THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE

Vol. 30, No. 3, pp. 659–684, 2004

The Short-Term Effects and UnintendedLong-Term Consequences of Binge Drinking in

College: A 10-Year Follow-Up Study

Karen M. Jennison, Ph.D.**

Department of Sociology, University of Northern Colorado,

Greeley, Colorado, USA

ABSTRACT

This study addresses binge drinking in college as a risk factor for heavy

drinking and alcohol dependence after college. A national probability

sample of 1972 college students from the National Longitudinal Surveys

of Youth (NLSY79) was interviewed in 1984 and reinterviewed again as

adults in 1994. The short-term effects of binge drinking in college were

assessed as well as the extent to which experiences of negative effects in

college predicted patterns of alcohol use across the transition from

college into postcollege years. As expected, college binge drinkers were

comparatively more likely than nonbinge drinkers to experience one or

more alcohol-related problems while in college. In addition, weighted

estimates of DSM-IV-defined diagnostic criteria in logistic regression

*Correspondence: Karen M. Jennison, Ph.D., Chair, Department of Sociology,

University of Northern Colorado, Candelaria Hall 2285, Campus Box 142, Greeley,

CO 80639, USA; Fax: (970) 351-1527; E-mail: karen.jennison@unco.edu.

659

DOI: 10.1081/ADA-200032331 0095-2990 (Print); 1097-9891 (Online)

Copyright D 2004 by Marcel Dekker, Inc. www.dekker.com

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models indicated that the binge drinking patterns exhibited during the

college years, for some former college students of both genders, posed

significant risk factors for alcohol dependence and abuse 10 years after

the initial interview, in conjunction with evidence of academic attrition,

early departure from college and less favorable labor market outcomes.

Key Words: Binge; Alcohol; Consequences; Students; College.

INTRODUCTION

Heavy episodic alcohol consumption by college students is a leading

problem on many U.S. college campuses (1,2). Over 40% of students

nationwide have been reported to participate in binge drinking behavior,

when it is defined as at least four drinks per drinking occasion for women

and at least five drinks for men (3–6). College binge drinking has been

associated with diverse campus and community alcohol-related problems

that constitute a threat to public health as well as a challenge to university

functions (7,8) and has been linked to fatalities, alcohol poisoning,

hangovers, and academic problems like missed classes, reduction in

classroom performance, lowered grades, dropping out, and school failure

(9–11). There are also secondary social effects such as increased rates of

alcohol-related mortality and morbidity (11–13), high rates of drunkenness,

alcohol-related aggression, attempted suicides, sexual assaults, property

damage, illness, campus disruptions, and trouble with police, together with

an increased risk of impaired driving (9,14–18).

The extent of binge drinking on college campuses has remained

relatively stable for a period of at least 20 years, notwithstanding

administrative attempts at modification of student drinking patterns,

preventive efforts to reduce heavy drinking (11,16), and the introduction

of new alcohol policies and changes during that time in the legal drinking

age (10,12,14). Because of the perceived seriousness of the college drinking

problem, in 1998 the National Advisory Council to the National Institute on

Alcohol Abuse and Alcoholism (NIAAA) established a task force on

College Drinking to contribute to the development of a national plan for

college drinking research at NIAAA. The task force commissioned a series

of background papers that have since been published (19).

This paper addresses a critical issue in the college drinking debate and

public dialogue: the question of whether college binge drinkers are more

likely to mature out of such behavior or whether they are likely to continue

to have problems with the use of alcohol after college. There have been

relatively few studies regarding the long-term consequences of episodic

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binge drinking in college as a risk factor for heavy drinking and alcohol

abuse and dependence later in life. Problematic drinking among college

students, though widespread, is thought to be only transitory by many and

to represent merely short-term physical consequences rather than long-term

alcohol dependence or any sustainable drinking-related problems (20).

Moreover, much of the growing body of alcohol literature developed to date

indicates, generally, that both men and women classified as problem

drinkers in college tend to mature out of such behavior after college and

become nonproblem drinkers as adults (9,21–26). Going to college and the

consequent higher educational attainment are mostly associated in past

research with lower levels of heavy drinking when individuals reach their

late 20s and 30s (20). However, although the findings of a majority of

studies on this issue subscribe to the generalization that most young people

eventually mature out of detrimental patterns of alcohol use, clearly not all

inevitably manage to successfully change their heavy drinking patterns,

either after college or as young adults (27–32). It is conceivable that, for

some individuals, addictive drinking habits built up in college may

sometimes be difficult to break in later years (33–35). Vaillant (30,36), for

example, studied the progression of symptoms of chronic alcohol abuse in

two community cohorts (inner city and college samples) of adolescent

males from 1940 to the present. The college cohort, followed-up from the

time they were college undergraduates until ages 70 and 80, were known to

be still abusing alcohol at 60 years of age and older and were considered

likely to remain chronic alcohol abusers. Valliant concluded that alcohol

abuse could thus continue for decades without remission of symptoms.

