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Behavior paper
1. A BEHAVIORAL THEORY ANALYSIS OF BINGE DRINKING
AMONG COLLEGE STUDENTS
Stephanie Galliera
Health 2400
Fall 2014
2. INTRODUCTION
Alcohol abuse has been recognized as a major problem on college campuses in the United States. Recently, a
particular pattern of alcohol consumption, binge drinking, has caused an uproar of concern. The consumption
of alcohol is part of many common traditions, and moderate use can aggrandize special occasions. Alcohol can
have a positive role in someone’s life, but nonetheless, it is a drug and needs to be treated as so. The
intoxicating substance found in beer, wine, liquor, and liqueurs is ethyl alcohol, or ethanol. If alcohol is
misused or abused, it can have detrimental effects. To put alcohol drinking into perspective, about half of the
entire American population consumes alcohol regularly (Donatelle, 2013).
Alcohol is the single most popular drug on college campuses, where about sixty percent of students report
having consumed at least one alcoholic beverage within the last thirty days. Almost half of all college students
admit to engaging in heavy episodic (binge) drinking – this means bringing the blood alcohol concentration to
at least 0.08 gram-percent within two hours. In general terms, this would mean a woman having four or more
drinks, or five or more drinks for a man (Donatelle, 2013).
For students entering college, consuming alcohol seems as a means to show their independence. It is likely that
someone who enters college will drink at some point in their college career. There are many reasons for
students to begin drinking in college: student customs (Greek life), social norms (reputation as party schools),
and traditional celebrations (Halloween) encourage students to drink. College students believe drinking will
make them feel better, less stressed, more sociable, and less self-conscious. A lot of students drink just to “have
fun,” usually meaning to intentionally get drunk. Doing so can be a way of dealing with stress, boredom,
anxiety, or academic and social pressures. The essential reasons college students will go to a bar are to become
intoxicated, to socialize with friends, to seek out romance/sex, and to relieve stress. Over eighty percent of
college students will drink alcohol to celebrate their twenty-first birthdays; they will consume an average of
thirteen drinks, which will bring their blood alcohol concentration to about 0.19 or higher. Binge drinking
prevalence does not fluctuate during the course of a year, however students binge drink most during nights,
weekends, sporting events, and holidays. No matter who it is, everyone has the same risk of experiencing the
negative effects of drinking too much alcohol if they do not control their behavior (Donatelle, 2013).
College students are particularly vulnerable to peer influence. College women tend to care how much men want
them to drink and to exaggerate how much men prefer they consume. Most students perceive that their peers
consume more alcohol than they actually do, which inclines them to feel the pressure to drink themselves. In a
national survey, students perceived that forty-two percent of students used alcohol 10-29 days a month; the
actual rate is about twelve percent (Donatelle, 2013).
3. The low price of alcohol usually perpetuates the rate for college students to drink and binge. A study showed
that students who paid the most money per gram of alcohol consumed the least amount of alcohol. Also,
college campuses with bars and alcohol outlets have higher rates of binge drinking. College students are more
likely than their non-collegiate peers to drink recklessly and to engage in dangerous drinking practices. A
common practice has the term “pre-gaming,” meaning to drink prior to going out to a bar or party. Pre-gamers
have more negative consequences, like blackouts, hangovers, passing out, and alcohol poisoning. The more
alcohol a student drinks, the more likely they are to start skipping class, fall behind on schoolwork, and lower
their grade point average. Around twenty-five percent of college students who drink reported having negative
consequences because of drinking (Donatelle, 2013).
Binge drinkers are at high risk for drinking-related problems, including violent physical and sexual assault,
property damage and theft, fatalities, unplanned and unsafe sexual activities, unintentional injuries, physical and
cognitive impairment, interpersonal problems, and poor academic performance (Werch et al., 2000). Binge
drinking can quickly escalate to extreme intoxication, unconsciousness, alcohol poisoning, and even death
(Donatelle, 2013). The burden of secondhand effects on other students include having their study or sleep
interrupted, having to take care of a drunken student, or being insulted or humiliated by an intoxicated student.
Moreover, it is estimated that more than half of the young adults who binge drink on a weekly basis exhibit
indications of alcohol abuse or dependency (Werch et al., 2000).
Most people realize it is important to drink alcohol with caution and practice precautionary measures. A lot of
students will eat before or while drinking, stay with friends they entire time they are drinking, have a designated
driver, predetermine how many drinks to have, and keep track of how many drinks they have had.
