Abstract
There is an unquestionable need to address drinking patterns in subcultures where excessive drinking is normative. Regulatory bodies advocate moderating alcohol consumption but it is unclear whether individuals have agency to do so, particularly when excessive consumption is the norm. This study aimed to address this gap by examining student’s perceptions of limiting consumption, as recommended by government guidelines, in one university in New Zealand. Using a qualitative social science approach, university students surveyed and interviewed their heavy-drinking peers (n = 201) to investigate perceptions of 3 drinking behaviors (Heavy, Moderation, and Abstinence). Thematic analysis revealed that students who drink heavily are labeled positively and viewed as sociable (Dr Froth, Liver of Steel, Trooper, Champion, Hero, Good Alcoholic, popular, a friend). Students who limit drinking, on the other hand, were viewed similar to those who abstain, labeled using explicit, emotive, and derogative terminology (eg, Fag, Vagina, Grandma, Weirdo, Coward, Killjoy) and excluded, ostracized, or the subject of peer pressure. They were also expected to provide a justification for moderating their drinking (eg, being an athlete, broke). Although individuals who moderated their consumption were perceived to have strong willpower and maturity (eg, self-aware, brave, sophisticated), these positive attributes were mentioned less frequently and involved less emotive language than were labels linking moderation to a negative social identity. The method employed in this study provided a frank insight into a student culture of intoxication and the barriers facing students who try to drink in moderation. Our findings reveal that limiting consumption, even occasionally, threatens students’ social identity and inclusion in the student drinking culture. These results suggest that individualistic harm minimization strategies are unlikely to be effective. Instead, the findings underscore the need to develop alternative cultures emphasizing extracurricular activities which may facilitate students’ agency to go against the norm and moderate their drinking.
Keywords: University students, social identity, drinking in moderation, stigmatization, alcohol
Introduction
Across English-speaking and Nordic cultures, government and nongovernment agencies have called for action to change the drinking culture, wherein excessive drinking is normative.1 Individuals who drink high volumes on individual occasions are at risk of serious consequences such as amnesia, aggression, hospitalization, sexual disinhibition, and loss of control.2 This risk increases with the frequency of heavy drinking episodes.3–6 Conversely, avoiding heavy episodic drinking can decrease the risk of harm.7
Cultures of intoxication are a particular concern in university populations where binge drinking is often normative. To encourage responsible consumption, regulatory bodies and governments advocate the use of national alcohol consumption guidelines.8 However, the efficacy of the consequential interventions for shaping behavior is largely unknown9 and is limited by the extent to which individuals are motivated to drink responsibly.10 In fact, international research shows that students are not motivated to drink within recommended guidelines11 and some students report using labeling intended to guide responsible consumption to maximize consumption.12
Public policy interventions must tackle the underlying culture13 but research informing drinking guidelines has tended to focus on patterns of drinking and associated harm and little attention has been directed toward understanding the wider drinking culture. Although public policies often recommend that individuals moderate their consumption of alcohol, there is a lack of research examining how drinkers perceive others who moderate their own drinking behavior, particularly within a culture of intoxication.
Worldwide, heavy alcohol consumption is normative among tertiary students and is an established practice organizing students’ social lives.14 Students perceive drunkenness as permissible, normal, and enhancing sociability.15,16 Although there is a dearth of research on the perceptions, or experiences, of students who moderate their drinking, research has shown that nondrinkers experience peer pressure to drink, are excluded, or are stereotyped negatively.17,18 Nondrinkers either avoid social situations19 or succumb to social pressure to drink.18 As such, participation in the culture of intoxication forms part of students’ identity and their connection with the university culture.16 Taken together, the normative culture of heavy drinking among tertiary students, as well as the significant barriers to abstaining within this culture, raises the question of whether students have unimpeded choice to drink in moderation.
Adults who drink heavily report experiencing pressure to drink from friends, colleagues, and even family members, and researchers argue that efforts to break the culture of excessive consumption must consider both interpersonal and subcultural influences.1 Research shows that subcultural influences, such as social norms, are the most influential factors shaping students’ drinking.20 For example, students rate others with similar drinking habits to their own more favorably21 and are likely to seek the company of like-minded others. University students are recruited into an established drinking culture and are aware that drinking is an expected part of the social ritual.22 This dominant social practice shapes group identity through shared experiences such as preloading23 and the shared suffering of hangovers.24 As such, individualistic harm minimization messages have been criticized for requiring students to step out of the established and dominant social practice of excessive consumption.14,18
Researchers argue that understanding the dominant social practices that facilitate and maintain excessive drinking is crucial to disrupt the practice.14,25 For example, Davies et al22 used a social practice approach to examine students’ views about reducing drinking harms and concluded that the creation of credible alternatives to drinking could provide one possible intervention. As such, the shared social practice of drinking becomes the target for intervention rather than focusing on individuals’ behavior.25 The prototype willingness model26 considers individuals’ perceptions of others who do, or do not, take part in specific health behaviors. It offers a theoretical basis for examining social practices, particularly the social significance of the behavior. For example, research with school students has shown that students who hold negative perceptions of other students who drink are themselves less likely to engage in the behavior.27 The perceptions individuals hold of drinkers in cultures where heavy consumption is normative, such as university cultures, are largely unknown, however.
