The Canadian Journal of Higher Education, Vol. XIII-2, 1983 La revue canadienne d'enseignement supérieur, Vol. XIII-2, 1983 Alcohol Use and its Consequences Among Canadian University Students ANUPPA CALEEKAL-JOHN and MICHAEL S. GOODSTADT* Alcohol use and abuse in Canadian society has been the focus of attention for many years. Studies have tended, however, to be concerned with either general populations (e.g. Single et al., 1981; Smart and Adlaf, 1982), or with those of school age (e.g. Smart et al., 1981). Little consideration has been given to the role and impact of alcohol in the lives of an important subgroup of Canadian society, namely, university and college students. Although small, this subpopulation represents a significant investment of society's educational and financial resources, and is also considered to be one of society's important future assets. The present review will examine the available data concerning college students' alcohol use; where appropriate comparisons will be made with United States' data. It is significant at the outset, to note that all Canadian data refer only to university students; no relevant information has been uncovered for students enrolled in colleges of applied arts and technology. PREVALENCE, FREQUENCY AND VOLUME OF ALCOHOL USE AMONG UNIVERSITY STUDENTS Table 1 summarizes alcohol consumption data from the few available studies of alcohol use among Canadian university students. Comparison between studies is problematic, since the data represents responses to different questions, presented to samples obtained by varying procedures, at different times and locations. The evidence suggests, however, that the overwhelming majority of students (approximately 90%) now report drinking alcohol. Equal proportions (i.e. approximately one-third) of drinkers drink less than once a week, once a week, and more than once a week; a small group (perhaps 6%) report drinking every day. Data regarding volume of alcohol consumed per drinking occasion are less consistent: a conservative estimate indicates that more than 13% of drinkers consume more than 5 drinks per occasion, while one survey (Bacchus, 1982) suggests that this figure may be as high as 34%. In examining the degree to which Canadian university students differ from other segments of the population, it appears that: (i) the prevalence and frequency of alcohol use is greater among Canadian university students than among * Education Research Section, Addiction Research Foundation, Toronto, Canada. TABLE 1 Summary o f Author(s) Year of Pubiicat ion Sample Alcohol Consumption Sampling Nova Scotia Undergrads. Prevalence 83%: " e v e r d r a n k " 'Representative" University Reported Size (Response Rate) University Students Doucet e t al. Among C a n a d i a n Characteristics Popula tion Information Canada Surveys of 917 (92%) Students Alcohol e T 3 T 3 Use Frequency 59%: " >once i n p r e v i o u s 6 months" 92%: "consume a l c o h o l i c beverages" Average Weekly Consump(Among drinkers) .$1.0 ' o z . a b s ' . a l c . 1.1 - 3.0 oz. 3 . 1 - 6.5 oz. 6.6 -11.1 oz. >11.1 o z . Kennedy 5 Raudoja Guelph Undergrads. (811) 970 McMirray Guelph Ihdergrads. 164 (96%) 90%: " p r e s e n t l y u s e . . . more than 6 times currently drinkers (Among d r i n k e r s ) 24%: once o r twice/month 32%: once/week 36%: 2-3 times/week 7%: d a i l y (Among d r i n k e r s ) 1 - 2 d r i n k s per o c c . 3-5 drinks per occ. 6-10 d r i n k s p e r occ (Among d r i n k e r s ) 29%: <once/week 39%: once/week (Among d r i n k e r s ) 27%: t h r e e times/week < 6%: d a i l y « CaleekalJohn Guelph Ihdergrads. Undergrade. (383) Availability 94%: ever consumed Course participants Wilfrid iaurier (in press) 403 (?) Grads. 5 Staff (20) 1981 New Brunswick - ( i . e . 29% 1 - 2 d r i n k s ; +10%: 4 - 6 d r i n k s ) - ( i . e . 211 1-2 d r i n k s ; +6%: 5. 4 - 6 d r i n k s ) - ( i . e . 