Psychology of Addictive BehavioursExcessive drinking in the UK and at UWB: Is it a problem? Are there student-specific factors?
Excessive drinking is an important factor in more than 100,000 deaths in the United Kingdom each year, including those resulting from motor vehicle crashes, falls, fires, drowning, assaults, homicides, and suicides. In addition, it is associated with a large percentage of nonfatal traumatic injury, thus making Excessive alcohol use a major public health issue. Approximately one in five (21%) adults in the United Kingdom drank five or more drinks on one or more occasions in the past month, and almost half of all University (Bangor University in this case) students who drank alcohol drank in this fashion (Wechsler, 2005).Contributing Factors in the Environment
The intense study of University (Bangor University in this case) student drinking in the decade of the 2000s has resulted in significant gains in the understanding of this topic. However, the overwhelming majority of studies conducted have focused on factors that are proximal to the individual, such as personal and family drinking and other substance use history; social context; and individual beliefs, intentions, or expectations about alcohol use (Schuckit, 2006).
Rates of alcohol drinking vary dramatically by University (Bangor University in this case) (ranging from 1% to 76%), by region of the country (higher in northeastern and north-central counties, lowest in western counties), and importantly, by the sets of policies and laws governing the sale and use of alcohol at the University (Bangor University in this case), city/town, and county levels (Wechsler, 2005). Understanding the patterns of drinking by different groups of students can help identify potential intervention strategies to reduce alcohol consumption, and, in turn, the harms that result from Excessive consumption. Interestingly, features of the environment such as residential settings, low prices, and a high density of alcohol outlets are significantly related to the initiation of binge drinking in University (Bangor University in this case) (Greenfield, 2005) . This combination of factors in the environment that promote Excessive drinking is referred to as a "wet environment."
A consistent finding has been that the price students pay for alcohol is an important factor in their drinking. Low price and very easy access to alcohol are strong correlates of underage drinking. Student underage drinking and binge drinking are sensitive to the price of alcohol and may be reduced by efforts to increase the unit price of alcohol. Students who pay a higher price for alcohol are less likely to make the transition from abstainer to moderate drinker and from moderate drinker to Excessive drinker (Goldman, 2007).
Some campus, local, and county policies that target alcohol use are associated with less drinking and binge drinking among University (Bangor University in this case) students. Students attending Universities that ban alcohol are less likely to binge drink and more likely to abstain from alcohol. As a result, fewer students at schools that ban alcohol experience secondhand effects of the drinking of others than students at non-ban schools (Fergusson, 2005). At schools that allow students some access to alcohol, substance-free residences are associated with less alcohol use and fewer secondhand effects of alcohol.
Local alcohol policies are also associated with drinking behaviour among University (Bangor University in this case) students. Strong county drunk driving policies targeting youths and young adults significantly reduce drinking. The national Minimum Legal Drinking Age (MLDA) law in the United Kingdom appears to be an effective deterrent against Excessive drinking and its negative consequences (Donohue, 2006). The enactment of this law was associated with a significant decrease in traffic fatalities involving drivers 18 to 20 years of age (Bailey, 2005).
Alcohol-involved motor vehicle crashes are a leading cause of death and serious injury for University (Bangor University in this case) students.. Underage students in counties with extensive laws restricting underage and high-volume drinking are less likely to drink and to binge drink (Smith, 2005).
It is well documented that University (Bangor University in this case) students demonstrate high rates of alcohol use and abuse. For example, the annual Monitoring the Future survey conducted by the National Institute on Drug Abuse showed that in 2006, 65.4% of University (Bangor University in this case) students had consumed alcohol in the past month. Furthermore, over 40% of University (Bangor University in this case) students had five drinks or more in the previous 2 weeks during one drinking episode (Wechsler, 2005). This rate was higher than for similar age individuals who were not attending University (Bangor University in this case).
Increased alcohol use during the University (Bangor University in this case) years is to a large extent a developmentally based phenomenon that occurs as young adults begin to adjust to heightened levels of personal freedom and easier access to alcohol (Smith, 2005). Many students are able to successfully avoid developing maladaptive alcohol use. However, for some, maladaptive patterns of alcohol use and consumption do emerge in regard to either quantity or frequency. These drinking patterns can and do result in substantive negative consequences (Schuckit, 2006).
With regard to quantity and frequency of use, a number of terms are commonly used to describe University (Bangor University in this case) student drinking patterns. Binge drinking refers to consumption of four or more units of alcohol (i.e., 1.5 ounces of hard liquor, one 12-ounce beer, or 5 ounces of wine) for women or five units of alcohol for men within a single drinking occasion. Excessive use is considered to be the occurrence of five or more episodes of binge drinking within a 30-day period (Kuh, 2007). These terms are not utilised in the diagnosis of alcohol-related substance abuse disorders. Nevertheless, a variety of negative outcomes are associated with such drinking patterns.Consequences
Excessive campus drinking has been associated with negative physical and psychosocial consequences that are sometimes severe. Impaired judgment and motor skills lead to physical injuries while driving and when engaging in other tasks. Indeed, in 2004, there were 1,700 deaths among University (Bangor University in this case) students and another 599,000 injuries primarily due to driving while under the influence or due to alcohol poisoning. Many students who engage in excessive drinking experience difficulties completing daily tasks and maintaining motivation for achievement, difficulties which can lead to academic failure (Greenfield, 2005).