The aim of this study was to examine how students’ perceptions of drinking in moderation might constrain or facilitate their ability to moderate their alcohol consumption in a culture in which the dominant social practice is heavy alcohol consumption. Building on the work by Davies et al,22 we explore students’ perceptions of their peers’ drinking behavior and, in particular, peers who moderate their drinking. The students in this study were enrolled in a New Zealand university where the drinking culture is one of heavy consumption. We extend previous prototype willingness research, which has tended to use survey methods involving researcher-prescribed adjectives, by employing an open-ended qualitative method in which responses are participant driven. This study also addresses the call by Davies et al22 for research to employ peer interviewers to reduce social desirability responding. Here, we use a novel method for examining the student drinking culture, namely, student researchers surveying and interviewing their peers.
Methods
Study setting
This study was conducted in a New Zealand university setting. In New Zealand, hazardous drinking is widespread among tertiary students28 and is associated with serious harms.29–31 Similar to other Western countries, tertiary students in New Zealand report normative and positive perceptions of intoxication, describing the behavior as acceptable, positive, and as enhancing social experiences. Students also accept a level of alcohol-related harm as a result of their drinking32 and, as such, New Zealand provides a good context for this research.
Study sample
This was a cross-sectional study of a sample of 201 students enrolled in a New Zealand university in 2015. The sample ranged in age from 18 to 25 years (M = 21.38, SD = 1.17 years), 48.3% were men, and 79.6% identified as New Zealand European, 5.0% as Māori, and 15.4% as other ethnicities.
Study procedure
This study was conducted using qualitative research methods to provide rich insights into perceptions of moderating consumption within a culture of intoxication.33 Qualitative approaches are useful for identifying perceptions34 and human experiences.35 Data collection was conducted by 50 students who were studying predominantly toward degrees in business and who were enrolled in a third-year marketing course. They recruited their peers/friends as participants and informed them that the study was about perceptions of drinking behavior. The only criterion for eligibility to take part in the study was that the participant be 18 years or older, in accordance with the university’s ethics requirements. This type of purposive sampling was employed to ensure that the student researchers and participants were embedded within the same culture thereby enabling an honest and frank insight into the culture. The use of peer-to-peer research is novel in the context of alcohol research. Other research has demonstrated, however, that including groups of friends in focus groups, for example, facilitates open discussion36 and yields rich information.23 The student researchers asked participants to complete an open-ended pen-and-paper survey, followed by an open-ended interview. All surveys and interviews were conducted individually, at a location convenient to each participant (typically their student flat), and lasted approximately 20 to 40 minutes.
Participants completed the written survey first. The survey consisted of 3 questions asking participants to describe a peer who
Drinks heavily on most social occasions (heavy drinker);
Sometimes decides to limit their consumption to a couple of drinks (limits drinks); and
Never drinks alcohol (abstainer).
Following completion of the survey, the student researchers asked participants to take part in an open-ended interview. The written survey questions guided the interview questions and provided participants with the opportunity to expand on their responses. All of the student researchers were trained in facilitative interview techniques by the first author (K.R.), who is a qualified and experienced clinical interview skills educator. Specifically, student researchers were taught the art of active listening (eg, paraphrasing, clarifying, summarizing, accepting silences), the use of open questions, and the avoidance of double barreled or leading questions. The student researchers recorded and transcribed both their own and the participant’s speech verbatim. The transcripts were inspected by K.R. to ensure that emergent themes were not driven by the student researchers’ questioning styles (the transcripts were also formally examined for interview style as part of the student researchers’ course requirements). The participants’ speech was anonymized in the transcription process. In the analyses and description of results that follow, we report only the findings of the written survey. The interview data are secondary data that provide additional depth to the survey responses.
Participants were also asked to report their alcohol consumption using the AUDIT-C,37 which assesses the frequency with which respondents drink alcohol, the number of drinks they typically consume, and the frequency with which they consume 6 or more drinks on one occasion (binge drinking). There was no incentive for participants to take part in the study. Participants gave their written and verbal consent to take part. Ethical approval was obtained from the Ethics Reviewer at the [University of Otago].
