Alcohol is the most widely used and abused drug in the United States, by a large portion. According to the NIH, 85.6% of Americans aged 18 and older have drunk alcohol at some point in their life, and 54.9% have drunk at least once in the past month. In comparison, 21.1% of people aged 12 and older used tobacco in the last month, and 13% used an “illicit” drug, like marijuana or cocaine. Thus, regular alcohol consumption is a normalized, accepted, and even an expected part of social engagements in the United States. It is typical for alcohol to be present at casual get-togethers, social outings, and even sports or big celebratory events. For college students, this national trend is similarly reflected in their drinking patterns. Despite the legal drinking age being 21, 53% of college students ages 18-22 have drunk alcohol in the past month. It is estimated that around 9% of all college students are currently experiencing alcohol use disorder.
According to the Mayo Clinic, Alcohol Use Disorder, or AUD, is a “pattern of alcohol use that involves problems controlling one’s drinking, being preoccupied with drinking, or continuing to use alcohol even when it causes problems”. To clarify, this does not include people who are “heavy drinkers” alone. Alcohol Use Disorder must be characterized by alcohol use that causes problems or dysfunction in a person’s daily life. That is to say that alcohol consumption is not necessarily good or bad, but it can develop into a pattern of dysfunction for some people. With the culture of “binge drinking” promoted in America, especially for college students, it is becoming increasingly difficult to avoid unhealthy patterns of alcohol consumption that could contribute to the development of AUD. Thus, I will discuss current approaches for promoting healthy use of alcohol on college campuses in an effort to mediate the prevalence of unhealthy, and even dangerous alcohol use that goes unnoticed and accepted on college campuses.
In my personal experience as a student at Vanderbilt University, I have encountered numerous situations where alcohol was present, in both small and excessive amounts. I have lost friends due to alcohol and heard of others with similar stories. Outside of Vanderbilt, I have known high school peers and family members struggle with and pass away due to alcohol overdoses. My own experiences may contain a negative bias toward excessive alcohol use that should be considered in this proposal; however, I do not discount the ability to consume healthy amounts of alcohol. I have seen people condone or ignore unhealthy amounts of alcohol consumption, but I have also known those who keep careful track of consumption and maintain healthy levels of inebriation. It is because of the large variety of situations I have encountered that leads me to believe that there needs to be increased efforts to encourage moderate alcohol use for all people.
Most people know the typical feelings associated with alcohol. After a day or night of heavy drinking that began with increased feelings of relaxation and decreased inhibitions, you might feel nauseous, have a headache, have difficulty concentrating, or experience other mild symptoms. In moderation, these symptoms may feel negative for a short time, but are not of any particular concern other than brief discomfort. What most people do not consider unless they have met someone with AUD, is that excessive use of alcohol can cause negative emotional and social consequences. People who are heavy drinkers are at an increased risk of developing mental health problems like anxiety and depression. They are also at higher risk of suffering from learning and memory deficits, even while not under the influence, or struggling with social expectations. These social problems are what often go unnoticed by peers of those with AUD as a direct side effect of excessive alcohol use, and what increasingly needs to be addressed. Social problems of excessive alcohol consumption can include family problems, job-related problems, and unemployment. Additionally, a person’s emotions can get out of their control, and they may do things they don’t remember by blacking out from excessive drinking. I have personally experienced damaged friendships because of heavy alcohol use, as the alcohol dependence changed my friend’s demeanor and behavior beyond the person I knew before their alcohol use. Maintaining peer relations is incredibly important in any aspect of life, and especially important for someone experiencing alcohol use disorder who is working to regain a healthier relationship with alcohol. Understanding the negative consequences of extreme alcohol use is vital to preserving the necessary social supports that are so vital for a successful and fulfilling life.
But how can alcohol abuse be addressed at the college level? Have there been any successful general treatments that could be used in a college setting? As a whole, there is a wide variety of treatment options available for people looking to reduce their alcohol consumption or change their behavior while under the influence of alcohol. These may include detox and withdrawal programs, psychological or psychosocial counseling, oral and injected medications, residential treatment programs, alternative medicine strategies, increasing social support, or many other methods. There are mixed findings as to which of these is the most effective treatment for AUD. But, these results refer to published peer-reviewed discussions on the topic. Part of the movement of Critical Psychiatry is expanding the discussion on stigmatized topics that may not reach the general public due to social or political factors. Thus, more work needs to go into determining if people with the lived experience of Alcohol Use Disorder feel that one intervention is more effective than others. Nonetheless, colleges across the US employ alcohol-specific intervention programs that use cognitive-behavioral strategies, a focus on rules/sanctions, or policy and education initiatives. A review published in 2002 found that the cognitive-behavioral based intervention was the most effective, but it must be considered that numerous developments in treatment have been made in the 20 years since its publishing, so it may not include recent progress in the field.
