A review of literature on alcohol abuse, binge drinking, and underage drinking on college campuses as well as best practices regarding alcohol education and programming, environmental and community initiatives, and discipline

A review of University protocols, policies and practices regarding disciplinary violations, health center and counseling center referrals, residence hall procedures, parental notification, and communication with students and parents

The development of a position statement that might be issued by the University

A review of educational and programming initiatives now in place as well as recommendations for new initiatives

While the focus of this task force was alcohol use and abuse, it will be helpful to include abuse of other substances as a focus where similar initiatives may be appropriate

Review of Literature

The literature review on alcohol use and abuse was divided into four areas- the problem, responses, specific approaches and recommendations. This is by no means presented as a thorough summary of all literature that was reviewed but rather highlights findings. Following are key components in each area:

The Problem

"Heavy drinking and the disruptive behaviors that accompany it have been part of campus life at American colleges since colonial days" (Wechsler, Seibring, Liu and Ahl, 2004). Most literature defining the problem of alcohol use and abuse in college settings is either written by Dr. Henry Wechsler or references the College Alcohol Study (CAS) which has been his ongoing work at the Harvard School of Public Health since 1993. Since that time over 50,000 students representing 140 colleges and universities in 39 states have responded to three surveys. Data has been gathered about alcohol use and abuse, prevention programs, policy enforcement and the student's attitude toward school initiatives (Weitzman, Nelson and Wechsler, 2004). Alcohol abuse or binge drinking is defined by 5 or more drinks in a row for men and 4 or more drinks in a row for women in a two week period. While it can be argued that this amount may not constitute what previous research has considered a binge, it is a useful bench mark in defining problem or dangerous consumption of alcohol (Wechsler and Nelson, 2001) and is the standard typically used in evaluating drinking among college students. Of the students surveyed most recently approximately 44% were classified as binge drinkers (Wechsler, J. Lee, Kuo, Seibring, Nelson and H. Lee, 2002).

Some factors that influence binge drinking include alcohol accessibility, living environment, parental attitudes and age at which a student began drinking. Educational initiatives in and of themselves have very little influence on college drinking behavior making it imperative that schools approach this challenge from multiple fronts.

The Response

In 2004 Join Together Online, a national organization whose mission is to support communities working to reduce substance abuse, published the various approaches that were in place to combat student binge drinking as provided by 747 school administrators representing colleges and universities across the country. Prevention measures include:

Banning alcohol on campus- 34% have banned alcohol for any student regardless of age.

Banning alcohol in residence halls- 43% prohibit alcohol in all residence halls, 81% offered some substance free floors or halls.

Restricting alcohol at events- 44% of all colleges restricted alcohol use in at least four of the following events: athletic contests, tailgate events, homecoming celebrations, on-campus dances or concerts, on-campus banquets and receptions and alumni events.

Providing alcohol education- 84% provide education for freshmen, 72% for fraternity and sorority members and 69% for athletes.

Conducting social norms marketing campaigns- 50% of colleges use these marketing campaigns that strive to reduce alcohol consumption among students by correcting misperceptions of drinking behavior of their peers through education and motivation.

Managing substance abuse among students- 90% offer some form of counseling and treatment program for students who abuse alcohol.

Campus coordination- 81% employ an assigned substance abuse official and 61% have a task force to deal with substance issues.

Specific Approaches

While significant attention has been paid to college student drinking over the past decade, little has changed since the early 90's (Weitzman, Nelson, Lee, Wechsler, 2004). The latest strategies in combating excessive alcohol use on campuses are taking an environmental approach that combine individually focused initiatives with ones that address the environment such as enforcement of minimum drinking age laws, limiting access to low-cost, high-volume drink specials and kegs, and providing responsible training for those who serve alcohol. One such initiative is the "A Matter of Degree" (AMOD) program which was developed and funded by the Robert Wood Johnson Foundation with programmatic support from the American Medical Association to foster collaboration between universities and the communities in which they are located. "Rather than blame students for their behavior or try to persuade them to stop drinking, participants in A Matter of Degree are identifying the environmental factors such as alcohol advertising and marketing, institutional policies and practices, local ordinances-even cultural beliefs and behaviors- that converge to encourage alcohol abuse, and work together to create positive change" (American Medical Association, 2005).

