Addressing High-risk Collegiate Drinking: An Argument for Investing in Prevention
© 2016 Robert J Chapman, PhD
Alcohol is nearly omnipresent in contemporary collegiate life, but reporting this is not news. As early as 1953, Robert Straus and Selden Bacon[i], sociologists at Yale, surveyed the drinking habits of approximately 15,747 students across 27 U.S. colleges. They reported that the majority of respondents engaged in drinking. However, they noted that students who reported drinking did so “frequently or heavilyii." Fast forward to the present, and in December 2015, the National Institute on Alcohol Abuse and Alcoholism suggested that 60% of college students responding to a survey reported drinking at least once in the previous month, with two-thirds indicating the consumption of enough drinks to reach a blood alcohol level of .08 or higher in 2 hours. In short, college students continue to consume alcohol and, for some of them, to the point of intoxication.
The complete turnover of a collegiate population every four to six years is one reason why collegiate drinking remains so persistent in collegiate culture. Those students whose drinking practices change during their collegiate tenure, often by moderating consumption, are simply replaced by new, inexperienced students. Some—many?—of these new students arrive on campus with established patterns of alcohol use. Others arrive having abstained in high school or having been infrequent users but quickly experience alcohol's prevalence on campus. Be that as it may, alcohol has historically been and remains a staple of collegiate life.
What has changed in the 60+ years since Straus & Bacon’s report is the availability of evidence-informed best practices that target student drinking behavior. Environmental management[ii] regarding the social-ecological model[iii] regarding the American College Health Association's core elements of a healthy campus - and social norming represent examples of “macro” efforts to affect student drinking behavior. Likewise, Brief Alcohol Screening and Intervention for College Students (BASICS) and computer-based brief motivational enhancement activities characterize steps to impact individual decisions regarding alcohol and its use. Reviewing such efforts is beyond the scope of this essay, however. Instead, the argument presented here suggests that preventing high-risk and dangerous student drinking is more cost-effective and philosophically consistent with the mission statements of contemporary institutions of higher education (IHE) than habitually addressing its untoward consequences.
To frame this argument, let's consider tobacco use and its numerous consequences. In the 1960s, cigarette smoking was not only socially acceptable but also considered a social norm in America. Cigarettes were routinely advertised on TV, sometimes featuring physicians as spokesmen, and socially conscious hosts always catered to the needs of smokers by ensuring ashtrays were available on conference tables. Airlines had ashtrays integrated into the armrests of airplane seats, and hosts of social events provided canisters filled with cigarettes or small "four-cigarette packs" for guests; smoking was expected, with only the use of pipes or cigars occasionally raising objections. As prevalent as smoking was in the AMC series Mad Men, it was even more common in the reality of mid-20th century America. Then, changes began as the first widespread public reports emerged linking smoking to heart disease, cancer, and emphysema.
Initially, the reported links between smoking and health issues were viewed with suspicion and skepticism. “Big Tobacco” questioned the authenticity of government findings, often funding their own “studies” to refute these claims. By the early 1980s, there had been little change in smoking behavior. However, the reports continued. The focus then shifted from solely reporting health-related concerns to advocating for the rights of non-smokers, leading to public policy decisions that initially mandated areas for non-smokers in public places, then established "smoke-free" environments, and ultimately banned tobacco products altogether.
Gradually but consistently, the public became less tolerant of smoking, and attitudes shifted to where tobacco use was relegated to specific areas, frequently to locations protecting the public from “second-hand” smoke if not banning tobacco use altogether, even in open spaces like public parks and college campuses.
It may have taken 60 years for America's views on tobacco and its use to change, but they did. More importantly, as these attitudes evolved, the negative consequences, particularly those related to health, began to shift. Incidents of smoking-related illnesses started to decline. With fewer tobacco-related health problems, there were consequently fewer associated deaths, leading to a reduction in healthcare costs linked to tobacco-related illnesses and diseases.
The point of this analogy is to suggest that the costs associated with preventing tobacco use—and note that, except for establishing a minimum legal purchase age for tobacco products, the use of tobacco products was not prohibited—were less than the costs associated with treating its health-related consequences. Health education, environmental management, and the application of the social-ecological model led to significant changes in behavior. Additionally, as attitudes regarding tobacco use shifted, fewer people began to smoke, and a greater number of smokers chose to quit. Consequently, the non-illness-related consequences of smoking started to decline, along with deaths from fires related to smoking in bed, automobile accidents due to drivers being distracted while searching for cigarettes and trying to light them, and forest fires resulting from discarded cigarettes are examples of these reductions.
