A task force of the National Institute on Alcohol Abuse and Alcoholism recently issued A Call to Action: Changing the Culture of Drinking at U.S. Colleges, a report that offers a new understanding of the consequences of excessive alcohol consumption by college students and urges solutions grounded in research.
The Task Force on College Drinking was convened three years ago by NIAAA's National Advisory Council on Alcohol Abuse and Alcoholism. Jointly chaired by Mark Goldman, Ph.D., research professor of psychology at the University of South Florida, and Reverend Edward Malloy, president of the University of Notre Dame, the task force represents the collaboration of more than three dozen college presidents, scientists, and students.
The task force conducted a research review to determine what prevention strategies have been working, what has not worked, and what additional research must be conducted if better prevention programs are to be developed. In issuing its Call to Action, the task force noted that research on the prevention of harmful drinking by college students is relatively new and that the data are incomplete. One of the objectives of the task force was to encourage a move beyond the more traditional approach of reporting mere numbers of drinkers and quantities of alcohol and toward a focus on the consequences of alcohol abuse in this population and on finding concrete solutions.
Nevertheless, these more traditional studies have had an important role in highlighting the alarming rates of binge drinking among college students, defined as consumption of at least five alcoholic beverages in a single session for men and at least four in a single session for women. In the Harvard School of Public Health College Alcohol Surveys, 44 percent of over 14,000 full-time students at four-year colleges and universities in 1999 reported that they had engaged in binge drinking at least once during the previous year. About a quarter of the students said that they had engaged in this behavior at least three times in the previous two weeks, which represented a 20 percent increase over the 1993 rate of frequent binge drinking in this population.
The task force commissioned 24 new studies to complement its own deliberations. Most of these studies were published in a supplement to the March 2002 issue of the Journal of Studies on Alcohol. One study estimated that more than 1,400 students between the ages of 18 and 24 years who were enrolled in two- and four-year colleges died in 1998 from alcohol-related injuries, including injuries sustained in motor vehicle accidents. According to surveys conducted in 1999 that were included in the study, more than 2 million of 8 million U.S. college students had driven a motor vehicle while under the influence of alcohol in the previous year, and more than 3 million had been the passengers of drivers who had been drinking. During the same period, more than 500,000 full-time four-year-college students were unintentionally injured as a result of alcohol abuse, and more than 600,000 were hit or assaulted by a student who had been drinking.
"The harm that college students do to themselves and others as a result of excessive drinking exceeds what many would have expected," said lead author Ralph W. Hingson, Sc.D., professor of social and behavioral sciences and associate dean for research at Boston University School of Public Health. "Our data clearly point to the need for better interventions against high-risk drinking in this population."
The task force identified three constituencies that prevention strategies need to target: the student population as a whole, the college and its surrounding environment, and the individual at-risk or alcohol-dependent drinker. It developed a framework to help colleges and universities design prevention programs aimed at each of these constituencies. The framework categorizes prevention strategies into four tiers based on the strength of the available scientific evidence to support or refute them: effective strategies that target college students, such as brief motivational interventions; strategies that are effective with the general population and that could be applied to college environments, such as restrictions on the density of alcohol retail outlets; strategies that have shown promise, such as the expansion of alcohol-free dormitories; and ineffective strategies, such as those that rely entirely on the provision of information about the dangers of alcohol.
In addition to its main Call to Action report, the Task Force on College Drinking has made its findings and recommendations available in several formats, including the reports of two task force panels: "High-Risk Drinking in College: What We Know and What We Need to Learn" and "How to Reduce High-Risk College Drinking: Use Proven Strategies, Fill Research Gaps." These materials are available at www.collegedrinkingprevention.gov or may be ordered by calling NIAAA at 301-443-3860.
A report commissioned by the Center for Mental Health Services provides estimates of the potential costs of six preventive mental health and substance abuse interventions when they are provided to members of a managed care organization. The complex models used for the cost calculations resulted in a range of costs expressed as a per-member-per-month cost across four scenarios, from a least expensive to a most expensive scenario.
Listed below are the costs representing the midpoint between the median costs of the least expensive and the most expensive scenario.