Analyses
Grounded theory38 was used to code participants’ responses to the 3 survey questions about drinking patterns. K.R. read the survey responses several times before identifying emergent themes using an inductive process. The 2 authors met regularly to clarify and refine the emerging codes and to identify patterns in the data, following the stages outlined by Braun and Clarke.34 This process was iterative until both authors were in complete agreement. (As part of their course requirements, the student researchers, in groups of 4, also analyzed and interpreted the data they had collected. We do not include their analyses here because their interpretations were based on the small sample size that each group of 4 had available to them (ie, approximately 20 surveys and interviews). We did, however, check our own interpretations against the student researchers’ interpretations to further the credibility of our findings.39) Four main themes emerged from the survey responses, as follows:
Social Identity Labels: positive (eg, “legend,” “good bastard/bitch”) and negative (eg, “Debby Downer,” “soft cock”);
Evaluations: positive (eg, “look up to”) and negative (eg, “embarrassing”);
Social Status: sociable (eg, “engaging,” “social climber”) and unsociable (eg, “not participating,” “not fitting in”);
Justifications (eg, “must have a reason for their behaviour,” “athlete,” “employed”).
Participants’ survey responses to each of the 3 questions were categorized into the 4 respective themes described above. Coding was exhaustive; however, themes that were mentioned very infrequently (and thus not representative of the sample) were discarded. In the results that follow, we present descriptive statistics of the number of participants who endorsed each of the themes as a function of the drinking patterns (heavy drinker, limits drinks, abstainer) that they described in each of the 3 survey questions. To ensure that our findings were not sex specific, χ2 analyses were conducted for each theme as a function of sex. We report only significant sex differences. As mentioned earlier, the primary focus of this article is on participants’ written survey responses; we have used the interview transcripts as secondary data only, to exemplify the main themes that emerged from the survey responses. As such, we did not code the interview transcripts in their entirety, but we read the transcripts several times to ensure that the content of the interviews reflected the themes that emerged from the surveys. Both authors checked and agreed on interview excerpts for inclusion as exemplars. Employing multiple methods in this way has enabled us to add depth and richness to this research.40
Results
Heavy alcohol consumption was normative
On average, participants indicated that they drank alcohol 2 to 3 times per week, typically consuming more than 6 drinks per occasion (often 10 or more), and engaged in binge drinking weekly. We calculated AUDIT-C scores and categorized participants as abstainers, moderate drinkers, or heavy/hazardous drinkers. We used cut points validated in a sample of 18- to 25-year-old US university students,41 which are higher than they would be in a general population.42 Most of the participants were classified as heavy/hazardous drinkers (85.6% of men, 79.8% of women), with only 1 abstainer. In line with past international and national research,43–45 these results show that heavy/hazardous alcohol consumption is normative among university students.
Social identities were linked to drinking behavior
Participants spontaneously used social identity labels to describe students based on the 3 drinking patterns, indicating that students’ social identity is closely linked to their drinking behavior. As shown in Figure 1, participants predominantly used positive social identity labels to describe a heavy drinker and negative social identity labels to describe peers who limit drinks or abstain. Concordantly, very few participants used a negative identity label to describe a heavy drinker and few participants used a positive identity label to describe a moderate or nondrinking peer. The χ2 analysis revealed that men (53.6%) were more likely than women (38.8%) to mention a negative social identity label to describe a peer who limits drinking (χ2(1, N = 200) = 4.39, P = .04, V = .15).
The extent to which drinking behavior defines students’ social identities is evident in the poignant nature of the labels. Positive valence labels for a heavy drinker pertained predominantly to their ability to drink to excess (eg, Dr Froth, Gas Peddler, Liver of Steel, Tankard, The Fish, Machine, Operator, Trooper, Piss Tank, Baller, Barfly, Big Unit, Cranker, The Battery, Hard Core, Trooper) and showed that heavy drinking behavior is respected (Malt Lord, Booze Lord, Master, The Boss, Champion, The Man, Top Man, Good Bastard, Ace, Good Bitch, Good Bloke, Good Bugger, Hero, Rooster, Good Alcoholic).
