Review on Related Literature (RRL) Essay
Review on Related Literature (RRL)
Recent data on college age drinking from NIH, specifically the National Institute on Alcohol Abuse and Alcoholism (NIAAA)–its first update since an initial review in 1976– has brought to light the significant consequences of binge drinking among college students. While the incidence of regular drinking has remained stable, the incidence of binge drinking has sharply increased. With it, the many adverse effects of overconsumption of alcohol can be life shattering not only among individuals and friends, but families. This report serves as a reminder of the serious effects of alcohol that may begin in youth and extend into young adulthood. This report importantly draws attention to the many serious consequences of binge drinking including blackouts, alcohol overdoses, motor vehicle accidents, poor academic performance, falls resulting in serious injuries, as well as the many lasting effects of sexual assaults (unwanted pregnancies, sexually transmitted diseases), and even death.
For example, numerous studies reveal that as binge drinking increases, a college student’s risk of experiencing adverse effects of alcohol use significantly increases. As an example, a recent study from Harvard revealed that students who binge one or two times during a 2-week period are nearly three times as likely as non–binge drinkers to experience a blackout, have unprotected or unplanned sex, destroy property, suffer an injury, do poorly in school, have a run-in with the police or drive after consuming alcohol. The bottom line is that the report provided a much needed update about the drinking behavior of college students as well as the negative consequences which are the end result. Contrary to popular beliefs, drinking levels have actually remained relatively unchanged at the same level on college campuses during the past 30 years or so. Two out of five male and female students take part in binge drinking.
Binge drinking is defined as having more than 5 or more drinks in one sitting for men and four for women. What is clear from the report is that estimates of the rates of alcohol use and accompanying consequences are far from ideal. Missing data related to drink sizes along with the effects of alcohol on memory highlight the problematic collection of precise data from traditional self-report surveys. In addition, sexual assaults are often underreported leading to a lack of accuracy in estimating the true scope of the problem. Further, mortality records may often leave out college specific information and because alcohol levels are not checked as commonly in non–traffic-related deaths leaves gaps of knowledge regarding the true number of college students who die from alcohol-related causes on an annual basis. Adding to this, college specific information is generally not contained in most hospital records or crime scene reports.
There are two active national data surveys which evaluate drinking behavior of college students in the US. Monitoring the Future (MTF) is a yearly nationwide survey of alcohol and other drug use with examining 50,000 students in 8th, l0th, and 12th grades pooled from 420 public and private schools. Roughly 2,400 graduating seniors undergo repeat surveys in following years, to examine evolution of trends in aspects of college drinking. The second tool is the National Survey on Drug Use and Health (NSDUH), a yearly survey underwritten by the Substance Abuse and Mental Health Services Administration (SAMHSA). It involves on one on one interview with over 67,000 children and teens above the age of 12 examining alcohol and other patterns of drug use.
According to a meta-analysis by Carey and colleagues in 2012, campus initiatives to reduce as well as prevent binge drinking have had a significant impact based on research data. Additional data from MTF suggests that levels of binge drinking are declining among 12th graders, especially males. As researchers employ more effective measurement tools coupled with improvements in prevention, a reduction in high school drinking will hopefully translate into a downward trend of alcohol use among college students and the negative consequences which can be the end result.
According to this article, Binge drinking gives an enormous impact on students especially on college levels. Various effects can be showcased based upon the statement of the article. As enumerated, alcohol brings instances that lead to things that are capable of misconduct and crime such as unwanted pregnancy, drink and drive, fist fight and even more that includes death for the most part. Binge drinking in particular is a continuous drinking of more than 4 shots or glass as well as consecutive days of drinking sessions. Thus, not an essential health habit specially in males. As it is, this kind of routine mainly by men has sharply increased
leading to a critical awareness of the government. These recent studies showed that there is an abrupt increase on the levels of drinking practices in young teens and this may bring forth when they reach adulthood. Upon reaching adult stage with drinking habits intact, another set of higher crimes in particular can be formed out of it.
Thus, the National Institute on Alcohol Abuse and Alcoholism are active and very supportive in making various actions towards the case of binge drinking on college students. Drinking must be avoided because college is one step towards living the real life. Thus, they must be aware of what alcohol can bring them and lead them towards. Yet when they’re in college, they are already capable of proper thinking and mature enough in making wise decisions in life. To prevent and be responsible enough towards binge drinking is essential and beneficial so that one can save money and health as well. At the University at Albany in 2000, Chad Waxman fit the profile of a college student primed for risky drinking: A freshman male fraternity brother who drank in high school, Waxman chose Albany in part for its balance between work and play. “I wanted that time to let loose,” he says. Despite the predictors, Waxman sailed through college in health and happiness, even serving in student government and winning multiple leadership awards at the university before graduating in 2003.