• Targeted cessation education and counseling for smokers, $0.03
• Presurgical educational intervention for adults to reduce anxiety, $0.26
• Brief counseling and advice to reduce alcohol use, $0.58
• Prenatal and infancy home visits for high-risk mothers, $0.76
• Targeted short-term mental health services, $1.48
• Health promotion through self-care education, $1.54
The effectiveness of each intervention is supported by at least two controlled studies, and some interventions by as many as six studies.
According to the report, the average increase in premium across all six interventions would be less than .5 percent. The national average premium for health maintenance organizations (HMOs) in 2000 was $187.49 a month for a single employee. The average per-member-per-month cost of all six preventive interventions combined is $0.77, which represents .41 percent of the average HMO premium.
The report strongly encourages managed care organizations to implement these low-cost interventions, which have been shown to improve medical outcomes, increase patient satisfaction, and reduce use and cost of medical care. The six interventions were selected on the basis of a literature review of more than 800 studies of the effectiveness of preventive interventions, and the report provides details about 54 of these studies. The report is available on the Web at www.mentalhealth.org/cmhs/managedcare (click on Featured Publications).
According to the most recent National Household Survey on Drug Abuse conducted by the Substance Abuse and Mental Health Services Administration, 16.7 million persons surveyed in 2000 had abused inhalants at some time during their lives, compared with only 6.4 million who had used Ecstasy and 400,000 who had used OxyContin. These figures translate to a rate of lifetime inhalant use that is about 2.5 times the rate for Ecstasy and OxyContin combined.
In March, the National Inhalant Prevention Coalition sponsored the tenth annual National Inhalants and Poisons Awareness Week, a joint effort by federal agencies, military bases, and communities across the nation to increase awareness of the popularity, dangers, and need for treatment for inhalant abuse, or "huffing." At a press briefing to launch this year's campaign, John P. Walters, director of the White House Office of National Drug Control Policy, said, "Nearly one in ten eighth graders is abusing potentially dangerous household products to get high. The chemicals in our cupboards and under our sinks are also under our children's noses, posing as deadly a threat as street drugs like cocaine and Ecstasy."
Inhalants are often the first substances that young people experiment with, because they are legal and easy to obtain and abuse is difficult to detect. More than 1,000 products have the potential for misuse, including butane, propane, gasoline, refrigerants, degreasers, correction fluid, nitrous oxide, aerosol cream, spray paint, paint thinner, nail polish, computer cleaner, air freshener, and cooking spray. When these products are inhaled, high concentrations of toxic chemicals penetrate the brain tissue, where they can cause irreversible damage or even death. Chronic abusers may experience effects such as loss of consciousness, short-term memory loss, hearing loss, limb spasms, and irreversible damage to the brain, liver, kidneys, and bone marrow.
Signs that a child or adolescent may be abusing inhalants include problems in school, paint or stains on the body or on clothing, spots or sores around the mouth, red or runny eyes or nose, a chemical odor on the breath, a dazed or dizzy appearance, nausea or loss of appetite, anxiety, excitability or irritability, and missing household products of potential abuse.
Resources on prevention of inhalant abuse can be obtained from the National Inhalant Prevention Coalition by calling 800-269-4237 or visiting www.inhalants.org.
Joint research effort by AHRQ and VA on evidence-based practices: The Agency for Healthcare Research and Quality (AHRQ) and the Department of Veterans Affairs (VA) have issued a joint program announcement to encourage and fund research that addresses the translation of research findings into clinical practice, with an emphasis on improving clinical practice, enhancing patient safety, and sustaining change in practitioner behavior across multiple health conditions, populations, and health care systems. Applicants for grants can find more information about the program announcement in the February 22 NIH Guide at http://grants.nih.gov/grants/guide.
Web site on childhood bipolar disorder: The Juvenile Bipolar Research Foundation (JBRF) has launched a Web site offering information on research studies sponsored by the foundation; a professional listserve designed to facilitate a dialogue between psychiatrists, pediatricians, and developmental neurologists; bimonthly grand rounds; and a referral network for parents. JBRF is the first charitable foundation to focus solely on research on childhood bipolar disorder. For more information, visit the Web site at www.bpchildresearch.org.