Gail M. Basch, M.D

Rush University Medical Center

Revised October 2013

Alcohol Medical Scholars Program

 

Note: Outline contains detail that would allow someone to give the lecture. Some slides contain animation that should be reviewed prior to lecturing to understand placement.

Special Populations- College Drinking (Slide 1)

I.                     Introduction.

A.                  College associated with heavy drinking. 1 2 3 (Slide 2)

1.                               Time of transition / exploration.

2.                               Time of life with heaviest drinking.

3.                               Incoming student believes heavy drinking = norm. 4,5

B.                  Pattern → much morbidity and mortality. 6–9 (Slide 3)

1.                               2,000 student deaths / yr. from alc related causes. 9

2.                               ~700,000 assaults / yr.

3.                               ~80,000 sexual assaults / yr.

4.                               ~2.8 million drove while intoxicated.13

5.                                U.S. spends $62 billion / yr. underage drinking.

C.                  Students have heavy drinking episodes.14–16 (Slide 5)

1.                               ~45% report heavy drinking / past 2 wks.

2.                               ~20% ♂drink 10 drinks / occasion.

3.                               ~10% ♀drink 8 drinks / occasion.

4.                                50% ~1+ blackout / college.17,18

5.                                40 % ~1+ alcohol problem prior yr. 

6.                                20% students drink 72% of all alcohol.

D.                  College heavy drinking → future drinking problems. (Slide 4)

1.                Clues for prevention efforts.

2.                Clues for Rx.

3.                Most clinicians learn little re: these issues.

 

E.                  This lecture reviews: (Slide 5)

1.                               Definitions.

2.                               Campus drinking & problems.

3.                               Risk factors for heavy drinking.

4.                               Prevention efforts.

II.                   Definitions.

A.                  Standard drink (10-12 g pure ethanol). 19 (Slide 6)

1.                               Volumes.

a.        12 oz. beer.

b.         8 oz. malt liquor.

c.         5 oz. wine.

d.        1.5 oz. 80 proof liquor (spirits).     

2.                               Volumes in Solo cup. (Slide 7)   

  a.      12 oz. beer

  b.      5 oz. wine

  c.       1 oz. spirits.

           

B.                  Heavy episodic drinking.19 (Slide 8)

1.                               5+ std drinks for ♂.

2.                               4+ std drinks for ♀.

3.                               ≥5 occasions during past month.

C.                  Blood alcohol concentration (BAC). 20 (Slide 9)

 1.               Std. drink ~ 12 g alcohol.

 2.               1 drink ­ BAC ~ 0.15g/dl ~15mg%.

 3.               ­ BAC with

          a.  ­ Drinks.

  b.  ♀.

  c.   ↓ Weight.

  d.   Drink without food.

4.        BAC’s effects. 21 (Slide 10)

a.     50mg% (1-3 drinks) Well-being, ↓ inhib.

b.    ≤ 100 → Sleepiness, ↓ coordination.

c.    ≤ 200 → Anger, moodiness, confusion.

d.     300 Difficulty awakening.

e.    > 300 ↓ Vital signs, coma, death.

D.                  Blackout.17,18,22   (Slide 11)

    1.      Forget events that occurred when intox.

    2.      Remain consciousness.     

E.                  Alcohol abuse & alcohol dependence = alcohol use disorders (AUDs). (Slide 12)

1.             Alcohol abuse: 1+ in same 12 mos (in absence of dep) of 23 

a.                                   Role failure.

b.                                   Risk of harm.

c.                                   Legal problems.

d.                                   Use despite problems. 

2.                               Alcohol dependence: 3+ in same 12 months of: 23

a.                                   Tolerance.

b.                                   Withdrawal.

c.                                   Larger/ longer.

d.                                   Unable to cut down.

e.                                   ↓Time elsewhere.

f.                                     Use despite problems.

F.                   DSM 5 Alcohol use disorders.24(Slide 13)

1.                               x Abuse vs. dependence.

2.                               x Legal. 

3.                               + Craving.

4.                               Within same 12 mos:

a.     Craving

b.     Role failure.

c.     Risk of harm.

d.     Use despite problems. 

e.     Tolerance.

f.       Withdrawal.

g.     Larger amts / longer time.

h.     Unable to cut down.

5.                               Severity scale:

a.     2-3 → Mild.

b.     4-5→ Mod.

c.     ≥ 6 → Severe.

