You Talkin’ to Me?An Overview of Disputed Terminology

in AOD Prevention

William DeJong, PhD

DirectorU.S. Department of Education’s Higher Education Center

For Alcohol and Other Drug Prevention

August 4, 2003

Language Matters

• Scientific discourse– Precision

• Public communication– Simplicity– Motivating

• Individual action• Environmental change

• Political meaning– Symbol– Litmus test

The B-Word: “Binge”

• “Binge drinking”– Definition:

• For men, 5 or more drinks in a row at least once in the past two weeks.

• For women, 4 or more drinks

– Advantages• Easy headlines

• It’s established in the press

“Binge Drinking”

• Imprecise measure of “problem drinking”– Length of the drinking episode? Body weight?– Preexisting clinical meaning

• Insensitive dichotomous measure– Poor gauge of progress

• Other issues– Mislabels some as “problem drinkers”– Implies that drinking at lower levels is “safe”– Produces misleading headlines

Survey of College Alcohol Normsand Behavior (SCANB)

• Self-administered, voluntary, and anonymous mail survey– National sample: 32 US four-year colleges/universities

– Baseline data: • 18 schools (Cohort A) in 2000

• 14 schools (Cohort B) in 2001

– N = 4,798 (full-length surveys)

“Drink”

Bottle of beer (12 oz.)

Glass of wine (4 oz.)

Wine cooler (12 oz.)

Shot of liquor (1 oz.)

Composite Drinking Scale (CDS)

(1) “During the past 30 days, on how many occasions did you use each of the following substances – alcohol (beer, wine, liquor)?” – Scored 1-7: “Never,” “1-2 times,” “3-5 times,” “6-9 times,” “10-19

times,” “20-39 times,” and “40 or more times”

(2) “What is the average number of drinks you consume in a week?”

(3) “When you party, how many drinks do you usually have?”

(4) “Think back over the last two weeks. What was the greatest number of drinks you consumed at one sitting?”

CDS Drinking Status/Score

• Abstainer– Reported no alcohol use to all 4 questions

• Drinker– Reported alcohol use to >=1 question

– CDS Score• Sum of 4 normalized z-scores

• Imputed with mean z-score of the other 3

– CDS/Q1-Q4 Drinker

– Internal Consistency Reliability (Cronbach’s coefficient alpha: 0.89; item-total correlations: 0.65 – 0.81)

• CDS Status Missing– Failed to respond to >= 2 questions

• Heavy Drinking

– Consumption of 5+ drinks in a row for men and 4+ for women, at least once in a 2-week period

• Non-Heavy Drinker

– Consumes alcohol but does not drink heavily

• Heavy Drinker

– Infrequent Heavy Drinker (1 or 2 times)

– Frequent Heavy Drinker (3 or more times)

Heavy (“Binge”) Drinking Measure

Distributions of Individual CDS Items: Profiles of CDS/Q1-Q4 College Student Drinkers

CDS Item Description CDS

Quartile Mean (SD)†

Min Max

Frequency of alcohol use in the past 30 days‡

1 1.8 (0.5) 1 4

2 2.7 (0.7) 1 5 3 3.8 (0.9) 1 7 4 4.8 (1.1) 1 7

Average number of drinks consumed in a week

1 0.6 (0.8) 0 5

2 2.4 (1.6) 0 12 3 6.2 (3.0) 0 22 4 17.9 (11.3) 0 80

Greatest number of drinks consumed at 1 sitting in last 2 weeks

1 0.7 (1.1) 0 6

2 3.0 (1.9) 0 10 3 5.8 (2.3) 0 17 4 11.3 (4.8) 0 30

Average number of drinks consumed when partying

1 1.7 (1.3) 0 6

2 3.5 (1.6) 0 10 3 4.9 (1.7) 0 17 4 8.8 (3.3) 3 24

Behavior-Based CDS Drinking Status – No. (Row %) Heavy (“Binge”) Drinking Status Q1 Drinker Q2 Drinker Q3 Drinker Q4 Drinker

Non-Heavy Drinker 854 (54.29) 560 (35.60) 150 (9.54) 9 (0.57)

Heavy Drinker 98 (4.46) 375 (17.07) 801 (36.46) 923 (42.01)

Infrequent Heavy Drinker 76 (5.72) 324 (24.40) 631 (47.52) 297 (22.36)

Frequent Heavy Drinker 22 (2.53) 51 (5.87) 170 (19.56) 626 (72.04)

Heavy (“Binge”) Drinking Status vs. CDS Drinking Status

Summary

• Key problem: possible misclassification

• Root of problem: single dichotomous measure– CDS: continuous measure with 4 strongly correlated

items

– Correlation: 0.77 (41% variance in continuous CDS scores unexplained by heavy drinking measure)

“Responsible Drinking”

• Definition: – None– Consumption or consequences?

• Disadvantages– Not a real guideline– Implicitly blames alcohol problems on the

drinker– Appropriated by the alcohol industry

Controversies

• “Abuse”– Ignores illegal use

• “Addict” and “Alcoholic”– Most problems created by non-addicted users

– Exculpatory (disease) vs. demonizing (sin)?

• “Harm Reduction”– Strategies viewed as enabling

– Some strategies favored by alcohol industry (e.g., designated driver)

The Higher Education Center for What?

• Alcohol and other drug prevention– How do you prevent alcohol?– Tobacco?– Blurs distinctions – “Red flag” for the alcohol industry

Next Steps?

• Proceedings document– Importance of language

– Major controversies

• Guidelines– Advantages/disadvantages of terminology

– Recommendations

– Specific to higher education (vs. CSAP/ICAP Joint Working Group on Terminology’s Working Papers)