Negative valence social identity labels for peers who sometimes limit their drinking included anti-Semitism, derogatory sexual terms, ageist language (eg, Fag, Gay Bitch, Gay Cunt, Little Pussy, Soft Cock, Vagina, Nana, Grandma, Square, Nerd, Geek, Weirdo), references to being weak and lame (eg, Wimp, Coward, Little Bish, Lightweight, Lame, Wet Blanket, Gutless, Flaky, Weak), and as ruining the fun (eg, Buzzkill, Debby Downer, Fun Police, Fun Sponge, Buildups, Downbuzz, Killjoy, Party Pooper, Prude). Many of the negative social identity labels for an abstainer overlapped with those used to describe a peer who sometimes limits drinks. Indeed, many participants perceived nondrinkers and peers who limit their consumption similarly, for example:
I kind of perceive [students who sometimes drink in moderation] as the same as non-drinkers. (Female Student)
Unique labels specific to a nondrinker included the following: Goody Good, Hermit, Reject, Retarded, Stuck-up, and Virgin. The interview data corroborate the view that the social stigma associated with limiting drinks or abstaining is one of the most influential factors driving the drinking culture, as depicted by the following participant:
I think the social stigma around drinking is probably the biggest thing fueling why people drink so much. (Male Student)
Interview findings also provided context for understanding the positive labels associated with heavy drinking and the negative social identity labels attached to drinking patterns that deviated from excessive consumption. The student drinking culture was described as an “all or nothing” culture where alcohol is consumed to achieve drunkenness and consuming less is thus seen as pointless as it will not result in intoxication:
You either drink and get wasted or you don’t drink at all. (Female Student)
I don’t see much point in doing that [limiting consumption] . . . ‘cause you can’t get pissed off only a couple. (Male Student)
I kind of think like what’s the point in that? If you’re going to drink, why drink a few? I guess it’s kind of like go hard or go home you know. (Female Student)
If you’re not drinking on a night out like what’s really the point . . . what’s the point in drinking a little bit? (Male Student)
[My friends] would probably ask what is the point of even drinking, hahaha they actually would! They would say there is no point, as you couldn’t possibly get drunk. (Female Student)
In this culture, limiting drinking is also seen as a waste of calories and money:
. . . because the culture is more all or nothing in this culture with drinking, and they think limiting consumption would be wasting alcohol and calories. (Male Student)
If you’re not getting drunk it’s kinda like pointless and a waste of money as bad as that is to say (laughs). (Female Student)
Heavy drinkers were perceived as sociable, whereas those who moderated or abstained were perceived as antisocial
Comments regarding the social status of students based on the heavy drinker, limits drinks, and abstainer drinking patterns were spontaneously reported by most of the participants. As shown in Figure 2, heavy drinkers were predominantly described as social, whereas peers who limit drinks or abstain were described as antisocial.
Terms used to describe a heavy drinker pertained mostly to popularity (eg, social climber, popular, friend, part of the group, in the clique) and to being fun (eg, engaging, entertaining, good time, hard case, life of the party, a laugh, hilarious, enjoyable, exciting). Peers who limit drinks were typically described as antisocial with examples pertaining to not fitting in (eg, antisocial, awkward, not fitting in, peculiar, strange, not cool), not engaging (not participating, let team down, uninvolved), and being boring (boring, destroying atmosphere, doesn’t have fun, dry, serious). Abstainers were also described as antisocial and many of the terms were similar to those used to describe peers who sometimes limit their drinking. Unique themes associated with abstainers pertained to the assumed nonexistence of nondrinkers (eg, don’t know any, fictional), nondrinkers being judgmental, and nondrinkers being described as not a student. Interview findings confirmed that peers who limit or abstain from drinking are perceived as out casting themselves, for example:
People think that [moderate drinkers are] a bit of a pussy for not drinking, because they think they should just be like everyone else and drink to excess. They may come across as isolating themselves from the group. (Male Student)
In fact, many of the students mentioned that a peer who planned to limit drinks would probably abstain from coming to the social occasion:
They generally wouldn’t be at the social occasion if they were not taking part fully. (Male Student)
No-one really goes out sober. (Female Student)
I feel like most of our friends and probably most of [removed for anonymity] would rather just not go out, like they would rather go out and drink excessively, not many would go out and just have 1 or 2 drinks. People do it to the extreme. (Female Student)
Well they are probably not a lad! Haha nah that’s just shit if they choose not to drink because it’s what we all do, so don’t even bother coming out! (Male Student)
Moderating consumption was linked to positive attributes
Participants made spontaneous evaluative comments of their peers’ behaviors based on the heavy drinker, limits drinks, and abstainer drinking patterns. As shown in Figure 3, participants were most likely to make positive evaluative comments about peers who limit drinks and negative evaluative comments about peers who are heavy drinkers.
Peers who limit consumption were perceived to have strong willpower (eg, knows limits, good will power, decisive, controlled, level headed, self-aware, brave) and maturity (eg, mature, responsible, sophisticated) to not succumb to peer pressure. Evaluative comments regarding an abstainer were similar in content, although fewer in number, to those of a peer who limits drinks.
