University and Alcohol
Heading off to university is often the start of true independence. That is, properly leaving home to explore a new self-ruling freedom (Dietz, 2008). However, in recent years, many students across the country have immersed themselves in the growing ‘culture of drinking’. For instance, upon arriving at university, alcohol is used to calm the nerves and facilitate making friends and acquaintances in the new environment (Schulenberg & Maggs, 2002; Szmigin et al., 2008). However, the extensive consumption of alcohol does not finish with freshers; as drinking practices are normalised and alcohol consumption is found to be consistently heavy - even after friends have been made and peer groups formed (Hebden, Lyons, Goodwin, & McCreanor, 2015). In addition, these peer groups often facilitate the uptake and involvement in further, hazardous levels of, drinking (Hebden, Lyons, Goodwin & McCreanor, 2015; Haines & Spear, 1996; Perkins, Haines & Rice, 2005).
With excessive alcohol consumption so normalised among students, it is no surprise that it is causing problems. For instance, research finds university students to be a group consistently ‘at risk’ for drinking problems and alcohol abuse (Kypri, Langley & Stephenson, 2005). However, one of the biggest concerns highlighted throughout the literature is that a significant amount of university students regularly engage in risky ‘binge drinking’ (Johnston & White, 2003; Bergmark & Andersson, 1999). The common view of binge drinking is of someone drinking a large amount of alcohol over a number of days. This is not binge drinking. Binge drinking is defined as consuming 4 drinks in 2 hours for females, and 5 drinks in 2 hours for males (Drug Info Clearing, 2002). That may be a surprise to some readers, as they may remember consuming more alcohol than that while ‘pre-drinking’ before a night out. This is part of the problem – students are ‘drinking to get drunk’, consuming as much as they can before a night out because being drunk is the ‘vital’ ingredient for a good night (Hebden, Lyons, Goodwin & McCreanor, 2015). Consequently, many students are binge drinking without even realising that they are doing so. The true number of student’s that binge drink has been found to vary. For instance, 62.6% of Scottish students reported ‘binge sessions’ (Delk & Meilman, 1996), whereas Wechsler, Dowdall, Maenner, Gledhill-Hoyt and Lee (1998) found that 44% of all students binge drink at least once a fortnight. Regardless, even if it is the lower estimate of 44%, the rate of binge drinking is far too high among students.
So, what is binge drinking doing to students? By the very least, it is facilitating a reliance on alcohol. For instance, Heather et al., (2011) found that over a number of universities, 21% of students classified for a diagnosable alcohol use disorder. However, students are not recognising that their binge drinking is a problem. On the contrary, many students believe that excessive drinking is temporary and enjoyable, and drinking to this extent will not damage them in the long run (Penny & Armstrong-Hallam, 2010). However, despite their beliefs, binge drinking can cause acute and chronic problems that may still be prevalent post-graduation (Hebden, Lyons, Goodwin & McCreanor, 2015; Huckle, Pledger & Casswell, 2006; Casswell, Pledger & Pratap, 2002). For instance, reviewing samples mainly made up of students, Courtney & Polich (2009) reported on how binge drinking affects the brain. They highlighted that binge drinking has been shown to cause auditory and verbal memory deficits (Nichols & Martin, 1997), problems with executive planning (Hartley, Elsabagh & File, 2004), episodic memory (Hartley et al., 2004), spatial working memory (Weissenborn & Duka, 2003) and inhibitory control (frontal lobe) (Townshend & Duka, 2005). Moreover, binge drinking has been linked to mental health problems – such as depression and anxiety – as well as certain types of cancer (Weitzman, 2004; Gupta, Wang, Holly & Bracci, 2010). It is clear that binge drinking at university can cause problems further down the line, despite what some students think. However, the short-term effects of binge drinking can be just as serious. For instance, binge drinking during pre-drinks on a Saturday night may lead you to get alcohol poisoning, or blackout and choke on your own vomit (Hingson & White, 2013). In addition, Wechsler and Nelson (2001) found that students that had binged 3 times in a 2-week time period were 48% more likely to have had 5 or more alcohol related problems, which include unplanned sex and driving drunk (see the table below to view all the alcohol related problems).