Unfortunately, even with the best intentions, not all college students behave this way. According to one study,
1,825 students die each year due to an alcohol-related unintentional injury. Alcohol consumption is the top
cause of preventable death among U.S. undergraduate students (Donatelle, 2013).
There are ways that someone can cutback on his or her drinking. He or she can write their reasons for cutting
down or stopping, set a drinking goal, keep a diary of their drinking, keep little or no alcohol in the home
setting, drink slowly, take a break from alcohol, learn how to say no, stay active, get support, and avoid
temptations. Besides being harmful to the individual drinking, binge drinking can have “secondhand” effects
on those around them (Donatelle, 2013).
According to Healthy People 2020, people aged 18-44 years old have the highest prevalence rate of binge
drinking (the lowest being those who are over 85 years old). In 2012, 27.1% of adults aged 18 years and older
reported that they participated in binge drinking within the past thirty days. Healthy People 2020’s target is to
4. change that percentage to 24.4%. Substance abuse is associated with a range of destructive social conditions,
including family disruptions, financial problems, lost productivity, failure in school, domestic violence, child
abuse, and crime. Moreover, both social attitudes and legal responses to the consumption of alcohol and illicit
drugs make substance abuse one of the most complex public health issues. Estimates of the total overall costs of
substance abuse in the United States, including lost productivity and health- and crime-related costs, exceed
$600 billion annually. Although a majority of colleges have sponsored campus alcohol education or prevention
programs for some time, the rates of binge drinking appear virtually identical to those reported over a decade
ago (Werch et al., 2000).
THEORY
The literature that is associated with the binge drinking of college students focuses on the individual’s beliefs,
and the social norms of the college or university. Because of this, most theories involved in trying to regulate
binge drinking among college students are Theory of Planned Behavior, Social Bond Theory, and Social Norm
Theory. It is important to understand these theories in order to see how they can be used to intervene with
further binge drinking among the population of students in college.
Theory of Planned Behavior
Ajzen’s (1988) Theory of Planned Behavior (TPB) has been used to describe health behaviors over which
someone has willing control (Collins and Carey, 2007). This theory proposes that behavior is the product of
attitudes toward the behavior, social norms, and perceived behavioral control (Simons-Morton et al., 2012).
This model focuses both on behavioral intention and perceived behavioral control as predicting factors. The
model assumes action is influenced by beliefs about what is involved in binge drinking (perceived benefits and
also the perceived expectancies of others), perceived outcomes of binge drinking, beliefs about social norms
regarding binge drinking, motivation to comply with the norms, and beliefs regarding the ease to binge drink.
In general, an individual will have a greater intention of binge drinking if their attitude, perceived subjective
norm and control are high (Weitzman, Nelson, and Wechsler, 2003).
It was hypothesized that past binge drinkers, drinking attitudes, subjective norms and drinking refusal self-
efficacy would predict intention, which would in turn predict future binge drinkers (Collins and Carey, 2007).
According to TPB, a certain set of motivational facts leads to the intention to act a specific way, and with the
right opportunity, people will have this intention become their behavior (Simons-Morton et al., 2012). The role
of intention in this model is believed to include attitudes, subjective norms, and perceived behavior control,
5. which should be able to predict behavior. Attitudes refer to people’s evaluation of their own behavior –
attitudes concerning alcohol use usually coincide with predicting how often and how much someone drinks.
For example, if someone was raised in a household where parents strongly support drinking alcohol, their
children are more likely to adapt the same attitude (Collins and Carey, 2007).
Perceived behavior control is believed to both indirectly and directly influence the behavior of heavy episodic
drinking. Both self-efficacy, meaning one’s perceived control over a certain behavior in a specific situation,
and controllability beliefs, or beliefs that the performance of a behavior depends on the individual alone, make
up the concept of perceived behavioral control (Collins and Carey, 2007).
For women, attitudes, perceived behavioral control and sociability expectancies predicted intention, whereas
attitudes, perceived behavioral control and subjective norms predicted intentions in men. Of the TPB variables,
only perceived behavioral control and positive control beliefs reached significance. The results of the multiple
regression indicated that attitudes, subjective norms and self-efficacy significantly predicted a high percentage
of the variance in intention to engage in binge drinking (Collins and Carey, 2007).