III.                  Campus drinking & problems. (Slide 14)

A.                  College students drink more than peers. 12,25–28 (Slide 15)

1.                               College drinking vs. non-college:

a.     Current drinkers / past yr: 63% vs 53%. 

b.     Current heavy episodic drinking: 45% vs 38%.

c.     Current alcohol use disorders / past yr: 18% vs 15%.

d.     DWI / 2 wks: 40% vs 25 %.

e.     Highlights college risk factors (some mentioned below).

B.                  Risk factors:  Some student subgrps have ↑ risk alc probs. (Slide 16)

1.                               ~40% environment  & ~60% genetics. (see pie chart).

a.         Environment:  Holidays, 21st b-day, game day, Greek,     athletes.

b.         Genetics:  AUD, impulsivity, low level of response to       alcohol (LR).

2.                               Environmental risk factors (~40%). (Slide 17)

a.     High-risk day/event → ­­drink.

i.             High-risk events.9 28–29 (Slide 21)

                                                          a'.                New Year’s Eve:  BAC~0.126 g/dl.

                                                          b'.                Spring Break:  BAC~0.107 g/dl.

                                                          c'.                Graduation:  BAC~0.093 g/dl.

                                                          d'.                Valentine’s Day:  BAC~0.076 g/dl.

                                                          e'.                Weekday: BAC~0.076g/dl  (see bar graph).

ii.            Next: At 21st birthday. 9,30 (Slide 18)  

                                                          a'.                Another example environmental risk.

                                                          b'.                 83% drink to celebrate.       

                                                          c'.                ~25 %  >21 b-day drinks.

                                                          d'.                ~40% report blackouts.

                                                          e'.                For 50% this is highest ever drinks.

                                                           f'.                BAC~0.186 g/dl.9

                                                          g'.                2 wks. after b-day: 72 %­ DWI.

 

iii.           Next: Game day drinking. (Slide 19)

                                                          a'.                Another example environmental risk.

                                                          b'.                E.g. tailgating.

                                                          c'.                ~60% drink on game day.

                                                          d'.                ~7drinks/game.

                                                          e'.                ↑ Impulsivity.

                                                           f'.                ↑ Expectations.

                                                          g'.                ­­drink.

                                                          h'.                 

b.     Next:  Members of fraternity/sorority. 31–34 (Slide 20)

i.             Greek members drink ­ with ­alc related conseq.

                                                          a'.                Another example  environmental risk.

                                                          b'.                ~60% heavy drinkers in high school.

                                                          c'.                ~80% heavy episodic drinkers currently.

ii.            ↑ Drinker peer groups.

                                                          a'.                Leaders drink ­­

                                                          b'.                 Set drinking norms.

                                                          c'.                ­­drink.

iii.           Fraternity/Sorority Blackouts: (Slide 21)

                                                          a'.                Members vs. non-members.

                                                          b'.                Blackouts / past 2 wks:

1.   ♂:      45% vs 23%.

2.   ♀:       42% vs 20%.

c.     Next:  Student athletes.35–38 (Slide 22)

i.             Athletes drink ­ with ­ alcohol related conseq.

                                                          a'.                Another example of environmental risk.

                                                          b'.                ~50% heavy episodic drinkers.

                                                          c'.                If athlete + Greek system → drinks ­­.

ii.             ↑ Drinker peer groups.

                                                          a'.                Team leaders drink ­­

                                                          b'.                Set drinking norms.

                                                          c'.                ­­drink.

3.                               Genetic risk factors (~60%). 2

a.     Students with alcohol dependent relatives. (Slide 23)

i.             Example of inherited genetic risk factor.

ii.            4x ↑ risk AUDs.39,40

iii.           Even if adopted out.

iv.          ­­drink.

b.     Next:  ↑ Impulsivity. 7,41–47 (Slide 24)

i.              Can inherit predisposition to impulsivity.

ii.            ↓ Ability to postpone reward.

iii.           ↑ Risk taking.

iv.          ↑ Urgency.

v.           ­­Drink.

c.     Next:  Low sensitivity (low level of response).39,48–53 (Slide 25)

i.             Well-studied genetic risk factor.

ii.            Not same as tolerance.

iii.           Need ­­ drinks for effects (“drink others under table”).

iv.          So ­­ drinks /occasion.

v.           Join peers who ­­ drinks /occasion.

vi.          Think everyone drinks ­­.

vii.         ­Stress from heavy drinking.

viii.       Use ­­drinks to cope.

ix.          ­­drink.

