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.

What Happens in College Doesn't Always Stay in College

Photograph courtesy of Amanda Berg

While a junior at the Rochester Institute of Technology, Amanda Berg noticed her female friends trying to match men drink for drink at parties. The trend bothered her and she was interested in exploring it further. So on Halloween, Berg decided to bring her camera to a party, and instead of knocking back drinks, she snapped photos.

The one-night experiment developed into a long-term project, and Berg continued to document her female friends while they partied. The fruit of this project, Berg's photo-essay, "Keg Stand Queens: Binge Drinking among College-Aged Women," explores "the complex relationship women undergraduates have with alcohol." 

Berg has plenty of images of binge drinking that we might expect from a photo-essay on college partying: students shotgunning beers, another chugging from a bottle of booze as she flips off the cheering crowd encircling her, and a young woman throwing up in the bathroom after partying too hard.

Other photos show the way drinking insinuates itself into the more mundane aspects of student life like one photograph of a half-empty bottle of Jack Daniels on a bathroom counter, nestled among makeup, toothpaste, and combs.

In some ways, it is this last photo that is the most troubling. It suggests the way drinking becomes as routine as brushing your teeth or combing your hair. Indeed, harm-prevention programs usually educate students about the dangers of binge drinking, but rarely do they mention the dangers of daily drinking.

 

The Importance of Weekly Limits

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines moderate drinking by both daily and weekly limits. For men, those limits are no more than four drinks a day or 14 drinks in a week. For women, it's three drinks a day or seven drinks in a week. Daily limits protect people from acute risks such as alcohol poisoning. Weekly limits, meanwhile, protect them from long-term risks associated with alcohol such as certain types of cancer.

While alcohol programs generally educate students about daily limits and the dangers of binge drinking, most don't mention weekly limits, even though keeping within both limits is important to students' health.

In a recent study published in Alcoholism: Clinical and Experimental Research, Bettina Hoeppner and her colleagues found that 50% of college women and 45% of college men exceeded the NIAAA's weekly limits at least once in their first year of college. The findings reveal a hole in some campuses harm-reduction efforts. By failing to educate students about weekly limits, Hoeppner argues, schools may be missing an important chance to have a long-term impact on students' lives, especially young women.

In fact, recent data show that while young adults binge less after college graduation, they continue to drink just as frequently if not more. "[T]his raises the possibility," Hoeppner speculates, "that the weekly limits become more relevant after leaving the college environment when weekly volume is less likely to be driven by heavy episodic drinking."

Breaking the cycle

College students are still more likely to exceed daily than weekly limits. Indeed, according to Hoeppner's data, almost no students exceeded weekly limits without also exceeding daily limits. Furthermore, the risks of binge drinking (blackouts, injuries, alcohol poisoning) are more acute than the potential long-term effects of regularly exceeding weekly limits. But, as Hoeppner's research suggests, students also need to think about how their drinking fits into a bigger picture.

Just as colleges and universities educate students for professional life after graduation, schools need to consider how their harm-reduction strategies promote healthier lifestyles at college and beyond.
Telling students that alcohol abuse is just a "college" problem reinforces the perception that there aren't long-term consequences to their behavior: "What happens at college stays at college."

Failing to warn students about the long-term consequences of heavy drinking not only lets women down, it lets all students down. Education programs prepare students for life, not just college.

The final image in Berg's photo-essay is a young girl practicing flip cup. She is surrounded by the detritus of a wedding celebration. Empty cups and containers are strewn across the table. In the distance, just out of focus, lies a discarded silver sandal. As Berg told Slate Magazine, "It seems like the end is the beginning, and it just goes on."

 

Works Cited

Hoeppner, B.B., Paskausky, A.L., Jackson, K.M., Barnett, N.P. (2013) "Sex Differences in College Student Adherence to NIAAA Drinking Guidelines," Alcoholism: Clinical and Experimental Research, 37, 1779-1786.

Court Rejects Ban on Alcohol Advertising in College Papers

Until the U.S. Court of Appeals for the Fourth Circuit's recent decision limited its reach, the Virginia Alcoholic Beverage Control Board's (ABC) regulations banned all college newspapers from running alcohol advertising. The ban is part of a comprehensive strategy aimed at reducing underage drinking.

Many colleges and universities take a similar "environmental" or "community-level" approach to combat high-risk drinking. These interventions often enlist retailers and advertisers as allies in prevention efforts. 