The interview data confirmed that participants viewed limiting drinking as a responsible option; however, peer pressure limits their agency to drink moderately:
It’s actually a really nice, responsible thing to do and I wish more people could do it. (Female Student)
Personally I see [someone who limits drinks] as inspiration as how we should all try to act but in reality that’s never going to happen because I’m not as strong minded as them . . . I don’t have the ability to cope with the peer pressure as much as them possibly. (Male Student)
Most of my friends don’t take drinking less as much of an option. (Female Student)
Definitely peer pressure, peer pressure has a big part to play, if we were in that particular social situation and there was one of the boys who were deciding to have a quiet one or a night off, if they didn’t have a good reason, they would definitely get a lot of shit . . . They would be encouraged to drink through people offering free beverages, and told to do funnels of drinks, and are often called things such as bitch or pussy for not drinking in those situations. (Male Student)
Participants offered both positive and negative evaluative comments about a heavy drinker. Positive evaluative comments of peers who drink heavily pertained to the amount they could drink (eg, committed, experienced, dedicated, good stamina, strong, tough, look up to). These comments were, however, outnumbered by negative evaluative comments; peers who drink heavily were predominantly referred to as liabilities (eg, irresponsible, liability, loud, messy, aggravating, troublesome, demanding, problematic, unreliable). Negative evaluative comments of peers who sometimes limit drinks or abstain focused on the view that deviating from excessive consumption is pointless, in line with the belief that the goal of drinking is to become intoxicated (eg, not living, stupid, no point).
Justifications were expected for moderating drinking
As shown in Figure 4, survey data revealed that students need to provide a justification for abstaining from or limiting drinking. Examples of justifications included being an athlete, broke, busy, a sober driver, religious, in poor health, a health science or international student, employed, on other drugs, or pregnant. Justifications for a peer who drinks heavily were only made by one participant.
The interviews confirmed that students who sometimes limit their drinking are questioned by their peers to provide a justification:
[if you decided to drink less than usual] I think people would almost be worried about you, if that makes sense. Like people would be like, “are you okay?” They’d be like, “well why are you deciding to drink less?” I think people would worry that you had like a really bad night or you had something really bad happen to you. And that’s why you are doing it. (Female Student)
The interview findings also illustrated that a reason, such as a commitment the next day, was important for students to justify deviating from excessive consumption:
If one of your mates is strongly against drinking one night you’re not going to be too mean about it, but in the back of your mind you’d kind of think, why not, you’ve got nothing on. (Male Student)
If you’re not dedicated to anything then I guess you probably should be drinking on like a Saturday night. (Male Student)
If they are on antibiotics that would be accepted as everyone knows that you can’t drink, so you know that the specific person would drink if they could. It’s not just because they’re piking out or being a pussy because they don’t want to. (Female Student)
Studying isn’t a good enough excuse. One of my friends even tries to get work on Saturday or Thursday if she doesn’t want to go out. (Female Student)
Furthermore, personal preference was not necessarily considered an acceptable justification for not drinking:
Generally the argument of wanting to remember the experience wins out . . . By itself this excuse won’t hold up ha ha. Most of my mates would view this as bitching out. But coupled with another excuse like lack of money [it] will usually get them off my back. (Male Student)
Discussion
This qualitative study examined students’ perceptions of peers who moderate their alcohol consumption. Our findings suggest that students find it extremely difficult to limit drinking within a subculture of intoxication. Students’ social identity is intrinsically attached to their drinking behavior and students who limit or abstain from drinking are ascribed a negative social identity. Most participants in this study labeled a peer who sometimes limits their drinking or abstains using explicit, emotive, and derogative terminology and described them as antisocial, ruining the fun, not fitting in, and not being part of the culture. Other research has shown that abstainers are excluded,17 are stereotyped negatively,32 and avoid social situations.19 The current findings extend this research to show that students who limit their drinking are stigmatized similar to those who abstain and reveals that limiting consumption threatens students’ social identity and inclusion in the student drinking culture. Furthermore, this social stigma might be more intense for men than it is for women; men in our sample were more likely than were women to use a negative social identity label to describe peers who limit their drinking. This finding aligns with research showing that some men equate heavy drinking with masculinity.46
Participants’ perceptions of heavy drinkers in this study resonated with findings from Australia;16 excessive consumption was expected, held in high regard, shaped students’ positive social identity and their inclusion in the student drinking culture, and was enforced through peer pressure. These perceptions pose significant challenges for policies aimed at changing the drinking culture. Our findings show that intoxication is the goal and alcohol is used as a tool to achieve the desired state. There is an “all or nothing” culture in which students are expected to “go hard or go home.” Thus, students perceive drinking in moderation to be illogical because it will not achieve drunkenness and, as such, is a waste of calories and money.
To be part of the culture, students are expected to drink to excess or provide a justification for their decision not to. In this way, if students do not have something on the next day (eg, work or sporting commitments), there is an expectation that they should be drinking and they are pressured by their peers to do so. Although preference for drinking in moderation was not readily accepted as a reasonable justification for limiting drinking, a number of other justifications, such as having commitments the next day, were acceptable. Therefore, students’ involvement in extracurricular activities, such as sports, could reduce the frequency of their heavy drinking episodes and thereby reduce the risk of alcohol-related harm.3-6 In fact, Furtwängler and de Visser11 found that contextual factors, such as having commitments the next day, are more influential in shaping how much students drink than are unit-based guidelines.
