Drinking among Young Adults: Screening, Brief Intervention, and Outcome

Both college and noncollege populations face a high risk of becoming heavy drinkers and experiencing negative consequences of alcohol use. Because young people in these populations do not tend to identify themselves as having alcohol problems, they may be more readily identified through proactive screening in locations where they are likely to seek treatment related to alcohol problems, such as hospital emergency rooms, their college campuses, or workplaces. This article summarizes research on screening and brief interventions for alcohol use among young adults, particularly brief motivational interventions (BMIs). KEY WORDS: young adult; undergraduate student; heavy drinking; binge drinking; alcohol dependence; problematic AOD (alcohol and other drug) use; AOD effects and consequences; harm reduction; identification and screening for AOD use; intervention (persuasion to treatment); brief intervention; motivational interviewing; school-based intervention; prison-based prevention; emergency room; medical-facility-based prevention; drinking and driving education; workplace-based prevention; Employee Assistance Program ********** Ample evidence demonstrates that excessive alcohol use among young people is a significant cause for public concern (see table). Young adults in the 18-25 age group consistently engage in high rates of risky behaviors such as unprotected sex and substance use (Arnett 2000). The National Survey on Drug Use and Health (Substance Abuse and Mental Health Services Administration [SAMHSA] 2003) revealed that young adults show the highest prevalence of problem drinking. Specifically, 41 percent of young adults reported drinking five or more drinks (1) per occasion at least once in the past month (i.e., binge use), and 15 percent reported drinking five or more drinks per occasion on at least 5 different days in the past month (i.e., heavy use). (2) Among college students, approximately 67 percent reported using alcohol at least once in the past month (Johnston et al. 2001), and 40 percent reported heavy episodic drinking (defined, for men, as drinking five or more drinks at least once in the past 2 weeks and, for women, four or more drinks at least once in the last 2 weeks) (Wechsler and Nelson 2001). Heavy drinking also is prevalent among young adults in the military. In a survey of 5,136 military personnel ages 18 to 25, 2,763 (53.8 percent) reported a heavy-drinking episode in the past month, with 1,422 (28 percent) experiencing at least one heavy-drinking episode a week in the past month (Bray et al. 2003). Young adults often exhibit heavy drinking before entering the military; for example, 1,506 of 2,002 Navy recruits (89 percent under age 21) consumed alcohol in the past year, and one-third (519/1,506) of these recruits reported heavy episodic drinking as their typical consumption pattern (Ames et al. 2002). Among young adults, 25 percent of males and 14 percent of females meet (or at some time have met) the diagnostic criteria for alcohol dependence (SAMHSA 2003), as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) (American Psychiatric Association 1994), with 13 percent of men and 6 percent of women meeting diagnostic criteria for alcohol dependence in the past 12 months (Grant et al. 2004). However, many young people "mature out" of or moderate excessive drinking; as they enter their mid-twenties, their drinking no longer meets the criteria for abuse or dependence (Jackson et al. 2001). (For more discussion of this phenomenon, see the article by O'Malley in this issue.) Despite the fact that young adults' alcohol use is in some sense developmentally normative, combating heavy alcohol use in this population is important for several reasons. The primary causes of illness and death among young adults involve lifestyle and behavioral factors, including excessive alcohol use (Schulenberg et al. 2001). Even one episode of excessive drinking can have serious consequences that persist well beyond adolescence and young adulthood, such as alcohol-related car crashes, unintended pregnancies, and physical fights leading to arrest or jail. …