5% 1 - 2 d r i n k s ; +1%:^ 10 d r i n k s ) 500 drinkers (Among d r i n k e r s ) 12%: ^once/month 30%: 2-3 times/month 29%: o n c e / w e e k , 2 - 3 'times/week (Among d r i n k e r s ) $6 d r i n k s / m o n t h 8 - 1 6 drinks/month >16 d r i n k s / m o n t h 89%: c u r r e n t l y d r i n k 9%: p r e v i o u s l y b u t n o t now 2%: have n e v e r (Among " e v e r " d r i n k e r s ) 91: N <once/month 18%: twice/month 32%: once/week 27%: twice/week 15%: t h r e e times/week (Among " e v e r " d r i n k e r s ) drink per occ. 2 drinks p e r occ. 3 drinks per occ. 4 drinks per occ. d r i n k s p e r occ. ("Drinkers) Male Female W 70%: >once/wk. 101 0%: times/ week. ("Drinkers") Male Female 70T~ 50%: 3 - 5 drink/wk. 701 101: >5 d r i n k s / w k (100%) O o o 61 Alcohol Use and its Consequences among Canadian University Students Canadian adults aged 15 years and over, but no greater than the equivalent agecohort (i.e. 20 — 24 year olds) in the general population (Health and Welfare Canada and Statistics Canada, 1981); (ii) whereas the prevalence of alcohol use for Canadian university students does not appear to differ greatly from that found for Ontario Grade 13 high school students (Smart et al., 1981), the university students' frequency of alcohol use is much greater than that of Grade 13 students (for example, only 24.1% ofGrade 13 students in 1981 reported drinking once a week or more frequently, and less than 1% drank almost every day). These differences in drinking patterns between Grade 13 and university students may be accounted for, in part, by university students being more likely to have reached the legal minimum age for alcohol consumption. In contrast to the paucity of Canadian data, many U.S. studies have compared trends in college students' alcohol use. These have all documented the same high rates of alcohol use and, in some cases, alcohol-related problems. Blane and Hewitt (1977), in reviewing 68 college surveys, concluded that drinking among U.S. college students has been rising since 1936(1936-65: 71.4%, 1966-70: 84.3%; 1971-77: 88.5%); today's students drink more frequently and become intoxicated more often than college students of twenty-five years ago; drinking among college students differ little as compared to non-college youth. Other studies have shown similar trends (e:g. Corder et al., 1974; Kraft, 1977; Hanson, 1977; Kopplin et al., 1977; Dezelsky et al., 1981). ALCOHOL USE IN RELATION TO THE USE OF OTHER DRUGS "Le Dain" Commission (Information Canada, 1973) surveys indicated that alcohol use was more prevalent than the use of any other drug: for example, an average of 83% had used alcohol compared to estimates of 30-45% for marijuana. Other comparative Canadian data are unavailable, although the results of surveys of Ontario adults (Smart and Goodstadt, 1976 and 1978; Smart and Adlaf, 1982) show that alcohol use among 18-29 year olds is much more frequent than the use of other drugs (approximately 85% vs 23%). U.S. studies have similarly shown that alcohol is the most extensively used drug, with marijuana coming a distant second (Milman, 1973; Fagerberg and Fagerberg, 1976; Kaplan, 1979; and Dezelsky et al., 1981). NEGATIVE BEHAVIOURAL CONSEQUENCES RELATED TO ALCOHOL USE Doucet et al., (1977), Caleekal-John (in press), Mills and McCarty (1983), have found relationships between increased alcohol consumption and occurrence of negative behavioural consequences. Caleekal-John found similarities between her Canadian data and the U.S. findingsofEngs(1977)andWalfishef al, (1981b), all of which employed identical measures: negative consequences included hangovers, vomiting, and drinking and driving; less common, but not inconsequential, were educational and psychosocial consequences. Doucet et al., (1977) found 62 Anuppa Caleekal-John and Michael S. Goodstadt that more than 50% of their sample reported missing classes and being sick due to alcohol consumption. Kennedy and Raudoja (1977) reported that 15% of students experienced hallucinations due to drinking, 33% suffered blackouts or memory loss, 9% had received special medical or psychological treatment for drinking, 13% of the sample worried about drinking and 39% said they had lost time from classes because of drinking. Similar reports of alcohol-related problems are to be found in U.S. studies (e.g. Kooi, 1961; Kraft, 1975; Wechsler and McFadden, 1979; Wechsler and Rohman, 1981). DEMOGRAPHIC CHARACTERISTICS RELATED TO ALCOHOL USE Sex and Age Male students have been consistently found to drink more frequently and more heavily than female students (Kennedy and Raudoja, 1977; Bacchus, (1982); Doucet et al., 1977). The Canada Health Survey (1978-79) showed that the comparable age group of young males, 20-24 years of age, constituted the cohort with highest proportion for those drinking more than 13 drinks per week. Similar findings are reported by U.S. studies (Strauss and Bacon, 1953; Engs, 1977; Kaplan, 1979; Wechsler and Rohman, 1981). Blane and Hewitt (1977) concluded, from their extensive review of U.S. studies, that sex seems to be more strongly associated with excessive alcohol use or abuse than with alcohol use perse. Class (Academic) Bacchus (1982) found some evidence that among