When conducting an experiment, demographic information was used (age, gender, year in college, ethnicity,
residence, and membership in a Greek organization). When measuring the intention factor of a participant, they
were measured by the Behavioral Intentions Questionnaire (BIQ). The BIQ consists of seven items asking
participants to rate their intentions of increasing and decreasing their drinking quantity/frequency, peak drinking
and heavy, episodic drinking in the next two weeks. Responses were scored on a 1 to 6 scale, where 1 =
definitely will not do and 6 = definitely will do. When determining attitude factors, participants rated their
“overall opinions” about “drinking to get drunk” along an unnumbered, nine-point scale framed by two
opposing word pairs on either end. The two global attitude word pairs used in the current study were like/dislike
and desirable/undesirable. In this study, higher attitudes scores represented more positive attitudes towards
drinking (Collins and Carey, 2007).
When determining the subjective norms of the participants, participants reported how much “an average
American college student” and their “closest friend” would approve or disapprove of their “drinking to get
drunk” on a five-point Likert scale, where 1 = highly disapprove and 5 = highly approve. Next, participants
rated the importance of these groups’ opinions to them on a scale ranging from 1 (highly unimportant) to 5
(highly important). For the third indicator of this factor, participants answered the question, “How confident are
you that, if you wanted to, you could cut down on your drinking?” Responses were made on a 7-point Likert
scale, where 1 =not at all confident and 7 =very confident (Collins and Carey, 2007).
At the baseline assessment, participants reported having consumed an average of 28.24 drinks and having
6. experienced 2.62 heavy-drinking episodes in the past 2 weeks. On their peak-drinking occasion, participants
reported having consumed 8.95 drinks (Collins and Carey, 2007).
Norman, Bennett, and Lewis (1998) examined binge drinking from the perspective of the Theory of Planned
Behavior. The results indicated that frequent binge drinkers were more likely to have a positive attitude to
binge drinking, perceive social pressure to binge drink, believe that binge drinking leads to various positive
consequences, and to see many facilitators of binge drinking. At the same time, they were less likely to believe
that binge drinking leads to negative consequences and that they had control over their drinking. In a
multivariate analysis, however, Norman et al. found that there were only two significant predictors of binge
drinking: behavioral control and positive control beliefs. Essentially, the study suggested that perceived control
over drinking behavior was the most important factor in determining whether someone will binge drink (Oei
and Morawska, 2004).
Social Bond Theory
A Social Bond model has been used to examine binge drinking. Travis Hirschi’s theory refers to the importance
of the connection between an individual and society. The theory postulates that deviance occurs when the
social bond is weak. The theory is dominant regarding behaviors that are deviant in nature (Durkin et al., 1999).
Significant predictors of binge drinking were respect for authority, acceptance of conventional beliefs, GPA,
and parental attachment, all of which were negatively related to binge drinking (Oei and Morawska, 2004).
This theory focuses on all of the different factors that affect someone’s behavior. An individual’s environment
greatly attributes to how they act and what they perceive as normal. For instance, Wechsler et al. (1995) found
that having a parent who is not an abstainer, as well as having a family who approve of alcohol use,
significantly elevated the risk of binge drinking for college students. In addition, a family history of alcohol
abused has been linked to drinking problems among college students.
The self-administered survey contained a number of questions designed to measure the various components of
the social bond. Attachment to parents was measured by the student's responses to the following items: (a) "my
parents want to help me when I have a problem"; (b) "my parents and I talk about future plans"; and (c) "I can
share my thoughts and my feelings with my parents." These items had response values which ranged from 1
(disagree strongly) to 6 (agree strongly). Similar questions were given to test the strength of all of the
constructs. For example some of the scales were relating to how many hours worked at a job, what their
definition of a drink was, or the respect they had for local authorities. Cherry (1987) conducted a study at a
university in Maryland, concluding that “students with strong bonds to the college community, religious
institutions, and family drank less than students with weakened or broken bonds.” (Durkin et al., 1999).
7. FACTORS
Intrapersonal Factors
Using intrapersonal factors to address why someone would engage in a binge drinking behavior can explain
why personal values and attitudes affect how an individual acts in this manner. The Social Bond Theory
specifically has a construct “beliefs,” which are crucial to determining how likely a college student is to
condoning to this deviant behavior. Based on all of the above theories used, values greatly affect if someone is
likely to binge drink in college. Interestingly, social anxiety was not correlated with amount and frequency of
drinking (Durkin et al., 1999).
Another component of the SBT theory is commitment, referring to the aggregate investment of time, energy,
and resources in conventional activities, like maintaining a job for example. Actions like these represent an
individual’s present stakes in conformity. People with stronger commitments will not jeopardize them by
engaging in the defiant behavior of binge drinking. For college students, these items could include academic
orientation, grade point average, and religious commitment, among other things (Durkin et al., 1999).
