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Drinking at college has become a ritual that students often see as an integral part of their higher education experience. Some students come to college with established drinking habits, and the college environment can lead to a problem. According to the 2021 National Survey on Drug Use and Health (NSDUH), 49.3% of full-time college students ages 18 to 22 drank alcohol in the past month. Of those, about 27.4% engaged in binge drinking during that same time frame.1 For the purposes of this survey, binge drinking was defined as consuming 5 drinks or more on one occasion for males and 4 drinks or more for females. However, some college students drink at least twice that amount, a behavior that is often called high-intensity drinking.2

In a national survey, college students who binge drank alcohol at least three times per week were roughly six times more likely to perform poorly on a test or project as a result of drinking (40% vs. 7%) than students who drank but never binged. The students who binge drank were also five times more likely to have missed a class (64% vs. 12%).9

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Unfortunately, although the standard drink (or alcoholic drink-equivalent) amounts are helpful for following health guidelines, they may not reflect customary serving sizes. A large cup of beer, an overpoured glass of wine, or a single mixed drink could contain much more alcohol than a standard drink. In addition, the percentage of pure alcohol varies within and across beverage types (e.g., beer, wine, and distilled spirits).

Factors related to specific college environments also are significant. Students attending schools with strong Greek systems or prominent athletic programs tend to drink more than students at other types of schools. In terms of living arrangements, alcohol consumption is highest among students living in fraternities and sororities and lowest among commuting students who live with their families.

Environmental-level strategies target the campus community and student body as a whole. They are designed to change the campus and community environments where student drinking occurs. Often, a major goal is to reduce the availability of alcohol because research shows that reducing alcohol availability cuts consumption and harmful consequences on campuses as well as in the general population.

1 Calculated using past 30-day quantity and frequency of alcohol use and past 30-day frequency of binge drinking (4+ drinks for females and 5+ drinks for males on the same occasion) from the 2021 NSDUH public-use data file. SAMHSA, Center for Behavioral Statistics and Quality [Internet]. 2021 National Survey on Drug Use and Health (NSDUH-2021-DS0001). Public-use file dataset, 2021. [cited 2023 Mar 3]. Available from: -survey-drug-use-and-health-2021-nsduh-2021-ds0001

Sometimes, families, friends, and health care workers may overlook the concerns about older people drinking. This can be the case because the side effects of drinking in older adults are mistaken for other conditions related to aging, for example, a problem with balance. But how the body handles alcohol changes with age.

Other people develop a harmful reliance on alcohol later in life. Sometimes this is a result of major life changes, such as the death of a spouse or other loved one, moving to a new home, or failing health. These kinds of changes can cause loneliness, boredom, anxiety, or depression. In fact, depression in older adults often aligns with drinking too much.

People who drink daily do not necessarily have alcohol use disorder. And not all who misuse alcohol or have alcohol use disorder drink every day. But heavy drinking, even occasionally, can have harmful effects.

In older adults, especially, too much alcohol can lead to balance problems and falls, which can result in hip or arm fractures and other injuries. Older people have thinner bones than younger people, so their bones break more easily. Studies show that the rate of various types of fractures in older adults increases with heavy alcohol use.

Adults of all ages who drink alcohol and drive are at higher risk of traffic accidents than those who do not drink. Drinking slows reaction times and coordination, and interferes with eye movement and information processing. People who drink even a moderate amount are at higher risk for traffic accidents, possibly resulting in injury or death to themselves and others. (Note that even without alcohol, the risk of a car accident goes up starting at age 55.) Also, older drivers tend to be more seriously hurt in crashes than younger drivers. Alcohol adds to these age-related risks.

In addition, alcohol misuse or alcohol use disorder can strain relationships with family members, friends, and others. At the extreme, heavy drinking can contribute to domestic violence and child abuse or neglect. Alcohol use is often involved when people become violent, as well as when they are violently attacked. If you feel that alcohol is endangering you or someone else, call 911 or obtain similar help right away.

Some people have no trouble cutting back on their drinking. But others will need to stop drinking completely. Alcohol problems can happen to people from all walks of life at any age, and, each year, millions of people seek help for alcohol problems.