Labor Market Outcomes

The impact of binge drinking on postcollege labor market outcomes is

another important predictor that should be considered in any assessment of

drinking trends after college. This subject has been largely neglected in

previous alcohol research on college student populations, primarily because

of limited data availability in the past for prospective studies (37). While

relatively little is known about the long range effect of college binge drinking

on postcollege occupational opportunities and careers within a life-cycle

framework, some evidence suggests that drinking problems in college may

significantly influence a person’s occupational opportunities (38). Dropouts,

for example, usually do not earn what their graduating counterparts will over

their lifetime (12). In general, existing research has shown that the labor

market choices and future job prospects of younger workers with alcohol

problems are relatively limited and lifetime earnings are lower than they are

among those without alcohol problems (39,40). As summarized by Roman

Consequences of Binge Drinking in College 661

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and Johnson (38), much of the literature indicates that college students who

drink heavily are less likely than other students to have successful college

careers; and if they do graduate, they are less likely to obtain white-collar

employment or career advancement. Two recent studies, in contrast, suggest

that high levels of alcohol consumption and alcohol problems among college

students do not appear to have an important effect on students’ academic

performance and achievement, when measured by grade-point average

(GPA), particularly when high school GPA and demographic characteristics

are controlled (41). Therefore, whether a student engages in binge drinking

while in college is considered inconsequential overall, since a high GPA is

believed to predict favorable future labor market outcomes for binge

drinkers, just as for other college students (42).

This paper extends the findings from earlier studies on college binge

drinking risks, in a developmental perspective, that could provide important

feedback regarding preventive programs and policies. The study uses

national data and a representative sample of college students to examine the

short-term nature of binge drinking in college in concert with prospective

10-year, long-term outcomes for dependence or abuse. Occupation (blue

collar/white collar) is also included as a potential predictor, not only as a

measure of the end-result of educational achievement and labor market

success but also as a potential mediator/moderator between past and future

alcohol problems. It is expected that binge drinkers, particularly frequent

binge drinkers, will more likely experience alcohol-related problems in

college than other drinkers. Although binge drinking students may not

manifest negative effects of alcohol for many years (12), if at all, they

continue to be at risk for developing drinking problems in later adulthood.

Therefore, it is hypothesized that negative drinking effects in college,

defined as the onset of alcohol-related problems, are likely to persist after

leaving school. Estimates of current alcohol consumption after 10 years and

the risk of dependence or abuse outcomes are expected to vary according to

gender, educational attainment, past history of binge drinking, and alcohol-

related problems in college, as well as by the life-cycle events of marriage

and occupational careers.

METHODS

The NLSY79 College Student Sample

This study is an analysis of secondary data consisting of a sample of

1972 college students from the 1984 wave of the National Longitudinal

Survey of Youth (NLSY79), who were followed and reassessed again in

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1994. A full description of the NLSY79 sample and multistage area

probability research design is reported elsewhere (43). Respondents in the

first wave of the NLSY79 were interviewed in 1979 at ages 14 to 21 and

annually since that time. The national cross-sectional base of the NLSY79

was supplemented with an oversampling of African Americans, Hispanics,

nonblack non-Hispanic, and economically disadvantaged white youth (44).

The NLSY79 was identified by the National Institute of Alcohol Abuse and

Alcoholism National Task Force as a potentially valuable data source on

drinking among college students (1). Questions on alcohol use were added

to this survey from 1982 through 1985, 1988, 1989, 1992 and 1994 with

funding from the National Institute of Alcohol Abuse and Alcoholism and

the National Institute on Drug Abuse. All phases of the NLSY79 were

conducted by the National Opinion Research Center (NORC) located at the

University of Chicago.

The NORC used special procedures in sampling college students that

ensured national representativeness. If properly weighted, every full- or

part-time college student is linked to a unique living unit (whether the

student was living in a dormitory, another dwelling unit away from the

parent’s home, or in the parental household) that has a known probability of

entering the sample. The full sampling frame included coverage for

unmarried, married, or cohabiting couples linked to their own dwelling

units, or couples not living in a dwelling unit on a year-round basis, or to

their respective parent’s dwelling unit. The overall NLSY79 weighting

procedures for college enrollments in the age 14 to 21 cohort base, without

adjustments, projected 4,967,000 full-time college attendees and 72,000

part-time attendees, which were comparable to the most current U.S.

Census estimates (45).

The college student sample in the NLSY 1984 wave consisted of 51%

(N = 1003) males and 49% (N = 969) females; 72% were white, 23%

African American, and 5% other racial groups, while the 1994 panel was

composed of 49% (N = 737) males and 51% (N = 768) females. Whites

comprised 70% of this follow-up group and blacks 25%. College student

ages ranged from 19 to 27 (median age was 21) in 1984 and 29 to 37 in

1994 (median age was 31) when they were no longer students. In 1984,

18% of the students were freshmen, 31% sophomores, 21% juniors, 20%

seniors and 9% were graduate students.