IV.                 Prevention efforts. (Slide 26)

A.                  Heavy drinking peers influence drinking. (Slide 27) 39,54–57 58

1.                               Offer ↑↑ number of drinks.

a.        Students fear rejection if refuse drink. 

b.        ~40% afraid to refuse.

c.         Lack skills to say no.

d.        ­­Drink.

2.                               Also overestimate peer/campus heavy drinking. 43 59–64 58

a.     Only 13 % students estimate drinking correctly.

b.     ↑Drinking to match estimation.

c.     Think heavy drinking desirable.

d.     ­­Drink.

3.                               If teach students about peer pressure → ↓ drink.

B.                   Next:  Inaccurate beliefs. (Slide 28)

1.                                False beliefs.

a.     Re: benefits of heavy drinking.

i.             ~65% believe heavy drink→ more fun.

ii.            ~55% believe heavy drink→ better sex.

iii.           Other myths.

                                                          a'.                Lite beer → ↓alcohol.

                                                          b'.                Caffeine, exercise, shower → helps hangover.

                                                          c'.                Used to hangover → good sign.

b.     Re: alcohol used incorrectly for:

i.             Muscle tension relief.

ii.            Better sleep.

2.                               Re: mis / under-informed on dangers of heavy drinking.

a.        Believe can guess BAC.

b.        Minimize alcohol overdose dangers.

c.        Alcohol + other drugs dangers.

4.                Educate students about alc & real effects → ↓ drink.      

 

C.                  Next:  Alcohol to cope.  58 64,65  (Slide 29)

1.                               Students falsely believe alcohol ↓ stress.

2.                               Low doses → ↓ mild anxiety.

3.                               2 or 3 drinks → ↑ anxiety.

a.   Later in evening.

b.   Next morning.

4.                               Drink to treat alcohol-induced anxiety.

a.   Can interfere with searching for better ways to handle stress.

b.   Drinking takes place of healthy coping skills.

5.                               Correct false belief & teach healthy coping skill → ↓ drink.

D.                  Key elements of campus drinking prevention incl.39,50,51,53 (Slide 30)

1.                               Orientation.

a.    Mandatory/optional internet program prior/during.

b.    Campus policy.

c.    1st student screen.

2.                               Student health.

a.   Screening.

b.   Brief Intervention.

c.   Referral to Treatment.

3.                               Campus life.

a.   ↑ reasons not to drink.

i.             Promote choose not to drink.

ii.            Friday tests.

iii.           x 3-day weekends.

b.   ↓ alcohol availability.

i.             x Kegs.

ii.            x Happy hours.

c.   ↑ Alcohol safety..

i.             Safe rides.

ii.            Hotlines for alc OD.

iii.           Teach safer drinking.

                                                          a'.                Discourage pregaming (Drink before go out).

                                                          b'.                Discourage drinking games.

                                                          c'.                Count drinks.

                                                          d'.                Alternate alc and non-alc drinks.

                                                          e'.                Choose 1 type of alc only.

                                                           f'.                Preset # drinks.

4.                               Dorm counselors.

a.   Older.

b.   Salaried.

5.                               Prevention campaigns.

a.   National Alcohol Screening Month is April.

b.   Campus-community partnership.

i.              ­ Alcohol prices.

                                                          a'.                Sales ↓.

                                                          b'.                Esp. freshmen.

ii.            ↓ Alcohol retail outlets.    

iii.           Enforce carding.

iv.          Sobriety checkpoints.

E.                  Prevention videos.   44,48 49 ,51 (Slide 31)

1.                               Taught about:

a.   Peer influence

b.   Accurate alcohol beliefs.

c.   Actual campus drinking patterns.

d.   New coping skills.

e.   Info:  can't guess BAC.

f.     Info: dangers of alcohol + drugs.

2.                               How taught:.

a.   Series of 5..

b.   Economical.

c.   Practical.

d.   Individualized feedback.

3.                               ↓ Heavy drinking.

F.                   Tailoring prevention to risk → ↓ heavy drinking/problems.

V.                  Conclusion. (Slide 32)

A.                  This lecture reviewed:

1.                               Definitions of alcohol use and problems.

2.                               Campus drinking & problems.

3.                               Risk factors for heavy drinking.

4.                               Prevention efforts.


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