Compulsive use of alcohol among college students
Introduction
Among college students, alcohol use is highly prevalent as between 70% and 80% of college students report having consumed alcohol in the previous 30 days (O'Malley and Johnston, 2002). However, among college students alcohol consumption can lead to severe short- and long-term negative consequences (Rosenberg and Mazzola, 2007, Hingson et al., 2009). In United States every year approximately 1800 college students die as a result of alcohol-related injuries, 599,000 students are injured due to drinking, 696,000 students are assaulted by another college student who has been drinking alcohol and 97,000 students are subjected to date rape or sexual assault associated with alcohol use (Hingson et al., 2009).
Among college students, heavy alcohol consumption is also associated with increased likelihood of use of licit and illicit drugs. For example, college students who drink heavily are approximately five times more likely to use marijuana and eight times as likely to use cocaine as their peers who engage in light drinking (O'Grady et al., 2008). Similarly, frequent binge drinking is associated with the usage of cigarettes, marijuana, hallucinogens, and LSD during the previous year (Wechsler et al., 1995). Substance use in addition to alcohol consumption is associated with greater number and severity of negative consequences (Bennett et al., 1999, Clapp et al., 2000). For example, students who binge drink and use drugs are twice as likely than those who binge drink only to ride with a drunk driver or to get into an accident (Feigelman et al., 1998), and are more likely to drink and drive, have blackouts, unplanned sex, and drug-related problems (McCabe et al., 2006).
Despite the significant problems associated with alcohol and drug use a small proportion of students who drink at a hazardous level and who use illicit substances seek treatment (Blanco et al., 2008, Caldeira et al., 2009). Thus, it is critical to find strategies to identify college students engaging in hazardous drinking behaviors who also use licit or illicit drugs and may be at higher risk for problems. Screening efforts have been advocated to identify at risk students (National Institute on Alcohol Abuse and Alcoholism (NIAAA), 2002, National Center for Addiction and Substance Abuse (CASA) at Columbia University, 2007) and given the high co-occurrence of alcohol use and drug use screening tools for hazardous alcohol consumption may also inform on the likelihood of use of illicit substances. However, not all heavy drinking college students use drugs (O'Malley and Johnston, 2002) thus screenings for drinking behaviors other than quantity of alcohol consumed may be more sensitive methods to identify those who are using illicit substances and are likely to have drinking and/or drug problems.
Compulsive drinking has been defined as a dimension of craving characterized by urges to consume alcohol, as well as by the inability to control these urges (Modell et al., 1992) and among college students it has been found to be associated with greater alcohol consumption (Anton et al., 1995, Pedrelli et al., 2011b), and with higher risk for alcohol-related negative consequences (Rosenberg and Mazzola, 2007), hazardous behaviors (Pedrelli et al., 2011a) and depressive symptoms (Pedrelli et al., 2011b). Moreover, among adults compulsive drinking is associated with severity of alcohol dependence and with increased likelihood of relapse (Anton et al., 1996, Moak et al., 1998). A recent study assessing compulsive drinking with a one-item question included in the Consumptive Habits Questionnaire (CHQ; Guidi et al., 2009) observed that college students who endorsed compulsive use of alcohol on the CHQ item reported greater daily alcohol use and likelihood of risky behaviors such as the use of licit and illicit substances, compulsive sexual behaviors and gambling, relative to those who denied compulsive use of alcohol (Pedrelli et al., 2011a). Thus, the CHQ compulsive use of alcohol item may be useful to identify students with greater likelihood for risky behaviors such as heavy drinking, hazardous alcohol use, licit and illicit drug use and substance use disorders. The present study investigated the ability of the CHQ compulsive use of alcohol item to detect heavy and hazardous alcohol use measured by the Alcohol Use Disorders Identification Test (AUDIT; Saunders et al., 1993) a common measure of hazardous alcohol use. Moreover, the study compared the ability of the CHQ compulsive use of alcohol item to detect the use of licit and illicit drugs and drug problems relative to employing the AUDIT.