He went on to earn his master’s degree in counseling psychology and school counseling from Albany in 2005 and is now a PsyD candidate at Nova Southeastern University. How did Waxman, now 33, avoid the pitfalls of drinking common among college students? That’s a question psychologists are probing deeply. After all, each year, more than 1,825 college students die from alcohol-related accidents and nearly 600,000 are injured while drunk, according to a 2009 study in the Journal of Studies on Alcohol and Drugs. Another 696,000 are assaulted by another student who has been drinking, and 97,000 are victims of alcohol-related sexual assault or date rape, the study found. Then there’s the 25 percent of college students who report academic consequences related to alcohol — a hangover can quickly derail plans for class or study — and the 11 percent who admit damaging property after a night of drinking (Journal of American College Health, 2002).
An estimated 5 percent get into legal trouble as a result of alcohol, the same study found. In all, of the 80 percent of college students who drink alcohol, half “binge drink,” or consume about four drinks in two hours for women and five in two hours for men, according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA). “College drinking is sometimes still viewed as a harmless rite of passage, when in fact [college students] are drinking more than any other age or demographic group,” says psychologist James Murphy, PhD, of the University of Memphis, who studies addictive and health risk behaviors, including among college students. That’s particularly dangerous given that research shows this age group is much more impulsive even when alcohol’s not involved, he says. There’s also evidence suggesting that excessive alcohol use in young adulthood may impair brain development, including in cognition and memory, according to the NIAAA. But college also presents an opportune time to equip students with the skills to approach alcohol intelligently, says Murphy.
With 63 percent of young Americans ages 25 to 29 having completed at least some college, according to a report from the Pew Research Center, the setting is “a last prevention point for our society to address the risks associated with drinking,” he says. (Most research on college drinking so far involves mainly full-time students in four-year colleges and universities.) For Waxman, the time was ripe. As a peer facilitator in Albany’s Counseling Center, he helped motivate other students — and in effect, himself — to shift their drinking behaviors using one of many emerging interventions designed and tested by psychologists. The approaches address why a student drinks and are tailored for specific populations of students, such as athletes and freshmen.
Some interventions are targeted to align with specific events, such as 21st birthday celebrations, as a way to reroute dangerous decisions made on a night that notoriously gets out of control. “Through learning the realities of alcohol, I realized you don’t have to drink like it’s a competition to have fun,” Waxman says. Most important, these interventions are evidence-based, says Mary Larimer, PhD, director of the University of Washington’s Center for the Study of Health and Risk Behaviors and associate director of the Addictive Behaviors Research Center. “We know a lot more about what influences excessive alcohol use in this population and we can tailor the interventions to address those risk factors as well,” Larimer says. “That’s contributed to our ability to make a difference.”
One way psychologists are fine-tuning their efforts is by pinpointing who is most at risk for problems related to drinking. So far, research indicates that those most at risk are incoming freshmen, student athletes and those involved in the Greek system. Studies also show that men tend to drink more on average than women — but women progress faster over time from alcohol use to abuse, says Larimer. In fact, one study led by psychologist Bettina Hoeppner, PhD, of Harvard Medical School’s Center for Addiction Medicine, found that college women exceed the NIAAA’s weekly limits more often than men (Alcoholism: Clinical and Experimental Research, 2013). “The gender gaps have closed a lot,” Larimer says.
Personality factors, such as impulsivity and sensation-seeking, also contribute to risky drinking. Psychological research suggests that how different people respond to alcohol can help predict whose behavior will become problematic. Those who need a lot to experience its effects or who experience more of alcohol’s stimulating rather than sedative effects, for example, are at higher risk. Students who overestimate how much their peers drink, as well as those who expect great things from alcohol (“I will feel outgoing and meet my future boyfriend!”), are more likely to overindulge and experience alcohol’s negative consequences, such as engaging in unsafe sex, adds Larimer. Another factor appears to distinguish between students who drink a lot yet remain relatively safe and those who drink the same amount or less yet suffer the consequences: subjective intoxication.