The NLSY79 consists of U.S. government data that is in the public

domain and, therefore, there are no restrictions on its use. The

confidentiality and identity of all participants in the study are protected

under the Privacy Act of 1974, as amended. The confidentiality of all

information provided by each respondent is also protected as well as the

identity of any employers, schools, relatives, persons, or entities.

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Measures

The repeated alcohol and substance use supplements for 1984 and

1994, the two periods studied, included questions on drinking patterns

including consumption quantity and frequency, and drinking-related

problems. Standard questions also assess lifestyle, demographic, and other

background characteristics. The NLSY79 data contain information on

current labor force status (employed, unemployed, out of the labor force)

and for those employed, information on occupation. The NLSY79 uses the

three-digit 1980 U.S. Bureau of the Census codes to classify occupational

categories of respondents’ current or most recent job (46).

Alcohol Measures

Alcohol measures in the study include past-month alcohol usage

frequency obtained at two time points, 1984 and 1994: (‘‘During the last 30

days, on how many days did you drink any alcoholic beverages, including

beer, wine, or liquor?’’) and past-month quantity of alcohol consumed per

drinking occasion estimates (‘‘On the days that you drank alcoholic

beverages, including beer, wine, or liquor in the last 30 days, how many

drinks per day did you drink?’’). The frequency of drinking was categorized

into four levels: none, one to three days, four to six days, and seven or

more days in the last month. The quantity-frequency heavy drinking

measure utilized for the post-college years consisted of the frequency of

having six or more drinks on one occasion during the last 30 days.

Binge Drinking

Measures of binge drinking are replicated from previous studies of

heavy drinking in college student populations (5,11) and are defined as

having five or more drinks on the same occasion one or more times in the

past month for men and four or more drinks on the same occasion one or

more times in the past 30 days for women. Infrequent binge drinkers were

defined as students who binged one or two times in the past month and

frequent binge drinkers as students who binged three or more times in the

past month. Nonbinge drinkers were students who consumed alcohol in the

past month but who did not binge. Abstainers were students who did not

drink alcoholic beverages in the past month. The five/four gender-specific

measure is used by the National Household Survey on Drug Abuse

(NHSDA), in tracking adults aged 18 and over in the Healthy People 2010

project (47), and it has become a standard in epidemiological studies as

well as in research on binge drinking among college students.

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Alcohol Problems in College

College respondents in 1984 were asked whether their drinking had

ever resulted in any of a number of possible problems. During the past

year: drinking interfered with school work; felt aggressive or cross while

drinking; gotten into a heated argument while drinking; gotten into a fight

while drinking; deliberately tried to cut down or quit drinking, but didn’t

manage to do so; afraid you might be an alcoholic or that you might

become one; once started drinking, it was difficult for you to stop before

you became completely intoxicated; had alcohol-related blackouts; often

take a drink the first thing when you get up in the morning; hands shake a

lot the morning after drinking; have sometimes gotten high or tight when

drinking by yourself; sometimes kept on drinking after promising yourself

not to. Alcohol problem measures were aggregated into a 12-item summary

measure of drinking consequences with an internal consistency and

reliability of 0.663 (Cronbach’s Alpha).

DSM-IV-Defined Alcohol Abuse and Dependence

Since publication of the fourth edition of the American Psychiatric

Association’s Diagnostic and Statistical Manual of Mental Disorders in

1994 (48), or DSM-IV, most DSM-IV diagnoses now have an empirical

literature generated by the substantial increase in clinical and social

research which supports the DSM-IV substance disorder criteria (49). DSM-

IV diagnostic criteria have been proven to be just as valid as the older

DSM-III and DSM-III-R criteria (50); research data have for the most part

accurately predicted the two-dimensional distinction between DSM-IV

alcohol abuse and dependence classifications (51) as well as the onset and

cessation of alcohol-related problems (52). Survey data are equally valid in

the prediction of DSM-IV-related medical and social consequences. The

DSM-IV diagnostic indicators in representative national surveys of the

United States population have met DSM-IV criteria consistent with those

drawn on clinical samples and also have practical implications for clinical

treatment (51,53,54).

The DSM-IV-defined diagnostic criteria used in this study were applied

exclusively to the adult population of former college students 10 years after

the initial assessment of binge drinking and alcohol problems in 1984. Two

DSM-IV measures of alcohol use disorders, alcohol abuse and alcohol

dependence, were obtained from both male and female former college

student respondents who reported consuming alcoholic beverages in the

month before the 1994 reinterview. The response scale of DSM-IV

diagnostic criteria for all of the questions was 1) never happened,

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2) happened in lifetime other than past year, 3) happened one time in past

year, 4) happened two times in past year, and 5) happened three or more

times in past year. Each dependence or abuse symptom item is scored 1 if

the event occurred at least three or more times in the last year and 0 otherwise.

The DSM-IV requires at least three of seven criteria defined for dependence to

cluster within a 12-month time frame: tolerance, drinking to relieve or avoid

withdrawal symptoms; drinking larger amounts or over a longer period than

intended; unsuccessful efforts to cut down or control alcohol use; a great deal

of time spent drinking; important social, occupational, or recreational

activities given up for drinking; and continued drinking despite problems

(48). The internal consistency ratings of the 19-item DSM-IV dependence

measure among former college students in the NLSY in 1994 show a relatively

high level of reliability (Cronbach’s alpha = 0.80).