The stigmatization of students who limit their drinking reveals that students’ unimpeded choice to drink in a way that deviates from the norm, even on isolated occasions, is all but prohibited. Students are not motivated to drink within recommended guidelines11 and our findings suggest that this lack of motivation could be partially explained by students’ perceptions that limiting drinking is not a viable option. Individual choice is limited by the influence of the collective norm of drinking to intoxication; it is how the student culture socializes, and students are expected to conform to that culture or refrain from attending the social gathering.
Participants’ evaluative comments in this study revealed that individual students are aware that excessive consumption carries costs; they often described heavy drinkers as liabilities. However, this evaluation was not evident in the predominantly positive social identity labels ascribed to heavy drinkers, reflecting the strength of the positive collective model of heavy drinkers. Students are aware that heavy drinking carries risks but these costs appear to be overpowered by the potential positive social identity benefits of engaging in the behavior.
The intensity of the labels students used to describe their peers reveals the extent to which the collective norm of drinking to excess shapes students’ drinking behavior, social identity, and inclusion (or exclusion) in the student culture. The intense pressure from social influence was also evident in the descriptions of students who abstain or moderate their drinking. These students were admired for their ability to overcome social influence and were described as aspirational, mature, responsible, and showing great willpower. In this way, the positive social identity attributes associated with drinking to excess were viewed as more important than were positive personal attributes such as strength and maturity. This disconnect in students’ perceptions of others who abstain from or moderate their drinking (positive personal attributes together with negative social identity labels) is consistent with Gibbons and Gerrard’s26 prototype willingness model. In this model, although an individual’s decision to engage in risky behaviors is guided by a rational decision process, the individual will also take into account any perceived social reactions.
There are some limitations to this study that warrant consideration. First, the cross-sectional design precludes interpretation of associations. Second, the small sample size and demographic composition (predominantly heavy drinkers) limit the generalizability of the findings. Third, students were recruited via purposive sampling and should not be considered as representative of all students. Note, however, that the drinking behavior was representative of the students’ peer groups. Fourth, participants were recruited to complete the survey by their friends/peers and thus may have provided socially desirable responses. However, because our interest lies in social practice and prevailing social perceptions, any desirability influence should have strengthened rather than limited the findings.
Notwithstanding the limitations above, the method employed here, of peer-to-peer research and questions regarding third persons, yielded frank, rich, unfiltered insights. Our findings extend prior research by revealing that students do not have agency to limit their drinking in the current culture of intoxication. Moderating consumption is recommended by public policy but this recommendation risks individuals being excluded, ostracized, or the subject of peer pressure. Adding to recent research in the area,1,14,18 our findings question the efficacy of individualistic harm minimization strategies because they require students to step out of the established and dominant social practice of excessive consumption and risk stigmatizing themselves.
As argued by others,14,16 the ingrained nature of drinking to intoxication and the resulting stigmatization of students who do not conform may be best challenged by initiatives that acknowledge the social practice of drinking and develop alternative cultures and ways for students to develop their identity. In accordance with Supski et al,14 Blue et al,25 and Davies et al,22 we argue that the social practice of drinking must be disrupted. Davies et al22 suggest that it is important to advertise other aspects of student life, hold alcohol-free events, and demonstrate alternative ways for students to use their leisure time. Our “raw” insight into the social practice of student drinking suggests that activities students can voluntarily opt in or out of, such as alcohol-free events, may not be powerful enough to disrupt the social practice of binge drinking. Specifically, our findings suggest that disruptive practices may need to act as a barrier to heavy drinking, rather than an alternative, to provide students with a justification for opting out of the culture. These can include paid employment, volunteer work, or sporting commitments, for example. To date, there is little in the academic literature about the efficacy of such interventions with university students; however, one study has shown that colleges in which students are more likely to be involved in volunteering have lower incidences of individuals engaging in binge drinking.47
The experiences and perceptions of students within a culture of intoxication evocatively demonstrate the strength of the normative culture in shaping individual behavior. To be effective, public policy interventions must be grounded in, and informed by, a frank understanding of the culture. At present, however, students perceive moderating consumption as illogical and a threat to their social identity and inclusion in the student culture. Our findings support a social practice approach25 for targeting problem drinking at the institutional level by setting expectations that students should engage in extracurricular activities, such as employment, in their free time. By disrupting the social practice of heavy consumption in this way, students may gradually be able to distance themselves from social norms based on drinking behavior.
Footnotes
Declaration of conflicting interests:The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding:The author(s) received no financial support for the research, authorship, and/or publication of this article.
Author Contributions: KR conceived and designed the research. KR, and KT analysed the data; contributed to writing the manuscript; agree with manuscript results and conclusions; jointly developed the structure and arguments for the paper. KR wrote the first draft of the manuscript. KR, and KT made critical revisions and approved the final version. All authors reviewed and approved the final manuscript.
