A common feature of the American college experience is the use and misuse of Alcohol and Alcohol-related substances (such as cocaine, nicotine and marijuana). The excessive consumption of alcohol among American college students has become a popular topic in the media and has been the focus of extensive research over the last two decades. As a result, bad habits such as the specific practice of heavy episodic drinking by students, commonly referred to as “binge drinking,” is now well known to be common among this group of people. First described by Wechsler and his colleagues in a Massachusetts sample in 1992, Binge-drinking is defined as the consumption of five or more drinks for men and four or more drinks for women in one sitting at least once during a 2-week period (Wechsler and Isaac, 1992). Its high prevalence among American college students has led to researchers such as Grossman, Platt, and Sloan (2011) to suggest that heavy drinking in college might be seen to some extent as a rite of passage. The adverse effects that heavy alcohol consumption has upon the academic performance of college students have been well documented by various research studies (Buckman et al., 2011). The obvious rigors of a normal college experience that involves listening to lectures, writing essays, and studying for tests can obviously be complicated and interfered with when students engage in heavy drinking. Aside from this, heavy drinking and usage of illegal substances pose a very serious health threat to the students who engage in it both physically and psychologically. Furthermore, it affects the general populace as these students could potentially pose a significant danger to others with their behavior whilst still in their altered state of mind. This paper seeks to evaluate over-indulgence in drinking and the usage of illegal substances by American college students by discussing its prevalence, symptoms of abuse, diagnosis, treatment, dangers and also the role of culture in the experience and recovery from this disorder.
Prevalence, Symptoms, Diagnosis and Treatment
The problems of college drinking and substance abuse are partly a product of development. The average college student is aged between 18 – 24. As such, the behaviors usually associated with “the college years” is largely characteristic of the years of late adolescence and early adulthood The college years are a time of transition that involve multiple adjustments including a reevaluation of identity, exploration of new social relationships, and changes in living situations. For both college and non-college youth, this period of life involves greater personal freedom and independence, increased involvement in intimate relationships, and freedom from the responsibilities that marriage, family life, and the workplace typically entail. College is a time when students, through the exploration of values, lifestyles, relationships, beliefs and behaviors, eventually make commitments to an integrated set of personal beliefs, values, and goals. Such exploration of identity is normal and healthy but may increase experimentation with risky behaviors, including high alcohol and illegal substance consumption.
Research on college-student drinking practices has focused its attention on the heavy drinking patterns of many college students. In 1993, 1997 and 1999, the Harvard School of Public Health College Alcohol Surveys (CAS) monitored “binge” drinking among college students. This was defined, for male student drinkers, as the consumption of five or more drinks in a single drinking session and, for female students, as four or more drinks (Wechsler et al., 1994, 1998, 2000). In the article, “Alcohol abuse and Dependence among U. S college students”, authors Knight, Wechsler, Kuo et.al (2002) sought to estimate the prevalence of alcohol abuse and dependence among students attending 4-year colleges in the United States. This research was part of the 1999 Harvard School of public health College Alcohol Study (CAS) that surveyed 23,751 students at 119 4-year colleges and universities from 40 states in the U.S. Earlier research conducted in 1993 and 1997 by the same Harvard school of public health had focused primarily on the type, frequency and amount of substances used and not on alcohol or drug related diagnoses as defined by the DSM-IV or its earlier equivalents. This study sought to evaluate other factors such as demographics and individual variables that affect this drinking behavior. Upon conclusion of the study, it was discovered that more than 30 percent of the students reported one or more symptoms of abuse and more than 40 percent reported one or more symptoms of either abuse or dependence (Knight, Wechsler, Kuo et.al, 2002).