But in 2006 two college newspapers affected by the regulation, The University of Virginia's Cavalier Daily and Virginia Tech's Collegiate Daily, sued the ABC, claiming the ban violated their First Amendment free speech rights.

The newspapers pointed out that a majority of their readership were over 21 (59-60% of the Collegiate Times' and 64% of The Cavalier Daily's readers). Therefore, while Virginia had a government interest in preventing underage drinking, the papers' wide distribution to people over 21 meant that the scope of the regulation was too broad.

In its decision, the Court sided with the college newspapers, acknowledging the state's interest but rejecting the regulation's overbroad reach.

"While commercial speech is protected by the First Amendment, there is a 'commonsense distinction' between commercial speech and other varieties of speech...[therefore] a regulation of commercial speech will be upheld if (1) the regulated speech concerns lawful activity and is not misleading; (2) the regulation is supported by a substantial government interest; (3) the regulation directly advances that interest; and (4) the regulation is not more extensive than necessary to serve the government’s interest."

Under this analysis, the Court concluded, "the challenged regulation fails...because it prohibits large numbers of adults who are 21 years of age or older from receiving truthful information about a product that they are legally allowed to consume...Accordingly, the challenged regulation is unconstitutionally overbroad."

The court also rejected the ABC's rejoinder that the regulation was justified by the state's more general interest in combatting abusive drinking, whether by underage or of-age drinkers. The Court cited a previous case that determined "states may not 'seek to remove a popular but disfavored product from the marketplace by prohibiting truthful, non-misleading advertisements.'"

The ruling, however, did not overturn the regulation itself. It only rejected the regulation as applied to these four-year college newspapers. As commentators have pointed out, where a paper's underage readership is the majority of its readership, the ban might still apply. A paper at two-year college, for instance, might still be subject to the regulation.

Critics of the ban have lauded the decision as a victory for free speech. Indeed, because school papers operate under tight budgets, the ban had a significant impact on the papers' finances and thus affected their primary mission of news reporting. According to estimates in The Cavalier Daily, lifting the prohibition would raise advertising revenue by 5 to 8%.

And while harm-reduction specialists may lament the loss of another valuable tool, the research is still divided on the effects of advertising on alcohol consumption. 

CampusClarity Wins Gold at the Annual Stevie Awards

Think About It won a Gold Stevie Award for Best Training Site at the 11th Annual American Business Awards. Think About It is CampusClarity's online training program on sexual violence and substance abuse for undergraduates and a compliance resource for college and university administrators.

The Stevies, considered the Oscars of the business world, are open to all U.S.-based organizations. With over 3,200 entries, this year's awards were a record-breaking size. More than 320 executives from across the country judged the entries.

The award-winning Think About It addresses campus sexual violence and substance abuse through a harm-reduction model that also helps schools comply with the Campus SaVE Act and Title IX.

The program is a collaboration between CampusClarity, a service of LawRoom, and the University of San Francisco's Division of Student Life. Instructional designers, student affairs administators, and lawyers worked alongside students to develop an effective course that would speak to students' college experiences.

Think About It includes bystander intervention training, customizable campus policies and resources, state specific laws on sexual and domestic violence, social norming exercises, a comprehensive discussion of consent, and in-depth reports on student attitudes and behaviors.

More than thirty-five colleges and universities nationwide use Think About It to train their students.

Accepting the gold for Think About It were Jeremy Beckman, Chief Instructional Designer at LawRoom, and Peter Novak, Vice Provost for Student Life at the University of San Francisco.

"It means a great deal," Novak said about the award. "It allows us to further collaborate on prospective projects and to really be of service to university students across the country."

LawRoom has been a leader in employment law compliance and training since it began in 1994. It has helped private and public companies, non-profits, and government entities comply with employment regulations. This year marked the first time the company participated in the American Business Awards or Stevies.

In addition to winning gold for Think About It, LawRoom also took home silver for its online sexual-harassment training, Lenses. 

The University of Montana's Cautionary Tale

"A rape-tolerant campus with ineffective programming, inadequate support services for victim survivors, and inequitable grievance procedures threatens every student." Diane G. Barz, retired Associate Justice Montana Supreme Court, Investigation Report dated January 31, 2012

Yearlong federal investigations of the University of Montana (UM) provide a cautionary tale for colleges and universities about how not to respond to reports of sexual assault. The U.S. Department of Education (ED) and the U.S. Department of Justice (DOJ) concluded that UM's responses to female students who reported sexual assaults were delayed, inadequate, and discriminatory.¹

ED's Title IX compliance review of UM produced "a blueprint for colleges and universities throughout the country to protect students from sexual harassment and assault." The DOJ's parallel investigation of UM's Office of Public Safety (OPS) resulted in a "roadmap for reform" that "will stand as a model" for other schools to prevent sex discrimination from interfering with an effective response to sexual assault complaints.

