Revised October 2013
Alcohol Medical Scholars Program
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.
References
1. Fillmore
KM, Hartka E, Johnstone BM, Leino EV, Motoyoshi M, Temple MT. A meta-analysis
of life course variation in drinking*. British Journal of Addiction.
1991;86(10):1221–1268. doi:10.1111/j.1360-0443.1991.tb01702.x.
2. Schuckit MA. Alcohol-use disorders. Lancet.
2009;373(9662):492–501. doi:10.1016/S0140-6736(09)60009-X.
3. Baer JS, Kivlahan DR, Blume AW, McKnight
P, Marlatt GA. Brief intervention for heavy-drinking college students: 4-year
follow-up and natural history. Am J Public Health. 2001;91(8):1310–1316.
4. Wechsler H, Nelson TF. What we have
learned from the Harvard School Of Public Health College Alcohol Study:
focusing attention on college student alcohol consumption and the environmental
conditions that promote it. J Stud Alcohol Drugs. 2008;69(4):481–490.
5. Neighbors C, Jensen M, Tidwell J, Walter
T, Fossos N, Lewis MA. Social-norms interventions for light and nondrinking
students. Group Processes & Intergroup Relations.
2011;14(5):651–669. doi:10.1177/1368430210398014.
6. Baer JS, Stacy A, Larimer M. Biases in the
Perception of Drinking Norms among College Students: Journal of Studies on
Alcohol and Drugs. 1991;52(6):580.
7. Balodis IM, Potenza MN, Olmstead MC. Binge
drinking in undergraduates: Relationships with gender, drinking behaviors,
impulsivity and the perceived effects of alcohol. Behav Pharmacol.
2009;20(5-6):518–526. doi:10.1097/FBP.0b013e328330c779.
8. Barnett NP, Lebeau-Craven R, O’Leary TA,
et al. Predictors of motivation to change after medical treatment for
drinking-related events in adolescents. Psychol Addict Behav.
2002;16(2):106–112.
9. BARNETT NP, GOLDSTEIN AL, MURPHY JG, COLBY
SM, MONTI PM. “I’ll Never Drink Like That Again”: Characteristics of
Alcohol-Related Incidents and Predictors of Motivation to Change in College
Students. J Stud Alcohol. 2006;67(5):754–763.
10. Knight JR, Wechsler H, Kuo M, Seibring M,
Weitzman ER, Schuckit MA. Alcohol abuse and dependence among U.S. college
students. J Stud Alcohol. 2002;63(3):263–270.
11. 1College_Bulletin-508_361C4E.pdf. Available
at: http://www.collegedrinkingprevention.gov/1College_Bulletin-508_361C4E.pdf.
Accessed January 13, 2013.
12. Hingson RW, Zha W, Weitzman ER. Magnitude of
and Trends in Alcohol-Related Mortality and Morbidity Among U.S. College
Students Ages 18-24, 1998-2005. J Stud Alcohol Drugs Suppl.
2009;(Supplement no. 16):12–20.
13. Fromme K, Wetherill R, Neal D. Turning 21
and the Associated Changes in Drinking and Driving after Drinking Among College
Students. J Am Coll Health. 2010;59(1):21–27. doi:10.1080/07448481.2010.483706.
14. harvardstudy.pdf. Available at:
http://www.campusfiresafety.org/uploaded/harvardstudy.pdf. Accessed January 19,
2013.
15. White AM, Kraus CL, Swartzwelder H. Many
college freshmen drink at levels far beyond the binge threshold. Alcohol
Clin Exp Res. 2006;30(6):1006–1010. doi:10.1111/j.1530-0277.2006.00122.x.
16. Wechsler H, Lee JE, Nelson TF, Kuo M.
Underage college students’ drinking behavior, access to alcohol, and the
influence of deterrence policies. Findings from the Harvard School of Public
Health College Alcohol Study. J Am Coll Health. 2002;50(5):223–236.
doi:10.1080/07448480209595714.