Wilfrid Laurier students, third and fourth year students were likely to drink more frequently (i.e., two or more times per week), to spend less time drinking (i.e., four or more hours per occasion), but to drink as much (i.e., four or more drinks) per occasion as compared to younger students. Kraft (1975) and Kaplan (1979, for male students only) reported a similar phenomenon in their U.S. studies. Place of Residence Doucet et al., (1977) found that type of student residence was closely associated with prevalence and frequency of drinking: the largest proportion of drinkers (and heavy drinkers) was found among students who lived in on-campus residences or in "other" locations in contrast to those who lived in apartments or at home or who roomed elsewhere. Ingra and Moos (1979), in the United States, found that a cohesive and drinking-oriented college living group was associated with an increase in students' drinking. ATTITUDES TOWARDS ALCOHOL USE The evidence indicates that students, especially drinkers (Doucet et al., 1977), hold pro-alcohol attitudes, including support for the status-quo regarding availability of alcohol on campus (Kennedy and Raudoja, 1977; Doucet et al., 1977), 63 Alcohol Use and its Consequences among Canadian University Students a belief that slight intoxication is sometimes helpful, and that moderate amounts of alcohol help social functioning. Students, however, state that they do not feel pressured to drink or to drink more than they should. They express tolerance for non-drinkers (Kennedy and Raudoja, 1977; Bacchus, 1982) and other responsible attitudes towards alcohol use (Bacchus, 1982), although these attitudes are not always in line with their reported behaviour (Caleekal-John, in press). MOTIVATIONS FOR DRINKING A large range of disparate but not mutually exclusive reasons have been found or suggested for students' alcohol consumption and/or abuse. Among these motivations are included: (i) (ii) (iii) (iv) Drinking as a symbolic act of rejecting authority, or asserting adulthood (Straus and Bacon, 1953); Drinking as a means of coping with new freedoms and challenges, stresses, feelings of frustration, powerlessness, feelings of anxiety or depression, feelings of boredom, and personal problems (e.g., Brooks et al., 1981; Ewing, 1977; Grossman, 1965; Hanson, 1974; Higgins and Marlatt, 1975; Kraft, 1971; Orford, 1976; Scheller-Gilkey et al., 1979; Zax and Specter, 1974); Drinking for psycho-social reasons, including the enhancement of relaxation, personal confidence, sexual arousal, celebration, and having fun (e.g., Bacchus, 1982; Scheller-Gilkey etal., 1979; Straus and Bacon, 1953; Wechsler and Rohman, 1981). Drinking to get high, drunk etc., to escape, for kicks (e.g., Cahalan et al., 1969, Cahalan, 1970; Jung, 1977; Larsen and Abu-Laban, 1968; Riley and Marden, 1947; Riley et al, 1948; Scheller-Gilkey et al., 1979; Wechsler and Rohman, 1981). The complexity (e.g. Segal et al., 1980) and significance of these reasons and motivations for college drinking require further scrutiny, especially as they relate to (a) problem drinking (e.g., Beckman and Bardsley, 1981) and (b) alcohol intervention programs. ENVIRONMENTAL INFLUENCE ON DEVELOPMENT OF STUDENT DRINKING PATTERNS Home Environment and Family as a Context for Developing Early Drinking Kennedy and Raudoja (1977) found that the majority of students were allowed to drink at home before 18 years of age, beginning by 15 years of age on average; 61% saw their fathers using alcohol excessively. In the U.S., Fontane and Layne (1979) found that college students' drinking was similar to that of their families. Reiskin and Wechsler (1981) found no such relationship between college students' and parents drinking, although students receiving psychiatric help were signifi- 64 Anuppa Caleekal-John and Michael S. Goodstadt cantly more likely than the general population of students to report that their parents drank heavily. High School Environment as a Context for Developing Drinking Patterns in University Kennedy and Raudoja (1977) found there was an increase in the amount and frequency of drinking at university in comparison to high school drinking. Evidence cited earlier suggest that, in Ontario, the frequency, but not the prevalence, of use appears to be dramatically greater among university students in comparison to those in Grade 13. Banks and Smith's (1980) found 26% of a sample of 90 students reported that their drinking had increased since attending college, while Wechsler and Rohman (1981) and Buckner (1967) found that heavy