Transcript You Talkin’ to Me? An Overview of Disputed Terminology in

You Talkin’ to Me?
An Overview of Disputed Terminology
in AOD Prevention
William DeJong, PhD
Director
U.S. Department of Education’s Higher Education Center
For Alcohol and Other Drug Prevention
August 4, 2003
Language Matters
• Scientific discourse
– Precision
• Public communication
– Simplicity
– Motivating
• Individual action
• Environmental change
• Political meaning
– Symbol
– Litmus test
The B-Word: “Binge”
• “Binge drinking”
– Definition:
• For men, 5 or more drinks in a row at least once in
the past two weeks.
• For women, 4 or more drinks
– Advantages
• Easy headlines
• It’s established in the press
“Binge Drinking”
• Imprecise measure of “problem drinking”
– Length of the drinking episode? Body weight?
– Preexisting clinical meaning
• Insensitive dichotomous measure
– Poor gauge of progress
• Other issues
– Mislabels some as “problem drinkers”
– Implies that drinking at lower levels is “safe”
– Produces misleading headlines
Survey of College Alcohol Norms
and Behavior (SCANB)
• Self-administered, voluntary, and anonymous mail
survey
– National sample: 32 US four-year colleges/universities
– Baseline data:
• 18 schools (Cohort A) in 2000
• 14 schools (Cohort B) in 2001
– N = 4,798 (full-length surveys)
“Drink”
Bottle of beer (12 oz.)
Glass of wine (4 oz.)
Wine cooler (12 oz.)
Shot of liquor (1 oz.)
Composite Drinking Scale (CDS)
(1) “During the past 30 days, on how many occasions did you use
each of the following substances – alcohol (beer, wine, liquor)?”
– Scored 1-7: “Never,” “1-2 times,” “3-5 times,” “6-9 times,” “10-19
times,” “20-39 times,” and “40 or more times”
(2) “What is the average number of drinks you consume in a
week?”
(3) “When you party, how many drinks do you usually have?”
(4) “Think back over the last two weeks. What was the greatest
number of drinks you consumed at one sitting?”
CDS Drinking Status/Score
• Abstainer
– Reported no alcohol use to all 4 questions
• Drinker
– Reported alcohol use to >=1 question
– CDS Score
• Sum of 4 normalized z-scores
• Imputed with mean z-score of the other 3
– CDS/Q1-Q4 Drinker
– Internal Consistency Reliability (Cronbach’s coefficient alpha:
0.89; item-total correlations: 0.65 – 0.81)
• CDS Status Missing
– Failed to respond to >= 2 questions
Heavy (“Binge”) Drinking Measure
• Heavy Drinking
– Consumption of 5+ drinks in a row for men and 4+ for women, at
least once in a 2-week period
• Non-Heavy Drinker
– Consumes alcohol but does not drink heavily
• Heavy Drinker
– Infrequent Heavy Drinker (1 or 2 times)
– Frequent Heavy Drinker (3 or more times)
Distributions of Individual CDS Items:
Profiles of CDS/Q1-Q4 College Student Drinkers
CDS Item Description
Frequency of alcohol use in the past
30 days‡
Average number of drinks consumed
in a week
Greatest number of drinks consumed
at 1 sitting in last 2 weeks
Average number of drinks consumed
when partying
CDS
Quartile
Mean
(SD)†
Min
Max
1
1.8 (0.5)
1
4
2
3
4
2.7 (0.7)
3.8 (0.9)
4.8 (1.1)
1
1
1
5
7
7
1
0.6 (0.8)
0
5
2
3
4
2.4 (1.6)
6.2 (3.0)
17.9 (11.3)
0
0
0
12
22
80
1
0.7 (1.1)
0
6
2
3
4
3.0 (1.9)
5.8 (2.3)
11.3 (4.8)
0
0
0
10
17
30
1
1.7 (1.3)
0
6
2
3
4
3.5 (1.6)
4.9 (1.7)
8.8 (3.3)
0
0
3
10
17
24
Heavy (“Binge”) Drinking Status vs. CDS Drinking Status
Heavy (“Binge”) Drinking
Status
Behavior-Based CDS Drinking Status – No. (Row %)
Q1 Drinker
Q2 Drinker
Q3 Drinker
Q4 Drinker
854 (54.29)
560 (35.60)
150 (9.54)
9 (0.57)
98 (4.46)
375 (17.07)
801 (36.46)
923 (42.01)
Infrequent Heavy Drinker
76 (5.72)
324 (24.40)
631 (47.52)
297 (22.36)
Frequent Heavy Drinker
22 (2.53)
51 (5.87)
170 (19.56)
626 (72.04)
Non-Heavy Drinker
Heavy Drinker
Summary
• Key problem: possible misclassification
• Root of problem: single dichotomous measure
– CDS: continuous measure with 4 strongly correlated
items
– Correlation: 0.77 (41% variance in continuous CDS
scores unexplained by heavy drinking measure)
“Responsible Drinking”
• Definition:
– None
– Consumption or consequences?
• Disadvantages
– Not a real guideline
– Implicitly blames alcohol problems on the
drinker
– Appropriated by the alcohol industry
Controversies
• “Abuse”
– Ignores illegal use
• “Addict” and “Alcoholic”
– Most problems created by non-addicted users
– Exculpatory (disease) vs. demonizing (sin)?
• “Harm Reduction”
– Strategies viewed as enabling
– Some strategies favored by alcohol industry (e.g.,
designated driver)
The Higher Education Center for
What?
• Alcohol and other drug prevention
–
–
–
–
How do you prevent alcohol?
Tobacco?
Blurs distinctions
“Red flag” for the alcohol industry
Next Steps?
• Proceedings document
– Importance of language
– Major controversies
• Guidelines
– Advantages/disadvantages of terminology
– Recommendations
– Specific to higher education (vs. CSAP/ICAP Joint
Working Group on Terminology’s Working Papers)