Drunkorexia: Calorie restriction prior to alcohol consumption among college freshman

Article (PDF Available)inJournal of alcohol and drug education 54(2):17-34 · August 2010with 2,981 Reads
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Abstract
Using a sample of 692 freshmen at a southeastern university, this study examined caloric restriction among students prior to planned alcohol consumption. Participants were surveyed for self-reported alcohol consumption, binge drinking, and caloric intake habits prior to drinking episodes. Results indicated that 99 of 695 (14%) of first year students reported restricting calories prior to drinking, with 6% reporting this behavior to avoid weight gain and 10% to enhance alcohols effects; no significant differences were found between males and females. Based on the study findings, practical campus-based and student-centered education and prevention strategies are presented to explore solutions to reduce drunkorexia. Effective evidence-based behavior change brief interventions such as Motivational Interviewing and the Brief Alcohol Screening and Intervention for College Students (BASICS) program are presented and discussed.
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August, 2010
Volume 54(2), 17-35.
Drunkorexia: Calorie Restriction Prior to
Alcohol Consumption among College Freshman
Sloane C. Burke1, Jennifer Cremeens1, Karen Vail-Smith1, Conrad L. Woolsey2
East Carolina University1
Oklahoma State University2
ABSTRACT
Using a sample of 692 freshmen at a southeastern university, this study examined caloric
restriction among students prior to planned alcohol consumption. Participants were
surveyed for self-reported alcohol consumption, binge drinking, and caloric intake habits
prior to drinking episodes. Results indicated that 99 of 695 (14%) of first year students
reported restricting calories prior to drinking, with 6% reporting this behavior to avoid
weight gain and 10% to enhance alcohols effects; no significant differences were found
between males and females. Based on the study findings, practical campus-based and
student-centered education and prevention strategies are presented to explore solutions to
reduce drunkorexia. Effective evidence-based behavior change brief interventions such as
Motivational Interviewing and the Brief Alcohol Screening and Intervention for College
Students (BASICS) program are presented and discussed.
INTRODUCTION
The misuse of alcohol and disordered eating are both major concerns on college
campuses nationwide. Several studies have examined alcohol use among college
students. In 2002, O’Malley and Johnston reviewed findings from several national data
sets which examined alcohol use among college students including the: College Alcohol
Study, the Core Institute, Monitoring the Future, and the National College Health Risk
Behavior Survey. Results of these national surveys are consistent indicating that
approximately 70% of college students report using alcohol in the past month and about
40% report binge drinking (defined as 4 drinks for women and 5 for men in one sitting).
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In 2008, more than three-fourths of college students reported alcohol use in the past
month (American College Health Association). Despite increased education and
prevention efforts over the past 15 years, the misuse of alcohol does not appear to have
changed much. In 2001, Hingson, Heeren, Zakocs, Kopstein, and Wechsler found that
the frequency of binge drinking among college students had remained the same since
1993. Despite increased efforts to prevent alcohol misuse among college students, the
prevalence of binge drinking remained fairly stable between 1993 and 2001, and the
prevalence of frequent binge drinking (3 or more times in the past two weeks) increased
from 19.7% to 22.8% (Wechsler, Lee, Kuo, Seibring, Nelson, & Lee, 2002).
Additionally, the percentage of students who reported drinking on 10 or more occasions
in the past 30 days increased (18.1% to 22.6%) and student who reported being drunk
three or more times in the past 30 days increased (23.4% to 29.4%). To reach these
conclusions about alcohol consumption patterns, Wechsler et al. (2002) examined four
waves of data from the 1993, 1997, 1999, and 2001 College Alcohol Study. Compiled
together, these studies indicate that the majority of college students use alcohol and a
large number (nearly half) participate in binge drinking episodes. Additionally, results
suggest that students who are binge drinkers binge more frequently today than in the past
(Ford, 2007).
Many college students engage in binge drinking and it appears that the majority of
alcohol consumed is done so by students who engage in this behavior (Wechsler, Molnar,
Davenport, & Baer, 1999). The College Alcohol Study (CAS) conducted at Harvard
University found that “frequent binge drinkers,” defined as those who engaged in binge
drinking on three or more occasions in the past two weeks, only constituted 19% of the
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sample, but consumed 68% of the 87,008 total drinks (Wechsler et al., 1999). In this
study, frequent binge drinkers also consumed an average of 17.9 drinks in a week. In
comparison, Infrequent binge drinkers, defined as those who engage in binge drinking no
more than two times in the past 2 weeks comprised 24% of the sample and only
consumed 23% of the total alcohol averaging 4.8 drinks a week. This study is just one of
many that demonstrate the ubiquitous nature of excessive alcohol consumption on college
campuses.