References
- 1. Room R, Callinan S, Dietze P. Influences on the drinking of heavier drinkers: interactional realities in seeking to “change drinking cultures.” Drug Alcohol Rev. 2016;35:13–21. [DOI] [PubMed] [Google Scholar]
- 2. Martinotti G, Lupi M, Carlucci L, et al. Alcohol drinking patterns in young people: a survey-based study. J Health Psychol. 2017;22:1889–1896. [DOI] [PubMed] [Google Scholar]
- 3. Connor J, Broad J, Rehm J, Vander Hoorn S, Jackson R. The burden of death, disease, and disability due to alcohol in New Zealand. N Z Med J. 2005;118:U1412. [PubMed] [Google Scholar]
- 4. Kraus L, Baumeister SE, Pabst A, Orth B. Association of average daily alcohol consumption, binge drinking and alcohol-related social problems: results from the German Epidemiological Surveys of Substance Abuse. Alcohol Alcohol. 2009;44:314–320. [DOI] [PubMed] [Google Scholar]
- 5. Meiklejohn J, Connor J, Kypri K. One in three New Zealand drinkers reports being harmed by their own drinking in the past year. N Z Med J. 2012;125:28–36. [PubMed] [Google Scholar]
- 6. Rehm J, Gmel G. Patterns of alcohol consumption and social consequences. Results from an 8-year follow-up study in Switzerland. Addiction. 1999;94:899–912. [DOI] [PubMed] [Google Scholar]
- 7. Rehm J, Baliunas D, Borges GL, et al. The relation between different dimensions of alcohol consumption and burden of disease: an overview. Addiction. 2010;105:817–843. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8. Furtwängler NA, de Visser RO. Lack of international consensus in low-risk drinking guidelines. Drug Alcohol Rev. 2013;32:11–18. [DOI] [PubMed] [Google Scholar]
- 9. Stockwell T, Room R. Constructing and responding to low-risk drinking guidelines: conceptualisation, evidence and reception. Drug Alcohol Rev. 2012;31:121–125. [DOI] [PubMed] [Google Scholar]
- 10. Kerr WC, Stockwell T. Understanding standard drinks and drinking guidelines. Drug Alcohol Rev. 2012;31:200–205. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11. Furtwängler NA, de Visser RO. University students’ beliefs about unit-based guidelines: a qualitative study. J Health Psychol. 2017;22:1701–1711. [DOI] [PubMed] [Google Scholar]
- 12. Jones SC, Gregory P. The impact of more visible standard drink labelling on youth alcohol consumption: helping young people drink (ir)responsibly? Drug Alcohol Rev. 2009;28:230–234. [DOI] [PubMed] [Google Scholar]
- 13. Patterson C, Katikireddi SV, Wood K, Hilton S. Representations of minimum unit pricing for alcohol in UK newspapers: a case study of a public health policy debate. J Public Health. 2014;37:40–49. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14. Supski S, Lindsay J, Tanner C. University students’ drinking as a social practice and the challenge for public health. Crit Public Health. 2017;27:228–237. [Google Scholar]
- 15. Colby SM, Colby JJ, Raymond GA. College versus the real world: student perceptions and implications for understanding heavy drinking among college students. Addict Behav. 2009;34:17–27. [DOI] [PubMed] [Google Scholar]
- 16. Hallett J, McManus A, Maycock BR, Smith J, Howat PM. “Excessive drinking—an inescapable part of university life?” A focus group study of Australian undergraduates. Open J Prev Med. 2014;4:616–629. [Google Scholar]
- 17. Conroy D, de Visser R. Being a non-drinking student: an interpretative phenomenological analysis. Psychol Health. 2014;29:536–551. [DOI] [PubMed] [Google Scholar]
- 18. Piacentini MG, Banister EN. Managing anti-consumption in an excessive drinking culture. J Bus Res. 2009;62:279–288. [Google Scholar]
- 19. Pennay A, MacLean S, Rankin G. Hello Sunday Morning: alcohol, (non)consumption and selfhood. Int J Drug Policy. 2016;28:67–75. [DOI] [PubMed] [Google Scholar]
- 20. Neighbors C, Lee CM, Lewis MA, Fossos N, Larimer ME. Are social norms the best predictor of outcomes among heavy-drinking college students? J Stud Alcohol Drugs. 2007;68:556–565. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21. Young CM, DiBello AM, Steers MLN, et al. I like people who drink like me: perceived appeal as a function of drinking status. Addict Behav. 2016;53:125–131. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22. Davies EL, Law C, Hennelly SE. You have to be prepared to drink: students’ views about reducing excessive alcohol consumption at university. Health Educ. 2018;118:2–16. [Google Scholar]
