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Many College Freshmen Drink at Levels Far Beyond the Binge Threshold

Aaron M. White, Courtney L. Kraus, and Harry Scott Swartzwelder

Background: Binge drinking is a dichotomous variable that allows researchers to sort students into categories based upon a specific threshold of consumption, commonly 4 (females) or 5 (males) drinks. Crossing the binge threshold increases the risk of negative alcohol-related consequences. The use of such thresholds has played a vital role in the study of college drinking. While extremely val- uable, the dichotomous nature of binge drinking variables removes information about how heavily students actually drink, leaving the characterization of college drinking incomplete. The present study examined patterns of alcohol use beyond the binge threshold.

Methods: The data set consisted of self-reported 2-week drinking histories from 10,424 first- semester freshmen at 14 schools across the United States during the fall of 2003. The number of students who reached the 41/51 binge-drinking threshold was calculated, as was the number who reached 2 times (81/101 drinks) or 3 times (121/151 drinks) the binge threshold. Logistic regression analyses were used to explore gender differences and to assess whether frequent binge drinkers (31 binges per 2 weeks) were more likely than infrequent binge drinkers (1–2 binges per 2 weeks) to reach high peak levels of consumption.

Results: Roughly 1 of 5 males consumed 101 drinks and 1 of 10 females consumed 81 drinks, twice the binge threshold, at least once in the previous 2 weeks. Gender differences were observed at every drinking level and were particularly large at higher peak levels. Frequent binge drinkers were more likely than infrequent binge drinkers to consume 2 or 3 times the binge threshold.

Discussion: A surprisingly large percentage of students, particularly males, drink at peak levels well beyond the binge threshold. Such findings suggest that schools might make additional progress in the battle against alcohol misuse by focusing on extreme drinking practices in addition to binge drinking per se.

Key Words: Binge, Alcohol, College Drinking, High Risk.

ALCOHOL MISUSE REMAINS a pervasive prob-lem on American college campuses. Three students at Colorado schools alone died from overdoses during the first few months of the fall 2004 semester (USA Today, 2004). Thirty-four students were treated for alcohol poi- soning at a single, medium-sized university in Delaware during that same time period (UDaily, 2004). Reports of sexual assaults, memory blackouts, vandalism, alcohol- fueled riots, and other deleterious outcomes associated with drinking have become increasingly common (Perkins, 2002; Wechsler et al., 1998; White et al., 2002). In recent years, research and media reports about col-

lege drinking have focused largely on binge drinking. When

used colloquially, the term binge drinking implies consum- ing large amounts of alcohol in a relatively short period of time. In studies of college drinking, the term refers to a dichotomous variable defined by meeting or exceeding a threshold, such as 4 or more drinks (41) for females and 5 or more drinks (51) for males (Wechsler et al., 1994). Research by Henry Wechsler and colleagues (Wechsler et al., 2002) at the Harvard School of Public Health, the main proponents of the 41/51 measure of binge drinking, suggests that roughly 45% of students nationwide meet or exceed this threshold at least once every 2 weeks. If con- sumed rapidly, 4 or 5 drinks could potentially produce blood alcohol concentrations (BACs) of 0.08% or higher, although field studies suggest that drinking at these levels often results in much lower BACs (Thombs et al., 2003). Statistically, students who meet or exceed the binge threshold are at greater risk of experiencing negative alcohol-related consequences than non–binge drinkers (Wechsler et al., 2002). The number of times within a 2-week period that students cross the binge threshold also provides useful information about the likelihood that students will experience negative alcohol-related conse- quences. Research indicates that binge drinking frequently (3 or more times in a 2-week period) leads to a

From the Department of Psychiatry, Duke University Medical Cen- ter, Durham, North Carolina.

Received for publication May 27, 2005; accepted December 15, 2005 The study was funded by NIAAA Grant 12478 to HSS, VA Senior

Research Career Scientist Award to HSS, and a Duke Undergraduate Research Fellowship to CLK.

Reprint requests: Aaron M. White, PhD, Department of Psychiatry, Box 3374, Duke University Medical Center, Durham, NC 27710; Fax: 919-286-4662; E-mail: aaron.white@duke.edu

Copyright r 2006 by the Research Society on Alcoholism.

