The Culture of College Drinking
Alcohol consumption on many campuses has evolved into a rite of passage.
Traditions and beliefs handed down through generations of college drinkers
serve to reinforce students' expectations that alcohol rehab is a necessary
component of social success (2). The role of alcohol in college life is
evident in the advertising and sale of alcoholic beverages on or near
campuses. This combination of social and environmental influences creates a
culture of drinking that passively or actively promotes the use of alcohol.
In a recent survey that questioned students about patterns and consequences
of their alcohol use during the past year (3), 31 percent of participants
reported symptoms associated with alcohol abuse (e.g., drinking in hazardous
situations and alcohol-related school problems), and 6 percent reported 3 or
more symptoms of alcohol dependence (e.g., drinking more or longer than
initially planned and experiencing increased tolerance to alcohol's
effects). Although it is true that most high-risk student drinkers reduce
their consumption of alcohol after leaving college, others may continue
frequent, excessive drinking, leading to alcoholism or medical problems
associated with chronic alcohol abuse (4).

Factors Influencing College Drinking
Students' drinking habits are influenced by a combination of personal and
environmental factors. Relevant personal factors include family influences,
personality, and a person's biological or genetic susceptibility to alcohol
abuse (5,6). In addition, many students arrive at college with preexisting
positive expectations about alcohol's effects and often with a history of
alcohol consumption. Thirty percent of 12th graders, for example, report
heavy episodic drinking in high school, slightly more report having "been
drunk," and almost three-quarters report drinking in the past year (7).
Certain campus characteristics also reinforce the culture of college
drinking. Rates of excessive alcohol use are highest at colleges and
universities where Greek systems (i.e., fraternities and sororities)
dominate, at those where sports teams have a prominent role, and at schools
located in the Northeast (8). In the local community, tolerance of student
drinking may permit alcoholic beverage outlets and advertising to be located
near campus. Likewise, there may be lax enforcement of the laws prohibiting
alcohol sales to persons below the minimum legal drinking age and penalizing
underage students who use fake IDs to obtain alcohol (9).

Changing the Culture of Drinking
In 1998 the National Advisory Council of the National Institute on Alcohol
Abuse and Alcoholism established a Task Force of college presidents, alcohol
researchers, and students to review the existing research literature on
college drinking as a basis for implementing and evaluating alcohol
prevention programs. The Task Force commissioned 24 studies examining the
problem of drinking among college students. The results of these studies are
summarized in the Task Force's final report (see "Resources" for information
on the availability of this report). Central to the findings was the concept
that it is first necessary to change the culture of college drinking if
prevention strategies are to be effective. The report emphasizes the need
for collaboration between academic institutions, researchers, and the
community to effect lasting change (2).
The Task Force's analysis strongly supports the use of a "3-in-1 Framework"
to target three primary audiences simultaneously: (1) individual students,
including high-risk drinkers; (2) the student body as a whole; and (3) the
surrounding community. Collaboration with the community promotes cooperative
prevention efforts for the benefit of all concerned (10-13).

Prevention Strategies
Before launching prevention strategies to address the problem of college
drinking, it is necessary to define the patterns of alcohol consumption that
may occur on campus. Surveys show that approximately 70 percent of college
students consumed some alcohol in the past month (14). Although some of
these students can be considered problem drinkers (e.g., frequent heavy
episodic drinkers or those who display symptoms of dependence), others may
drink moderately or may misuse alcohol only occasionally (e.g., drinking and
driving infrequently). Surveys of drinking patterns show that college
students are more likely than their age-mates who are not in college to
consume any alcohol, to drink heavily, and to engage in heavy episodic
drinking. However, young people who are not in college are more likely to
consume alcohol every day (14).
Evidence supporting the effectiveness of alcohol prevention strategies is
incomplete and often inconsistent. In addition, many strategies have not
been evaluated specifically for application to college-age drinkers. The
Task Force reviewed potentially useful preventive interventions and grouped
them into "tiers" according to their effectiveness as determined by the
results of available research-based studies.
Tier 1. Strategies Effective Among College Students. The strategies in this
tier have been shown to be effective among alcohol-dependent drinkers,
problem drinkers, and students whose drinking patterns place them at
increased risk for developing alcohol problems. Strong evidence supports the
effectiveness of the following strategies: (1) simultaneously addressing
alcohol-related attitudes and behaviors (e.g., refuting false beliefs about
alcohol's effects while teaching students how to cope with stress without
resorting to alcohol); (2) using survey data to counter students'
misperceptions about their fellow students' drinking practices and attitudes
toward excessive drinking; and (3) increasing students' motivation to change
their drinking habits, for example by providing nonjudgmental advice and
evaluations of the students' progress. Programs that combine these three
strategies have proven effective in reducing alcohol consumption (15). Some
specific examples are reviewed in the Task Force report (2).