In other words, a student’s likelihood to get into trouble during or after drinking has as much to do with how drunk he or she feels as it does with how much he or she actually drinks, according to an NIAAA-funded study conducted by Kim Fromme, PhD, of the University of Texas at Austin’s SAHARA Lab (Studies on Alcohol, Health and Risky Activities) and colleagues. And those different perceptions could have biological roots, Fromme says. “We’re predicting specific genetic influences on those differences in people’s subjective levels of intoxication,” she says. Why a student drinks can also reveal a lot about how problematic his or her alcohol use may become, according to Clayton Neighbors, PhD, who directs the University of Houston’s Social Influences and Health Behaviors Lab. While some students drink for social and environmental reasons, such as being at a party, others drink for emotional reasons, such as coping with a bad grade or a breakup. It’s the latter group — who may be turning to alcohol to handle another mental health problem such as post-traumatic stress disorder, depression or anxiety — whose members are primed for long-term alcohol abuse, researchers say.
Up until the late 1990s, most colleges and universities approached risky drinking from a one-size-fits-all perspective. Campus-wide awareness campaigns and educational sessions during freshman orientation were popular but ineffective, the NIAAA Task Force on College Drinking found in 2002. That changed in 1999 when the late psychologist Alan Marlatt, PhD, of the University of Washington, and his team introduced Brief Alcohol Screening and Intervention for College Students, or BASICS. The intervention is used in varying forms by colleges nationwide when students come in for primary care or mental health services or are referred for an alcohol-related offense. BASICS gives students personalized feedback on their drinking behaviors, including comparing how much they drink with how much the average student on their campus drinks. The intervention also uses motivational interviewing by asking students open-ended, non-judgmental questions to explore drinking behaviors and generate motivation to change. Finally, it offers individualized strategies — such as putting ice in drinks or assigning a designated driver — to help students drink in less risky ways.
The method, which has been shown to reduce how much students drink as well as to reduce related negative consequences up to four years out, meets NIAAA’s highest standards for evidence-based college drinking interventions (American Journal of Public Health, 2001). But BASICS doesn’t work for every student. Those with high levels of social anxiety, for example, aren’t easily influenced to change by the notion that they’re overestimating how much their peers really drink. This can make them less receptive to the “norms correction” component of BASICS, a 2012 study in Psychology of Addictive Behaviors finds. About one-third of students who receive the intervention don’t change their drinking habits. Another drawback to the intervention is staffing: The traditional method requires one or two 50-minute sessions with a trained facilitator, who is often a mental health professional. That’s why many psychologists are experimenting with variations of BASICS, such as by offering it in a Web-based format or presented by trained peers, rather than by mental health professionals.
Researchers are also looking at ways to shorten the intervention: A 2013 study in Addictive Behaviors by Larimer and colleagues found that a 10-minute version of BASICS was just as effective as a 50-minute one. Larimer says shortening the intervention by picking and choosing from among its individual components — namely, the part that corrects students’ misperceptions of campus norms and the one that offers strategies for safer drinking — might be enough to elicit short-term effects and to work for students at lower risk. “The more comprehensive interventions, then, may have longer-lasting effects,” she suspects, but she says more research is needed to tease apart which variations work for whom. There’s also evidence that students can deliver the interventions just as effectively as mental health professionals. In one study, Larimer and colleagues delivered a BASICS-like intervention to 12 fraternities, varying who gave them feedback — either a peer interviewer or a professional research staffer. They found that both groups significantly reduced their alcohol intake when compared with controls (Journal of Alcohol Studies, 2001).
Another study led by Fromme that looked at peers and professional providers who headed an alcohol prevention “lifestyle management course” for college students found similar outcomes (Journal of Consulting and Clinical Psychology, 2004). But the research comes with caveats, says University at Albany psychologist Maria Dolores Cimini, PhD, who explored peer facilitators’ effectiveness through a five-year study funded by an NIAAA Rapid Response to College Drinking Problems grant and got mixed results. “Students can deliver these interventions, but they must be well-trained and very closely supervised,” she says (Journal of Studies on Alcohol and Drugs, 2009). Waxman, who became trained as a peer facilitator at Albany’s Counseling Center during his sophomore year, said his efforts paid off among the peers he intervened with. “Having someone you can relate to … saying, ‘This is the reality,’ really changes behavior,” he says.