17. Mundt MP, Zakletskaia LI, Brown DD, Fleming
MF. Alcohol-induced memory blackouts as an indicator of injury risk among
college drinkers. Inj Prev. 2012;18(1):44–49.
doi:10.1136/ip.2011.031724.
18. Mundt MP, Zakletskaia LI. Prevention for
College Students Who Suffer Alcohol-Induced Blackouts Could Deter High-Cost
Emergency Department Visits. Health Aff (Millwood). 2012;31(4):863–870.
doi:10.1377/hlthaff.2010.1140.
19. DeJong W, Larimer ME, Wood MD, Hartman R.
NIAAA’s Rapid Response to College Drinking Problems Initiative: Reinforcing the
Use of Evidence-Based Approaches in College Alcohol Prevention. J Stud
Alcohol Drugs Suppl. 2009;(Supplement no. 16):5–11.
20. Schuckit MA. Drug and Alcohol Abuse: A
Clinical Guide to Diagnosis and Treatment. Softcover reprint of hardcover
6th ed. 2006. Springer; 2010.
21. Acute_Alcohol_Intoxication_20121.ppt.
Available at: http://www.alcoholmedicalscholars.org/web/presentations/ppt/Acute_Alcohol_Intoxication_20121.ppt.
Accessed February 13, 2013.
22. Oorsouw K van, Merckelbach H, Ravelli D,
Nijman H, Mekking-Pompen I. Alcoholic blackout for criminally relevant
behavior. J Am Acad Psychiatry Law. 2004;32(4):364–370.
23. Association AP. Diagnostic and
Statistical Manual of Mental Disorders DSM-IV-TR Fourth Edition. 4th ed.
American Psychiatric Association; 2000.
24. by. Diagnostic and Statistical Manual of
Mental Disorders, 5th Edition (DSM-5). Barnes & Noble. Available at:
http://www.barnesandnoble.com/w/diagnostic-and-statistical-manual-of-mental-disorders-5th-edition-american-psychiatric-association/1116698742.
Accessed October 1, 2013.
25. Carter AC, Brandon KO, Goldman MS. The
College and Noncollege Experience: A Review of the Factors That Influence
Drinking Behavior in Young Adulthood. J Stud Alcohol Drugs.
2010;71(5):742–750.
26. Dawson DA, Grant BF, Stinson FS, Chou PS.
Another look at heavy episodic drinking and alcohol use disorders among college
and noncollege youth. J Stud Alcohol. 2004;65(4):477–488.
27. Slutske WS. Alcohol use disorders among US
college students and their non-college-attending peers. Arch Gen Psychiatry.
2005;62(3):321–327. doi:10.1001/archpsyc.62.3.321.
28. Slutske WS, Hunt-Carter EE, Nabors-Oberg RE,
et al. Do college students drink more than their non-college-attending peers?
Evidence from a population-based longitudinal female twin study. J Abnorm
Psychol. 2004;113(4):530–540. doi:10.1037/0021-843X.113.4.530.
29. PubMed Central Full Text PDF. Available at:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3139334/pdf/nihms291068.pdf.
Accessed January 12, 2013.
30. Neighbors C, Atkins DC, Lewis MA, et al.
Event Specific Drinking Among College Students. Psychol Addict Behav.
2011;25(4):702–707. doi:10.1037/a0024051.
31. Cashin JR, Presley CA, Meilman PW. Alcohol
use in the Greek system: follow the leader? J Stud Alcohol.
1998;59(1):63–70.
32. Scott-Sheldon LAJ, Carey KB, Carey MP.
Health Behavior and College Students: Does Greek Affiliation Matter? J Behav
Med. 2008;31(1):61–70. doi:10.1007/s10865-007-9136-1.
33. Larimer ME, Turner AP, Mallett KA, Geisner
IM. Predicting Drinking Behavior and Alcohol-Related Problems Among Fraternity
and Sorority Members: Examining the Role of Descriptive and Injunctive Norms. Psychol
Addict Behav. 2004;18(3):203–212. doi:10.1037/0893-164X.18.3.203.
