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College Drinking…and Beyond

Fall is upon us with its vibrant leaves and academic fervor. Midterms and tailgates are the colors of the season for earnest college students who, like the temperature outside, are going through transitions.

Part of the passage into adulthood includes leaving the warmth and security of the parents’ homes and working towards independence. Academic rigors are only part of the experience. Dating, rushing, rebelling, and partying are universal experiences and part of the formative process.

And for many students, partying includes drinking alcohol. Whether it’s for fun, relaxation, or in response to peer pressure, young adults imbibe for a variety of reasons.

A Flurry of Activity

The therapist’s office is often flooded with students around this time of year. It’s common for people to present to therapy because of the consequences of a drinking incident. They don’t come with a chief complaint of problematic drinking.

Arriving on campus, young collegiates are anxious to establish their place in a new setting. First-years are learning from upperclassmen and women (usually about twice their size) and in many cases trying hard to impress them by matching each drink for drink.

Mental illnesses, such as depression, bipolar disorder, anxiety, and psychosis, tend to emerge during young adulthood. Alcohol, which is a central nervous system depressant, can either precipitate or perpetuate psychiatric disorders.

These facts are too often not a consideration for students, however, who are receiving the message that glamorized drinking is essential for the college experience.

College Drinking Statistics

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) has studied college student drinking and reports the following annual statistics:

  • About half of college student drinkers engage in heavy episodic consumption, defined as four to five drinks in a row, respectively, for women and men during a two-week period.
  • Fellow students who have been drinking alcohol assault nearly 700,000 students.
  • Almost 600,000 students are injured – and about 1,825 students die – as a result of alcohol poisoning and alcohol-related accidents.
  • Nearly 100,000 students are survivors of sexual assault while under the influence of alcohol and upwards of 400,000 students have unprotected sex while drunk.
  • About 25% of college students report negative academic consequences because of their drinking, including missing class, doing poorly on exams or papers and receiving lower grades overall.

Becoming an “Alcoholic”

The long-term effects of college binge drinking include a higher risk of lifelong alcohol dependency than more temperate peers. NIAAA reports that nearly three-quarters of people have a single period of heavy drinking in their lives that lasts on average three to four years during college. This tends to peak around ages 18 to 24 and then they may mature out of it.

The signs of alcoholism manifest in the form of both psychological and physiological symptoms. Examples can include:

  • Tolerance is defined by either a need for markedly increased amounts to achieve intoxication or desired effect or markedly diminished effect with continued use of the same amount.
  • Withdrawal symptoms can range from tremors, to headache and nausea and vomiting. It can also manifest as early morning imbibing to avoid the described physical symptoms of withdrawal.
  • Additional signs of addiction are continued use despite negative personal and physical consequences, expending time seeking out alcohol, drinking more than intended, stopping social or recreational activities due to alcohol use, and a persistent desire to cut back.

Determining the Risks

Unfortunately, there is no clear way to determine which individuals will phase out of binge drinking and which will continue. There are a number of risk factors that increase the chance of an individual developing a more severe and lasting alcohol use disorder.

Genetics, environment and predispositions toward mental illness all make someone vulnerable. College students who experience the following should be on alert: blacking out, inability to have just one to two drinks, obsess about alcohol, need to be drunk before going to a party (i.e. “pre-gaming”) and spend lots of time with heavy drinkers.

How to Approach the College Student Drinker

The approach to a college drinker is different depending on your role. Friends are well advised to look out for each other and have a friend’s backs. When going out, there is safety in numbers and it’s a good idea to make a deal to leave a party together as this best assures that everyone gets home safely. Making a deal to keep one another in check with regard to drunken behaviors and cutting each other off is also helpful. Certainly, if vehicles are involved, having a designated driver is in order.

The best approach for parents is to encourage their children to talk openly about their alcohol consumption. Being non-judgmental is just as important as is refraining from glorifying your own college drinking days in what that might be read as permission to indulge in the same behaviors.

A good approach for parents to use when broaching the difficult drinking conversation is to ask what their college student does at night on campus or what goes on for fun.

Such simple questions could lead to some eye-opening revelations.

Avoid either lecturing about risks and remedies. If you have concerns and feel the door might be open for advice, however, you can gently ask if your child is experiencing consequences he or she might be concerned about, and point out that the college or university likely has a counseling center to help with such concerns or they can refer you to the experts who can.

The Therapist’s Role

It’s important for the mental health professional to be astute to the fact that binge drinking is not just social. It’s often a way that students manage their feelings, including anxiety, depression, worry and sexuality.

It is normal for college students – flooded with hormones and learning to manage life on their own – to have some difficulty with self-soothing.-Helen M. FarrellThe bottom line is that binge behavior is really due to difficulties in calming and regulating oneself. Pacifying oneself is a difficult task in the best of times – college students, who are thronged with hormones, commonly experience this as
an exceptional challenge.

My experience with college students has often been that, much as they long to be independent from their parents, they actually still need someone else to provide those functions during their freshman and sophomore years, and sometimes even afterwards.

Motivational interviewing is extremely useful when talking with the college student engaging in binge drinking behaviors. There are multiple domains of motivational interviewing which include asking permission, eliciting change, exploring confidence, asking open-ended questions and reflective listening.

Asking permission communicates respect for patients who are more likely to discuss changing when asked, rather than being told to change. “Can we talk a bit about your drinking?” has been an effective question in my therapy meetings with young adults.

Exploring Confidence and Change

Eliciting change helps to give patients a voice. During the therapy session, it is important that the patient, not the therapist, define the need for changing. The alternative is a therapist lecturing the importance of and reasons why a patient should change – an ill-advised strategy that promotes stagnation rather than growth.

Consider, for example, the difference between these two approaches:

  • “What would you like to see different about your current situation?”
  • “If you stop drinking, you could get out of this mess.”

Exploring confidence in the patient serves two roles. First, it provides the therapist with information about how patients view the importance of changing and the extent to which they feel change is possible. Second, it gives patients the opportunity to put a voice to what they would need to do to change.

Other useful strategies include asking open-ended questions such as, “What’s happened since we last met?” Reflective listening is also an empathic way to respond to patients and builds trust.

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