Psychologists rely on the Diagnostic statistical manual (DSM) when diagnosing disorders. Although there are some notable differences between the DSM-IV and DSM-V, they are still somewhat similar in their diagnosis of Alcohol abuse and dependence. According to the DSM-5, a “substance use disorder describes a problematic pattern of using alcohol or another substance that results in impairment in daily life or noticeable distress.” The DSM-5 states that in order for a person to be diagnosed with a disorder due to a substance, they must display 2 of the following symptoms within a 12-month period which include but are not restricted to; I) Consuming more alcohol or other substance than originally planned, ii) worrying about stopping or consistently failed efforts to control one’s use, iii) spending a large amount of time using drugs/alcohol, or doing whatever is needed to obtain the high, iv) “Craving” the substance (alcohol or drug), v) continuing the use of a substance despite health problems caused or worsened by it vi) building up a tolerance to the alcohol or drug. Tolerance is defined by the DSM-5 as “either needing to use noticeably larger amounts over time to get the desired effect or noticing less of an effect over time after repeated use of the same amount” vii) Experiencing withdrawal symptoms after stopping use. Withdrawal symptoms typically include, according to the DSM-5: “anxiety, irritability, fatigue, nausea/vomiting, hand tremor or seizure in the case of alcohol” etc. The severity of the disorder ranges from mild (the presence of two to three symptoms) to severe (presence of six or more symptoms)
Misdiagnosis
The issue of the likelihood of misdiagnosing adolescents with an Alcohol/Substance abuse disorder or dependence disorder is one that needs to receive more consideration. One challenge facing proper diagnosis of this disorder is the fact that Alcohol and substance use can progress rapidly from experimentation to abuse or dependence for teens. Martin and colleagues (1995) reported that some adolescents can be diagnosed with abuse or dependence in as little as 12 months after their initial use. This is in contrast to adults whereby the development of a Substance Use disorder typically takes much longer. Furthermore, it has been documented that teens often underestimate or ignore severe potential consequences. Symptoms are often minimized (Lewinsohn, Rohde, & Seeley, 1996) while teenagers engage in a risky lifestyle riddled with significant Alcohol and substance use that they inaccurately feel they can control (Botvin & Tortu, 1988). Other factors that may hinder early assessment include the common adolescent that reveal lack of respect for authority, are egocentric, and carryout risk-taking behaviors. Moreover, adolescents demonstrate delays in social and emotional functioning (Noam & Houlihan, 1990) and may lack the necessary insight to accurately report their use of alcohol and related substances (Winters,2001).
Another issue that leads to a misdiagnosis is that adolescents who are involved with Alcohol/Substance use often have co-existing psychological disorders (Clark & Bukstein, 1998). Rohde and colleagues (1996) reported that among adolescents who were either abusing or dependent on alcohol, 80 percent also had some other form of psychopathology. In addition to disruptive behavior disorders, mood disorders such as depression and anxiety have been found to be correlated with Alcohol/Substance use disorders. Clark & Sayette (1993) reported that emotional dysregulation, which is associated with depression and anxiety, may pose risk factors associated with Alcohol/Substance use disorders. Other studies reported that early use of alcohol was found to significantly predict later major depressive disorder (Brook, Brook, Zhang, Cohen, & Whiteman, 2002), diagnosis of Alcohol/Substance use disorder was predictive of later major depressive disorder in adolescent females, (Rao, Daley, & Hammen, 2000) and adolescents with an Alchohol/Substance use disorder reported higher rates of affective disorders and symptomology, especially for females (Deykin, Levy, & Wells, 1987; Martin, Lynch, Pollock, & Clark, 2000).
Role of Culture and the Environment
The role of cultural influences with regard to problem drinking has been well documented via cross-cultural studies on the subject of alcohol use. Angermeyer et al., (2008) provides valuable insight via their research study which compared worldwide alcohol consumption rates between numerous countries. Angermeyer et al. (2008) demonstrated effectively that collectivist cultures exhibit low levels of alcohol abuse compared to individualistic cultures where the rates were much higher. Grossman, Platt, and Sloan (2011) discuss their research study which focused on the question of whether or not heavy drinking during the college years is connected to negative behavioral effects later in the lifespan. The authors hypothesized that heavy drinking during the college years led to negative educational endeavors later in life and a greater likelihood of chemical dependence (Grossman, Platt, & Sloan, 2011). The study incorporated a previous data sample of more than 10,000 participants that surveyed individuals on a number of issues such as chemical substance use, education accomplishment, career successes and much more (Grossman, Platt, & Sloan, 2011). The authors concluded that heavy alcohol use during the college years was directly correlated to chemical dependence later in life, but had little to no correlation with any negative future educational endeavors (Grossman, Platt, & Sloan, 2011).