These problems were not confined to UM's Missoula campus. The DOJ also investigated the Missoula Police Department (MPD) and reviewed over 350 reports of sexual assault made by Missoula women, including UM students, received between January 2008 and May 2012. In the opening paragraph of its May 15, 2013 Letter of Findings, the DOJ concluded that the MPD's "response to sexual assaults compromise the effectiveness of sexual assault investigations from the outset, make it more difficult to [uncover] the truth, and have the effect of depriving female sexual assault victims of basic legal protections."

We'll first look at the underlying problems that contributed to UM's "rape-tolerant campus" because policies and procedures alone cannot fix systemic problems. Instead, they require an ongoing commitment to effect change in attitudes that turn into action. In later posts, we'll discuss the specific steps to Title IX compliance laid out in the "blueprint" and "roadmap."

 

Acknowledging the Problem

Before the federal investigations, UM had been grappling with its sexual assault problem. In December 2010, a female student reported to the MPD that four UM football players drugged and raped her.² While the MPD found there wasn't enough evidence for criminal charges, police informed UM's football coach about the allegations, but that report was not passed along to UM administrators until a year later.³

In December 2011, Royce Engstrom had been UM's president for just fourteen months when he received a call about the allegations. Once President Engstrom became involved, UM hired retired Montana Supreme Court Justice Diane Barz to investigate sexual assault reports at UM. Her final report found nine incidents reported between September 2010 and December 2011. Her recommendations included making information and resources on sexual assault readily available, training UM personnel on how to report and respond to sexual assault, and educating students on the consequences of risky behavior.⁴

Despite Barz's report, there was internal resistance to acknowledging UM's sexual assault problem. Around that time, internal email messages showed that UM Vice President Jim Foley questioned UM Dean of Students Charles Couture's use of the term "gang rape" to describe the December 2010 incident. Foley suggested that Couture should have called it "date rape." Couture replied, "Jim, I used that term [gang rape] when I accused the four football players of rape … because that is what it was.”

Over the next six months, Engstrom had fired UM's football coach and athletic director, and Foley had stepped down as UM's Vice President.

But just a month after Justice Barz's report, two more women complained to UM employees that they were sexually assaulted on the same night by the same male student, but he fled the country after UM's Dean of Students notified him of the charges and there was a one-week delay in reporting the incidents to local law enforcement.

 

Sexual Assault Case Reviews

Against this backdrop, the ED and DOJ reviewed UM's responses to twenty-three sexual assault complaints and ten sexual harassment complaints received by UM over the prior three school years. They found that UM's delayed and inadequate responses to complaints resulted in students not feeling safe on campus, suffering mental health problems, becoming suicidal, withdrawing from classes, or leaving the University altogether.

A sampling of cases discussed in the ED and DOJ's Joint Letter of Findings shows that UM's problematic responses were not confined to a particular area. In one case, the UM official investigating a sexual assault complaint knew that the victim was upset because she repeatedly saw her attacker on campus, but took no steps to protect her. Another sexual assault victim's roommate reported to their Resident Assistant (RA) that the victim was suicidal. The RA reported this to the Residence Life Office but there was no record of any action taken to ensure her safety. In yet another case, sufficient evidence was found to expel the student accused of sexual assault, but he was allowed to stay on campus for six more weeks to finish the semester. While the victim had left the University shortly after she reported the sexual assault, allowing her attacker to remain on campus may have left other students at risk of assault or harassment.

In two other cases, UM stopped its investigation because it "assumed the victims had stopped cooperating," even though UM had not received any communication from the victims that they no longer wished to continue with the grievance process.

Given these experiences, it is not surprising that other students were reluctant to report sexual assault because they feared retaliation, or that the University wouldn't respond, or, if it did, would respond negatively. One student said that University employees said things that indicated they didn't believe her. Another former student said she didn't report being sexually assaulted by a football player because they "could get away with whatever they wanted." Other students, community members, and faculty echoed that assessment, with some people saying that football players were treated like they were "Gods."⁵

And the DOJ's investigation of UM's campus security revealed another major problem: OPS's responses to student reports of sexual assault were "marked by confusion, repetition, and poor investigative practices."