From student responses regarding similar approaches at Vanderbilt University, the implementation that I believe has the most potential to be effective regards the importance of harm reduction tactics and peer support for intervention. Harm reduction, according to Single, “focuses on decreasing the risk and severity of harmful consequences arising from alcohol consumption with-out necessarily decreasing the level of consumption itself”. This is a person-focused approach that gives the individual aiming to change their patterns of alcohol consumption leeway if they do not succeed in their goals immediately. As opposed to abstinence-based strategies like Alcoholics Anonymous (AA), or other group counseling, harm reduction allows for periodic growth that is much more realistic. This is especially applicable in a college setting where residential treatment would not be an option for those who wish to remain in their classes and where extensive alcohol presence on campuses could result in higher chances of relapse. Additionally, it is crucial that peer support be emphasized in encouraging healthy alcohol practices on campus. Many colleges have a “medical amnesty” policy where students receive legal immunity for seeking emergency medical treatment for someone in serious danger after consuming an illicit substance. This link provides a comprehensive list of the medical amnesty policies across American universities. It is common for a peer’s first concern to be legal repercussions they could face for involvement in a substance-related altercation. However, if students know of this policy, they are less likely to think of how they could be poorly affected; instead, the policy provides an incentive for students to support other students if a situation gets out of hand. The individual affected does not receive immunity if a university official calls for emergency services, further promoting the practice of peers holding each other accountable for making safe decisions in regard to alcohol.
Outside of any programs or official policies, peer support is crucial for people with Alcohol Use Disorder to know that they are not alone, not bad people, and not unworthy of care and support. Though society highly normalizes alcohol consumption, it vilifies those who experience Alcohol Use Disorder and addiction even more. Because of these systematic trends, people with AUD can be rejected by peers for “being a victim” of alcohol. This is not the attitude that should be associated with supporting someone in their experiences with alcohol. AUD is ultimately a social construct, and the level of dysfunction is relative to a person’s own adaptive behaviors. Because it is peers who observe and understand their friend’s (or other relation) typical behavior best, they need to be active participants in a recovery process. Also, a person cannot change their relationship with alcohol to a more moderate level without intentionally making steps in that direction. To handle that alone requires enormous mental and emotional strength. Having the presence of peers to encourage the individual through healthier practices, celebrate little successes, and gently motivate them in more difficult periods could be the deciding factor between progress or a stagnant unhealthy level of alcohol consumption.
Thus, I propose that more resources go into promoting intervention methods that encourage peer involvement in situations where alcohol is present. To mention my university specifically, Vanderbilt has a harm reduction program called BASICS, or Brief Alcohol Screening and Intervention for College Students. However, even as someone who is actively involved in mental health and substance use resources on campus, I was unaware of the program until creating this blogpost. With the inclusion of promising intervention methods, there needs to be increased publicity and awareness about those resources. Many students complete college without realizing how many hugely beneficial programs are available to them on any college campus. Colleges need to be more purposeful about actively and directly exposing students to these resources; and not in an online module, but in comprehensive, in-person circumstances. In discussing this issue with other students and faculty on campus, it has been proposed that a required in-person course be implemented that involves students physically visiting several on-campus resources. Additionally, students need actual incentives in order to take these resources seriously, so this should be a course that actually impacts their GPA. Of course, there are other solutions to expanding information about interventions for mental health and substance abuse issues on campus, but this is one potential method that could improve top-down, institutional measures.
Overall, the most important takeaway is the importance of fostering community concern regarding safe alcohol use in student populations, as well as giving the individual affected grace to make mistakes in their journey to reach their personal goals. As shown by the lack of recent scientific literature on the subject, the mixed results on which practices are most effective, and the continued stigma against those who experience Alcohol Use Disorder, there is much work to be done. People will continue to drink alcohol, but if they can partake in a controlled and safe manner, many serious problems could be avoided.
Phoebe Young is a junior undergrad from Nashville, TN majoring in Cognitive Studies and Neuroscience at Vanderbilt University. She is a research assistant in the Winder Lab at the Vanderbilt Center for Addiction Research, where she studies molecular changes during abstinence from alcohol use disorder in mouse models. She hopes to continue studying similar topics through a PhD after graduation.