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Nat
ion
al I
nst
itu
te o
n A
lcoh
ol A
bu
se a
nd
Alc
ohol
ism
Nat
ion
al I
nst
itu
te o
n A
lcoh
ol A
bu
se a
nd
Alc
ohol
ism
College Drinking in its Developmental Context
Mark Goldman, Ph.D.
Associate Director
National Institute on Alcohol Abuse and Alcoholism
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NIAAA Staff Contributors
Bowersox , John Chezem, Linda
Donodeo, Fred Faden, Vivian (CoLeader)
Goldman, Mark (CoLeader) Hartman, Roger
Hingson, Ralph Lazarow, Jason
Lowman, Cherry Mattson, Margaret
Miller, Diane Moss, Howard
Powell, Patricia Roa, Gregory
Witt, Ellen Bryant, Kendall
Higley, Dee Hommer, Dan
Sorenson, Roger Twombly, Dennis
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NIAAA Task Force on College Drinking Chairs:
Rev. Edward Malloy (Notre Dame)
Dr. Mark Goldman (South Florida)
Members:
college presidents
researchers
students
Timeframe: 1998 – 2002
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Task Force Roster:Presidents
Rev. Edward Malloy, Notre Dame (co-chair)
Tomas Arciniega, Cal. State Bakersfield
Robert Carothers, URI
John Casteen, UVA
Edward Foote, U of Miami
Michael Hooker, UNC Chapel Hill
William Jenkins, LSU
William Kirwan, Ohio State
James Lyons, Cal. State Dominguez Hills
Susan Resneck Pierce, U. of Puget Sound
Judith Ramaley, U of Vermont
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Task Force Roster:Researchers and Practitioners
Mark Goldman, USF (co-chair)
Marilyn Aguirre-Molina, Columbia U.
David Anderson, George Mason
Michael Fleming, Wisc-Madison
Bill DeJong, HEC
Ellen Gold, Eastern Michigan
Ralph Hingson, BU
Harold Holder, PIRE
Patrick Johnson, CASA
Donald Kenkel, Cornell
G. Alan Marlatt, U of Washington
Marcus Rothschild, VA Med. Cntr
Robert Saltz, PIRE
Kenneth Sher, U of Missouri
Henry Wechsler, Harvard
Sharon Wilsnack, U. of North Dakota
Robert Zucker, U of Michigan
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Task Force Report
• Key Features:
•Analysis and extent of the problem
•Research-based recommendations for presidents & administrators
•Recommendations for future research
•Recommendations to NIAAA for supporting future research
•“3 in 1” Framework
• 4 Tiers Originally published April 9, 2002
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Related Materials
• 2 Panel Reports
• Journal articles
• 3 Brochures
• Planning and Evaluation Handbook
•Related materials include--
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New College Drinking Web Sitewww.collegedrinkingprevention.gov
Important information is more easily accessible to users from the homepage.
The new site better highlights the main conclusions of the Task Force.
Improved usability makes navigation more intuitive for the user.