34. Substance Abuse Higher in Fraternities
and Sororities. About.com Alcoholism. Available at:
http://alcoholism.about.com/od/college/a/blnida050918.htm. Accessed January 15,
2013.
35. Nelson TF, Wechsler H. Alcohol and college
athletes. Med Sci Sports Exerc. 2001;33(1):43–47.
36. Grossbard JR, Geisner IM, Mastroleo NR,
Kilmer JR, Turrisi R, Larimer ME. Athletic identity, descriptive norms, and
drinking among athletes transitioning to college. Addict Behav.
2009;34(4):352–359. doi:10.1016/j.addbeh.2008.11.011.
37. Neal DJ, Fromme K. Hook ‘Em Horns and Heavy
Drinking: Alcohol Use and Collegiate Sports. Addict Behav.
2007;32(11):2681–2693. doi:10.1016/j.addbeh.2007.06.020.
38. Yusko DA, Buckman JF, White HR, Pandina RJ.
Risk for excessive alcohol use and drinking-related problems in college student
athletes. Addict Behav. 2008;33(12):1546–1556.
doi:10.1016/j.addbeh.2008.07.010.
39. Schuckit MA, Smith TL, Trim R, et al. The
performance of elements of a “level of response to alcohol”-based model of
drinking behaviors in 13-year-olds. Addiction. 2008;103(11):1786–1792.
doi:10.1111/j.1360-0443.2008.02325.x.
40. Schuckit MA, Smith TL. The relationships of
a family history of alcohol dependence, a low level of response to alcohol and
six domains of life functioning to the development of alcohol use disorders. J
Stud Alcohol. 2000;61(6):827–835.
41. 082-Presley.pdf. Available at:
http://www.collegedrinkingprevention.gov/media/Journal/082-Presley.pdf.
Accessed January 27, 2013.
42. 3-15.pdf. Available at:
http://pubs.niaaa.nih.gov/publications/arh321/3-15.pdf. Accessed January 27,
2013.
43. Brown SA, McGue M, Maggs J, et al. A
Developmental Perspective on Alcohol and Youths 16 to 20 Years of Age. PEDIATRICS.
2008;121(Supplement):S290–S310. doi:10.1542/peds.2007-2243D.
44. Decisionmakingshort.ppt. Available at:
http://www.alcoholmedicalscholars.org/web/presentations/ppt/Decisionmakingshort.ppt.
Accessed January 26, 2013.
45. Kassel JD, Jackson SI, Unrod M. Generalized
Expectancies for Negative Mood Regulation and Problem Drinking among College
Students. Journal of Studies on Alcohol and Drugs. 2000;61(2):332.
46. Arnett JJ. The Developmental Context of
Substance Use in Emerging Adulthood. Journal of Drug Issues.
2005;35(2):235.
47. Papachristou H, Nederkoorn C, Corstjens J,
Jansen A. The role of impulsivity and perceived availability on cue-elicited
craving for alcohol in social drinkers. Psychopharmacology (Berl).
2012;224(1):145–153. doi:10.1007/s00213-012-2747-4.
48. Trim RS, Simmons AN, Tolentino NJ, et al.
Acute ethanol effects on brain activation in low- and high-level responders to
alcohol. Alcohol Clin Exp Res. 2010;34(7):1162–1170.
doi:10.1111/j.1530-0277.2010.01193.x.
49. Silveri MM. Adolescent brain development and
underage drinking in the United States: identifying risks of alcohol use in
college populations. Harv Rev Psychiatry. 2012;20(4):189–200.
doi:10.3109/10673229.2012.714642.
50. Schuckit MA, Smith TL, Hesselbrock V, et al.
Clinical implications of tolerance to alcohol in nondependent young drinkers. Am
J Drug Alcohol Abuse. 2008;34(2):133–149. doi:10.1080/00952990701877003.
51. Schuckit MA, Smith TL, Kalmijn J, et al.
Comparison across two generations of prospective models of how the low level of
response to alcohol affects alcohol outcomes. J Stud Alcohol Drugs.