At the University at Albany Counseling Center, an intervention called the STEPS Comprehensive Alcohol Screening and Brief Intervention Program takes BASICS and tailors it for specific populations of high-risk drinkers, including first-year students, student athletes and students seeking primary health and mental health care on campus. A student athlete, for example, learns how alcohol affects hydration and athletic performance — even days after taking the last sip. The key is speaking the students’ language, says Cimini, who directs the program. “If we can’t engage students and get them in for the intervention in the first place, we lose a golden opportunity to mobilize the change process at a time when students are most resilient and receptive to interventions.” In surveys conducted three and six months post-intervention, STEPS has been shown to significantly reduce alcohol use and risky behavior among each subgroup.
Colleges, universities, community-based mental health service providers and higher-education-focused consortia across at least five states, including Washington, Pennsylvania and Mississippi have been trained in the method, and it has been accepted for inclusion in the Substance Abuse and Mental Health Services Administration’s National Registry of Evidence-Based Programs and Practices, Cimini says. That means it’s been peer-reviewed and is ready to be disseminated. At the University of Memphis, Murphy’s team is further personalizing BASICS by adding a one-hour supplement during which clinicians talk to students about their goals for college and beyond and then show them how their drinking patterns fit in with those aspirations. A student who wants to be a lawyer, for instance, might be given information about a pre-law club as well as the GPA typically needed to get into law school and to earn his desired future salary.
The clinician then shows the student a plot based on his responses to an assessment revealing the number of hours per week he typically spends drinking compared with studying or participating in other academic activities. With the graph on hand, the two might then consider potential schedule changes such as dedicating one night a week to law club and another to homework to be more consistent with the student’s long-term goals. “Students often [don’t] think about their behavior in these sorts of aggregates, and when they’re forced to do so,” they’re motivated to change, Murphy says. The approach is based on behavioral economics, or the idea that behavior is influenced by availability and cost. In college, where beer is typically cheap and abundant, the framework helps to explain why drinking often gets out of control. But by highlighting appealing alternatives to partying, the approach suggests students will be more likely to steer clear of alcohol’s short-lived rewards. “All of that unstructured time, and a lack of awareness of the future benefits of engaging in college or the community, is a lot of what is fueling this binge drinking problem,” he says.
The approach appears to be working: In a preliminary study, Murphy’s team found that the intervention significantly reduced alcohol problems and heavy drinking among participants. With a new grant from the NIAAA, they’re now looking to replicate those findings and track the intervention’s long-term effects, on both drinking and college outcomes. “Given that the goals of the intervention are so consistent with the goals of universities, once we can show long-term effects, I’m optimistic that colleges will like it,” he says. Another emerging way to intervene with college drinking targets certain events, rather than people. Twenty-first birthdays are notoriously dangerous: In a 2011 study of 150 students in Psychology of Addictive Behaviors by Fromme and colleagues, participants reported drinking an average of 10.85 drinks on their 21st birthday. Many also experienced blackouts, had unsafe sex and engaged in other risky behaviors.
To keep students safe on that milestone birthday, psychologists are looking at ways to time interventions so that students are reminded to use protective strategies if they plan to celebrate with alcohol. In one study by Neighbors and colleagues, for example, students received one of five BASICS-oriented interventions one week before their 21st birthdays (the interventions varied, with some being Web-based or in person, and some from each group involving a friend).Compared with a control group that received no intervention, the in-person interventions and some of the Web-based ones reduced negative consequences students had on their birthdays. The BASICS interventions that didn’t explicitly talk about the risks of 21st birthdays, but rather the risks of drinking in general, reduced both alcohol use and risky behavior, the study found (Journal of Consulting and Clinical Psychology, 2012). While the event-specific approach is promising, it’s a short-term fix for a larger problem, Neighbors says. “The bigger picture question is: How do we change the culture of drinking on college campuses? It will take more time.”
According to the study, drinking gave numerous valid percentages based upon statistical data conducted. The data gave inkling on what instances can be extracted for further results. Such as, college drinking can be incontrollable if not prevented or diverted by another hobby since college level can have more time binge drinking compared to adult level persons. Making worse results relating to numeral crimes. Although drinking may be a bad thing, but it can also be beneficial in a reason that college is the specific stage on which students can act and drink responsibly yet some may not be able to resist against it. As stated by Mary Larimer PhD, there are a lot of reasonable statements on why and what triggers alcoholism on college students. This stance of Mary Larimer gave a more mature understanding on the study of college drinking towards a student’s academic performance. Alcohol is a potent beverage that can stimulate one’s emotions.
