So it’s another weekend in your local emergency department which means multiple traumas, medical codes and high patient volumes. The only thing is my attention and concern is directed to another group – drunken college students — they are drilling deep inside my head. There is just so many of them! I do not know if it’s having “kids” their age or their total loss of control or if it’s because I’m worried I’m looking at humanity’s future. Whatever the reason though, this bothers me bad. Real bad!
One of these patients threatens me. He shows there is no depth he will not sink to when it comes to spewing profanity in my direction. He flinches like he’s going to hit me despite the three security guards standing in the room. I feel my temperature rising as he continues to needle me. He insults my choice of profession indicating that I must not be “man enough” to be a doctor.(?) He picks on my slight frame and makes sure I know how bad a hurt he can put on me. This kid is a real charmer. His chatter is incessant; his vitriol is vile.
The rage I see in many of the young men, like this one, is scary. I’ve lost count on how many times I’ve been injured by these crazies. It’s not always the type of hurt to put you into workmen’s comp. Instead, it’s those all over aches that remind you of the previous night’s fun. Hitting, biting, kicking spitting, grabbing – nothing is off limits for these out of control patients. Four-point leathers and “two & five” (2mg of lorazepam and 5mg of haloperidol) IM once ruled the day. Today though, the trend is “verbal de-escalation” and creating “a healing environment”. This is great if your name is Obi Wan and you have a little green guy with pointy ears in your contact list. Otherwise, it’s keep a sharp eye and maintain the reflexes of a cat to avoid getting hurt.
Those deemed worthy of two & five add a more difficult degree of danger. The only way to give it is via injection – not fun when your target is a 220-pound bucking bronco. The risk for a needle injury is high; the guilt you pay should you injure a colleague is higher. Part of me understands this is an intervention of last resort. Then again, it’s effectiveness in keeping everyone (patient included) safe leads me to think we’re waiting too long to pull out the big guns.
The “blacked out” young women I see cause me graver concern. I know Cyndi claimed “Girls Just Wanna Have Fun” but at what cost? The level of vulnerability and life endangerment achieved by this group is mind boggling. This weekend’s chants of “Shots, Shots, Shots”, or the like, meant several female students in our ED got the ultimate high – on Propofol, breathing via ventilators. Those not quite as intoxicated still awoke unaware of their current location, wondering how they got into different clothes (a hospital gown and diaper) and hooked up to an IV. A vague recollection of the previous night starts to form as they run their fingers through their hair; the dried vomit stiffens their locks like no other product. These are the lucky ones, though, because they ended up in an emergency department.
I understand I may just sound like a “Daddio”, “Old Head”, “Wet Blanket” and/or “Buzz Killer” but to that, I respond, “What ‘evs”! The numbers from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) prove my point:
- About 1825 college students die from alcohol related unintentional injuries annually
- About 690,000 college students are assaulted by another student that’s been drinking alcohol
- About 599,000 unintentional injuries are linked to alcohol use among college students annually
- About 97,000 students report experiencing alcohol-related sexual assault or date rape annually
REPORT!? What is the actual number?
Does the party just roll on or is there something we can do about this? I believe there’s at least three avenues to explore.
Parents play the first crucial role in prevention but it needs to start before their children head to college. One study shows when parents glamorize their own college drinking experience, students internalize this as permission to engage in a similar manner. The same study also showed a statistically significant higher risk for heavy episodic drinking in students facing overbearing parental disapproval. Balanced, honest conversations between parents and students need to happen throughout the years of adolescence. One caveat is parental influence wanes as physical and mental distance builds in this stage of young adulthood.
Medical/nursing professionals are a second line of defense. We need to provide meaningful patient education following ED visits involving alcohol misuse. Honest conversation identifying the dangers of binge drinking requires non-judgmental straight talk. Referral to college-based drug and alcohol programs is a needed inclusion in the discharge summary. More importantly, a “Kids will be kids” attitude needs to go. Young people that die on your watch haunt you throughout your career. Knowing you speak the truth in love, when the opportunity presents itself, softens this guilt.
We also need to enlist the help of the friends supporting our patients. Students must take the lead in alcohol injury prevention because they possess the most influence. Social normalization of alcohol misuse by students is identified as a key factor in propagating this problem. Yet, research shows there is an amplified misperception amongst college students when it comes to levels of acceptance for drinking to intoxication i.e. a majority of students do not find this behavior acceptable.
The basic idea is simply to communicate the truth about peer norms in terms of what the majority of students actually think and do concerning alcohol consumption. Thus the message to students is a positive one—that the norm is one of safety, responsibility and moderation because that is what the majority of students think and do in most student populations.
Social Norms and the Prevention of Alcohol Misuse in Collegiate Contexts
Wesley Perkins, Ph.D.
Purely stated, when the truth is known, the truth sets free!
As always, please feel free to add comments from your experience. The references below may be useful in your practice. I particularly recommend the PDF from the NIAAA as an educational tool to give out to students.
NIAAA College Drinking Fact Sheet – http://pubs.niaaa.nih.gov/publications/CollegeFactSheet/CollegeFactSheet.pdf
Neighbors, C., Jensen, M., Tidwell, J., Walter, T., Fossos, N., & Lewis, M. A. (2011). Social-norms interventions for light and nondrinking students. Group Processes & Intergroup Relations : GPIR, 14(5), 651–669. http://doi.org/10.1177/1368430210398014
Perkins HW. (2002). Social norms and the prevention of alcohol misuse in collegiate contexts. Journal of Studies on Alcohol. 14(Suppl):164–172.
Rulison, K. L., Wahesh, E., Wyrick, D. L., & DeJong, W. (2016). Parental influence on drinking behaviors at the transition to college: The mediating role of perceived friends’ approval of high-risk drinking. Journal of Studies on Alcohol and Drugs, 77(4), 638-648.