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.