It is quite staggering to see how damaging binge drinking is, as well as the prevalence of binge drinking in students. As a consequence, we aimed to change, or at least positively influence, the drinking habits of students at The University of Warwick.
What We Did
Initially we wanted to produce a video; however, we were very wary of inadvertently promoting alcohol consumption. In addition, we felt that we could only produce an ‘amateur’ video (we’re poor filmers/editors to be truthful!) and we wanted our message to be taken as seriously as possible. Thus, we created three posters – each with a different aim – to target binge drinking. We hoped to inform students of what constitutes a ‘binge’, the negative effects of binge drinking, and what students could do to prevent binge drinking.
In addition, our posters contained a number of different techniques to influence students to alter their drinking habits, for instance:
The Fear Tactic:
The ‘fear tactic’ has often been used in health advertising to promote behaviour change. This tactic aims to link an action or behaviour to an undesirable outcome, which thus influences a change in behaviour to prevent such an outcome. Witte and Allen (2000) conducted a large meta-analysis to assess whether fear tactics do actually influence behaviour. They found that fear appeals are effective when they target a significant, and relevant, threat. In addition, the results demonstrated that high-threat fear campaigns are significantly more likely to have a persuasive effect.
For these reasons, we chose to use the fear tactic for one of our posters (poster B), as we know that the issue of binge drinking is both a significant and relevant threat. That is, all students know that drinking is a big part of university life, and most students have had a night where they have perhaps had one drink too many. Thus, we could ensure to a certain degree that our poster would be somewhat effective in making people think about how much they were drinking. In addition, due to the results of the meta-analysis conducted by Witte and Allen (2000) we decided to include some of the most drastic consequences of binge drinking. That is, we listed some of the most serious ‘drinking related consequences’ such as ‘criminal record’ and ‘alcohol poisoning’ rather than ‘miss a lecture’. Furthermore, we made sure that the consequences were the only things in red text on the poster, as the colour red is associated with danger and should therefore unconsciously increase levels of threat (Elliot & Maier, 2007). By designing the poster to maximise the levels of fear, we hope some members of our target audience choose to act upon the fear of binge drinking consequences, and drink responsibly.
“Thinking, fast and slow”
Kahneman (2011) outlined two separate systems for decision making – System 1 and System 2. System 1 thinking is fast and automatic, requiring little attention. On the other hand, System 2 thinking is slow and effortful, and engagement in such thinking requires energy and attention. We designed our posters very specifically to utilise Kahneman’s (2011) ‘System 1 and System 2’ to get the best persuasive results. For instance, two of our posters were bold and clear, and the only writing on the posters aimed to directly address the problem. We did this because it would appeal to people that did not want to use too much ‘mental energy’, as the poster could be processed quickly and without any real effort. For poster A, we aimed for people to clearly see and quickly process exactly what constitutes binge drinking. Hopefully, the next time a member of our audience went ‘out’, alcohol would act as a cue for memory of the poster, leading to careful consideration of alcohol consumption. For poster B, we wanted to people to be able to quickly take in the message on the poster, but also we hoped that the fear tactics aforementioned would then facilitate System 2 thinking, which would lead to a more conscious and effortful encoding of our message. With more conscious processing, we hope that our message is taken seriously and leads to a degree of positive behaviour change.
Poster C was slightly different. We packed it full of information, making it more visually crowded and difficult to processes using System 1 thinking. Thus, in order for somebody to engage with the poster, they would have to do so consciously and effortfully. However, we made sure to include an extensive list of harmful binge drinking consequences. This was done to tap into a System 1 type persuasive method called the ‘peripheral route’. The peripheral route occurs when motivation is relatively low and so attitudes are determined by positive cues (Petty & Cacioppo, 1986). Often, people are not so motivated to read a long list, and they thus use the number of items in the list to determine the strength of the argument (Olson & Mathias Thjømøe, 2003). Consequently, we hoped that this poster would encourage people to view the long list of consequences as a persuasive reason to watch their drinking - as binging must be harmful if there are so many negative consequences! In addition, because we hoped people were initially drawn into effortful system 2 thinking, and persuaded that binge drinking is bad through the peripheral route, we listed ways in which our audience can prevent binge drinking (‘spread your drinks out’). With heightened engagement and persuasion against binge drinking, we again hope that people took this onboard for the future, and perhaps used some of our suggestions to drink safely and responsibly.