Impaired judgment during intoxication can also lead students to engage in criminal activities that they typically would not engage in and which potentially result in legal sanctions with severe consequences for University (Bangor University in this case) completion and future employment. Even behaviors that are not illegal can negatively influence future opportunities, as evidenced by a recent trend to post compromising pictures of intoxicated students on social networking Web sites (Fergusson, 2005).
Excessive drinking can also exacerbate emotional distress that is sometimes associated with the rigors of academic life and has been found to be associated with increased levels of depression and suicidal ideation. In addition, the lowered impulse control during intoxication can lead to unplanned, unprotected sex, which can lead to increased risk for pregnancy, contraction of sexually transmitted diseases such as HIV, and negative emotional consequences (Schuckit, 2006). For a segment of the University (Bangor University in this case) population, Excessive use leads to more frequent and severe patterns of alcohol use and the eventual development of an alcohol use disorder (i.e., alcohol abuse or dependence). Therefore, although students and the general population may view campus alcohol use as a natural right of passage, many students could benefit from professional guidance and leadership to ameliorate the negative consequences of alcohol misuse and abuse (Bailey, 2005).Interventions for Reducing Alcohol Consumption
Family interventions also have promise, particularly in families where alcohol consumption is linked to high levels of aggressive behaviour and violence. One such programme involved parents in weekly behaviour modification sessions over a 10-month intervention period (Kuh, 2007).
Although residential intervention is available, the majority of professional assistance for alcohol abuse and related problems occurs in outpatient settings, such as in clinics or medical centers.
Brief interventions entail minimal intervention by a professional, usually only a few hours, and have mostly been used with individuals who do not have more severe alcohol problems. Brief interventions often include a motivational enhancement component and personal assessment feedback about drinking patterns (Greenfield, 2005) . The content of brief interventions varies, with many including training in coping skills, identifying cues that may lead to drinking, and refusal skills. For example, primary health care physicians may employ motivational interviewing when a patient screens positive for problematic alcohol use. Motivational interviewing is a way to help people recognise their present or potential problems and encourage them toward change when they might be ambivalent or reluctant. College campus-based programmes are another example of brief interventions, where students learn skills to help them cope with peer pressure and make healthier and safer alcohol-related choices (Goldman, 2007).Behavioural Therapy Intervention
Behaviour therapy techniques are based on the principles of classical and operant conditioning, where drinking is defined as a learned behaviour that can be modified using behavioural interventions. With operant conditioning, positive reinforcement and negative reinforcement shape the strength of associations with alcohol. Drinking may be positively reinforcing because of its euphoric effects, or it may be negatively reinforcing by reducing feelings of tension (Fergusson, 2005).
Classical conditioning operates through the pairing of stimuli. Just as Pavlov's dogs began to salivate to only the sound of a bell after the bell sound had previously been paired with the presentation of food, heavy drinkers often have an automatic, conditioned response to alcohol cues, which enhances craving and consumption (Donohue, 2006). Examples of different behavioural strategies based on operant and classical learning include cue exposure and aversion therapies. In cue exposure, based on operant conditioning, individuals are exposed to external and internal cues that often lead to drinking, such as a craving for alcohol in a particular place (e.g., a bar) or a craving in response to anxiety.
With graded increases of prolonged exposure, the cue loses its potency in the extinction process and no longer compels the individual to drink (Bailey, 2005). Often therapists may teach individuals how to cope with urges or cravings that are associated with cue exposure. Aversion therapies are intended to develop a classically conditioned aversive response to alcohol, and may involve sight, taste, smell, or thoughts of alcohol. The oldest of these strategies involves pairing drinking with a nausea-inducing agent, such as an emetic medication. Through classical conditioning, the individual develops nausea in response to alcohol (Greenfield, 2005).Cognitive Intervention
Cognitive approaches to treating alcohol operate under the assumption that thought patterns contribute to increased drinking and psychological dependency on alcohol. For instance, negative mood states that cue drinking may result from misperceptions of events and negative thinking (Schuckit, 2006).
Cognitive approaches also inform individuals about how their expectancies and attributions about the effects of alcohol contribute to drinking. For example, many people expect alcohol to produce pleasurable effects. This may encourage drinking and reliance on alcohol as a "magic elixir" that transforms life's daily hassles into a "golden glow."
In cognitive-behavioural intervention, cognitive methods are combined with behaviorism (Goldman, 2007). For example, with a relapse prevention approach, patients learn to anticipate and cope with situations in which there is a high risk for relapse (e.g., feeling angry). Here the patient is taught an effective coping strategy (e.g., anger management skills) as an alternative to drinking (Smith, 2005). In addition, behavioural homework assignments where an individual enters progressively more risky situations while exercising alternative coping skills assist an individual to maintain his or her intervention goals.