- 23. Atkinson AM, Sumnall H. “Isn’t it mostly girls that do pre-drinks really?” Young men and women’s accounts of pre-loading in the UK [published online ahead of print October 3, 2017]. Drugs. doi: 10.1080/09687637.2017.1377154. [DOI] [Google Scholar]
- 24. Griffin C, Freeman M, Adams S, Smith P. “All suffering together”: student drinkers’ experiences of alcohol hangover [published online ahead of print March 21, 2018]. Addict Res Theory. doi: 10.1080/16066359.2018.1453063. [DOI] [Google Scholar]
- 25. Blue S, Shove E, Carmona C, Kelly MP. Theories of practice and public health: understanding (un)healthy practices. Crit Public Health. 2016;26:36–50. [Google Scholar]
- 26. Gibbons FX, Gerrard M. Predicting young adults’ health risk behavior. J Pers Soc Psychol. 1995;69:505–517. [DOI] [PubMed] [Google Scholar]
- 27. Gerrard M, Gibbons FX, Houlihan AE, Stock ML, Pomery EA. A dual-process approach to health risk decision making: the prototype willingness model. Dev Rev. 2008;28:29–61. [Google Scholar]
- 28. Kypri K, Langley JD, McGee R, Saunders JB, Williams S. High prevalence, persistent hazardous drinking among New Zealand tertiary students. Alcohol Alcohol. 2002;37:457–464. [DOI] [PubMed] [Google Scholar]
- 29. Kypri K, Paschall MJ, Langley J, Baxter J, Cashell-Smith M, Bourdeau B. Drinking and alcohol-related harm among New Zealand university students: findings from a national web-based survey. Alcohol Clin Exp Res. 2009;33:307–314. [DOI] [PubMed] [Google Scholar]
- 30. McGee R, Kypri K. Alcohol-related problems experienced by university students in New Zealand. Aust N Z J Public Health. 2004;28:321–323. [DOI] [PubMed] [Google Scholar]
- 31. Polak MA, Conner TS. Impairments in daily functioning after heavy and extreme episodic drinking in university students. Drug Alcohol Rev. 2012;31:763–769. [DOI] [PubMed] [Google Scholar]
- 32. McEwan B, Swain D, Campbell M. Controlled intoxication: the self-monitoring of excessive alcohol use within a New Zealand tertiary student sample. N Z Med J. 2011;124:68–74. [PubMed] [Google Scholar]
- 33. Green J, Thorogood N. Qualitative Methods for Health Research. Thousand Oaks, CA: SAGE; 2018. [Google Scholar]
- 34. Braun V, Clarke V. Successful Qualitative Research: A Practical Guide for Beginners. London: SAGE; 2013. [Google Scholar]
- 35. Sandelowski M. Using qualitative research. Qual Health Res. 2004;14:1366–1386. [DOI] [PubMed] [Google Scholar]
- 36. Crossley ML. “Could you please pass one of those health leaflets along?”: exploring health, morality and resistance through focus groups. Soc Sci Med. 2002;55:1471–1483. [DOI] [PubMed] [Google Scholar]
- 37. Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA. The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Arch Intern Med. 1998;158:1789–1795. [DOI] [PubMed] [Google Scholar]
- 38. Glaser BG, Strauss AL. The Discovery of Grounded Theory: Strategies for Qualitative Research. New Brunswick, NJ: Transaction Publishers; 2009. [Google Scholar]
- 39. Nowell LS, Norris JM, White DE, Moules NJ. Thematic analysis: striving to meet the trustworthiness criteria. Int J Qual Meth. 2017;16:1609406917733847. [Google Scholar]
- 40. Flick U. Designing Qualitative Research. London: SAGE; 2007. [Google Scholar]
- 41. DeMartini KS, Carey KB. Optimizing the use of the AUDIT for alcohol screening in college students. Psychol Assess. 2012;24:954–963. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 42. Reinert DF, Allen JP. The Alcohol Use Disorders Identification Test: an update of research findings. Alcohol Clin Exp Res. 2007;31:185–199. [DOI] [PubMed] [Google Scholar]
- 43. Davoren MP, Shiely F, Byrne M, Perry IJ. Hazardous alcohol consumption among university students in Ireland: a cross-sectional study. BMJ Open. 2015;5:e006045. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 44. Heather N, Partington S, Partington E, et al. Alcohol use disorders and hazardous drinking among undergraduates at English universities. Alcohol Alcohol. 2011;46:270–277. [DOI] [PubMed] [Google Scholar]
- 45. Kypri KYP, Cronin M, Wright CS. Do university students drink more hazardously than their non-student peers? Addiction. 2005;100:713–714. [DOI] [PubMed] [Google Scholar]
- 46. De Visser RO, Smith JA. Alcohol consumption and masculine identity among young men. Psychol Health. 2007;22:595–614. [Google Scholar]
- 47. Weitzman ER, Kawachi I. Giving means receiving: the protective effect of social capital on binge drinking on college campuses. Am J Public Health. 2000;90:1936. [DOI] [PMC free article] [PubMed] [Google Scholar]