According to recent study, males are more prominent in the field of alcoholism than women yet the opposite sex are more abusive than males. In terms of medical and scientific studies, alcohol impulses the brain to do things that are beyond limits and enhances the mind in a worse perception such as malevolent actions and false decisions due to unconsciousness of the environment. In some other points and limits, alcohol can deteriorate brain functions and in a much worse effect such as intoxication due to dizziness and continual vomiting. The NIAAA and other government organizations that is active in alcoholism awareness are continually making programs for the benefit of those students especially on college on how to control and prevent binge drinking that may lead up to intoxication and other poor decisions to be made. Through mature viewpoints and decisions, one can prevent alcoholism based upon focus and willingness. Importantly, one should consider and keep memories intact of how alcohol can make your mind, health, and wealth be depleted in an instant.
Worst thing is, unnoticed. The extent to which alcohol consumption impacts on both the quantity and quality of human capital accumulation is an important question given that it has long run implications for earnings. Following the human capital model developed by Becker (1964), an individual will invest in acquiring additional levels of human capital based on the expected return in future earnings. This decision takes into account both the costs of schooling and the rate at which future beneﬁts are discounted. At the same time, facing both budget and time constraints, students make decisions about how much alcohol to consume. The consumption of alcohol can be expected to have a negative impact on schooling both directly through its potential impact on cognitive ability and indirectly through its impact on study habits. A negative correlation between alcohol consumption and schooling also may be observed, however, due to the fact that individuals who face high costs and/or place a lower value on future earnings may invest less in schooling and at the same time these individuals may be more likely to engage in heavy drinking behavior.
Hence, controlling for the potential endogeneity between drinking and schooling is of key importance in establishing a causal link between alcohol use and schooling outcomes. Establishing such a causal link will inform policy makers about the impact of alcohol policies on human capital accumulation and the potential to reduce productivity losses associated with increased alcohol consumption. The results from the existing literature that examines the impact of alcohol consumption on educational attainment is mixed. Not surprisingly, studies that do not account for the potential endogeneity between drinking and schooling measures ﬁnd that alcohol consumption signiﬁcantly reduces schooling levels. In this regard, drawing on the National Longitudinal Survey of Youth (NLSY), Yamada, Kendix and Yamada (1996) found that both the number of liquor and wine drinks consumed during the past week and being a frequent drinker signiﬁcantly reduced the probability of high school graduation. A 10% increase the probability of being a frequent drinker was found to reduce the likelihood of graduation by 6.5%. Also without accounting for endogeneity, Mullahy and Sindelar (1994) used data from the Wave 1 of the New haven site of the National Institute of Mental Health Epidemiological Catchment 3Area survey and found that alcoholic symptoms prior to age 22 reduced years of schooling by 5%.
Among the studies that control for the possible correlation between the unobservables that aﬀect both drinking and schooling choice, the results range from signiﬁcant to moderate to no eﬀect at all of youthful drinking on educational attainment. Using two-stage-leastsquares (2SLS) to account for endogeneity, Cook and Moore (1993) draw on the NLSY to examine the eﬀect of alcohol consumption (number of drinks per week, frequent drinking, and being frequently drunk) on the years of post-secondary schooling. The authors found that all three drinking measures signiﬁcantly reduce years of schooling with frequent drinkers completing 2.3 years less of college. Most recently, Koch and Ribar (2001) use data on samesex siblings from the 1979-90 NLSY to examine the eﬀect of the age at which youths ﬁrst drank regularly on the number of years of schooling completed by age 25. Using a siblings IV model, the results suggest that the eﬀect of drinking onset is moderate – delaying drinking for a year leads to 1/4 year of additional schooling. However, drawing on 1977-92 Monitoring the Future data, Dee and Evans (1997) use a two-sample instrumental variables procedure relying on within-state variation in their instruments to examine the eﬀect of being a drinker, moderate drinker, and heavy drinker on high-school completion and college entrance and attainment.
Overall, they ﬁnd that controlling for endogeneity, teen drinking does not have a signiﬁcant eﬀect on educational attainment. Similarly, based on NLSY data, Chatterji (1998) ﬁnds that her estimation results based on models that account for endogeneity reveal no signiﬁcant eﬀect of teen alcohol consumption on the number of grades completed by age 21. Most of this literature focuses on the educational outcomes related to prior teenage drinking behavior. In this paper, we propose to focus on college-level educational outcomes as a result of current drinking behavior. This is a particularly relevant issue, given that alcohol is a common element in the environments of most college campuses (in 1999, the annual alcohol prevalence rate among college students was 83.6% (Wechsler, Lee, Kuo and Lee, 2000)).
