Monday, December 23, 2013

You Can't Be an Alcoholic If You're in College, Right?

Have you heard this one before? It's not uncommon to find it on the lips of college students. For some it's almost a rallying cry.

The sheer prevalence of binge drinking and the youth of college drinkers can mislead students into thinking that heavy drinking is just a college thing, a rite of passage that they'll mature out of, and that it therefore poses little risk to them in the short or long term.

For many students that may be true. But some students won't outgrow their dangerous drinking habits, while others are already suffering the negative consequences of excessive drinking.

Young Adults and Alcohol Dependency


Contrary to college lore, there is no minimum age for alcoholism. Sadly, many young adults do meet the criteria for alcohol dependency and abuse. A 2002 study found that 31% of college students abused alcohol and 6% could be diagnosed with alcohol dependency.

A 2007 study identified five "subtypes" of alcohol dependency: young adult, young antisocial, intermediate familial, functional, and chronic severe. Only the chronic severe abusers fit into popular stereotypes of what most of us associate with alcohol abuse, yet they are the smallest percentage of problem drinkers.

Shockingly, young adults made up the largest subtype (31.5%), according to the study. They are also the least likely to seek help for their drinking.

In an interview with Psychiatric News, the researchers themselves expressed surprise with their finding "that so many of the individuals who met diagnostic criteria for alcohol dependence were young adults [in their early 20s]."

Young adult drinkers drank less frequently than other subtypes, but when they drank, they tended to binge (73% of the time). Since over a third of young adult drinkers are still in school, the researchers suggested that "they may be an unrecognized part of the college drinking problem."

More recently, the American Psychiatric Association (APA) has changed how they define substance use disorder.

Previously, the APA treated substance abuse and dependency as an either/or scenario: either you had a problem or you didn't. In contrast, the newest Diagnostic and Statistical Manual of Mental Disorders (DSM-5) treats substance use disorders on a continuum from mild or moderate to severe.

As Dr. Charles O'Brien explained, "In DS- 4, we had essentially two diagnoses: one was abuse and the other, dependence...By doing a lot of research, we've discovered addiction doesn't work that way. It starts off mild at the beginning and becomes gradually more severe."

There was some controversy over the new standards. Critics claimed as many as 40% of college students could end up being labelled as alcoholics if the DSM 5's new diagnoses are followed.

This increase in diagnoses, critics argued, could do more harm than good. Rather than encouraging students to seek help, the diagnosis might lock them into the identity of an alcoholic or addict, causing them to act and think accordingly.

"And that poses a huge problem," wrote Maia Szalavitz for Time,  "particularly for adolescents and young adults with mild problems who may be pushed to adopt an addict identity and to see themselves as having no way to control their drinking or drug use if they ever 'relapse'. Rather than empowering those who do have control to use it, these programs essentially tell kids that if they ever have just one drink or puff on a joint, they’re lost."

But if telling students that they're problem drinkers doesn't work, then what other solutions are available?

Drinking Problem versus Problems with Drinking


Some researchers have suggested another approach that avoids the labels associated with substance use disorders. The Harvard School of Public Health, for example, has recently released a series of books that addresses the grey area between normal and problem drinking.

The series is called the "almost effect" and discusses circumstances where individuals may experience negative consequences from their drinking, such as poor sleep, depression, a drop off in work performance, or relationship troubles, but may not qualify for a formal diagnosis of alcohol dependency. They call these individuals "almost alcoholics."

Though they may not be formally diagnosed for a substance use disorder, they may nonetheless benefit from counseling or a brief intervention in order to help them see the connection between their drinking and its consequences.

Dr. Joseph Nowinski, one of the series' authors, explains that the decision that your drinking is a problem "does not imply that you admit to having a 'diagnosis', or that you are 'mentally ill'. Rather, it simply means that you have decided to make some changes in your lifestyle in the interest of your overall health."

In other words, perhaps the problem isn't that students think you can't be an alcoholic in college, but that they're thinking in terms of alcoholic or not alcoholic. Such binary thinking prevents them from seeing how their drinking is beginning to cause them problems and from doing something about it. Even if it's not an official diagnosis and even if it doesn't lead to problems later in life, college drinking can still be a problem now.








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