Language and Commitment
On all of our posters, we specifically highlighted the word ‘you’. We did this because interpersonal engagement is an important tool to relate to readers and draw them in (Hyland, 2008). Moreover, specifically using the word ‘you’ moves the responsibility of the issue onto the audience, which makes them assess whether they are behaving negatively and what they can do to change. Consequently, we hope that the audience were able to internalise the message and relate it to themselves, promoting self-analysis of drinking habits and thus potential behaviour change. In addition, we used the technique of rhetorical questioning for all of the posters - for instance “are you in the 44% of students who binge drink?”. We used this technique because it has been found to facilitate persuasiveness when paired with a strong argument (Petty, Cacioppo & Heesacker, 1981); while again encouraging the audience to reflect and review the relevance of the question and overall message. Thus, we hope that our audience internalised both the poster, and the argument - promoting a potential change in their behaviour.
In the bottom right hand corner of posters A and B, we put a QR code. This code either led to the NHS webpage on binge drinking and its consequences, or the drinkaware webpage with questionnaires to determine whether you have a problem, as well as how and where to get support. We hope that with the personal involvement of the poster, our audience would be intrigued by the QR codes ‘directed at them’. By scanning the code, members of our audience would take a further ‘commitment step', which significantly increases the likelihood that they will change their behaviour, as they will feel the need to be consistent with their commitment (Cialdini, 2007). In addition, the use of the NHS and drinkaware websites was key, as they are both ‘credible sources’ - which increases the extent to which people believe and follow recommendations (Hovland & Weiss, 1951).
Did we succeed?
The culture of drinking at university is a problem, and binge drinking is at the heart of it. The main intent for our behaviour change campaign was to persuade people to stop and think about their drinking. Not to stop drinking altogether, but to be more responsible with their drinking habits and nights out. It is not possible to precisely measure how many people saw our campaign, but given the areas we placed our posters, we hope that a good proportion of the thousands of students on campus took something positive from the posters. Even if just one student positively changed their behaviour and avoided some of the irreparable consequences of binge drinking, we consider this campaign to be successful.
Robbie Chandler & Lauren Milbourne
Bergmark, K. H., & Andersson, T. (1999). The development of advanced drinking habits in adolescence – a longitudinal study. Substance Use and Misuse, 34, 171-194.
Casswell, S., Pledger, M., & Pratap, S. (2002). Trajectories of drinking from 18 to 26 years: Identification and prediction. Addiction, 97, 1427-1437.
Cialdini, R. B. (2007). Influence: The psychology of persuasion, 173-174. New York: Collins.
Courtney, K. E., & Polich, J. (2009). Binge drinking in young adults: Data, definitions, and determinants. Psychological bulletin, 135, 142.
Delk, E. W., & Meilman, P. W. (1996) Alcohol use among college students in Scotland compared with norms from the United States. Journal of American College Health, 44, 274–281.
Dietz, C. M. (2008). Development of binge drinking behavior in college students: A developmental analysis. Graduate Journal of Counseling Psychology, 1, 86-96.
Drug Info Clearing. (2002). The facts about binge drinking. Retrieved from: http://nceta.flinders.edu.au/files/4512/5004/2169/Binge_drinking.pdf on 15/04/2018.
Elliot, A. J., & Maier, M. A. (2007). Color and psychological functioning. Current directions in psychological science, 16, 250-254.
Gupta, S., Wang, F., Holly, E. A., & Bracci, P. M. (2010). Risk of pancreatic cancer by alcohol dose, duration, and pattern of consumption, including binge drinking: a population-based study. Cancer Causes & Control, 21, 1047-1059.
Haines, M., & Spear, S. F. (1996). Changing the perception of the norm: A strategy to decrease binge drinking among college students. Journal of American College Health, 45, 134-140.
Hartley, D., E, Elsabagh, S., File S., E. (2004). Binge drinking and sex: Effects on mood and cognitive function in healthy young volunteers. Pharmacology, Biochemistry and Behavior, 611–619.