The DSM-IV criteria for alcohol abuse (48) require one of four

negative social consequences of alcohol use to be present in the preceding

12 months including recurrent use of alcohol resulting in a failure to fulfill

major role obligations at work, school, or home; recurrent use in situations

in which it is physically hazardous; having alcohol-related legal problems;

and continued substance use despite having persistent or recurring social or

interpersonal problems caused or exacerbated by the effects of the

substance (Cronbach’s Alpha = 0.66).

Statistical Models

Logistic regression models of cross-sectional data were used in the first

(1984) phase of the study to assess the relative risks of alcohol-related

problems during the college years for binge drinkers compared with

nonbinge drinkers. In the second phase in 1994, the extent to which

experiences of negative effects in college predict patterns of use and

drinking continuity or discontinuity over time are prospectively estimated

for college dropouts as well as for graduates. In addition to unadjusted odds

ratios (ORs), adjusted ORs, with controls, and 95% confidence intervals are

estimated for college binge drinking effects, behavioral consequences, and

the long-term risks for DSM-IV alcohol dependence or abuse 10 years after

college. Weights to adjust for design effects and nonresponse were applied

to both samples of current drinkers. The assessment of effect modification

and adjustment for confounding were based on forward stepwise logistic

regression models with p values < 0.05 (55). To develop models, the

potential effect modification by gender was first assessed and then main

and interaction effects of potential confounders and any potentially strong

independent predictors were added to the model if doing so changed the

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estimate of the alcohol variables. Then final models were reestimated in the

prospective analysis for comparison (56).

RESULTS

College Student Binge Drinking: 1984

Table 1 includes a description of binge drinking in the college sample

of 1885 students who responded to questions on alcohol consumption. The

1984 panel included 1447 students (76.8%) who reported drinking alcoholic

beverages within the month prior to the interview. Weighted estimates of

alcohol use among the college student population indicated that males were

significantly more likely to be binge drinkers, particularly frequent binge

drinkers (25%), whereas female college students were more likely to be

nonbinge drinkers (38%) or abstainers (20%). This observed trend among

college students, shown in Table 1, was also statistically significant in a

chi-square test of the difference of proportions between nonbinge and binge

college drinkers according to gender (Chi-square = 73.72, p < 0.000). These

results are consistent with previous studies that describe alcohol use in

college student populations (3,10,11,57,58).

Table 1. College student patterns of alcohol use in past month 1984, by gender

(in percentage).*

Category**

Men

(N = 966)

Women

(N = 919)

Total

(N = 1,885)

Abstainera 15.5 20.1 17.7

Nonbinge drinkerb 32.2 37.8 34.8

Infrequent binge drinkerc 27.0 24.3 25.7

Frequent binge drinkerd 25.3 17.8 21.8

Total 100.0% 100.0% 100.0%

*Weighted percentage.

**Note: Binge drinking is defined as five or more drinks on the same occasion one or

more times in the past month for men and four or more drinks on the same occasion

one or more times in the past month for women.aStudents who did not drink alcohol beverages in the past month.bStudents who consumed alcohol in the past month but did not binge.cStudents who binged one or two times in the past month.dStudents who binged three or more times in the past month.

Consequences of Binge Drinking in College 667

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Binge Drinking and Alcohol Problems in College

A subset of significant independent predictors of alcohol problems in

college was identified from stepwise statistical procedures in the initial

stage of analysis. In the final analysis, a full multivariate logistic regression

model was used to estimate the odds ratios for the existence of alcohol-

related problems, for different levels of a variety of independent variables.

A total of 14 predictors of alcohol-related problems were assessed on 29

levels, distributed among 19 individual dimensions, and 12 two-way

interactions derived from the levels of these individual dimensions.

Statistically significant findings from this analysis are shown in Table 2.

As expected, college binge drinkers were more likely to experience one or

more alcohol-related problems while in college than were other drinkers.

Although frequent binge drinkers represented only about 22% of the college

student population, they accounted for over 40% of alcohol-related

problems. Significant main effects for binge drinking in logistic models

varied according to gender. Male frequent binge drinkers, similar to reports

in previous studies (3,11,33,35), were nearly three and a half times

(OR = 3.43) more likely than nonbinge drinkers to report that they had

experienced alcohol-related problems. Male freshmen, as reported in other

studies (59) and sophomores were more likely to experience negative

drinking-related consequences relative to upperclassmen (OR = 5.37)

whereas year in college had no predictive value for females. Bar patronage

among males, but not among females, was associated with frequent binge

drinking, which often led to alcohol-related problem behavior.