Recommendations

The most comprehensive set of recommendations have been put forward by the Task Force of the National Advisory Council on Alcohol Abuse and Alcoholism in its report "A Call to Action: Changing the Culture of Drinking at U.S. Colleges." The report suggests that it is imperative to develop strategies that focus on individuals, including at-risk or alcohol dependent drinkers; the student population as a whole; and the college and surrounding community. It stresses the importance of focusing simultaneously on each of the three primary audiences. Specific strategies include:

Combining cognitive-behavioral skills with norms clarification and motivational enhancement interventions

Offering brief motivational enhancement interventions in student health centers and emergency rooms

Challenging alcohol expectancies

Increased enforcement of minimum drinking age laws

Implementation, increased publicity, and enforcement of other laws to reduce alcohol-impaired driving

Restrictions on alcohol retail density

Increased price and excise taxes on alcoholic beverages

Responsible beverage service policies in social and commercial settings

The formation of a campus/community coalition

Adopting campus-based policies to reduce high-risk use (e.g. reinstating Friday classes, eliminating keg parties, establishing alcohol-free activities and residences)

Increasing enforcement at campus-based events that promote excess drinking

Increasing publicity about enforcement of underage drinking laws, eliminating "mixed" messages

Consistently enforcing disciplinary actions associated with policy violations

Conducting marketing campaigns to correct student misperception about alcohol use on campus

Provision of "safe rides" program

Regulation of happy hours and sales

Enhancing awareness of personal liability

Informing new students and parents about alcohol policies and penalties

Review of University Protocols, Policies and Practices

Disciplinary Violations

A review of historical disciplinary data revealed a system that sometimes allowed for multiple incidents without a significant response such as a fine or suspension. Responses were educational- such as a reflection paper or requirement to facilitate an alcohol awareness program, or therapeutic- such as an evaluation at the Health Center or Counseling with required follow through with practitioner recommendations. This approach permitted some students to have multiple chances to improve behavior before a higher level of disciplinary action was initiated.

While we still believe whole-heartedly in these approaches they may be too lenient and not as effective in deterring problematic alcohol behavior. A new "three strike system" is being implemented this fall. This system applies to alcohol misuse as well as any other violation of the Student Conduct Code. A first violation will result in a written warning and any other appropriate educational/therapeutic intervention. A second violation will result in a fine and parental notification. A third violation during a twelve month period will result in suspension from the University. As is the case with any violation of the Student Conduct Code, any egregious violation (even a first offense) can be punished with sanctions up to and including expulsion.

Health Center and Counseling Center Referrals

Systems currently in place at both the Health Center and Counseling Center were found to be appropriate and beneficial to the student body. We have the benefit of having expertise in alcohol use and abuse among staff members in both centers which greatly enhances the services these departments are able to provide. The Counseling Center subscribes to E-Chug and E-Toke, an alcohol and marijuana self-assessment tool respectively, that provides individual feedback as well as peer comparison data. Both departments also support specific peer programs providing an additional level of outreach and intervention.

Residence Hall Procedures

The "three strike system" described above will govern alcohol use in the residence halls as well. The task force also recommended that the resident advisors (RAs) visit each student room during the first few weeks of classes and spend time talking about alcohol misuse and the potential consequences both from a health and social perspective as well as a disciplinary one. All RAs are required to have an alcohol program during September; the Task Force recommends that this is a good opportunity to invite upper- class students to talk about their own experience with alcohol. Peer presentation of alcohol information is often much more effective than hearing the information from speakers or administrators.

Parental Notification

There was previously no specific standard for parental notification. As stated previously parents will be notified of any second disciplinary violation occurring within a twelve month period. This notification will clearly state that a third violation will result in suspension from the University.

Communication with Students and Parents

For the past five years the Dean of Student Life has mailed a letter to parents of incoming students in August discussing alcohol issues as well as other issues faced by first year students. Some sort of informational pamphlet has also been included as well as an invitation to complete Alcohol Edu, a mandatory on-line course that all freshmen complete before they arrive on campus in September.

Incoming students are mailed a description and log on information for Alcohol Edu, a course that covers all the basics regarding alcohol use and abuse in six independent modules. It takes approximately two hours to complete and students are required to complete the course before they arrive on campus. A two month follow up occurs as well. The data from the course is provided to the University at the end of the first semester. Our results indicate that while drinking still increases among our students during the first semester the rate of increase is less than the rate observed among college students that do not participate in Alcohol Edu.

Position Statement

The Task Force has drafted the following position statement that would be suitable to be issued by the University.

The Johns Hopkins University recognizes that alcohol use and abuse is one of the greatest challenges facing American universities. Today's college students face powerful social and commercial influences to consume alcohol. The University is committed to taking every step necessary to address alcohol and other drug difficulties which affect safety and impede students from achieving academic and personal success. Key components of this commitment include providing education and appropriate support services, emphasizing student responsibility and accountability, minimizing risk and expanding social opportunities.

