Cutting back on alcohol may be more effective than immediately abstaining for preventing misuse among college students

A new study from the Texas A&M University School of Public Health explores a theoretical framework for implementing an alcohol reduction strategy to support U.S. college students at high risk for alcohol misuse.

Alcohol consumption is a common part of many young adults’ collegiate experiences. According to the 2021 National Survey on Drug Use and Health (NSDUH), approximately 50 percent of full-time college students between the ages of 18-22 consumed alcoholic beverages in the past month, with a significant proportion consuming alcohol at levels that pose serious health risks.

The 2021 NSDUH survey found that more than 1 in 4 college students engaged in binge drinking, which is defined as consuming five or more drinks for men and four or more drinks for women on a single occasion. This type of consumption pattern increases an individual’s blood alcohol concentration to 0.08 percent or higher, the legal definition of impairment according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA). The survey also revealed that some college students consumed alcohol at levels twice the threshold for binge drinking.

Excessive alcohol consumption poses significant risks for college-age drinkers. According to the NIAAA, these risks can include academic problems, injuries, health problems, alcohol use disorder, assault, sexual assault, unsafe sexual behaviors, driving under the influence, vandalism, damage, involvement with the police, suicide attempts and fatalities from unintentional injuries such as motor vehicle crashes.

A research team led by Benjamin Montemayor, PhD, assistant professor at the School of Public Health, used a novel approach by utilizing theory to examine factors that predict or are associated with the intention to reduce alcohol consumption, rather than focusing on factors that predict or are associated with increased alcohol use, as seen in previous research. This new research creates a line of inquiry into the concept of harm reduction, which may be a more feasible approach for college students who are drinking heavily.

“We know what factors are associated with an increase in alcohol use from numerous studies, but little research has examined it from the antithesis viewpoint,” Montemayor said. “Reducing alcohol use aligns with a harm reduction approach, because we want to prevent the onset of adverse outcomes associated with excessive drinking.”

The researchers surveyed 822 high-risk college student drinkers from a large U.S. public university. They analyzed the students’ intention to reduce alcohol consumption using the Theory of Planned Behavior, which focuses on attitude (personal behavior), subjective norms (perceived social pressures), and behavior control (perceived control of the behavior).

The analysis found that students’ attitudes—viewing alcohol use reduction as good/bad, beneficial/harmful or healthy/unhealthy—and social norms, such as basing their decisions on the influences of important individuals in their lives, were strongly linked to their intention to cut back on drinking. However, the researchers found that the students’ perceived behavior control, which reflects their agency in deciding to lower alcoholic consumption, was not linked with intention to reduce alcohol use. This suggests that while students felt capable of controlling their alcohol use, this perception does not translate into a strong intention to actually reduce their intake.

Montemayor stressed that taking a harm reduction approach does not condone nor subtly encourage high-risk alcohol use among college students; instead, he suggested that this theoretical application allows for a practical approach targeting students’ attitudes, social norms and other protective factors known to reduce alcohol use. This approach would be specifically designed to address a population of at-risk students known to engage in harmful levels of drinking more frequently than their non-college peers.

“We’re being realistic about the approach we take, which is to say, ‘Okay, we know that half of college students drank in the past 30 days. Why not then focus on a program that helps reduce this alcohol use instead of sending a message that abstaining is the preferred option?’” he said. “And then we can focus on progressing that reduction toward overall abstinence or helping students transition out of this period and into older adulthood, when alcohol use often declines significantly due to changes in environment and a shift in focus to adult responsibilities such as full-time work and families.”