Compulsive drinking in the CHQ is measured by an item saying “Compulsive use of Alcohol” to which respondents may circle “yes” or “no”, thus the CHQ does not provide an explicit definition of compulsive use of alcohol and it is unclear whether the behavior measured is consistent with previous definitions of compulsive drinking. Compulsive drinking has been primarily assessed with the Obsessive-Compulsive Drinking Scale (OCDS), a validated self-report measure including 14 items assessing several dimensions of craving, and that includes a compulsive drinking subscale (Anton et al., 1995, Connor et al., 2008). Preliminary analyses performed in a sample of 332 college students showed that students reporting compulsive use of alcohol on the CHQ had a significantly higher OCDS compulsive drinking subscale score as well as OCDS total score and greater severity of drug related problems than students who denied compulsive use of alcohol on the CHQ (Pedrelli et al., 2011a). These observations suggest that the CHQ compulsive use of alcohol item measures a behavior related to the theoretical definition of compulsive drinking at the bases of the OCDS. However, preliminary analyses did not examine the dimensions of compulsive drinking associated with the CHQ compulsive use of alcohol item and were not performed separately by sex. The current study aims at furthering the understanding of reported compulsive use of alcohol on the CHQ by examining its relationship with the specific items included in the OCDS compulsive drinking subscale. Moreover, the associations between the CHQ compulsive use of alcohol item and the OCDS compulsive drinking subscale and the OCDS total score are examined separately by sex. To examine drinking behaviors separately in male and female college students it is critical for several reasons. Differences in prevalence of risky behaviors across sexes, including rates of compulsive use of alcohol, have been consistently reported (Rosenberg and Mazzola, 2007, Bellis et al., 2008, Randolph et al., 2009, Pedrelli et al., 2011a). Furthermore, male college students consume more alcohol (Wechsler et al., 1994, O'Donnell et al., 2006, White et al., 2006), have more addictive tendencies toward alcohol (Greenberg et al., 1999), and have more alcohol related negative consequences (Geisner et al., 2004, Harrell and Karim, 2008) than female students. Similarly, men are more likely to use marijuana and other illicit drugs than women (Gledhill-Hoyt et al., 2000, O'Malley and Johnston, 2002, Mohler-Kuo et al., 2003). Moreover, male and female college students report different drinking motives (Park and Levenson, 2002, Harrell and Karim, 2008) and experience different types of alcohol-related problems (Norberg et al., 2011). Finally, biological evidence suggests that women and men absorb and metabolize alcohol differently and that the same amount of alcohol consumed by a woman and a man of the same weight is associated with a greater level of blood–alcohol -level (BAL) in the former than the latter (Thomasson, 1995). These dissimilarities have prompted the exploration of different models to explain drinking behaviors in men and women and the delineation of different screening guidelines to define problematic drinking behaviors in men and women (Wechsler et al., 1994, Willenbring et al., 2009).
In summary, the present study will inform as to the utility to employ the CHQ compulsive use of alcohol item to detect male and female students at risk for negative consequences relative to current screening methods. Specifically, sensitive screening methods for risky use may facilitate prompt identification and referrals of students who would benefit from treatments focusing on hazardous use of substances and may prevent further problems. Moreover, the study may shed light into whether compulsive use of alcohol measured by the CHQ is consistent with a current definition of compulsive drinking and it may inform on mechanisms at the basis of the co-occurrence of alcohol use and risky behaviors, and drug problems.
Section snippets
Participants
Participants consisted of 332 undergraduate college students, who were predominantly female (62.3%), white (non-hispanic) (77.7%), single (99.7%) and not an international student (94.6%) and with a mean average age of 19±1.7 years. Table 1 displays demographic statistics and information for the current study.
Procedures
The present study was part of a larger ongoing project investigating a suicide prevention program for college students at multiple Boston-area universities. The data included in the present
Prevalence of risky behaviors
Table 2 displays the prevalence of risky behaviors among students in our sample, separated by sex. Approximately one out of six male students endorsed compulsive use of alcohol and of street drugs, while approximately one out of eight female students endorsed compulsive use of alcohol and of street drugs.
CHQ compulsive use of alcohol item and hazardous behaviors and severity of problems
Among male college students there was not a significant difference in daily alcohol use between students who reported compulsive use of alcohol relative to those who did not (M=2.1+2.4 vs. M
Discussion
The primary aim of the study was to examine the CHQ compulsive use of alcohol item relative to current measures of hazardous and heavy alcohol use and drug problems. In the present study in male students compulsive use of alcohol co-occurred greatly with compulsive use of illicit drugs. However, the CHQ compulsive use of alcohol item had low sensitivity to detect frequency of heavy drinking, of hazardous alcohol use, and of substance use problems. Thus, the CHQ may not be used instead of
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