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New College Bulletin to update aspects of the Report
Research Update on Individual and Environmental Interventions for College Students
New Statistics
New Definition of Binge Drinking
New Discussion of Alcohol Poisoning
New Chart of Drinking Patterns during Freshman Year
Updates on NIAAA’s “Rapid Response” Grant Program and “Underage Steering Committee”
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Update on College Drinking Consequences:1998 compared to 2001
Deaths: 1400/ 1700 Alcohol-Related Unintentional Injury Deaths
Injuries: 500,000/ 599,000 unintentional injuries
Assault: 600,000/ 696,000 assaults
Sexual Assaults or Date Rapes: 70,000/ 97,000Source: Hingson et al. 2002 and 2005
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Recommendations
The 3-in-1 Framework -- “a useful introduction to encourage presidents, administrators, college prevention specialists, students, and community members to think in a broad and comprehensive fashion about college drinking”
Individuals, including at-risk or alcohol-dependent drinkers
Student body as a whole
College and surrounding community
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Recommendations
Tier 1 Evidence of Effectiveness Among College Students
Tier 2: Evidence of Success With General Populations That Could Be
Applied to College Environments
Tier 3: Evidence of Logical and Theoretical Promise, But Require More Comprehensive Evaluation
Tier 4: Evidence of Ineffectiveness
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Tier 1: Effective with College Students
Combined cognitive-behavioral skills /norms clarification
/motivational enhancement
Brief motivational enhancement
Alcohol Expectancies (now
controversial)
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Tier 2: Effective with General Populations
Increased enforcement- MLDA laws
Restrict retail density
Increased price and excise tax
Responsible beverage policies
Formation of campus/community
coalitions
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Tier 3: Promising
Adopt specific campus-based policies (e.g. reinstate
Friday classes)
Increased enforcement at campus events
Increasing publicity of enforcement
Enforce disciplinary action of violations
Marketing campaigns correcting students
misperceptions about alcohol use
Awareness of personal liability
Informing new students/parents about alcohol policies
and penalties
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Tier 4: Ineffective
Educational interventions when used alone
Sobriety tests
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m Recent findings from my lab:
Del Boca et al. (2004). JCCP
Greenbaum et al. (2005). JCCP
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But the problem begins
before college…
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“What the NIAAA task force called a culture of drinking leads many students to harm themselves or others and clearly is antithetical to academic success. The task force is right that we will need a concerted and coordinated effort if we are to change this culture…sadly and tragically, the serious problem of alcohol abuse and misuse on college campuses persists with students often coming to our campuses with histories of excessive drinking.”
(Susan Resneck Pierce, former President U of Puget Sound).”
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0
5
10
15
20
25
30
35
40
45
50
8th 10th 12th
Grade
Pe
rce
nt
Us
ing
in P
as
t M
on
th
Alcohol
Cigarettes
Marijuana
Alcohol is the Drug of Choice Among Adolescents
Source: Monitoring the Future, 2003
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Youth drink less frequently than adults, but drink more per occasion
Source: SAMHSA National Survey on Drug Use and Health, 2002
2.67
4.79
8.91
4.87
0
2
4
6
8
10
Underage Adults
Drinks per Occasion Drinking Days per Month
(12-17) (26 and older)
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Drinking Trends AmongHigh School Seniors, 1975-2002
0102030405060708090
100
1975
1978
1981
1984
1987
1990
1993
1996
1999
2002
Per
cen
t Yearly
Monthly
5+ Drinks
Source: Monitoring the Future, 2002
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About 50% of kids start drinking by the 8th grade.
Binge drinking (past 2 weeks):
12% of 8th graders
22% of 10th graders
28% of 12th graders
Drunk (ever):
20% of 8th graders
40% of 10th graders
60% of 12th gradersSource: Monitoring the Future, 2003
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mUnderage Drinking in Europe
AustriaBelgiumBulgariaCroatiaCyprus
Czech RepublicDenmark
EstoniaFarce Islands
FinlandFrance
GermanyGreece
GreenlandHungary
IcelandIreland
Isle of ManItaly
LatviaLithuania
MaltaNetherlands
NorwayPoland
PortugalRomania
RussiaSlovak Republic
SloveniaSweden
SwitzerlandTurkey
UkraineUK
USA
AustriaBelgiumBulgariaCroatiaCyprus
Czech RepublicDenmark
Estonia
FranceGermany
GreeceGreenland
IcelandIreland
Isle of ManItaly
LatviaLithuania
MaltaNetherlands
NorwayPoland
PortugalRomania
RussiaSlovak Republic
SwedenSwitzerland
TurkeyUkraine
UKSpainUSA
Slovenia
Percent of 15-Year Olds Who Drank to Intoxication in the Past 12 Months
Percent of 15-Year Olds Who Consumed an Alcoholic Beverage in
the Past 12 MonthsESPAD 2003
Farce IslandsFinland
Hungary
0 10 20 30 40 50 60 70 80 90 100 0 10 20 30 40 50 60 70 80 90 100
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Direct Consequences
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m Annually, about 5,000 youth under 21 die from alcohol-related injuries.