2012;73(2):195–204.
52. Schuckit MA, Tapert S, Matthews SC, et al.
fMRI differences between subjects with low and high responses to alcohol during
a stop signal task. Alcohol Clin Exp Res. 2012;36(1):130–140.
doi:10.1111/j.1530-0277.2011.01590.x.
53. Schuckit MA, Kalmijn JA, Smith TL, Saunders
G, Fromme K. Structuring a college alcohol prevention program on the low level
of response to alcohol model: a pilot study. Alcohol Clin Exp Res.
2012;36(7):1244–1252. doi:10.1111/j.1530-0277.2011.01723.x.
54. Wood MD, Read JP, Mitchell RE, Brand NH. Do
Parents Still Matter? Parent and Peer Influences on Alcohol Involvement Among
Recent High School Graduates. Psychology of Addictive Behaviors.
2004;18(1):19–30. doi:10.1037/0893-164X.18.1.19.
55. BORSARI B, CAREY KB. How the quality of peer
relationships influences college alcohol use. Drug Alcohol Rev.
2006;25(4):361–370. doi:10.1080/09595230600741339.
56. Kinard BR, Webster C. The Effects of
Advertising, Social Influences, and Self-Efficacy on Adolescent Tobacco Use and
Alcohol Consumption. Journal of Consumer Affairs. 2010;44(1):24–43.
doi:10.1111/j.1745-6606.2010.01156.x.
57. LONCZAK HS, HUANG B, CATALANO RF, et al. The
Social Predictors of Adolescent Alcohol Misuse: A Test of the Social
Development Model. J Stud Alcohol. 2001;62(2):179–189.
58. Schuckit MA, Smith TL, Danko GP, et al. An
evaluation of the full level of response to alcohol model of heavy drinking and
problems in COGA offspring. J Stud Alcohol Drugs. 2009;70(3):436–445.
59. Labbe AK, Maisto SA. Alcohol expectancy
challenges for college students: a narrative review. Clin Psychol Rev.
2011;31(4):673–683. doi:10.1016/j.cpr.2011.02.007.
60. White AM, Kraus CL, McCracken LA,
Swartzwelder HS. Do College Students Drink More Than They Think? Use of a
Free-Pour Paradigm to Determine How College Students Define Standard Drinks. Alcoholism:
Clinical and Experimental Research. 2003;27(11):1750–1756.
doi:10.1097/01.ALC.0000095866.17973.AF.
61. Devos-Comby L, Lange JE. “My drink is larger
than yours”? A literature review of self-defined drink sizes and standard
drinks. Curr Drug Abuse Rev. 2008;1(2):162–176.
62. Reslan S, Saules KK, Serras A. “Partier”
self-concept mediates the relationship between college student binge drinking
and related adverse consequences. Addict Behav. 2011;36(8):855–860.
doi:10.1016/j.addbeh.2011.03.018.
63. Wechsler H, Nelson TF. Relationship between
level of consumption and harms in assessing drink cut-points for alcohol
research: Commentary on “Many college freshmen drink at levels far beyond the
binge threshold” by white et Al. Alcohol Clin Exp Res.
2006;30(6):922–927. doi:10.1111/j.1530-0277.2006.00124.x.
64. Pressure to drink could be all in the mind -
Epsom and St Helier University Hospitals NHS Trust. Available at:
http://www.epsom-sthelier.nhs.uk/news/news-archive/2010/march-2010/pressure-to-drink-could-be-all-in-the-mind/.
Accessed January 20, 2013.
65. Schuckit MA, Smith TL. Onset and course of
alcoholism over 25 years in middle class men. Drug Alcohol Depend.
2011;113(1):21–28. doi:10.1016/j.drugalcdep.2010.06.017.
66. Schuckit MA, Smith TL, Heron J, et al.
Testing a level of response to alcohol-based model of heavy drinking and
alcohol problems in 1,905 17-year-olds. Alcohol Clin Exp Res.
2011;35(10):1897–1904. doi:10.1111/j.1530-0277.2011.01536.x.