Young Adults and Drinking

Screening and Brief Intervention
by National Institute of Health

Both college and noncollege populations face a high risk of becoming heavy drinkers and experiencing negative consequences of alcohol use. Because young people in these populations do not tend to identify themselves as having alcohol problems, they may be more readily identified through proactive screening in locations where they are likely to seek treatment related to alcohol problems, such as hospital emergency rooms, their college campuses, or workplaces. This article summarizes research on screening and brief interventions for alcohol use among young adults, particularly brief motivational interventions.

Ample evidence demonstrates that excessive alcohol use among young people is a significant cause for public concern. Young adults in the 18-25 age group consistently engage in high rates of risky behaviors such as unprotected sex and substance use. The National Survey on Drug Use and Health (Substance Abuse and Mental Health Services Administration revealed that young adults show the highest prevalence of problem drinking. Specifically, 41 percent of young adults reported drinking five or more drinks1 per occasion at least once in the past month, and 15 percent reported drinking five or more drinks per occasion on at least 5 different days in the past month. The National Institute on Alcohol Abuse and Alcoholism [NIAAA] defines a standard drink as about 14 g of alcohol, which corresponds to approximately 1.5 oz of 80-proof distilled spirits, one glass of wine, or one 12-oz beer or wine cooler.; 2 These definitions of heavy drinking and binge drinking differ from those provided by NIAAA, which defines binge drinking as consumption of 4 or more drinks in about 2 hours for women, and 5 or more drinks for men; heavy drinking is defined as more than 7 drinks per week for women and more than 14 drinks per week for men. Among college students, approximately 67 percent reported using alcohol at least once in the past month, and 40 percent reported heavy episodic drinking (defined, for men, as drinking five or more drinks at least once in the past 2 weeks and, for women, four or more drinks at least once in the last 2 weeks).

Heavy drinking also is prevalent among young adults in the military. In a survey of 5,136 military personnel ages 18 to 25, 2,763 reported a heavy-drinking episode in the past month, with 1,422 experiencing at least one heavy-drinking episode a week in the past month. Young adults often exhibit heavy drinking before entering the military; for example, 1,506 of 2,002 Navy recruits consumed alcohol in the past year, and one-third of these recruits reported heavy episodic drinking as their typical consumption pattern.

Among young adults, 25 percent of males and 14 percent of females meet (or at some time have met) the diagnostic criteria for alcohol dependence, as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, with 13 percent of men and 6 percent of women meeting diagnostic criteria for alcohol dependence in the past 12 months. However, many young people "mature out" of or moderate excessive drinking; as they enter their mid-twenties, their drinking no longer meets the criteria for abuse or dependence.

Despite the fact that young adults' alcohol use is in some sense developmentally normative, combating heavy alcohol use in this population is important for several reasons. The primary causes of illness and death among young adults involve lifestyle and behavioral factors, including excessive alcohol use. Even one episode of excessive drinking can have serious consequences that persist well beyond adolescence and young adulthood, such as alcohol-related car crashes, unintended pregnancies, and physical fights leading to arrest or jail. Young adults who engage in heavy episodic drinking are significantly more likely than those who do not drink heavily to get in trouble with police, damage property, sustain injuries, drive after drinking, and engage in unplanned and unprotected sexual activity. Alcohol use can trigger health problems even as early as adolescence and young adulthood. In one study, adolescents who drank heavily during their teen years were significantly more likely to be overweight and have high blood pressure by the time they were 24 years old. Finally, repeated instances of heavy episodic drinking among youth can have negative effects on the developing brain and brain function.

On college campuses, alcohol consumption consistently is linked to a variety of serious consequences. For example, in 1998 and 2001, more than 500,000 students were injured in drinking-related incidents, more than 600,000 were assaulted by a fellow student who had been drinking, and more than 1,600 students died each year from injuries related to alcohol use.

In addition, neighbors of colleges who lived within 1 mile of campus were 135 percent more likely to report secondhand effects of college student drinking, including vandalism, assault, and other public disturbances. Excessive alcohol use by college students is linked to risky sexual behavior. Among college women who reported being raped, 72 percent reported that the rape occurred while they were intoxicated. Alcohol consumption also is associated with academic impairment, including missing classes, doing poorly on tests, and getting behind in schoolwork. Despite these risks, college students usually accept higher drinking levels than experts do when defining a drinking problem in a peer. They also tend to report feeling in control of their drinking even after acknowledging excessive alcohol use, and to dismiss the need to reduce heavy drinking although reporting alcohol tolerance and alcohol-related problems.

When they need medical attention for intoxication or injuries associated with alcohol use, many college students seek treatment off campus rather than campus-based medical care. As a result, college administrators may significantly underestimate the number of students who require medical attention for alcohol-related incidents. In addition, if intoxicated students drive themselves to off-campus medical facilities or rely on friends who have been drinking to drive them, they may risk further injury and harm.

A considerable number of students appear to require, but do not seek, medical treatment. A recent survey of more than 14,000 students revealed that 6.3 percent met DSM-IV criteria for alcohol dependence at some time over the past year, but only 6.2 percent of this 6.3 percent of students had sought treatment for their drinking. Some students may not seek medical help for illness or injuries related to drinking, or for alcohol dependence, because of concerns regarding confidentiality and administrative reprisals. For example, in one survey of 215 students, almost the entire sample reported having helped other students during or after an alcohol-related negative event, such as acute intoxication, passing out, and the like, and more frequently utilized off-campus medical help and local police rather than on-campus resources. These findings suggest that most college student drinking does not come to the attention of campus officials. Finally, in addition to a general lack of knowledge about the nature of drinking and related problems among young adults and among college students specifically, little is known about these problems among young adults who do not attend college.

About the Author

NIH is the nation's medical research agency - making important medical discoveries that improve health and save lives. The National Institutes of Health (NIH), a part of the U.S. Department of Health and Human Services, is the primary Federal agency for conducting and supporting medical research.