The Task Force reviewed programming and educational initiatives now in place. All of these fall within categories that were sited in the literature review. The current efforts typically fall within the education and enforcement categories with less attention being paid to broader community interventions. While all of these will be continued a range of new initiatives will be implemented in the fall. A sample of current initiatives is listed below:

Students and parents receive communication from the University regarding alcohol use and abuse before classes begin and periodically through out their tenure at the institution

All new students are required to complete Alcohol Edu, an on-line alcohol education program, before arriving on campus in September

A large scale alcohol program featuring a professional speaker will take place during Orientation and parents are made aware of our policies and expectations during the parents' portion of this program as well

Resident Advisors follow up with an alcohol program for their residents during the first month of school. They are provided with five programs that have had past success as resources to facilitate their efforts

Students have the option of choosing substance free housing

Long-standing alcohol policies prohibit kegs and advertising of alcohol

Procedures are in place for on-campus alcohol events which include third party vendors who are responsible for alcohol distribution

Significant efforts have been made to improve and expand on campus programming with broad appeal; Orientation which will be followed by a welcome weekend for all students, Fall Festival and the institution of the "Nest" at home athletic competitions are three examples.

A range of new initiatives have been developed or recommended and will be in place this fall. Included in this group are:

The development of a party registration protocol (see attached form) for on campus and off campus events sponsored by recognized student organizations including Greeks

New passive education approaches such as manikins placed around campus with eye-catching slogans on their shirts and "teasers" that encourage students to find out more

A board of students and staff will be established to oversee peer education programs, identify volunteers to remain sober at parties, sponsor TIPS training (alcohol management program), recruit students to share their stories of overcoming alcohol abuse

Work with the fraternities to enforce current national alcohol, develop an Inter Fraternity Council policy regarding alcohol use and revamp the judicial process

Strengthen sanctions in response to conduct code violations as outlined in the new "three strike" policy

Provide more on-campus activities designed to attract a broad range of students

Our task force believes strongly that a revamping of the class schedule from a predominately Monday/Tuesday/Wednesday schedule to a more traditional Monday/Wednesday/Friday schedule would go a long way in addressing Thursday night parties which are particularly problematic in the neighborhood

Implement use of an annual assessment measure that will allow us to more effectively track our progress in these areas

While much is already in place at our institution in the battle against alcohol misuse and abuse, it is imperative monitoring, evaluating and revamping our efforts needs to be an on-going process. A permanent task force will continue to function to facilitate this effort. It is also important that those at the highest level of the University continue to lead the charge as we move forward.

Bibliography

Join Together Online. Colleges split in approaches to student binge drinking. Mar 16, 2004. Press release, College Alcohol Study, Harvard School of Public Health. Retrieved March 17, 2004, from www.jointogether.org/

Join Together Online. Environment a strong predictor of binge drinking behavior among college freshmen. January 22, 2003. Press release, College Alcohol Study, Harvard School of Public Health. Retrieved May 27, 2003, from www.jointogether.org/

New study reveals reduction in drinking and alcohol-related problems at colleges with multiple prevention policies on and off campus, Sept 10, 2004, American Medical Association. www.ama- assn./ama/pub/article/print/1616-8839.html

Task Force of the National Advisory Council on Alcohol Abuse and Alcoholism. (2002). A Call to Action: Changing the Culture of Drinking at US Colleges. National Institutes of Health, US Department of Health and Human Services.

Wechsler, H, Seibring, M, Liu, I-C, & Ahl, M. Colleges respond to student binge drinking: Reducing student demand or limiting access. Journal of American College Health 2004: 52(4), 159-168.

Wechsler H, Lee, JE, Kuo, M, Seibring M, Nelson TF, & Lee, H. Trends in alcohol use, related problems and experience of prevention efforts among US college students 1993-2001: Results from the 2001 Harvard School of Public Health College Alcohol Study. Journal of American College Health 2002: 50 (5), 203-217.

Wechsler, H, Nelson TF. Binge drinking and the American college student: What's five drinks? Psychology of Addictive Behaviors 2001; 15:287-291.

Weitzman, ER, Nelson, TF, Lee, H, Wechsler, H. Reducing drinking and related harms in college: Evaluation of the "A Matter of Degree Program." American Journal of Preventive Medicine 2004: 27(3), 187-196.

Weitzman, ER, Nelson, TF, & Wechsler H. From knowledge to action: How Harvard's college alcohol study can help your campus design a campaign against student alcohol abuse. College Alcohol Study, Harvard School of Public Health, 2002. Retrieved April 23, 2005 from www.hsph.harvard.edu/cas/Documents/change- article/

© 2005 The Johns Hopkins University. Baltimore, Maryland. All rights reserved.
Last updated 09Sep05 by dgips@jhu.edu