Paola Pedrelli, Ph.D.Massachusetts General Hospital

Boston, MA

Heavy Drinking And Depressive Symptoms In

College Students

1© AMSP 2015

Alcohol in Young Adults• Alcohol increases at a young age

• Alcohol common age 21-25

• 70% consume alcohol

2© AMSP 2015HED Current Frequent HED

3© AMSP 2015

This Lecture Reviews:

Definitions & alcohol on campus

Depressive symptoms on campus

Depressive symptoms & HED

Implications

4© AMSP 2015

This Lecture Reviews:

Definitions & alcohol on campus

Depressive symptoms on campus

Depressive symptoms & HED

Implications

Definition

Standard drink = 10-12 g pure ethanol

Heavy Episodic Drinking

• BAC: Amount of alcohol in blood

• HED ~ 0.08 BAC

• HED: ♀/♂ > 4/5 drinks/occasion 2h

6© AMSP 2015

HED Common in College Students

Past month prevalence of HED

7© AMSP 2015

• Everyone drinks heavily in college

• Drinking heavily on weekends is OK

• Students will grow out of it

Myths About HED

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• Among <21 age: costs $27 Billion/yr

- 61% from lost productivity

- 25% from premature death

• 40,000 hospitalizations/yr due to alcohol

HED Societal Costs

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Each yr in college students

•~600,000 injuries

•~700,000 assault

•~97,000 victim sexual assault

•~1800 deaths

HED Personal Costs

10© AMSP 2015

Jackie: 20-year-old female student

• Mild depressive symptoms

• ↓Interest in social activities

• Behind with schoolwork

• ↓Grades

• Sleeping 8-10 hrs/day

• Consume 8-10 drinks 1x/week

Illustrative Case

11© AMSP 2015

Role failure

Risk of harm

Social problems

Tolerance

Craving

DSM-V Alcohol Use Disorders

12© AMSP 2015

Withdrawal

Larger/longer

Unable to ↓ down

↓ Time elsewhere

Use despite problems

>2 past 12 mos

13© AMSP 2015

AUD in College Students

•24% ♂ have AUD

•13% ♀ have AUD

Alcohol Problems in Students

• 57% physically sick & blackout

• 30% school problems

• 31% regretted a sexual activity

• 20% physically injured

• 13% drank and drove

• 7% got into physical fight© AMSP 2015 14

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Predictors of HED

16© AMSP 2015

This Lecture Reviews:

Definitions & alcohol on campus

Depressive symptoms on campus

Depressive symptoms & HED

Implications

Depressed Mood

Markedly ↓ interest

Weight loss/gain

Diff sleeping

Agitation

Major Depressive Disorders

17© AMSP 2015

Fatigue

Feel worthless

↓ Ability think

Suicidal ideation

>5 past 12 mo

• Unique development stage

- Identity exploration

- From dependence to independence

• ↓Support from old friends

College is Difficult

18© AMSP 2015

Depressive Symptoms

Symptoms Women Men

Have MDD 10% 8%

Are sad 66% 51%

Felt hopeless 50% 38%

Hard to function 33% 27%

Seriously considered suicide

7% 6%

Attempted suicide 1% 1%

Problems with Dep Sx

• Mild dep sx ↑ early school drop out

• Mild dep sx ↑ psychosocial problems

• SI present at sub-threshold MDD

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• Tired all the time

• Feels lonely

• ↓ Motivation

• ↓ Piano playing & exercise

• Sleeps > 10 hr many days

• Grades ↓& skipping classes

• Isolates

Jackie

21© AMSP 2015

22© AMSP 2015

This Lecture Reviews:

Definitions & alcohol on campus

Depressive symptoms on campus

Depressive symptoms & HED

Implications

Depressive Sx + HED =↑ Problems

• Dep sx + HED = ↑ risk for alcohol problems  

• Dep sx + HED = ↑ risk for suicide

• Unsafe sex

- 14% Dep sx +HED

- 10% HED alone

• Behind at school

- 29% Dep sx +HED

- 24% HED alone© AMSP 2015 23

Social Learning Theory

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Alcohol is used:

• To ↓ negative emotional states

• With expectation ↑ mood

• Belief no alternative ways to cope

Jackie

• Drinks to feel better

• Behind in school due to HED

• Regrets actions during HED

© AMSP 2015 25

26© AMSP 2015

This Lecture Reviews:

Definitions & alcohol on campus

Depressive symptoms on campus

Depressive symptoms & HED

Implications

Settings for Screenings

• Throughout school

• College counseling centers

• Primary care

• Emergency care © AMSP 2015 27

Screening Tool for AlcoholAlcohol Use Disorders Identification Test (AUDIT-C)

• Items on:

- Frequency of any alcohol use

- Typical number of drinks

- Frequency of 6+ drinks

• Responses are summed

• Score > 3/5 ♀/♂ indicates at-risk drinking© AMSP 2015 28

Screening Tool for Depression

• Patient health questionnaire (PHQ-9)

- 9 items ask frequency of sx

- Responses are summed

- Score >10 indicates MDD

© AMSP 2015 29

Recommended Treatment• Combined vs single Tx

- 90% vs 30% abstinent

- 65% vs 45% improvement dep sx

• HED & dep sx should be treated together

- Tx for HED not effective in dep students

- Tx for 1 disorder leads to ↑ relapse rates

- Combined HED/dep TX → better outcome

AMSP 2015 30

Tx For Co-occurring Sx

• Motivational interviewing (MI) + Cognitive

Behavioral Therapy (CBT)

- Both address motivations for drinking

- Integrating MI and CBT is feasible

- CBT+MI effective for co-occurring sx

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CBT• Thoughts feelings behaviors

• Brief and time-limited

• Structured

• Educational

• Collaborative relationship

• Socratic method

• Includes homework

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CBT Tenets

• Dep sx relate to negative views of:

- Themselves

- The future

- The world

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CBT Techniques

• Change unhelpful thoughts

- Evidence for and against thoughts

- Reduce catastrophizing

- Identify mind reading

• ↑ Enjoyable activities

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MI

• Therapy ~ partnership

• Patient-centered

• Directive method communication

• Elicit own motivation to change

• Explores ambivalence re change

• Guide pt towards change

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MI Therapist

• Express empathy of current behavior

• Examine inconsistencies

• Promote belief that change is possible

• Roll with resistance

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Combined Tx For Jackie

• Feedback from brief MI

- On drinking behaviors

- Blood Alcohol Concentration

- Drinking problems

• Education on

- Peers' normal alcohol use

- Gender specific effects of alcohol© AMSP 2015 37

CBT For Jackie

• Changed thoughts:

- “I am flawed”

- “My friends do not like me”

• Increased pleasant activities:

- Encouraged resuming piano

- Encouraged resuming exercising

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Jackie: Results

• Attending classes consistently

• ↑ Exercising and playing piano

• Seeing friends daily

• Drink < 4 drinks per occasion

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Conclusion/Summary

In college students:

•Depressive symptoms + HED are common

•Screening important

•Combined Tx more effective

•CBT+MI example of combined Tx

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