The TPB model assumes action is influenced by beliefs about what is involved in binge drinking (perceived
benefits and also the perceived expectancies of others), perceived outcomes of binge drinking, beliefs about
social norms regarding binge drinking, motivation to comply with the norms, and beliefs regarding the ease to
binge drink. In general, an individual will have a greater intention of binge drinking if their attitude, perceived
subjective norm and control are high (Weitzman, Nelson, and Wechsler, 2003).
Interpersonal Factors
If someone was raised in a household where parents strongly support drinking alcohol, their children are more
likely to adapt the same attitude. All social interactions correlate with someone’s behavior if this individual
highly regards these persons’ beliefs. A student in college is surrounded by peers who they perceive to think
want them to drink. As noted, students will overestimate how many of their peers actually engage in drinking
alcohol. Nevertheless, students will overcompensate for any of their insecurities by engaging in this deviant
behavior because it is socially accepted as a norm on college campuses (Donatelle, 2013).
The subjective norms from TPB are a person’s perceptions of others’ evaluations of this person participating in
binge drinking. These subjective norms are broken into two categories: the perception of others’ evaluations
and the importance of the others’ opinions to person (motivation to comply with perceived norms of binge
drinking). This means that a college student is more likely to binge drink if others, whose opinions the person
values, approve of the person binge drinking. This construct is very important dealing with this behavior,
8. because adolescents and college students report being more influenced by their peers than adults would be
(Collins and Carey, 2007).
In regards to Social Bond Theory, “attachment” refers to the ties that an individual has to significant others (i.e.
family members and loved ones). This construct refers to the degree to which an individual has emotional ties
to these people, identifies with them, and cares for their expectations. This involves some of the interpersonal
factors an individual has, dealing with their social interactions and social influence. According to this theory,
the stronger the attachment a person has for the loved ones in his or her life, they least likely they are to behave
defiantly (Durkin et al., 1999).
Organizational, Community, Environment, and Policy Factors
All of the organization, community, environmental, and policy factors can have a great influence on someone’s
belief that he or she should engage in binge drinking. If a college student considers himself or herself religious
or actively involved in the community, they are less likely to participate in binge drinking. The environment
completely shapes their perception of what is normal, so the fact that drinking alcohol is socially accepted
increases the likelihood of a student entering college to drink at some point. Policy factors are hard to control
regarding substance use, because students are able to find ways around this. It is hard to control how people act
in the privacy of their own homes, but security on school campuses can decrease the amount of alcohol found
on campus grounds, including in dormitories (Werch et al., 2000).
In regards to Social Bond Theory, an element of the bond is involvement, consisting of the amount of time a
person spends engaging in their conventional activities. This construct relates to organizational, community,
and environment factors; instead of policies in these factors affecting someone directly, it is their involvement
in these criteria that influences their behavior. For a college student, this could mean participating in clubs or
activities, studying, or working a part-time job. Individuals who spend their time involved in conventional
pursuits do not have enough time to engage in deviant behavior (Durkin et al., 1999).
Predisposing Factors
If a college student has been previously exposed to others that associate drinking with positive outcomes, they
will believe that they may do the same. Also, if someone was already someone who binge drank in high school,
they are more likely to continue these habits when they reach college (Donatelle, 2013). If someone was raised
in a household where parents strongly support drinking alcohol, their children are more likely to develop the
same attitude and values (Collins and Carey, 2007). Living on campus during the first year of college increases
the risk of exposure to alcohol, because of the close proximities in which the students live (Werch et al., 2000).
9. Enabling/inhibiting Factors
The drinking age in every state in the United States is twenty-one years old; this inhibits all college students to
access alcohol. Nevertheless, students find ways to avoid this by having older friends by them alcohol, going to
parties where it is already provided, or purchasing a fake identification card that portrays an untrue age. These
factors can allow a college student the access to become a binge drinker. As mentioned earlier, the low price of
alcohol also makes it very accessible to college students. Those who are twenty-one years of age have no
problem finding alcohol they want for a decently low price (Wechsler, Kuo et al., 2000).
Reinforcing Factors
As stated before, it has been noted that parents can act as a reinforcing factor among college students. If a
college student’s parents have a positive attitude associated with drinking, the children can also inherit this
belief. This, and of course the general peer pressure of the their friends, takes on a toll as what they deem to be
normal behavior. It is also assumed to work in reverse: if parents are religious and do not have a positive
attitude towards drinking, their children are more likely to carry the same opinion (Donatelle, 2013).