Often a factor in physical and sexual assault and unintended sexual activity.
Contributes to academic problems.Exposure of the developing brain to alcohol might have long-lasting effects.
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Second-Hand Effects
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Half of all persons who die in traffic crashes involving drinking drivers under age 21 are persons other than the drinking driver.
Among college students under age 21 alone, 50,000 experience alcohol-related date rape, and 430,000 are injured by another student who has been drinking.
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Alcohol Dependence
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Prevalence of Lifetime Alcohol Dependence by Age of First Alcohol Use and Family History of Alcoholism
Source: Grant and Dawson. J Subst Abuse. 1998. 10(2):163-73.
0
10
20
30
40
50
60
13 14 15 16 17 18 19 20 21
Age at First Alcohol Use
% P
reva
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Family History Positive
Total
Family History Negative
Age at First Alcohol Use
% P
reva
lenc
e
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Prevalence of Past-year DSM-IV Alcohol Dependence: United States, 2001-2002
0%
2%
4%
6%
8%
10%
12%
14%
18-2
021
-24
25-2
930
-34
35-3
940
-44
45-4
950
-54
55-5
960
-64
65-6
970
+
Grant, B.F. et al., Drug and Alcohol Dependence, in press 2004.Source: Grant BF et al. Drug Alcohol Depend. 2004. 74(3):223-34.
Avg.4.8%
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The Dilemma of Adolescence and
Drinking
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m Adolescence (in Humans): The period between sexual
maturation and the attainment of adult roles and responsibilities.
Many body systems are restructured.
Number, types, and connectivity of brain cells is changed.
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With Puberty, Adolescents (in many species) Increase : sexual interest, romantic motivation,
emotional intensity, sleep/arousal regulation, appetite.
risk-taking, novelty-seeking, sensation seeking.
motivation for social status.
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In Contemporary Society (U.S.): Average age of menarche is now age 12;
average age of first marriage for females is 26.
Many adult social roles--starting careers, owning a home, becoming parents--are now occurring a decade or more after puberty.
Adolescence has expanded from a 2-4 year interval to an 8-15 year interval in contemporary society.
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Health Paradox of Adolescence:
Adolescence is the healthiest and most resilient period of the lifespan.
YET:
Overall morbidity and mortality rates increase 200-300% between middle childhood and late adolescence/early adulthood.
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Morbidity and Mortality Due to:
Problems with control of behavior and emotion.
Increase in risk-taking, sensation-seeking, and erratic (emotionally-influenced) behavior.
Early onset of co-occurring illnesses including depression, eating disorders, alcohol and other substance use disorders.
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Solving the Conundrum of Adolescent Risk/Alcohol-Related
Casualties
How do we reduce alcohol-related risk in adolescence despite the normal risk-inducing processes inherent to adolescence?
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Related Questions:Does alcohol distort normative adolescent development?
How do the processes of adolescence contribute to immediate and lifetime alcohol risk?
Are adolescents particularly vulnerable to alcohol-induced organ damage?
How can we design policy/prevention/ intervention appropriate to transitional stages?
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What do we know now?
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Neurobiological Mechanisms
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Less sensitive: aversive effects of acute alcohol intoxication (sedation, hangover, ataxia).
More sensitive: social facilitation.
Adolescent Alcohol Sensitivity(New Findings, Animal Research)
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Prenatal or early postnatal alcohol exposure increases alcohol preference during infancy and adolescence.
Under separation stress, adolescent nonhuman primates double their rates of alcohol consumption--related to changes in corticotrophin and cortisol levels or serotonin.
