College Drinking Gail M Basch M D Department

College Drinking Gail M. Basch M. D Department of Psychiatry Rush University Medical Center © AMSP 2013 1

College Heavy Drinking Transitional time Heaviest drinking epoch Believe heavy drinking = norm © AMSP 2013 2

Morbidity & Mortality ~2, 000 student deaths/yr ~700, 000 assaults/yr ~80, 000 sexual assaults/yr ~2. 8 million drove while intox $62 billion /yr underage drinking © AMSP 2013 3

College Heavy Drinking → Drinking problems Clues for prevention Clues for Rx © AMSP 2013 4

This Lecture Reviews: • Definitions • Campus drinking & problems • Risk factors for heavy drinking • Prevention efforts © AMSP 2013 5

Standard Drink © AMSP 2013 6

Standard Drink in Solo Cup Beer (12 oz) Wine (5 oz) Spirits (1 oz) © AMSP 2013 7

Heavy Episodic Drinking 5+ ♂ / 4+ ♀ ≥ 5 occas/month © AMSP 2013 8

Blood Alcohol Concentration Standard drink ~12 grams alcohol 1 drink → BAC 0. 015 g/dl (~15 mg%) ↑ BAC with: ♀ ↓ Weight Drink w/out food © AMSP 2013 9

BAC’s Effects BAC (mg%) > 300 ↓Vital signs, coma, death ≤ 300 Difficulty waking ≤ 200 Anger, moody, confusion ≤ 100 Sleepiness, ↓ coordination ≤ 50 (1 -3 drinks) Well-being, ↓ inhib © AMSP 2013 10

Blackout Intox →forget events Remain consciousness © AMSP 2013 11

DSM IV Alcohol Use Disorders Abuse Dependence ≥ 1 Role failure Risk of harm Legal problems Use despite problems Dependence ≥ 3 Tolerance Withdrawal Larger/longer Unable to cut down ↓ Time elsewhere Use despite problems © AMSP 2013 12

DSM 5 Alcohol Use Disorders Abuse Dependence 2 -3 mild, 4 -5 mod, ≥ 6 severe Legal problems Cravings Role failure Risk of harm Use despite problems Tolerance Withdrawal Larger/longer Unable to cut down ↓ Time elsewhere © AMSP 2013 13

This Lecture Reviews: • Definitions • Campus drinking & problems • Risk factors for heavy drinking • Prevention efforts © AMSP 2013 14

Heavy Drinking Episodes ~45% heavy drinking/2 wks ~20% ♂ drink 10 drinks/occas ~10% ♀ drink 8 drinks/occas ~50% 1+ blackout/college ~40 % 1+ alcohol problem prior yr ~20% students drink 72% of alcohol © AMSP 2013 15

College vs Non-College © AMSP 2013 16

Risk Higher For: Single event/game day/holiday 21 st birthday Fraternity/sorority Student athletes ↑Impulsivity AUD relative Low LR to alcohol © AMSP 2013 17

BAC ↑Drink Days © AMSP 2013 18

st 21 Birthday ~83% drink to celebrate ~25% >21 b-day drinks ~40% blackouts ~50% highest ever drinks ~72% ↑ DWI risk © AMSP 2013 19

Game Day Drinking ~60% drink ~7 drinks/game ↑ Impulsive ↑ Expect drunk →↑ Drink © AMSP 2013 20

Fraternity/Sorority ~ 60% prior heavy drinkers ~ 80% heavy episodic drinkers Greek peers = heavier drinkers Believe ↑ drink norms →↑ Drink © AMSP 2013 21

Fraternity/Sorority Blackouts/Past 2 Weeks © AMSP 2013 22

Student Athletes ~50% heavy episodic drinkers Leaders ↑ drink and set norms Athlete peers = heavier drinkers Athlete + Greek →↑ Drink © AMSP 2013 23

Family History 4 x ↑ AUD risk Even if adopted out © AMSP 2013

Impulsivity ↓Postpone reward ↑Risk taking ↑Urgency →↑ Drink © AMSP 2013 25

Level of Response ↑↑ Drinks/occas for effects →Join peers ↑↑ drinks/occas →Think everyone drinks ↑↑ →↑ Stress Use ↑ drinks to cope →↑ Drink © AMSP 2013 26

This Lecture Reviews: • Definitions • Campus drinking & problems • Risk factors for heavy drinking • Prevention efforts © AMSP 2013 27

Peer Influence Students fear rejection ~40% afraid to refuse Overest. peer/campus drink ↑ Drinking to match © AMSP 2013 28

Inaccurate Beliefs False beliefs: ~65% more fun ~55% better sex ↓Muscle tension Better sleep Other myths Underinformed: Alcohol OD Predict BAC Alcohol + Drugs © AMSP 2013 29

Alcohol to Cope Low doses → ↓ mild anxiety 2 or 3 drinks →

Prevention Programs Orientation Student health Campus Life Dorm counselors Prevention campaigns © AMSP 2013

Prevention Videos Peer influence Accurate alcohol beliefs Actual campus drinking Healthy coping Can’t guess BAC Alcohol + drugs dangerous → ↓ Drink © AMSP 2013 32

This Lecture Reviewed: • Definitions • Campus drinking & problems • Risk factors for heavy drinking • Prevention efforts © AMSP 2013 33

Acknowledgements Marc A. Schuckit, M. D. Department of Psychiatry University of California, San Diego Marcy Gregg AMSP Scholars www. alcoholmedicalscholars. org © AMSP 2013 34