquaintance. Sexual assaults that did not involve alcohol were more likely to be committed by a romantic partner (Norris et al., 1998). No one profile fits men who have committed sexual assault and no specific personality traits have been linked to female victimization. However, college women who experience sexual assault are more likely than their nonassaulted female peers to have been sexually assaulted in childhood, to be heavy drinkers, and to have frequent sexual relationships (Abbey et al., 1996; Gidycz et al., 1993; Greene and Navarro, 1998; Himelein, 1995).

People who were sexually abused as children experience “guilt, shame, anger and loss of self-esteem … [and] may express their inner turmoil through … alcohol and other drug use and indiscriminate sexual behavior” (Wilsnack, 1984). Heavy drinking and frequent dating, in turn, put women at greater risk of sexual assault because men view them as easy targets and because they are less able to resist advances when intoxicated (Bowker, 1979; Harrington and Leitenberg, 1994; Wilsnack et al., 1997). Female college students report that sometimes it is easier to give in than to fight a sexually coercive male (Murnen et al., 1989). The fact that alcohol consumption and sexual assault frequently co-occur does not mean that alcohol causes sexual assault. However, it is likely that alcohol plays an important but complex role (Abbey, 2002).

Differences in Consequences Among Population Subgroups

Certain negative consequences associated with heavy drinking such as property damage and aggression are more common among men than among women. This pattern is not surprising because male college students consume more alcohol, on average, than female students (Berkowitz and Perkins, 1987).

Women. Although women may not drink as much, on average, as men, women who drink heavily may actually experience more serious consequences due to higher levels of intoxication. CAS found that women who drank four drinks in a row were about as likely to experience negative consequences from their drinking as men who drank five drinks in a row (Wechsler et al., 1995b). Some researchers have argued that gender differences in overall negative consequences from heavy drinking have been overestimated. In their view, research has not adequately accounted for the types of consequences that commonly affect female students who drink (Perkins, 1992). Although males are more likely to damage property and physically injure others while drinking heavily, gender differences decline or all but disappear when academic performance, unintended sexual activity, blackouts, and injury to self are considered (Lo, 1996; Wechsler and Isaac, 1992).

Race/Ethnicity. In terms of racial and ethnic differences, it appears that rates of drinking consequences closely follow the racial/ethnic patterns reported for consumption levels (Presley et al., 1996a,b). That is, White students have the most problems as a result of heavy drinking, followed by Hispanics. African-Americans and Asians have the lowest levels of reported problems.

Strategies for Filling Gaps in Knowledge: Consequences of Student Alcohol Consumption

Although many studies on the negative consequences of student drinking have been published, a systematic assessment of the damage is far from complete. There is a need for:

• More longitudinal studies that track drinking histories and subsequent collegiate performance;
• Research on the cost of lost educational opportunities and impaired athletic performance due to drinking;
• Information on the clustering of adverse consequences by type of damage or among student subgroups; and
• Studies exploring what consequences students perceive and experience as negative to help researchers understand why students misuse alcohol.

In addition, studies are needed on such consequences as the extra demands created by student alcohol misuse for student health and counseling services, college security and enforcement, custodial services, and legal counsel. Public relations costs for administrative damage control directed toward parents, the community, the media, and alumni should also be included.

Carefully designed studies in settings where drinking and risky sex may co-occur could offer new insights into whether, and how, alcohol affects sexual risk-taking and suggest possible strategies for risk reduction. Diary methodology could also be helpful in elucidating the relationship between drinking and risky sex.

There is no single profile that will predict intoxicated aggression in all persons; studying variables that affect alcohol-related aggression (such as temperament, regulation of emotions, and hostility) might help elucidate the mechanisms that underlie the alcohol-aggression relationship.

Additional studies are needed to collect information about the prevalence of sexual assault at given institutions and to review disciplinary procedures to ensure that they are “victim friendly” rather than “victim punitive.” Conducting sexual assault needs assessment surveys and focus groups with students can provide useful information that will help administrators tailor risk reduction and prevention programs to the needs of students at their institutions.

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Historical document
Last reviewed: 9/23/2005