Now, let's return to the consideration of preventing high-risk and dangerous collegiate drinking. For the sake of discussion, imagine a private college with 4,000 students. Let’s assume that tuition at this college is $35,000 per year, in addition to room and board, books, and other fees. It is not uncommon for institutions of higher education (IHEs) to experience an attrition rate between 10% and 15% annually, with 20% being a common statistic. Applying a conservative attrition rate of 10%, 400 students leave the college each year before graduation. There are numerous reasons students choose to depart. Some decide to transfer to another school with a curriculum better suited to their academic interests. Others leave to escape various quality-of-life issues such as the "three Vs of residence life": vomiting, vandalism, and violence, often linked to intoxication. Additionally, some students leave to live closer to home or, as you might expect, due to overtly alcohol-related problems such as academic and/or judicial issues stemming from their drinking.
Now, let’s do the math: $35,000 per student in tuition multiplied by 400 students leaving equals $14,000,000 in lost tuition revenue each year, and this is based on a conservative 10% attrition rate. True, the college might recruit 400 new students to replace those who left, but retaining an already enrolled student is far cheaper than finding, recruiting, and admitting replacements. Moreover, who can say that some of these “replacements” won't bring the same issues that affect the existing students they replaced?
So, we have a college facing a $14,000,000 loss of revenue per year. Again, conservatively, let's say that only 10% of those 400 students left for alcohol-related reasons, such as quality of life concerns, academic dismissal, judicial problems, expulsion, etc.; this represents 40 students. Let’s also assume that this college is considering investing in the prevention of high-risk and dangerous drinking by hiring dedicated staff experienced in employing evidence-informed best practices like those cited above. To achieve this, the college proposes hiring 3 prevention specialists at $60,000 per year each, plus benefits, and budgeting an additional $60,000 per year to hire graduate interns to assist with more individualized, if not clinically oriented, prevention strategies, such as BASICS, along with $10,000 to purchase the necessary licenses to involve all incoming students in an evidence-based online brief motivational alcohol education experience. This investment totals $250,000 plus benefits for the 3 full-time equivalents (FTEs). With benefits at 25% per FTE, this adds another $62,500. Including $7,500 for miscellaneous related expenses to round out the figures, our college is considering an expenditure of $320,000 per year to provide prevention services.
With a tuition of $35,000 per year, how many of the 400 students who leave each year need to remain enrolled to cover the cost of the prevention program? Let’s do the math: $320,000 ÷ $35,000 = 9.143 students. The likelihood that this college’s investment in prevention will reduce the number of students leaving the institution by at least 9.14 each year is virtually certain, with any additional students who remain each year contributing to a net return on investment (ROI). In short, if a straightforward cost-benefit analysis indicates that a $320,000 investment will likely yield returns exceeding $320,000, logic suggests this is a prudent choice for this college. Besides the tuition retained by the college, consider the 1) marketing potential in promoting proactive measures to tackle one of the more “notorious” collegiate issues, 2) likely improvement in campus–community relations, 3) opportunity to demonstrate the college’s commitment to its mission statement, and 4) potential influence on the overall campus culture by employing the social-ecological model, resulting in a win-win-win-win-win situation.
Preventing high-risk and dangerous collegiate drinking is not only the right thing to do from a humanitarian perspective, but it also shows sound business sense and illustrates the type of stewardship reflected in the mission statements of every college and university.
REFERENCES
1 - Straus, R. & Bacon, S., 1953; Drinking in college. Greenwood Press.
[1] Straus, R. & Bacon, S. (1953). Drinking in college. Greenwood Press.
[2] These “subjective measures” are not described
[3] National Institute on Alcohol Abuse & Alcoholism (2015). College drinking. http://bit.ly/1wjXF1k
[6] 1 prevention specialist with a Public Heal/Health Education background employing the social-ecological model, including public policy issues, and 2 clinically oriented prevention specialists experienced in brief motivational enhancement strategies like BASICS.
[7] Something like the College Drinker’s Check-up – see https://www.perplexity.ai/search/what-is-the-social-ecological-bSazfU0.SLGG66T8z9uMbA#1
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