Another Round (or Five)

A female student who drinks four Appletinis during a night of club hopping is a binge drinker, according to most experts who study campus health behaviors. But so is a male student who ends up in a campus health center after an intense night of keg stands and beer pong.

Researchers say that curbing negative consequences resulting from drinking -- an already difficult task -- has been complicated because much past research has often not differentiated the levels of college drinking behaviors. A new study, which will be published in the June issue of Alcoholism: Clinical & Experimental Research, offers some startling differentiations, which indicate that almost 30 percent of all freshmen regularly drink two times the amount of alcohol that defines traditional binge drinking.

In most studies of college drinking, the term “binge drinking” is a dichotomous variable defined by meeting or exceeding a threshold -- four or more drinks for females and five or more drinks for males. In 2004, a National Institute on Alcohol Abuse and Alcoholism panel narrowed the definition of a binge to having those numbers of drinks within a two-hour period, which would theoretically lead the average male or female to achieve a peak blood alcohol content level of roughly .08 percent.

“Despite the utility of the modern definition of binge drinking, it is unfortunate, in my opinion, that we have all focused so intently on crossing a specific threshold rather than discussing the real issues -- the consequences,” says Aaron M. White, assistant professor in the department of psychiatry at Duke University Medical Center and lead author of the study. “One of the real limitations of the way that the word ‘binge’ is now used is that the same level of risk is assigned to all students that cross the threshold regardless of how far beyond the threshold they go.”

White says that by failing to differentiate between those who just pass the threshold and those who double or triple it, policy makers often fail to focus on dangerously real problems.

Research by Henry Wechsler and his colleagues at the Harvard School of Public Health, the main proponents of the 4+/5+ measure of binge-drinking, has shown that students who meet or exceed the binge threshold are at greater risk of suffering negative alcohol-related consequences than non-binge drinkers.

Many researchers believe that further differentiations are necessary. In that effort, White and his colleagues analyzed the self-reported drinking histories of 10,424 first-semester freshmen at 14 institutions across the U.S. They not only measured the numbers of students who reached the 4+/5+ binge-drinking threshold, they also detailed those who drank at two and three times the binge threshold.

They found that that roughly 20 percent of all freshman males and 8 percent of females had 10 or more drinks at least once during a 24-hour period in the two weeks preceeding the study. Almost 8 percent of males and 2 percent of females drank 15 or more drinks.

“It might be true that 40 percent of students nationwide engage in ‘binge drinking,’ but it’s certainly not the case that 40 percent of all students are causing problems,” says White. “My guess is that the problems are much more likely to arise from the smaller group of students going way overboard when they drink. 

“Focusing more attention on that group, rather than persecuting nearly half of the college students in the country, might allow us to make more progress toward minimizing the damage that alcohol is doing to quality of life on college campuses,” he says.

Wechsler, who will contribute an editorial regarding the White study in the upcoming issue of Alcoholism: Clinical & Experimental Research, offers a mixed review of the new research: “While it may be useful to use higher thresholds for individual diagnoses, it’s better for the general population of college drinkers for us to be to curbing the overall problems associated with the established binge drinking threshold,” he says. 

Such problems cover such diverse consequences as low grades to dropping out to death.

Many researchers argue that the variety of negative effects that flow from the lower binge drinking threshold makes it difficult to serve students who are most at risk of hurting themselves or others.

“We need to find ways to focus on the 20 percent of students who are the very serious problem,” says H. Wesley Perkins, a professor of sociology at Hobart and William Smith Colleges, who has studied the campus drinking culture for years. “The crude measures have gotten this topic on the map, but in the long run, I don’t think it’s been helpful in the most serious of situations.”

Perkins says that many students seem to fear that administrators are trying to eradicate drinking from campuses altogether. “I hope we can create more of a divide between students,” he says. “So it’s not an ‘us versus the administration’ mentality. We should be driving a wedge between responsible student drinkers and the high-risk drinkers.”

He believes that strong support from students could help alter the culture of alcohol use on campuses such that excessive drinking is no longer tolerated. He also argues that many students have become wary of hearing that almost half of them are binge drinkers, when there are sometimes no negative consequences associated with drinking at the levels Wechsler defines as binge drinking.

White says that Wechsler’s points on consequences are well-taken: “He has eloquently responded to critics by reminding them that, regardless of what you call it, crossing that threshold increases one’s risk of consequences.  The consequences are the main issue, not the drink threshold per se.”