Heather, N., Partington, S., Partington, E., Longstaff, F., Allsop, S., Jankowski, M., Wareham, H., & St Clair Gibson, A. (2011). Alcohol use disorders and hazardous drinking among undergraduates at English universities. Alcohol and alcoholism, 46, 270-277.
Hebden, R., Lyons, A. C., Goodwin, I., & McCreanor, T. (2015). "When you add alcohol, it gets that much better": University students, alcohol consumption, and online drinking cultures. Journal of Drug Issues, 45, 214-226.
Hingson, R. W., & White, A. (2013). Trends in extreme binge drinking among US high school seniors. JAMA pediatrics, 167, 996-998.
Hovland, C. I., & Weiss, W. (1951). The influence of source credibility on communication effectiveness. Public opinion quarterly, 15, 635-650.
Hyland, K. (2008). Persuasion, interaction and the construction of knowledge: Representing self and others in research writing. International Journal of English Studies, 8, 1-23.
Johnston, K. L., & White, K. M. (2003). Binge-drinking: A test of the role of group norms in the theory of planned behaviour. Psychology and Health, 18, 63-77.
Kahneman, D. (2011). Thinking, fast and slow. Macmillan.
Kypri, K., Langley, J., & Stephenson, S. (2005). Episode-centred analysis of drinking to intoxication in university students. Alcohol and Alcoholism, 40, 447-452.
Nichols, J. M., Martin, F. (1997). The effect of lorazepam on long-term verbal recall in heavy and light social drinkers. Alcohol, 455–461.
Olson, E. L., & Mathias Thjømøe, H. (2003). The effects of peripheral exposure to information on brand preference. European Journal of Marketing, 37, 243-255.
Penny, G., & Armstrong-Hallam, S. (2010). A multi-level analysis of student alcohol (mis) use and its implications for policy and prevention strategies within universities, cognate educational establishments and the wider community. Student Choices and Alcohol Matters (SCAM), 1-134.
Perkins, H., Haines, M. P., & Rice, R. (2005). Misperceiving the college drinking norm and related problems: A nationwide study of exposure to prevention information, perceived norms, and student alcohol misuse. Journal of Studies on Alcohol, 66, 470-478.
Petty, R. E., & Cacioppo, J. T. (1986). The elaboration likelihood model of persuasion. In Communication and persuasion, 1-24. Springer New York.
Petty, R. E., Cacioppo, J. T., & Heesacker, M. (1981). Effects of rhetorical questions on persuasion: A cognitive response analysis. Journal of personality and social psychology, 40, 432.
Schulenberg, J. E., & Maggs, J. L. (2002). A developmental perspective on alcohol use and heavy drinking during adolescence and the transition to young adulthood. Journal of Studies on Alcohol, 14, 54-70.
Szmigin, I., Griffin, C., Mistral, W., Bengryhowell, A., Weale, L., & Hackley, C. (2008). Re-framing "binge drinking" as calculated hedonism: Empirical evidence from the UK. International Journal of Drug Policy, 19, 359-366.
Townshend, J. M., Duka, T. (2005). Binge drinking, cognitive performance and mood in a population of young social drinkers. Alcoholism: Clinical and Experimental Research, 317–325.
Wechsler, H., Dowdall, G. W., Maenner, G., Gledhill-Hoyt, J. and Lee, H. (1998) Changes in binge drinking and related problems among American college students between 1993 and 1997. Journal of the American College of Health, 47, 57–68.
Wechsler, H., & Nelson, T. F. (2001). Binge drinking and the American college students: What's five drinks? Psychology of Addictive Behaviors, 15, 287.
Weissenborn, R., & Duka, T. (2003). Acute alcohol effects on cognitive function in social drinkers: Their relationship to drinking habits. Psychopharmacology, 306–312.
Weitzman, E. R. (2004). Poor mental health, depression, and associations with alcohol consumption, harm, and abuse in a national sample of young adults in college. The Journal of nervous and mental disease, 192, 269-277.
Witte, K., & Allen, M. (2000). A meta-analysis of fear appeals: Implications for effective public health campaigns. Health, Education and Behaviour, 27, 591-615.