For female college students, in comparison with males, alcohol

problems were almost three times more likely to occur as the result of

frequent (seven or more times monthly) drinking (OR = 2.75), and as the

result of additional negative effects such as hangovers (OR = 3.22), which

interfered with school activities the next day. It, therefore, appears likely, as

suggested in previous research, that what is often labeled binge drinking

among college students may not provide as accurate an estimation of

problem drinking outcomes for women as for men (60). Although no

information was available in the data set on fraternity/sorority residence and

drinking patterns, two-way interaction terms in logistic models indicate that,

for both genders, interactions between college living arrangements, such as

living on or off campus away from parents, and moderate levels of binge

drinking were risk factors for alcohol-related problems in college, as was

also reported in past research (61,62). There was no systematic evidence

that the relationship between residence patterns and student binge drinking

was mediated by an intervening variable.

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Table 2. Risk of alcohol-related problems among American college students in 1984

by binge drinking, independent predictors and gender.a

Predictors

Males (N = 769) Females (N = 678)

ORb 95% CI ORb 95%CI

Binge drinkingc

Non-binge Reference

Infrequent binge

(1–2 times month)

NS NS

Frequent binge

(3+ times month)

3.43* 3.42,3.43

Drinking frequency

1–3 days Reference Reference

4–6 days NS NS

7 or more days NS 2.75* 1.42,5.01

#Days had hangover in

past month

No hangover days Reference Reference

One or more days NS 3.22a 2.24,7.66

Class standing

Lower classmen 5.37a 5.36,5.38 NS

Upper classmen NS

Graduate student Reference Reference

Frequent bingeing � #days

(� 2) frequent bars

6.0* 5.98,6.01 NS

Infrequent bingeing

X/living off campus

4.30* 4.30,4.31 3.51* 3.51,5.52

*Adjusted Odds Ratios are significant at the p < 0.01 level or below.aAlcohol problems include drinking interfered with school work, aggressiveness while

drinking, became argumentative while drinking, fighting while drinking, failed in

attempts to cut down on drinking, afraid they were alcoholic, drinks until intoxicated,

had drinking-related blackouts, morning drinking, hand tremors morning after

drinking, getting high/tight alone, and kept drinking after promising not to.bOR = weighted adjusted odds ratio. CI = confidence interval. Logistic regression

models include controls for age, race/ethnicity, marital status, and selective interaction

factors. Model chi-square for males = 120.713, df = 20, p < 0.001; Model chi-square

for women = 124.098, df = 15, p < 0.001.cBinge drinking = Five or more drinks for males and four or more drinks for females

one or more times in the past month.

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DSM-IV Alcohol Dependence andAbuse After College: 1994

Prospective 12-month DSM-IV criteria were estimated for former

college students who reported drinking alcoholic beverages in the month

before interviews in 1994 (N = 967; 75.8%). Weighted estimations of DSM-

IV diagnostic criteria indicate that 22% of men and 14% of women

respondents met the criteria for alcohol dependence, and 24% of men and

19% of women met criteria for alcohol abuse. Nearly 10% of males and 8%

of females reported experiencing three or more symptoms of alcohol

tolerance in the preceding year (the same amount of alcohol has less effect

than before, need to drink more to get the same effect). In addition, 16% of

males and 29% of females reported one or more symptoms of alcohol

withdrawal (felt depressed, irritable, or nervous after drinking, or the

morning after; was sick or vomited after drinking; or the morning after;

heavy sweating/shaking after drinking; or the morning after; takes a drink

to stop shaking after drinking). Evidence of tolerance and withdrawal are

indicators of physiological dependence (48). Withdrawal symptoms are

most central to dependence (63). Maladaptive patterns of alcohol abuse

clustered largely around two symptoms: role failure and hazardous drink-

ing. Twelve-month abuse was defined by recurrent use of alcohol resulting

in a failure to fulfill major role obligations at work, school, or home,

among males (34%) and females (37%). Especially common was recurrent

use of alcohol in situations in which it is physically hazardous, such as

driving an automobile when impaired by alcohol, for males (56%) and

females (58%).

Correlates of DSM-IV Dependence andAbuse After College

Although many young college students engage in binge or problem

drinking, it is unclear whether college drinking patterns decline with the

passage of time or continue into adulthood. Logistic models evaluating

DSM-IV-defined criteria and independent predictors are shown in Table 3

for dependence outcomes and Table 4 for abuse. Prospective estimates

indicated that, for some former college drinkers in the study, 10 years after

the transition from college to postcollege life, the binge drinking practices

and alcohol-related problems experienced during the college days posed

significant risk factors for DSM-IV assessed abuse and dependence. This

finding suggests that drinking problems among collegians may not be just

strictly a college phenomenon.

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Table 3. Long-term risk for DSM-IV alcohol dependence among former college

students in 1994 by gender and independent predictors.