Tier 2. Strategies Effective Among the General Population That Could Be
Applied to College Environments. These strategies have proven successful in
populations similar to those found on college campuses. Measures include (1)
increasing enforcement of minimum legal drinking age laws (16); (2)
implementing, enforcing, and publicizing other laws to reduce
alcohol-impaired driving, such as zero-tolerance laws that reduce the legal
blood alcohol concentration for underage drivers to near zero (17); (3)
increasing the prices or taxes on alcoholic beverages (18); and (4)
instituting policies and training for servers of alcoholic beverages to
prevent sales to underage or intoxicated patrons (9,19).

The value of an alliance between the campus and the community is supported
by positive results obtained by several comprehensive community efforts to
reduce alcohol consumption and its consequences among both youth and adults.
Examples include (1) Communities Mobilizing for Change, which succeeded in
reducing alcohol sales to minors (20); (2) the Massachusetts Saving Lives
Program, which accomplished relative declines in alcohol-related fatal
crashes involving drivers ages 16 to 25 (21); and (3) the Community
Prevention Trials Program, which reduced drinking-driving crashes,
alcohol-related assault, and alcohol sales to minors (11,12,19).

Tier 3. Promising Strategies That Require Research. These strategies make
sense intuitively or show theoretical promise, but more comprehensive
evaluation is needed to test their usefulness in reducing the consequences
of student drinking. They include more consistent enforcement of campus
alcohol regulations and increasing the severity of penalties for violating
them, regulating happy hours, enhancing awareness of personal liability for
alcohol-related harm to others, establishing alcohol-free dormitories,
restricting or eliminating alcohol-industry sponsorship of student events
while promoting alcohol-free student activities, and conducting social norms
campaigns to correct exaggerated estimates of the overall level of drinking
among the student body.


Key Role for Campus Administration
The leadership of college presidents and school administrators is crucial to
develop appropriate plans, supervise the integration of policies pertaining
to different aspects of student life, and ensure consistent enforcement of
drinking-related policies (22,23). Because the effectiveness of a particular
strategy depends on individual campus characteristics, school administrators
must determine the nature and scope of drinking and related problems on
their campuses before undertaking prevention planning. A strong research
base also is necessary to define realistic program objectives and maximize
the use of resources, thereby increasing the likelihood of program
effectiveness. Progress should be evaluated with the help of the research
community, and the results should be publicized to ensure the continuation
of successful programs and to add to the existing knowledge base (2).

Changing the Culture of Campus Drinking-A Commentary by Raynard Kington,
M.D., Ph.D., Acting NIAAA Director
The National Institute on Alcohol Abuse and Alcoholism's (NIAAA's) Task
Force on College Drinking was created in response to growing national
concern about hazardous college drinking and the recognition that there are
gaps in our knowledge base regarding effective prevention interventions. The
Task Force Report, A Call to Action: Changing the Culture of Drinking at
U.S. Colleges, which is the subject of this Alert, describes our new
understanding of dangerous drinking behavior by college students and its
consequences for both drinkers and nondrinkers. The Task Force Report is
unique in several ways. First, it moves beyond the sheer number of college
students engaged in high-risk drinking and focuses on the tremendous overall
societal burden created by high-risk drinking on campus. Second, it
describes research-based solutions and tools for college presidents,
parents, communities, and students to reduce the consequences of high-risk
drinking on our Nation's college campuses. Finally, it proposes a vigorous
research agenda to decrease the gaps in our current knowledge.
The Task Force Report is only the beginning of what promises to be an
extensive, long-term effort. Changing the culture will not come quickly or
easily. The chancellor of a university where a student recently died as a
result of excessive alcohol consumption said, "Our children's lives are at
real risk, and universities need to make every effort to prevent any more
lives from being wasted." This report underscores the wisdom of that advice
and urges us to join forces in changing the culture of drinking on our
Nation's campuses-from one that fosters destructive behavior to one that
discourages it.
Resources

A variety of brochures and handbooks on preventing college drinking are
available from NIAAA. The full text of the Task Force's final report,
including recommendations and supporting review articles, can be downloaded
or ordered from http://www.collegedrinkingprevention.gov/Reports/.