Adolescent rats show an attenuated corticosterone response to ethanol, with gender differences.
Role of Early Exposure to Alcohol and Stress(New Findings, Animal Research)
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Binge-like episodes produce long-lasting changes in memory, and damage to frontal-anterior cortical regions.
Prolonged ethanol exposure enhances withdrawal-related behavior and produces long-lasting neurophysiological changes in cortex and hippocampus.
Consequences of Adolescent Alcohol Use on the Developing Brain
(New Findings, Animal Research)
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Consequences of Adolescent Alcohol Use on the Developing Brain
(New Findings, Human Studies)
Adolescents with severe alcohol abuse/ dependence disorders have:
• neuropsychological impairments
• reduced brain hippocampal volumes
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Genetics of Adolescent Alcohol Use
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In Adults:
Genetic component (from twin, family, adoption studies)
Environmental Factors
Alcohol availability & access
Life experiences and events
Societal customs
Peer relationships
Family interactions
Stress
Trauma
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The genetic contribution to early substance use may be small relative to the environmental contribution.
Progression leading to and desistance from alcohol abuse and dependence
Initiation of drinking:
Continuing use:
Problem use:
Termination:
But in adolescents?
Dynamic Interplay of genetic and environmental risk
factors
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Personality TraitsExternalizing /Internalizing
Disinhibition Negative Emotionality
Brain Maturation Limbic System Frontal Cortex
Social Influences Parents Peers Romantic interests
Transitions Middle School High School College Adult roles
Hormonal Changes
Time Time
Development
Time Time
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Psychosocial Processes of Risk and Protection
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Personality:• Behavioral Disinhibition
Antisocial PersonalityConduct disorderImpulsivitySensation seeking
• Negative Emotionality• Internalizing/Externalizing
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59N
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m Expectancies about alcohol:
•Develop on average before age 9 and sometimes before age 5.
•Can be found in children before drinking begins.
•Shift from primarily negative at about age 9 to primarily positive by age 13.
60N
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m •Correlate with drinking.
•Predict drinking prospectively.
• Influence drinking decisions.
•Mediate Biological and Psychosocial Risk.
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Cognitive Development and Adolescent Decision-Making:• Immaturity of cognitive processing leads to risky decisions.
• Or… reason-based decision-making overridden in social-emotional contexts.
• Or… adolescent decision-making is configured for adolescent transitions—without intervention (scaffolding), there will be casualties.
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Parents, Peers, and Community Influences:
•Warm, loving parents are protective; child-parent conflict increases risk (not well supported).
•Involvement with problem peers increases risk (better supported).
•Supportive communities may be protective (e.g., availability of after school programs).
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Alcohol Advertising
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Youth are routinely exposed to appealing alcohol advertising (television, radio, magazines).
Cross-sectional studies have found small but positive correlations between exposure to and awareness of alcohol advertising and drinking beliefs and behaviors among youth.
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Alcohol Price
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Alcohol beverage prices and taxes are associated with lower levels of alcohol consumption and alcohol-related problems.
But, wide variability in the extent of the impact — particularly for underage.
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Drinking Laws
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Minimum legal drinking age and zero tolerance laws have reduced death and injuries due to alcohol-impaired driving. But:
*enforcement is inconsistent.
*youth have been found to be unaware of zero tolerance
laws.
*enforcement can have unintended adverse impact.
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Prevention and Treatment
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Can be Difficult to Distinguish in Adolescents
Both Designed to Change Developmental Pathways
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Intervening Is Complicated
Because adolescence is complicated.
Because multiple systems are involved in complex behaviors.
Because what resonates with kids changes frequently and is different for different kids.
Because we want enduring effects.
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Scaffolding Can Facilitate Healthy Adolescent Development
•Positive Peer Groups•Parental Monitoring•Alternative Activities•School Connectedness
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m YOUTHADOLESCENCE
CULTURE
ALCOHOL
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The End
Thank you