use of alcohol among college students was strongly associated with students' drinking patterns in high school. University Environmental Influence in the Development of Drinking Patterns Group Influence and Role Modelling: Drinking among college students is a group phenomenon (Fleming, 1976), being influenced especially through friendship patterns (Hanson, 1974; Liccione, 1980), and the approval for the moderate "social drinker" and rejection of the abstainer and heavy users (Trice and Beyer, 1977). Students' drinking patterns may also be influenced by the large number of (not always responsible) alcohol-related advertisements in college newspapers (Walfish et al., 1981a), and by the high level of alcohol use among university faculty (Leung, 1980). Availability of Alcohol on Campus: The university environment offers pubs for on-campus alcohol consumption, which, through its availability and favourable pricing, encourage on-campus drinking. (Statistics for Ontario indicate an increase from 14 licensed public establishments on university and college campuses in 1974, to 94 such establishments in 1981). Availability is also increased through the special licensing of on-campus events at which alcohol is served — statistics indicate that approximately 200 Special Occasion (liquor) Permits were issued to Ontario Universities and Colleges during the months October — December, 1982. Role of University Student Service Personnel: Few universities appear to provide support systems to encourage responsible drinking, and for the identification and treatment of students with alcohol-related problems (see Goodstadt and Caleekal-John (in press) for a review of university alcohol education programs). Henggeler et al., (1980) showed that students rated alcohol abuse, smoking and drug abuse as the three most serious mental health problems, whereas the professionals rated career choice, academic difficulties and coping with stress as the most serious. 65 Alcohol Use and its Consequences among Canadian University Students UNIVERSITY ENVIRONMENT AND DRINKING PATTERNS AS A CONTEXT FOR DEVELOPING DRINKING PATTERNS IN LATER LIFE There are only limited longitudinal data regarding the continuity of problem and non-problem drinking from college years to early adulthood; no such Canadian data have been found. Fillmore's (1974) 20-year follow-up study of college students found that earlier frequency, quantity and problem drinking were predictive of problem drinking in middle age. Donovan etal's., (1981) longitudinal data suggest that males are more likely to develop problem drinking, and are also more likely to continue in this pattern into adulthood. For both males and females, earlier problem drinking was found to be more persistent than more recently developed problems; this suggests that the maturation process might act as an independent variable in influencing the continuity of problem drinking. IMPLICATIONS Evidence that the overwhelming majority of university students drink does not imply that the college population is composed of alcoholics and problem drinkers. The elevated level of consumption and evidence of serious negative consequences of alcohol use, however, is a cause for concern, particularly if drinking patterns established early in life remain constant for a long period of time. This has implications for the potential health and productivity of graduates. As Donovan (1981) remarks, ". . . alcohol problems on campus mirror those off campus and deserve equal attention. Indeed, since today's students will be tomorrow's leaders, one might argue a higher priority". It is not clear to what extent students consider the implications of their alcohol use in terms of disruptions and costs to themselves, their campus, family, friends and their community at large. Intervention is suggested as a necessary preventive step in reducing or avoiding these consequences, both while at university and after leaving the university environment. Evidence indicates that interventions should not be limited to junior level students. Alcohol education, however, may not be essential for the entire student population; specific subgroups such as males, in their third and fourth years, living in residences may require it more than other subgroups. Although it may be argued that prevention programs at the college level is not worthwhile because drinking attitudes have already been established by the time a person enters college, it can also be argued that the choice of how to drink remains. 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