February 29, 2016

Excessive drinking among students is an issue besetting almost every university campus around the world. University students, regardless of which continent they are on, are susceptible to problematic alcohol usage. In a foreign country, students may be exposed to a variety of unfamiliar drinking customs. In some cultures, heavy drinking is viewed as socially acceptable and the norm. Moreover, alcohol content, minimum purchasing age and standard drink sizes can vary. Regardless of location, the repercussions associated with excessive drinking can range from minor to lethal and, unfortunately, can victimize innocent bystanders. Studying abroad increases in popularity every year. In fact, the number of students studying internationally increases by 12 percent each year. Due to this growing student population abroad, risk managers need to be aware of global variations in alcohol customs and consumption so that they are not only better able to prepare to launch students abroad, but also to fine-tune screening tests used to monitor excessive drinking.


Variable Drinking Customs Around the World

In terms of health, drinking patterns over a period of time are as relevant as the volumes of alcohol consumed. Different patterns of drinking with the same level of consumption result in very different health outcomes. Moderate drinking patterns, such as having a drink daily or almost daily, as well as having a drink with a meal, are considered lower risk. Moderate drinking patterns have been associated with helping combat Type 2 diabetes mellitus, osteoporosis in postmenopausal women and coronary heart disease and even reducing the risk of dementia. Countries with the least risky drinking patterns are generally located in western and southern Europe. On the other hand, heavy-to-excessive drinking patterns have been linked to both intentional and unintentional injuries. Statistically, the countries with the most risky patterns of drinking are Russia and Ukraine. The short- and long-term health outcomes associated with heavy and excessive drinking patterns include, but are not limited to, irrational behavior; violence; depression; nervousness; memory loss; cancer of the throat, mouth and breast; reduced resistance to infection; inflamed internal organs; vitamin deficiency; heart failure; anemia; vomiting; diarrhea; and numbness and tingling of arms, legs, fingers and toes. Furthermore, binge drinking - which will be discussed later - can cause a person to become physically dependent on alcohol.


Variable Minimum Purchasing Age Around the World

The minimum purchasing age (i.e. drinking age) varies from 18 years to 25 years of age depending on the country. Furthermore, the minimum purchasing age may vary depending on whether the individual is buying alcohol at a pub, bar or restaurant versus a supermarket or package store. Such variations make it nearly impossible for universities to enforce underage drinking policies among students who travel abroad.


Variable Alcohol Content in Drinks Around the World

Since the amount of alcohol by volume in the same types of drinks (e.g., wine, beer, spirits, etc.) varies within countries and across the globe, the World Health Organization (WHO) and other countries have normalized for this variation by using the "standard unit" or “standard drink.” The “standard drink” for the WHO, Australia, Austria, France, Hungary, Ireland, New Zealand, Poland and Spain is defined to be 10 grams of ethanol. However, there are other countries that define this term far differently: the United Kingdom defines it at 8 grams; Finland at 11 grams; Denmark, Italy and South Africa at 12 grams; Canada at 13.6 grams; Portugal and the United States at 14 grams; and Japan at 19.75 grams. Thus, when problematic drinking is defined in terms of the number of drinks, there can be a high degree of variation of alcohol by volume for which universities and students must account.


Binge Drinking Among College-aged Students

Binge drinking, also known as heavy-episodic drinking, is a problem among young adults. According to the WHO, 16 percent of drinkers worldwide over the age of 15 engage in binge drinking, and the prevalence of monthly binge drinking is slightly higher among individuals 15-19 years old. Binge drinking among individuals over 15 is more prevalent in the Americas, European countries and countries in the Western Pacific region than in Africa and Asia. Furthermore, North America, South America, Europe and Australia have the highest occurrence of problematic alcohol usage among college students.

Binge drinking and alcohol dependence were significantly more common in college students in the United States than their non-student peers, according to one study.


No Standard Definition of “Binge” Drinking Among Countries

The exact definition of a drinking “binge” remains controversial, as do the definitions for drink sizes, drink strength and the duration of the event. The WHO defines binge drinking “as consumption of 60 or more grams of pure alcohol on at least one single occasion at least monthly.” The WHO assumes that a standard drink has about 10 grams of ethanol, assuming that more than six drinks on at least one single occasion at least monthly would constitute binge drinking. However, some countries, as seen above, have different definitions of a “standard drink.” Therefore, the definition of “’binge drinking” varies by country.


Advice for Risk Managers

Risk managers with students abroad, as well as student populations, need to be made aware that alcohol customs, content and standard drink definitions vary from country to country. This can have a significant impact on students’ drinking behavior. Therefore, communication and education about alcohol custom and usage is essential. One of the most common problematic usages of alcohol among college-aged populations abroad is binge drinking. Screening procedures, such as AUDIT, are helpful tools that can be used by risk managers, school administrators and students to quickly assess who is at high risk of excessive drinking and problematic alcohol usage.


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