Males (N = 541) Females (N = 426)

Predictors OR* 95% CI Predictors OR* 95% CI

Marital status

(unmarried)

2.90 1.32,4.71 Marital status

(unmarried)

3.73 3.72,3.74

Current heavy

drinking 1994a x

5.78 5.77,5.79 Alcohol problems

in college 1984 x

7.68 7.66,7.70

College frequent

binge drinking

1984b

College drinking

frequency 1984d

Low incomec

x

9.68 9.63,9.72 Current drinking

quantity 1994e x

12.1 12.13,12.19

White collar

occupational

status

College drinking

frequency

1984

Current heavy

drinking x

2.71 2.71,2.72 Current drinking

frequency d x

7.40 7.39,7.42

Blue collar

occupational

status

College dropout

status

Current drinking

frequency x

9.53 9.51,9.56

College graduate

status

*OR = weighted odds ratio. CI = confidence interval. Adjusted Odds Ratios are all

significant at the p < 0.01 level or below unless otherwise indicated. Logistic

regression models include controls for age, educational level, marital status,

employment status and selective interaction factors. Model chi-square = 71.123,

df-9, p < 0.01 for men. Chi-square = 82.997, df = 22, p < 0.001 for women.aThe number of times a respondent drank six or more drinks on one occasion during

the past 30 days.bStudents who binged (5 + drinks) three or more times in last 30 days.cBelow $25,140.00 total family income in past year.dSeven or more times monthly.e� Four or more drinks per drinking occasion.

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Table 4. Long-term risk for DSM-IV alcohol abuse among former college students

in 1994 by gender and independent predictors.

Males (N = 541) Females (N = 426)

Predictors OR* 95% CI Predictors OR* 95%CI

Marital status

(unmarried)

2.03 1.02,4.11 Marital status

(unmarried)

2.17 1.33,4.90

Current drinking

quantity 1994a2.45 0.980,11.4 Current drinking

frequency 1994e x

4.41 0.979,7.39

Alcohol problems

in college 1984

Current heavy

drinking 1994b x

4.31 1.39,7.42 Current drinking

quantity 1994a x

12.0 11.9,12.03

College infrequent

binge drinking

1984c

Current drinking

frequency 1994

Current heavy

drinking 1994 x

9.34 9.33,9.35 Current drinking

frequency 1994 x

7.71 7.70,7.72

College frequent

binge drinking

1984d

College dropout

status

Blue collar

occupational

status 1994 x

4.67 4.67,4.68 Current drinking

frequency 1994 x

2.63 1.22,16.3

College dropout

status

College graduate

status

*OR = weighted odds ratio. CI = confidence interval. Adjusted Odds Ratios are

significant at the p < 0.01 level or below unless otherwise indicated. Logistic

regression models include controls for age, educational level, marital status, family

income, employment status, and selective interaction factors. Model chi-square for

men = 71.590, df = 24, p < 0.01. Model chi-square for women = 85.987, df = 19,

p < 0.001.a� Four or more drinks per drinking occasion.bSix or more drinks on one occasion during last 30 days.cStudents who binged (5+ drinks) one or two times in past month.dStudents who binged (5+ drinks) three or more times in last 30 days.eSeven or more days in last 30 days.

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Gender Differences

Twelve-month main effect estimations by gender indicated that marital

status (never married, separated, divorced) directly predicted long-term

increased risks for DSM-IV alcohol dependence (men: OR = 2.90; women:

OR = 3.73) and abuse (men: OR = 2.03; women: OR = 2.17). An additional

main effect for alcohol abuse among adult men in their midthirties was

current high alcohol consumption quantity per drinking occasion

(OR = 2.45). Several two-way interactions in logistic models emphasize

the importance of earlier college drinking patterns of both men and women

as discriminating predictors of prospective long-term outcomes. There were

significant interactions, for example, between infrequent as well as frequent

binge drinking in the college years for males and current heavy drinking,

which increased the likelihood for a dependence outcome nearly six times

(OR = 5.78), and over nine times for abuse (OR = 9.68). Interestingly, for

some males, previous infrequent binge drinking practices in college

apparently escalated afterward, changing in the direction toward heavier

rather than toward lighter drinking (Abuse: OR = 4.31), a trend which

likely reflected the growth and continuance of an episodic high-risk form

of drinking.

For women, as for men, the dynamic nature and relationship of college

drinking effects, 10 years past, with subsequent alcohol use in the

postcollege years was indeed striking. In logistic regression two-way

interaction models, for example, the long-term odds of problematic drinking

for women across the transition from college into their midthirties were

greatly increased if they continued to drink on as frequent a basis as they

did while in college (dependence: OR = 12.1), or if they drank frequently in

college (seven or more days monthly) and simultaneously experienced

negative effects from alcohol-related problems within the same environment

and time frame (dependence: OR = 7.68; abuse: OR = 4.41). Women also

had a high risk for alcohol abuse associated with concurrent high stability

in drinking frequency and quantity of drinking per drinking occasion

(OR = 12.0). Therefore, one of the most important determinants of long-

term alcohol problems among females in the study appeared to be drinking

continuity or consistency over time. The stability of the drinking frequency

predictor for women remained virtually unchanged after introducing a series

of control covariates into logistic regression models.