For example, one OPS case narrative focused on the woman's alcohol-scented breath and "clean and undamaged" clothing. A victim advocate said OPS interviews were "painful" for the victims because they were interviewed by several officers who asked "very personal questions" without warning or explanation of their relevance, and students were also discouraged from filing a police report. Victims who did report their assault to the Missoula Police Department (MPD) had to relive their trauma by answering the same questions because OPS officers didn't provide MPD with enough information.

Two OPS officers described a sexual assault reported in a university residence hall as "regretted sex." And OPS Chief Taylor told investigators that the responding officer's job is to determine if the sexual assault is "provable." However, as the DOJ found, determining the veracity of the woman reporting a sexual assault before a thorough and unbiased investigation is completed not only indicates a failure to adequately respond to sexual assault, but "is particularly problematic given the data showing that the overwhelming majority of sexual assault allegations reported to the police are true."⁶

Based on ample evidence, the DOJ concluded that the OPS's "failure to adequately respond to reports of sexual assault is due at least in part to gender discrimination." By discouraging them from reporting sexual assaults to law enforcement, OPS discriminated against women, deprived them of basic legal protections, and put their safety at risk.

 

Systemic Change

With mounting evidence and media coverage of UM's sexual assault problems, Missoula City Councilman Dave Strohmaier told over 100 community members gathered to hear from UM and community leaders, "If there are systemic problems with how we are addressing violence within our community then we absolutely need to move aggressively on all fronts to address it."

As Justice Barz said, a rape-tolerant campus climate threatens every student. So, Title IX requires that when systemic problems discourage students from reporting sexual assault, schools must take "actions … to address the educational environment, including special training, the dissemination of information about how to report sexual harassment, new policies, and other steps designed to clearly communicate the message that the college or university does not tolerate, and will be responsive to any reports of, sexual harassment."

The ED's and DOJ's findings and conclusions in the UM case show that a top-down strategy is the foundation for creating a campus culture that does not tolerate sexual assault, and that other key components of the ED-DOJ strategy are education and effective procedures for handling problems when they arise.

In future blog posts, we'll dig deeper into the UM investigations and the resulting documents that provide the ED's and DOJ's "blueprint" and "roadmap" for schools on how to respond to sexual assault, create a safe learning environment, and avoid becoming a cautionary tale.

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<sup>1. The settlement agreement relating to the Title IX compliance review among UM, the DOJ, Civil Rights Division, and ED, Office for Civil Rights is set forth in the Resolution Agreement dated May 9, 2013. The settlement agreement between the DOJ and UM Regarding OPS's Response to Sexual Assault is set forth in the Memorandum of Agreement (MOA) dated May 9, 2013.
2. Another female student reported that she was drugged and raped around that same time but did not want to pursue action against her assailants (Investigation Report dated January 31, 2012).
3. Missoula County Attorney Fred Van Valkenburg discussed the case with a local newspaper reporter, stating "I think that clearly the evidence in the case indicates that what happened was with consent, not without consent," he says. "There may have been sex with more than one person—that may seem sort of odd to people that someone might agree to have sex with more than one person—but I don't think because it's odd makes it automatically a non-consensual situation."
4. Justice Barz also noted, "I am disappointed with the lack of response from students with knowledge of house parties where the incidents were alleged to have occurred. Some that have been questioned have not been truthful. I believe 'lying' is also covered under the Student Conduct Code" (Investigation Report dated January 31, 2012).
5. In August 2012, the New York Times reported pending rape charges against two UM football players, and a "widespread feeling in Missoula that players had been coddled, their transgressions ignored or played down." In January 2013, running back Beau Donaldson pled guilty to rape and was sentenced to ten years in prison. Quarterback Jordan Johnson was acquitted on rape charges on March 1, 2013.
6. The Letter of Findings cites Kimberly A. Lonsway, Joanne Archmbault & David Lisak, "False Reports: Moving Beyond the Issue to Successfully Investigate and Prosecute Non-Stranger Sexual Assault," 3 The Voice 1-3, NDAA's National Center for the Prosecution of Violence Against Women (2009).</sup>

Blurred Lines: How Gendered Descriptions of Drinking Hurt Campus Safety

Imagine a young man and woman, both heavily intoxicated, stumbling around a college party. What would their friends say? Would they perceive the man and the woman in the same way? And if they didn't, what might be the consequences?