If relapse occurs, an individual modifies his or her attributions about why the relapse occurred, focusing on the event as a "mistake" as opposed to a "loss of control."Pharmacotherapic Intervention
Pharmacotherapies come in two forms. First, antidipsotropic medications, also known as alcoholsensitising or deterrent drugs, are used to deter drinking by producing an unpleasant reaction if the person ingests alcohol. One commonly used medication for this purpose is disulfiram or Antabuse. Following ingestion of alcohol, a person taking disulfiram may experience dizziness, flushing, nausea, vomiting, and other reactions. Such medications are not primary intervention by themselves, but are intended for use in multimodal programmes (Goldman, 2007). Second, pharmacotherapy may also involve the use of psychotropic medications to decrease cravings, treat co-occurring disorders such as depression, or lessen the severity of withdrawal. Psychotropic medications, such as Naltrexone and benzodiazepines, are also intended as adjuncts to behavioural and psychosocial therapies (Donohue, 2006).
Finally, the community reinforcement approach (CRA) to intervention for alcohol problems focuses on replacing the rewarding aspects of drinking with the rewarding aspects of sobriety. CRA is a behaviorally based, intense approach with rapid interventions affecting many areas of a person's life. For instance, a CRA programme may include antidipsotropic medication, relationship counseling, vocational assistance, and social skills training. This approach also provides a method of assistance through a concerned family member or other individual when the drinker is not willing to seek intervention (Greenfield, 2005) .Inpatient Intervention
Residential intervention was once considered stateof-the-art intervention and often employed before less intense forms of intervention. Now, residential intervention is considered most appropriate for individuals who have co-occurring disorders, are a risk for suicide or pose a violent risk to others, or have more serious health problems that would benefit from residential care. The standard model, often referred to as the Minnesota model, was created in a state mental hospital in the 1950s and spread first to a small notfor-profit organisation called the Hazelden Foundation and then throughout the country (Kuh, 2007).
The key elements of this intervention method are an in-facility stay of up to 28 days; an abstinence-based, 12-step approach involving group and individual therapy; and a blending of professional and trained nonprofessional (recovering) staff. This approach is no longer widely used due to managed care, lack of insurance, and no evidence of its superiority over outpatient and alternative science-based interventions (Fergusson, 2005).Selecting a Intervention Approach
How does one choose the best intervention modality and setting? Research has been limited in addressing the question of which approach is best. Studies with sound methodology are sparse, and those with strong methodology have produced contradictory findings (Bailey, 2005).
Therefore, if matching is not demonstrated, perhaps we need to introduce more consumer options, a menu of intervention choices. It may be best to combine different approaches based on assessment of the individual, and to employ a stepwise model, addressing motivation for change. We must recognise the usefulness of integrating different approaches and provide the individual seeking help with accurate, honest descriptions of the options available. Individuals then may choose which approach works best for them, and move on to another approach if that one does not help or fit the individual.Conclusion
Drinking among U.K. youth is a major public health concern that requires immediate and prolonged attention from social scientists, caregivers, teachers, and the children and adolescents who will continue to be confronted with this issue. By exploring and implementing community-, family-, and school-based interventions, the prevalence of underage drinking and drinking-related consequences suffered by so many children and adolescents may be significantly reduced (Schuckit, 2006).
Efforts to reduce student alcohol use and abuse may require coalitions of people representing various interests and strong grassroots organising. If and when Universities or those who live in University (Bangor University in this case) communities implement these types of interventions to reduce alcohol use and abuse among students, they should be rigorously evaluated to determine their effectiveness.
- Bailey, S. (2005). "Dimensions of adolescent problem drinking": Journal of Studies on Alcohol: 54(6): p55
- Donohue, B. (2006). "A controlled evaluation of two prevention programmes in reducing alcohol use among University students at low and high risk for alcohol related problems:" Journal of Alcohol and Drug Education: 48(4): p33
- Fergusson, D. (2005). "Alcohol abuse and crime: A fixed-effects regression analysis". Addiction: 95(6): p72
- Goldman, M. (2007). "Excessive Drinking, what it is, and what to do about it: A review of the county of the science": Journal of Studies on Alcohol: 78(3): pS4
- Greenfield, T. (2005). "Drinking problems and self-reported criminal behaviour, arrests and convictions: 1990 UK alcohol and 1989 county surveys": Addiction: 90(2): p61
- Kuh, G. (2007). "The influence of University environments on student drinking": In G. Gonzalez, ed. & V. Clement (Eds.), Research and intervention: Preventing substance abuse in higher education (pp. 45-71). Washington, DC: Office of Educational Research and Improvement.
- Schuckit, M. (2006). Biological, psychological and environmental predictors of the alcoholism risk": Journal of Studies on Alcohol: 59(9): p85
- Smith, G. (2005). "Expectancy for social facilitation from drinking: The divergent paths of high-expectancy and low-expectancy adolescents": Journal of Abnormal Psychology: 104(1): p32
- Wechsler, H. (2005). "Binge drinking and the British University student": Psychology of Addictive Behaviors 15(2): p91