DOI: 10.1111/j.1530-0277.2006.00122.x

Alcohol Clin Exp Res, Vol 30, No 6, 2006: pp 1006–10101006

ALCOHOLISM: CLINICAL AND EXPERIMENTAL RESEARCH Vol. 30, No. 6 June 2006

greater risk of negative consequences than binge drinking infrequently (1 or 2 times per 2-week period) or drinking but not binging (Wechsler et al., 2002). Without question, the use of binge drinking thresholds

yields valuable information about alcohol consumption on college campuses. Unfortunately, one limitation of this approach is that it removes data regarding how heavily students actually drink (Alexander and Bowen, 2004). Indeed, several authors have suggested that the intense focus on binge drinking in recent years has led some researchers to overlook other important aspects of alcohol use among college students, including levels of consump- tion beyond the binge threshold (Gruenewald et al., 2003). The same level of risk is assigned to all students who cross the threshold regardless of how far beyond the threshold they go. For instance, the measure places students who consume 5 drinks and 25 drinks in the same category despite the fact that the risks associated with these dispa- rate levels of consumption are far from equivalent. Thus, while extremely useful, binge drinking measures simply cannot completely characterize the drinking habits of college students. The purpose of the current study was to examine pat-

terns of alcohol use on college campuses beyond the binge threshold. Survey data from 10,424 first-semester fresh- men at 14 United States colleges and universities were examined. It was hypothesized that frequent binge drink- ers might be more likely than infrequent binge drinkers to consume high peak levels of alcohol, which could help account for the higher incidence of consequences among such students. Findings from the study could yield much- needed insight into the magnitude of alcohol misuse on American campuses.

METHODS

Subjects and Data Collection

Self-reported drinking data were collected via an online survey administered to freshmen before their participation in an alcohol education and prevention course. Universities utilized the course for educational purposes and therefore did not require students to sign a research consent form. When logging onto the course for the first time, each student was provided with the confidentiality policy of the online course provider, which included a guarantee of full anonym- ity. The use of the data in the current article is consistent with that policy and all analyses were performed retrospectively on fully anon- ymous aggregate data. Subjects were not compensated for their par- ticipation. The project was approved by the Institutional Review Board at the researchers’ institution.

Twenty-three schools across the United States instructed all of their freshmen, a total of 13,718 students, to complete the survey and the online course during the fall semester of 2003. Enforcement methods varied considerably from school to school, leading to var- iability in the percentages of freshmen who complied. To provide the most accurate snapshot possible of freshmen drinking habits, anal- yses were based on data from schools at which at least 70% of all freshmen completed the survey. This process resulted in a total sam- ple of 10,424 students representing 14 schools. Response rates at the schools ranged from 70 to 98%, with an average response rate

of 82%. By geographic region, 5 schools were located in the Mid-Atlantic states, 4 in the Northeast, 3 in the Southeast, 1 in the Midwest, and 1 in the West.

Students were asked to indicate how many drinks they consumed during each day of the 2 weeks preceding the survey. A drink was defined as a 12 oz of 5% beer, 5 oz of 12% wine, or 1.5 oz of 40% liquor in a shot or mixed drink.

Fifty-two percent of the students in the sample were female. Cau- casian students represented 69.3% of the sample, 8.4% of students were African American, 10.1%Asian or Pacific Islanders, 6.7%His- panic or Latino, and 1.3%Native American Indian. The average age was 18.14 (SD5 0.44). All but 100 students (0.9%) were 18 or 19 years old. In addition to demographic questions, students were asked to indicate how much alcohol they consumed during each day of the previous 2 weeks. Those data were the focus of the analyses in the current paper.

Variables and Statistical Analyses

The number of students who reached the binge-drinking threshold as defined in the Harvard College Alcohol Study (41 drinks for females/51 drinks for males), as well as the number who reached twice (81/101 drinks) or 3 times (121/151 drinks) the binge thresh- old, was calculated.

Logistic regression analyses were used to explore gender differ- ences in peak drinking levels and to determine whether frequent binge drinkers (3 or more binge episodes in a 2-week period) were more likely than infrequent binge drinkers (1 or 2 binge episodes) to consume 2 or 3 times the binge threshold.

RESULTS

Roughly 55% of all students drank alcohol in the 2 weeks before the survey. Among these students, the aver- age number of drinking occasions was 4.35 (SD5 2.99) for males and 3.35 (SD5 2.32) for females [t(5,647)5 14.01, po0.001]. Males drank an average of 5.97 (SD5…

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