According to a new study, college students are likely to describe the man as heavily intoxicated --- wasted, tanked, trashed. But they'll probably describe the woman as only moderately intoxicated -- maybe just tipsy or buzzed.[1] This is true even when the man and woman are equally intoxicated.

The Problems of Misperception

It may not seem like a big deal, but students' misperceptions about how drunk someone is carry serious consequences.

For example, the study notes that misperceptions could normalize heavy drinking. If a male student boasts that everyone was wasted at a party -- even if everyone wasn't -- other men may be encouraged to drink more when they hear how fun the party was.

These misperceptions could also lead college women to underestimate the risks associated with intoxication. For example, a young woman who thinks she's just "tipsy" may also believe she's fine to drive home, even when she's not.

Another potentially more troubling issue, however, surrounds alcohol and consent to sexual activities. Alcohol abuse and sexual violence are intimately connected. Consider these findings:

• Half of all sexual assaults are committed by men who have been drinking.
• Half of all sexual assault victims report that they had been drinking when they were assaulted.[2]
• 72% of college women who were raped were intoxicated at the time of the attack.[3]
• Each year more than 97,000 students between 18 and 24 suffer alcohol-related sexual assault or rape.[4] 

Though research suggests that campus sexual assaults are rarely just drunken misunderstandings,[5] alcohol does play a role in most campus sexual assaults. If a man thinks a severely intoxicated woman is only "tipsy," he may misjudge her ability to consent. Similarly, friends and bystanders may underestimate the risk of a situation, and let a friend do something (or have something done to her) that puts her at risk.

Researchers also speculate that men may use alcohol to justify sexual coercion.[6] By labeling himself and his friends as "wasted" or "tanked," a man absolves them of any responsibility for their actions and implicitly condones coercive behaviors that are seen as part of being drunk.

Ways Forward

Although it's not clear what causes these differences in perceptions, the researchers hypothesize that while women are encouraged to drink as much as men, they must also navigate the negative stereotypes applied to women who drink heavily. "This double standard," the researchers explain, "may lead women to apply moderate intoxication terms to themselves and to other women to downplay their level of intoxication and not violate perceived social and gender norms" (Levitt et al. 2013, 5).

For men, meanwhile, heavy drinking constitutes an important part of what it means to be a "man" in college. Thus, they want to be seen as heavy drinkers and describe themselves as such.

The study only reinforces the importance of drinking cultures on campuses. It's not just alcohol, but students' perceptions about alcohol that are problematic.

In response, student affairs specialist should consider dedicating some of their time to helping students become more aware of how they describe each other's drinking behaviors and encouraging students to discuss the relationship between drinking and gender stereotypes.

Works Cited

[1] Levitt, A., Schlauch, R.C., Barholow, B.D., Sher, K.J. (2013). Gender Differences in Natural Language Factors of Subjective Intoxication in College Students: An Experimental Vignette Study. Alcoholism: Clinical and Experimental Research. DOI: 10.1111. <accessed 20 July 2013>. See also the earlier study Levitt, A. Sher, K.J., Bartholow, B.D. (2009). The Language of Intoxication: Preliminary Investigations. Alcoholism: Clinical and Experimental Research, 33, 448-454.

[2] Abbey, A., Zawacki, T., Buck, P.O., Clinton, A.M., McAuslan, P. Alcohol and Sexual Assault. National Institute on Alcohol Abuse and Alcoholism. <Accessed 26th July 2013>. Abbey, A. (2002) Alcohol-Related Sexual Assault: A Common Problem among College Students. Journal of Studies on Alcohol Supplement, 14. Available on College Drinking. <Accessed 8th July 2013>.

[3] Mohler-Kuo, M., Dowdall, G.W., Koss, M.P., Wechlser, H. (2004). Correlates of Rape while Intoxicated in a National Sample of College Women. Journal of Studies on Alcohol, 65,37-45.

[4] College Drinking. National Institue on Alcohol Abuse and Alcoholism. Web. <Accessed 8th July 2013>.

[5] See for instance Lisak, D., Miller, P. (2002). Repeat Rape and Multiple Offending among Undetected Rapists. Violence and Victims, 1, 73-84.

[6] Abbey, A., Zawacki, T., Buck, P., Clinton, A.M., McAuslan, P.. (2004). Sexual assault and alcohol consumption: what do we know about their relationship and what types of research are still needed. Aggression and Violent Behavior, 9, 271-303.