Authored by Lowinger Robert*
Abstract
Alcohol misuse is common in college students and often results in a variety of negative academic, behavioral, and social consequences for the student and those associated with the student. There are a variety of instruments and measures which have been developed to assess the nature and extent of these consequences. This article reviews the most commonly used instruments to assess the negative consequences of alcohol misuse in college populations. Relevant conceptual and psychometric issues are also addressed.
Introduction
Studies indicate that of the nine million college students, about 45% engage in heavy or problem drinking [1]. There has been a growing research literature [2-6] aimed toward understanding the negative physical, social, and behavioral consequences that apply specifically to college students who misuse alcohol; these consequences include death, unintended physical injuries, assaults, property damage, arrests, fines, unwanted sexual experiences, decreased cognitive functioning, decreased academic functioning, and relationship difficulties [7]. In response to the growing importance of this topic especially from a research perspective, several instruments have been developed which provide measures of the types and extent of negative consequences experienced by college students who misuse alcohol (see below). Some of these instruments incorporate scales of negative consequences as part of a more comprehensive measure of alcohol abuse [8] while others primarily measure negative consequences of alcohol use [9].
The purpose of this article is to review the major most commonly used available instruments to assess the negative consequences of alcohol abuse in college students although it is hoped that this review will also be applicable to assessment in related areas. In order to limit the review to the specific topic at hand, we only considered instruments which were specifically developed to measure negative consequences of drinking in general college populations. We do not review instruments which are primarily used for clinical assessment which tend to primarily measure indications of, or the severity of, alcohol addiction. We do not consider instruments or scales which address the frequency and quantity of alcohol consumed [10]. There are many instruments designed to identify alcohol use disorders, alcohol dependence, and problem drinking for diagnostic and treatment purposes which are not particularly targeted for college students including the DSM- 5, Composite International Diagnostic Interview [11], Michigan Alcoholism Screening Test [12] and CAGE Questionnaire [13] etc. These instruments have been reviewed elsewhere [14-16] and will not be addressed in this article. In addition, there is some recent interest in the positive consequences of drinking [17] which is also beyond the scope of this review. Rather this review is limited to popularly used and psychometrically sound instruments which can be administered in survey format to better understand the negative consequences of drinking in college populations among casual as well as binge drinkers.
Conceptual Issues
There is a confusing array of definitions as to what constitutes negative consequences of drinking both in terms of the categories of consequences which are measured and the type of items which are considered comprising a category of consequences. Perkins HW [18] comprehensive classification of negative consequences of risky drinking behavior divides negative consequences into the broad categories of damage to self, damage to other people, and institutional costs. Damage to self, includes academic impairment, blackouts, personal injuries and death, short and long-term physical illnesses, unintended and unprotected sexual activity, suicide, sexual coercion/rape victimization, impaired driving, legal repercussions, and impaired athletic performance. Damage to other people includes property damage and vandalism, fights and interpersonal violence, sexual violence, hate-related incidents, and noise disturbances. Institutional consequences refer to deleterious effects on the institutional well-being of colleges and universities; we will exclude this domain from further consideration in this article because it is not assessed by any of the measures considered in this article. However, in operationalizing the category definitions by delineating specific subcategories, Perkins HW [18] omits or neglects some potentially important characteristics: Regarding damage to self, Perkins HW [18] doesn’t mention doing something you later regret and forgetting where you were or what you did, characteristics assessed in several instruments noted below. Perkins includes the subcategory of “academic impairment”; but this is not clearly delineated and could include missing classes, getting behind in schoolwork, inability to study or concentrate, among others. Perhaps more importantly, entire categories of negative consequences are omitted, for example, referral for help (e.g., being referred to an alcohol treatment program or educational program), symptoms of alcohol dependence (e.g., craving a drink upon waking), or emotional problems which could result from alcohol misuse like anxiety or depression.
Instruments which contain measures of different dimensions of negative consequences differ markedly on the dimensions which are contained. For example, the Rutgers Alcohol Problem Index [9] includes three dimensions- dependent symptoms, social consequences, and personal consequences- while the Young Adult Alcohol Consequences Questionnaire [19] assesses seven dimensions – social interpersonal consequences, impaired control, diminished self-, poor self-care, risky behavior, academic/ occupational, physiological dependence, and black-out drinking. The lack of agreement as to what dimensions of negative consequences should be measured and what items should be included to measure each is problematic.
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