If a college student perceived him or herself as accepted and receiving positive recognition, he or she will
continue to participate in the binge drinking behavior. Based on operant conditioning, it is known that people
will learn to repeat a behavior if they receive positive benefits and appraisal from doing so. If binge drinking at
bars on the weekends is what everyone wants this said individual to do, they are more likely to do so. It was
noted before that college students are more susceptible to peer pressure than other adults (Donatelle, 2013).
The TPB model demonstrates that past behaviors will be indicative of future behavior. There have been results
that indicate that past repeated behavior was a stronger predictor of behaviors repeated than intention. For
behaviors that are not performed regularly, such as getting a flu shot or voting, past behavior is a weak predictor
for future behavior relative to intention. Another study found that past or habitual behaviors could predict a
range of other cognitive components such as attitude accessibility, self-concept, intent, attitudes, subjective
norms and perceived behavioral control. It is important to note that just because a behavior has been habitual
does not mean it directly correlates to be performed in the future, but just offers a type of predictability (Collins
and Carey, 2007).
SUGGESTIONS FOR INTERVENTION
Some colleges are installing strong policies against drinking, while also offering assistance to those who are
already suffering from drinking problems. Programs that have proven effective are cognitive-behavioral skills
10. training and motivational interviewing, and e-Interventions. Colleges and universities are also trying a social
norms approach by reducing alcohol consumption (Donatelle, 2013).
One study was conducted which used self-reported responses of students in the 1999 Harvard School of Public
Health College Alcohol Study. Analyses that were performed using the SAS statistical package suggest the
importance of a comprehensive prevention approach to prevent the acquisition of binge drinking in college.
Evidence suggests that pre-college interventions should focus on delaying drinking onset and discouraging high
school consumption, whereas college interventions should balance educational and normative prevention with
more environmentally oriented approaches, including efforts to maximize substance-free housing while
minimizing easily accessed low cost alcohol (Weitzman, Nelson, and Wechsler, 2003). Changing the
availability of alcohol may be achieved through working with the community, aiming for lower prices and
ensuring that outlets will be serving appropriately. A study done by Johnson and Hoffmann (2000) suggests
that colleges wishing to reduce their binge drinking problems should examine student-body composition and
demographic diversity (Wechsler, Kuo et al., 2003).
Drinking by college students now constitutes a major field within alcohol abuse prevention research; the field
has matured due to recognition among academic researchers that health and social-risk behaviors are occurring
frequently on about every college or university campus (Lange et al., 2002). Public health is increasingly
making use of a variety of behavior change strategies to support a comprehensive, systems-wide approach for
prevention. Systems-change programs share an assumption that behavior is shaped by many factors, including
those associated with individuals and their environment. In preventing alcohol abuse, systems-change
approaches are coupling education about alcohol with efforts to alter relevant policies, reduce supply, and
change media and marketing practices that shape or reflect norms. Until quality evaluation data are available,
only a comprehensive examination of existing prevention programs will allow administrators to assess
strengths, weaknesses, and gaps in their approaches to campus alcohol problems (Wechsler, Kelley et al., 2000).
A study at the Harvard School of Public Health used self-administered surveys to acknowledge self-reports of
alcohol use, binge drinking, alcohol-related problems, preferred type of drink, access to alcohol, and price paid
per drink. The results suggested that underage students drink less often but have more drinks per occasion, are
more likely to drink in a private setting, and pay less per drink than do of-age students. With this information,
the conclusion was to create effective controls on price, access, and fraternity and off-campus parties, and
reinforce minimum drinking age laws in order to reduce the high levels of binge drinking and related health and
behavioral problems of college students. Unfortunately, there is no way to completely detect how accurate
these implementations are, except to wait and see an end result (Wechsler, Kuo et al., 2000).
A multisite randomized trial of social norms marketing (SNM) campaigns was conducted to determine its
11. effectiveness in reducing college student drinking. These campaigns are intended to adjust misperceptions of
subjective drinking norms, therefore resulting in a decrease of alcohol consumption. Different institutions were
selected to either be treated, or serve as a control group. At the treatment group institutions, these campaigns
delivered school-specific, data-driven messages through a mix of campus media venues. It became evident that
using an SNM was significantly associated with lower perceptions of student drinking levels and lower alcohol
consumption, which was measured by a composite drinking scale, recent maximum consumption, blood alcohol
concentration for recent maximum consumption, drinks consumed when partying, and drinks consumed per
week. Analysis revealed that students who were exposed to SNM campaigns had a lower relative risk of
alcohol consumption than students attending the control group institutions (DeJong et al., 2006). This is
expected to be the most useful and interactive way to prevent binge drinking from being an enormous problem
among college campuses.
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