Educational Attainment and Occupation

When later drinking-related problems are considered within the context

of educational attainment and school-to-labor force transitions, it becomes

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increasingly clear that, for some former college students, heavy drinking

habits built up in college days were sometimes transferred from college life

into occupational life. Those who engaged in binge drinking in college were

either less likely to continue their education or were more likely to find

work in less prestigious occupations. In this study, 25% of DSM-IV-

dependent males, for example, and almost 38% of dependent females in the

study were college dropouts, as were over 20% of males and almost 37% of

females who met the criteria for DSM-IV-defined alcohol abuse. About

44% of male college dropouts, including many who had attained two or

three years of college, were employed in blue collar occupations while over

one quarter of female dropouts and 13% of female graduates were working

in clerical white collar jobs in 1994.

As shown in logistic models (Table 3 for dependence and Table 4 for

abuse), there was a significant interaction between white collar worker

status and alcohol dependence for males (OR = 9.68), who were mostly

white collar workers earning less than 25 thousand dollars annually in 1994.

Among males, there was also a significant interaction between blue collar

worker status and concurrent heavy drinking and dependence (OR = 2.71).

Alcohol abuse among males was related to interactions between blue-collar

worker status and lower educational attainment, particularly college dropout

status (OR = 4.67). Alcohol abuse and dependence among females in later

years, in contrast to males, appeared to be more strongly predicted by

interactions between drinking frequency and alcohol-related problems in

college, in combination with lower educational attainment (drop-out status)

and concurrent frequency of drinking (OR = 7.71), rather than by occu-

pational status, although drinking problems were not concentrated in any

specific educational level.

DISCUSSION

A national probability sample of college students was followed over a

10-year period in order to assess the long-term consequences of college

binge drinking in later life. Only if followed up prospectively can the

attempt at earlier identification of potential problem drinking be effectively

evaluated. The data, consistent with other national estimates (4,57,64),

confirmed that frequent binge drinking in college is indeed widespread,

especially among males. The results further underscored, for a significant

proportion of collegians, male as well as female, that trajectories of risky

binge drinking styles and experiences of negative effects in college directly

predicted or contributed to residual developments such as DSM-IV criteria

of alcohol dependence and abuse 10 years after college, in conjunction with

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evidence of academic attrition, early departure from college, and less

favorable labor market outcomes. This may be a cause for concern. It

should be emphasized at the same time, however, that the evidence

presented is not interpreted or seen as an increase or escalation of such

problems among previous college student-defined populations. Secondarily,

when interpreting the results, one must bear in mind that the majority of

students in the study were not binge drinkers in college, and most of those

who were tended to reduce their heavy alcohol consumption patterns after

college. In addition, the comorbidity of alcohol and drug use or drug

dependence was not independently assessed among former collegians; the

co-occurrence of these factors has been found extensively in studies

employing national survey data (65). While this study, thus, represents an

important step toward understanding some of the unintended, long-term

consequences of college student binge drinking, additional prospective

studies from representative student samples are needed to confirm and

establish these findings.

The findings provide support for the continuous model rather than the

discontinuous model of excessive alcohol consumption in college student

populations. In the discontinuous model of alcohol use, changes in frequent

binge drinking usually occur over time and transitional experiences such as

employment, marriage, and parenthood reinforce the ‘‘maturing-out’’

process whereby young adults who drink heavily during college decrease

their drinking in the following years (20,22). Conversely, in the continuous

model of alcohol usage, college bingeing and substantively related drinking

problems are viewed as progressive, gradually developing into alcohol

dependence or abuse later in life (29–31,36). These results suggest that age

alone, or maturation, may not be as crucial in distinguishing between

persons who are likely to successfully change their drinking patterns after

college and those who are less likely to change. For the most part,

according to a longitudinal study whose findings were replicated in this

study, it is upwardly mobile college students who seem to age out of

problem drinking; downwardly mobile students and those who do not

graduate are less likely to mature out (28). Therefore, the addictive binge

drinking habituation learned or reinforced in college (33,35), at least for

some individuals, can be considered as high risk behavior for the

development of ongoing and protracted problematic drinking (30,36).

The data on drinking modalities among onetime collegians do not

appear to support the assumptions of a gender convergence; rather, the

results suggest that different frequencies of drinking might help to account

for gender differences in the relative risk of developing alcohol dependence

after college, which may vary as a function of collegiate drinking practices.

While men still drink more heavily and consistently exceed women in

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typical drinking frequencies, quantities and adverse drinking consequences

(66,67), women’s frequency of drinking was shown to remain high after

college and did not perceptibly decline with age (68). College women in

this study binged less than men did and had fewer alcohol-related problems,

yet they experienced negative drinking effects in the college years and

beyond that were related to drinking frequency. Higher educational level,

being married, and having children were related to reduced consumption

among women, whereas being separated or divorced was related to

increased drinking, as in previous studies (24,33,69). Younger cohorts of

women attending coeducational colleges comprise larger proportions of

drinkers now than in the past (70). The observed patterns of ongoing

frequent drinking among college-educated women may, therefore, reflect

growing national drinking trends among women in the general population

(71) which is a critical issue for future research.