Heavy drinking environments seem to increase the risk of an alcohol diagnosis. Students from colleges with high rates of heavy episodic drinking and members of fraternities and sororities are at high risk. Prior studies have consistently found that fraternity members have more drinks per week, drink more often, and experience more negative consequences as a result of drinking than do other students (Borsari and Carey, 1999; Cashin et al., 1998; Larimer et al., 2000; Wechsler et al., 2000a). In addition, fraternities and sororities may disproportionately attract underage students with an existing propensity to heavy drinking (Borsari and Carey, 1999; Larimer et al., 2000; Wechsler et al., 2000a). Students who use marijuana or engage in risky sexual behavior are also at higher risk, as are those who are heavily involved in the collegiate party scene and social activities, who watch a great deal of TV, and who study little (Wechsler et al., 2000a).
One factor that may entice adolescents to experiment with Alcohol/Substance use involves the psychological benefits they may receive from substance use. Social acceptance, elevated mood, recreational enjoyment, and stress reduction are all outcomes adolescents may experience from Alcohol/Substance use (Petraitis,Flay, & Miller, 1995). An important finding in one study revealed that of these psychological benefits, social conformity and mood enhancement were found to be more important to adolescents who have a substance use dependence disorder than to those who use AOD infrequently (Henly & Winters, 1988). The impact these psychological benefits may have on the allurement and exacerbation of Alcohol and Substance use among adolescents emphasizes the importance of effective prevention and early intervention efforts.
Universalist and Relativist Features
Certain features of Alcohol/Substance abuse are universal while others are relative to certain cultures in particular. An example of a universalist feature of Alcohol/Substance abuse is that it exists in all cultures. While some cultures might have a higher rate of Alcohol/Substance b abuse, it is present among college students around the world. Alcohol/Substance abuse also affects people other than the abuser universally. The National Institute on Alcohol Abuse and Alcoholism gives an insightful breakdown of how drinking affects other college students, communities and families. According to the institute, Alcohol and substance abuse leads to the death of about 1,825 college students between the ages of 18 and 24 as a result of alcohol-related unintentional injuries. More than 690,000 students within the same age bracket are assaulted by another student who has been drinking, 97,000 of those being victims of alcohol-related sexual assault or date rape. Alcohol/Substance abuse is also responsible for the unintentional injuries of 599,000 students between the ages of 18 and 24 receive while under the influence of alcohol. This just shows how much of a global concern Alcohol/Substance abuse among college students is. Furthermore, college students report academic consequences of their drinking including missing class, falling behind, doing poorly on exams or papers, and receiving lower grades overall. Sweating or Rapid pulse, vomiting, anxiety, illusions and blacking out are common resultant effects of abuse.
One of the relativist features of Alcohol/substance abuse is that what is considered “abuse” varies from culture to culture. For example, with reference to the earlier definition of Binge Drinking, when the students were asking to measure what they considered one drink, the study shows that they measured above what was considered a drink by bartenders. Also, individuals from different cultures have different thresholds and tolerance rates for alcohol. A good example is Asian Americans which have a gene that slows down their metabolism so that they get drunk easier and faster than others. Thus, what gets an Asian American drunk might not necessarily affect a Hispanic-American since they have the highest annual prevalence rates.
Treatment
After diagnosis of an Alcohol/Substance abuse disorder, the next focus is treatment. One form of treatment for Alcohol/Substance abuse is detoxification. This Is useful immediately after discontinuing the consumption of alcohol. However, because detoxification does not neccesarily stop the craving for alcohol, the most effective form of treatment is therapy. This can either be inpatient (patient attends and stays a treatment facility) or outpatient (patient is allowed to stay at home while receiving treatment) treatment. Both forms of treatment could involve a mixture of individual and group therapy to help patients recover. Cognitive Behavior Therapy (CBT) and Motivational Enhancement therapy are some of the varieties of treatment that may be employed in any of the treatment settings mentioned earlier.
Conclusion
Alcohol/Substance abuse among college students is a societal problem that requires more attention than it currently is getting.