College student binge drinking and the "prevention paradox": Implications for prevention and harm reduction
Weitzman ER, Nelson TF 
Journal of Drug Education. 2004;34(3):247-266.

(quoted from Harvard's College Alcohol Study page)

Considerable attention has been paid to heavy episodic or "binge" drinking among college youth in the United States. Despite widespread use, the binge measure is perceived by some as a low intervention threshold. We use data from the Harvard School of Public Health College Alcohol Study (n = 49,163) to describe patterns of consumption and harms along a continuum including the binge measure to demonstrate the validity of the binge threshold and prevention paradox in college. While the heaviest drinkers are at greatest risk for harm, they are relatively few and generate proportionately small amounts of all drinking-harms. The risk of harms is not zero among lower level drinkers in college. Because they are numerous, they account for the majority of harms. This paradoxical pattern suggests we moderate consumption among the majority using environmental approaches, the efficacy of which are described using case study data from a national prevention demonstration. Implications for prevention policy, programming, and media advocacy are discussed.

Click article to read entire study

This article, although somewhat dated, is (tangentially) related to my recent position (see last 2 posts) regarding the next frontier on which prevention professionals may wish to focus their attention; the moderate drinker. Although I have been arguing this point from a more qualitative position, namely, lets attempt to access the perspectives of contemporary "moderately drinking collegians" to learn what impacts their decisions regarding use, this information can inform prevention efforts to moderate student drinking and reduce the untoward incidents associated with episodic high-risk consumption.

Consider a “pincer movement” of sorts as regards attempts to change the campus culture regarding alcohol and drinking. Each front in such a movement approaches the objective of change from a different perspective. First, investigation of student perspectives regarding alcohol use, in particular the perspectives of those students who are moderate in their consumption or abstain altogether--see my previous two posts for more on this. Doing so will enable prevention specialists to learn more about those variable/factors that affect moderate consumption and do so by interviewing and observing those students already doing what preventionists advocate. At the same these perspectives are being obtained, activate the second prong of the pincer; pursue the reduction of episodic high-risk consumption via the use of environmental management strategies.

Such an approach would not "move away from" addressing the needs or behaviors of the frequent "binge drinker," but it would acknowledge that there is more to be learned about collegiate drinking than can be learned from only those who constitute the minority of contemporary collegians. To exclusively focus on the frequently "binge drinking" student when considering prevention is to react to the problem rather than act on the pursuit of a solution. 

What do you think?
Dr. Robert


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