First-year college students have been identified as a high-risk population for
engaging in the behavior of binge drinking (Larimer & Cronce, 2002). Research
indicates that freshman are the most vulnerable to experience serious alcohol related
problems in their first few months of school, with this being a time that they are likely to
engage in high-risk drinking behaviors (Larimer & Cronce, 2002). Several studies have
reported an increase in quantity and frequency of alcohol consumption among first-year
students (Baer, Kivlahan, & Marlatt, 1995; Bishop, Weisgram, Holleque, Lund, &
Wheeler-Anderson, 2005; Grekin & Sher, 2006; Weitzman, Nelson, & Wechsler, 2003).
Some factors that have been indentified for contributing to this increase are: First-year
students are faced with heightened academic rigor, college campus social norms
promoting alcohol use, and a drastic decline in parental supervision during the transition
to college life (Baer, 2002; Baer & Bray, 1999; Baer, Kivlahan, & Marlatt, 1995;
Schulenburg & Maggs, 2002; Schulenburg et al., 2001). First-year students also make up
the majority of students attending parties at dorms and Greek houses where alcohol is
most commonly consumed in the form of binge drinking on Thursday, Friday, and
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Saturday nights (Del Boca, Darkes, Greenbaum, & Goldman, 2004; Harford, Wechsler,
& Seibring, 2002;).
Disordered Eating
Disordered eating is also a significant issue on college campuses. According to
the National Eating Disorder Association (2006), approximately 20% of college students,
both male and female, reported that they have had an eating disorder at some point in
their lives. Studies have also discovered other subclinical disordered eating behaviors
among college students which include: binge eating, chronic dieting, fasting or purging to
control weight, self-induced vomiting, and the use of diet pills or diuretics (Forman-
Hoffman, 2004; Mints & Betz, 1988; Tylka & Subich, 2002.). Furthermore, the
freshman year of college is marked by an increase risk in disordered eating and the
perpetually rumored “freshman 15,” at term used to describe weight gain thought to
typically occur during this time period (Anderson, Shapiro, & Lundgren, 2003; Hoffman,
Policastro, Quick, & Lee, 2006; Striegel-Moore, Silberstein, & Rodin, 1986). Therefore,
while the general college student population may engage in extreme behaviors relating to
weight control, freshman may be at an even greater risk for such behaviors due to the
additional stress and environmental changes in this transition year.
The co-occurrence of eating disorders and alcohol misuse has been noted in many
research studies (Dansky, Brewerton, & Kilpatrick, 2000; O’Brien & Vincent, 2003;
National Center on Addiction and Substance Abuse at Columbia University [CASA],
2001). A 2001 CASA report, estimated that 30-50% of individuals with bulimia and 12-
18% of individuals with anorexia either abuse or are dependent on alcohol. In addition,
results indicated a distinct comorbidity between substance dependency and eating
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disorders with approximately 35% of people with alcohol or drug dependency also being
identified to have an eating disorder. Among college students, studies have demonstrated
an association between alcohol use and unhealthy eating patterns. This association
extends beyond those clinically diagnosed with an eating disorder to include those with
less severe disordered eating behaviors such as binge eating (Cooley & Toray, 1996;
Krahn, Kurth, Gomberg, & Drewnowski, 2005; Anderson, Simmons, Martens, Ferrier, &
Sheehy, 2006; Krahn, Kurth, Demitrack, & Drewnowski, 1992). Krahn et al. (1992)
noted a positive relationship between dieting severity and frequency of alcohol
consumption and binge drinking. Stewart, Angelopoulous, Baker, & Boland (2000) found
similar results, which indicated that higher levels of dietary restraint were associated with
increased excessive drinking episodes and the likelihood of being classified as a binge
drinker.
Among a population who is already at-risk to suffer from serious alcohol related
consequences, the restriction of calories or not eating prior to alcohol consumption makes
the use of alcohol even more dangerous. Studies among those who engage in disordered
eating behaviors such as vomiting after eating, binge eating, caloric restriction, taking
laxatives or stimulants for weight loss, etc. indicate a higher propensity to experience
alcohol-related negative consequences, such as doing something regretted, engaging in
forced intercourse, and blacking-out (Anderson, Martens, & Cimini, 2005; Dams-
O’Conner, Martens, & Anderson, 2005; Dunn, Larimer, & Neighbors, 2002; Krahn,
Hurth, Gomberg, & Drewnowski, 2004; White, A, 2004). For women, the effects of not
eating prior to alcohol consumption are a great concern as women are already at an
increased risk to suffer from serious alcohol related consequences due to differences
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