Binge drinking in college among a segment of students, confirming

earlier research findings (38–40), had a significant, negative impact on

educational attainment as well as an equally negative effect on postcollege

occupational careers and wages. Analysis revealed that individuals who

binged frequently in college and who failed to mature out after college

were more likely to be college dropouts who were employed in blue collar

occupations. Among respondents defined as alcohol dependent, those who

graduated from college, even if working in white collar occupations, were

more likely to be earning lower wages in 1994 than were those without

alcohol dependence. Although previous research has indicated that

individuals in lower status occupations are at greater risk for alcohol

dependence (72), drinking customs and practices among former collegians

in the study preceded their entry into the work force.

There are several limitations to the study that require comment. First,

sample attrition in the 1994 follow-up college sample, after a 10-year

interval, may be a potential source of bias. Although a certain amount of

attrition is to be anticipated between panel observations over time due to

deaths, institutionalizations, refusals, panel dispersion, and tracking

difficulties, the 1994 retention rate of 68% is partly attributable to a

variety of noninterview reasons. Respondents, for instance, who refused to

participate or were noninterviews for two consecutive years for any reason

were dropped from the study. Furthermore, the elimination of two

supplemental subgroups of respondents (military and disadvantaged white

youth) from the primary NLSY79 sample after 1984 and prior to1994,

consisting of a total of 2722 cases, or 21%, to some extent affected sample

mortality. Nevertheless, to remain representative, the NLSY79 sample

population weights have been adjusted at each successive wave to

compensate for noninterviews and nonresponses. Actually, the retention

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rate for the 1994 wave of the college student sample is comparable to other

National Longitudinal Survey representative samples in which the retention

levels in longitudinal panels ranged between 58% and 65% (46). Moreover,

the observed drinking item nonresponses were minimal in the latter time

period. The percentage of reported drinkers among former college students

in 1994 was equivalent to 1984 reports (76% and 77%, respectively).

Second, the issue of early onset of drinking patterns at the high school

level was not addressed in the study. For example, Wechsler and associates

(7) found that, for many students, high school bingeing was a very strong

predictor of college bingeing. Thus, drinking styles of adults in their

midthirties could actually be a derivative of early high school onset that

was mediated by college experiences. The high school to college, or even

middle school to high school transitions (73) may very well be an important

focus for future study of alcohol consumption for both genders.

Third, lifetime dependence prevalence was not estimated; therefore, the

relationship between binge drinking in college and dependence in later life

is not shown to be an exclusively linear progression, as different individuals

may experience drinking problems at different times in the life cycle (74).

For example, problem drinking after college could have been continuous for

some respondents, similar to previous research reports (21), but for others

there may have been intermittent periods of reduced consumption,

abstinence, or quite possibly self-change without formal treatment (75,76)

over the 10-year period of the study after which they suffered relapse.

Finally, although the findings suggest a positive association between

alcohol abuse or dependence and occupation, the question of causal

direction between alcoholism and labor market outcomes opens up the

prospect of reverse causal effects, which is an incompletely resolved issue.

The direction of causation has not been established empirically in research

studies and the debate is ongoing (37,77). I believe that the results of the

study are minimally affected by this consideration in view of sufficient

longitudinal evidence presented here suggesting that the drinking patterns of

respondents were established in college and preceded entrance into the

labor force. Elements of reverse causality could be related to features of the

individual’s job or to nonwork social relationships. Sorting out complete

causal variability between dependence factors and occupational status

would, therefore, require structural equation modeling and the development

of a simultaneous model of alcohol use and labor market decisions (40).

A major strength of the study is the prospective 10-year follow-up of

college students with concurrent measures of drinking in both time periods

and the finding of important long-term implications associated with college

student problem drinking. Other strengths of the study include generaliz-

ability to college students in the general population for the time period

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studied, the identification of different binge drinking developmental

trajectories, the comparison of cross-sectional and prospective research

designs, and the use of alcohol measures based on the most current

psychiatric classification, the DSM-IV (78). Notably, the research also

meets the need for outcome measures that have been validated on a unique

sample of women. Measures and definitions of risky drinking for female

populations have been especially problematic in the past (73).

The results of the present study involving collegiate binge drinking have

implications for research and prevention practices that are clearly situated

within the larger issues of college student health, alcohol education, and

problem resolution. The finding of trajectories of developmentally distinct

drinking patterns reflecting drinking styles and problems among college

students that can potentially have serious long-term ramifications provides

additional data that support intervention policies. The evidence presented

here suggests the need for continued diverse programs on college campuses,

including the strengthening of existing preventive programs as well as the

implementation of promising new strategies based on research evidence and

outcomes, which are specifically designed to reduce the possible long-term

risks associated with college cultures and customs that commonly promote

excessive alcohol use among college student populations.

ACKNOWLEDGMENTS

The data source for the study was the National Longitudinal Survey

of Youth (NLSY79). The NLSY survey was sponsored by the Bureau of

Labor Statistics (BLS) of the U.S. Department of Labor and data were

made available from the Center for Human Resource Research, Ohio

State University.

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