Drawing on information available in the Harvard School of Public Health College Alcohol 4Study (CAS), we provide evidence on the extent to which alcohol consumption impacts on college study habits which in turn are expected to aﬀect human capital accumulation. Assessing the mechanisms through which alcohol consumption impacts schooling may shed further light on the extent to which policies aimed at reducing alcohol consumption among young adults may aﬀect the quality and quantity of human capital accumulation. Current evidence exists on the direct eﬀect of drinking on cognitive ability. Based on clinical studies, Nordby (1999) showed that drinking reduces recall which can be expected to have a direct eﬀect on schooling. However, we are not aware of existing empirical evidence of the eﬀects of alcohol consumption on indirect eﬀects such as study habits. We examine the impact of alcohol consumption deﬁned by the average number of drinks consumed per drinking occasion among college students who drink on the probability of skipping a class and getting behind in school.
We use a two-stage generalized least squares estimation procedure to account for potential correlation in the unobservables that determine drinking behavior and study habits. Generating consistent estimates of the eﬀect of drinking on college study habits requires an exogenous source of variation in college drinking. That is, we require variables that aﬀect college drinking levels but do not directly aﬀect study habits. In this regard, we use the price of alcohol, college-level information on access to alcohol, and state-level alcohol policies to identify alcohol consumption. Our results reveal that given the endogeneity of college drinking and study habits, single-stage estimation methods overestimate the true eﬀect of the quantity of college drinking on the likelihood of missing a class and getting behind in school. To further investigate the study habit behavior of our college sample, we also estimate our model separately by year of class. We ﬁnd diﬀerential eﬀects of drinking on the study habits of freshman and their upper-year counterparts. Our paper is organized as follows. Section 2 describes our model of the relationship between alcohol consumption and study habits. Section 3 describes our data and summary statistics.
Our estimation results are presented in section 4 and we conclude in section 5 with a discussion of potential policy implications to improve study habits and reduce productivity losses due to alcohol consumption among college students. Alcohol consumption has occurred for thousands of years. In many parts of the world, drinking alcoholic beverages is a common feature of social gatherings. Underage drinkers are susceptible to the immediate consequences of alcohol use, including blackouts, hangovers, and alcohol poisoning, and are at elevated risk of neuro-degeneration (particularly in regions of the brain responsible for learning and memory), impairments in functional brain activity, and neuro-cognitive defects . In addition to the individual’s personality itself, many variables influence drinking behavior: genetics; gender; ethnicity; college; religiosity; occupation; marital status; friends and family. Young college students are especially vulnerable to alcohol and this wide availability favors abusive use.
Despite of all risks, they are still not protected by laws against alcohol industry and therefore, it is known that they represent the main target population of advertising campaigns, which encourage alcohol use as a way to belong to their group, freedom, and especially, entrance to adulthood, a sense of being free from the family control. Worldwide studies have addressed the behavior of college students regarding psychoactive substances. Most of them focused on the vulnerability of students and the need to encourage intervention and preventive measures about alcohol consumption. College students consume more alcohol than their age-matched, nonstudent peers. How does problem drinking affect young people’s schooling? In some cases the linkage between problem drinking and study habits is profound. Drinking can affect the biological development of young people as well as their school-related achievement and behavior.
Serious alcohol use among youth has significant neurological consequences. Alcohol damages areas of the brain responsible for learning and memory, verbal skills and visual-spatial cognition. Diagnosticians often find that these skills in adolescents who drink are deficient in comparison to those who aren’t drinking. Scientists know that alcohol problems are tied to lower grades, poor attendance and increases in dropout rates. The 2000 National Household Survey on Drug Abuse (NHSDA – now known as the National Survey on Drug Use and Health), a federal study, found that as rates of alcohol use by 12- to 17-year-olds increase, grade point averages decrease. Middle school students whose peers avoid using alcohol and other drugs score higher on state reading and math tests than other students. In any given age group, heavy and binge drinkers are 4-6 times more likely than nondrinkers to say they cut classes or skipped school. They are twice as likely as nondrinkers to say that their school work is poor, and they report more frequently that they are disobedient at school. Among high school students, those who use alcohol are five times more likely to drop out than those who don’t use alcohol. These problems are not limited to the middle and high school setting; hangovers and drinking by college students lead to missed classes and falling behind in school work.