As you evaluate your alcohol use, you may find that you drink more often in particular settings or in reaction to certain emotions, such as stress or boredom. Take time to learn about your habits and plan ahead on ways to make a change. Here are some ideas:

Over the past century, differences in alcohol use and related harms between males and females in the United States have diminished considerably. In general, males still consume more alcohol and experience and cause more alcohol-related injuries and deaths than females do, but the gaps are narrowing. Among adolescents and emerging adults, gaps in drinking have narrowed primarily because alcohol use among males has declined more than alcohol use among females. Among adults, alcohol use is increasing for women but not for men. Rates of alcohol-related emergency department visits, hospitalizations, and deaths all have increased among adults during the past 2 decades. Consistent with the changing patterns of alcohol use, increases in these outcomes have been larger for women. Recent studies also suggest that females are more susceptible than males to alcohol-induced liver inflammation, cardiovascular disease, memory blackouts, hangovers, and certain cancers. Prevention strategies that address the increases in alcohol consumption and unique health risks for women are needed.

The Dietary Guidelines for Americans recommends that adults of legal drinking age can choose not to drink, or to drink in moderation by limiting intake to 2 drinks or less in a day for men or 1 drink or less in a day for women, on days when alcohol is consumed.4 The Guidelines also do not recommend that individuals who do not drink alcohol start drinking for any reason and that if adults of legal drinking age choose to drink alcoholic beverages, drinking less is better for health than drinking more.4

People drink for many reasons: to celebrate, socialise, commiserate or drown our sorrows. We may drink to try and change our mood: to feel more relaxed, courageous or confident. However, the effect of alcohol is only temporary. As it wears off, we often feel worse because of how alcohol withdrawal affects our brain and body.

In the short-term, drinking too much can lead to alcohol poisoning, sleep problems, an upset stomach, bloating and migraines. It may make you behave recklessly or aggressively, have an accident or become the victim of violence.

There is a strong scientific consensus that alcohol drinking can cause several types of cancer (1, 2). In its Report on Carcinogens, the National Toxicology Program of the US Department of Health and Human Services lists consumption of alcoholic beverages as a known human carcinogen.

Numerous studies have examined whether there is an association between alcohol consumption and the risk of other cancers. For cancers of the ovary, prostate, stomach, uterus, and bladder, either no association with alcohol use has been found or the evidence for an association is inconsistent. However, evidence is accumulating that alcohol consumption is associated with increased risks of melanoma and of prostate and pancreatic cancers (4, 15).

Many individuals of East Asian descent carry a version of the gene for ADH that codes for a "superactive" form of the enzyme. This superactive ADH enzyme speeds the conversion of alcohol (ethanol) to toxic acetaldehyde. Among people of Japanese descent, those who have this form of ADH have a higher risk of pancreatic cancer than those with the more common form of ADH (30).

Most of the studies that have examined whether cancer risk declines after a person stops drinking alcohol have focused on head and neck cancers and on esophageal cancer. In general, these studies have found that stopping alcohol consumption is not associated with immediate reductions in cancer risk. The cancer risks eventually decline, although it may take years for the risks of cancer to return to those of never drinkers.

For example, ex-drinkers still had higher risks of oral cavity and pharyngeal cancers than never drinkers even 16 years after they stopped drinking alcohol, although it was lower than before they stopped drinking (34). One study estimated that it would take more than 35 years for the higher risks of laryngeal and pharyngeal cancers associated with alcohol consumption to decrease to the level of never drinkers (35).

Cao Y, Willett WC, Rimm EB, Stampfer MJ, Giovannucci EL. Light to moderate intake of alcohol, drinking patterns, and risk of cancer: Results from two prospective US cohort studies. BMJ 2015; 351:h4238.

Some studies show that drinking three or more alcoholic drinks per day increases the risk of stomach and pancreatic cancers. There is also evidence that drinking alcohol increases the risk for prostate cancer. All alcoholic drinks, including red and white wine, beer, and liquor, are linked with cancer. The more you drink, the higher your cancer risk. ff782bc1db