Addressing psychiatric and psychosocial issues related to children and adolescents Youth in Mind

College students seek peer acceptance and op-portunities for social interaction. For many, it may be the first time away from home, away from the supervision and watchful eyes of par-ents and other family members. Whether for fun, thrill, competition, or the need to socialize with others, approximately two thirds of U.S. college students participate in the risky binge

drinking behavior called drinking games. Re-gardless of the game type, the goal of this be-havior is to become intoxicated in a short peri-od of time. Significant consequences and harm can result from this dangerous social behavior. This article, the first of two parts, will describe the problem; Part 2 will discuss the implications for community and mental health nurses.

AbstrAct

Nancy r. Ahern, PhD, rN; and Mary Lou sole, PhD, rN, ccNs, FAAN, FccM

Drinking Games and college studentsPart 1: Problem Description

Teena M. McGuinness, PhD, CRNP, FAAN, Section Editor

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Journal of Psychosocial nursing • Vol. 48, no. 2, 2010 17

Youth in Mind

Ping pong, card games, checkers, and word games are safe ways to socialize in

the college environment, right? Hardly! Often, these games are combined with drinking and promote risky behavior. Drink-ing games are popular on college campuses, with reports of 47% to 62% of college student partici-

pation (Borsari, 2004). Drinking games are appealing because they promote social interactions and provide opportunities for compe-tition (Borsari, 2004). Although the specific game, grade level of student, and type of alcohol con-sumed may vary, participants of drinking games often become in-toxicated quickly.

Many students meet the cri-teria for heavy episodic drink-ing (i.e., consuming four or more drinks in a row [women] or five or more drinks in a row [men] during the past 2 weeks) (Wechsler, Davenport, Dowell, Moeykens, & Castillo, 1994) or binge drinking (i.e., a drinking pattern that results in a blood alcohol concentration of 0.08% or higher) (National Advisory Council on Alcohol Abuse and Alcoholism [NIAAA], 2002). Drinking behavior has also been defined using the categories of heavy and frequency. Using these two categories, Presley and Pi-mentel (2006) grouped student drinkers into three categories of risk: nonheavy, heavy (i.e., con-

sumption of five or more drinks at least once during the past 2 weeks), and heavy and frequent (i.e., five or more drinks at least once and three or more days of alcohol consumption during the past 2 weeks). Agencies, organizations, and academic in-stitutions may use any of these or other definitions to describe

heavy or binge drinking. Re-gardless, these dangerous drink-ing behaviors put college youth at great physical and mental health risk. Collaborative ap-proaches for solutions must include continued research, evidence-based practice guide-lines, college health programs, social policy initiatives, and community action.

Reducing drinking-related morbidity and mortality of U.S. college students has been a national priority since the late 1990s. In 2002, the Na-tional Advisory Council of the NIAAA task force published A Call to Action: Changing the Culture of Drinking on U.S. Col-lege Campuses. Several programs were initiated as a result of this publication; however, results have been mixed (National In-stitutes of Health, 2007).

WhAt Are DriNkiNG GAMes?

Drinking games can be or-ganized into six categories: con-sumption, gambling, media, motor

skills, team, and verbal skills games (Table). All of the games described are designed to cause intoxication in the shortest period of time.

What Are the Motivators to Participate?

Motivation to participate in, avoid, or stop playing drinking games are not well researched. Reasons for participation include competition and thrills, confor-mity, novelty, desire for a sexual encounter, fun and celebration, relaxation, and boredom (Borsa-ri, 2004; Borsari, Bergen-Cico, & Carey, 2003; Johnson & Sheets, 2004; Zamboanga, Rodriquez, & Horton, 2008). Students stop playing drinking games for many reasons: They get too drunk, sick, or bored, or are influenced by others who choose to quit (John-son, 2001). Students abstain from drinking games because of negative views of alcohol, so-cial isolation, unfamiliarity with the games, past bad experiences with drinking, or personal choice (Johnson & Cohen, 2004). Moti-vations to play, stop, or not begin at all offer clues to the develop-ment and implementation of in-terventions aimed at preventing this risky behavior.

Who is at risk?Although there is little evi-

dence in the literature to ex-plain motivators to participate or not, there has been consider-able research to determine the populations at risk. Of great risk are those who began drinking between ages 14 and 16 (Borsari et al., 2003). College students at high risk include athletes (Grossbard, Geisner, Neighbors, Kilmer, & Larimar, 2007; Zam-boanga et al., 2008), fraternity and sorority members (Capone, Wood, Borsari, & Laird, 2007), and those who abuse drugs (in-

Peer influences also increase the likelihood

of participation in drinking games..., which may explain why

students who live on campus may be at a greater risk for participation.

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Youth in Mind

cluding over-the-counter medi-cations) (Simons et al., 2005). Peer influences also increase the likelihood of participation in drinking games (Borsari & Car-ey, 2001), which may explain why students who live on cam-pus may be at a greater risk for participation (Sharmer, 2005). In addition, holidays and college events, such pregame tailgat-

ing and themed parties, create an environment conducive to drinking games. Although an extreme example, anyone who has viewed the popular movie Animal House (Reitman, Sim-mons, & Landis, 1978) will re-member the drinking behaviors portrayed by actor John Belushi at the fraternity house “toga party.”

What Are the Potential harms and consequences?

Drinking game participation in-creases the risk for students to ex-perience associated alcohol-related harms and consequences (Borsari, 2004). Games encourage heavy al-cohol consumption in a relatively short period of time and thus are associated with consequences that occur with binge drinking. Harmful

tAbLe

DriNkiNG GAMe cAteGories, With DescriPtioNs AND exAMPLes

Category Description ExamplesConsumption (or endurance) games

No strategy or rules except that the player drinks as much as possible in the shortest time.

• 100 minute club (i.e., one shot per minute for 100 minutes) • Chug-offs • Shotguns • Beer bongs • 100 beer club • Power hour

Gambling games Use of cards or dice and based on chance. Losers must drink a designated amount. Games of chance increase the risk of becoming intoxicated.

• Three man• Up and down the river• Presidents• Kings• Beer checkers• Beer hunter

Media games Players are cued to drink by a certain television show, video, movie, or song.

• Hi Bob (i.e., player drinks when any performer on The Bob Newhart Show says “Hi, Bob”) • Have a drink on me, Roseanne

Motor skills games Certain motor skills are to be performed. Failure to perform results in forced drinking.

• Quarters (i.e., toss quarter into shot glass)• Cardinal puff• Chandeliers• Thumper

Team games Two or more teams compete with each other. Most popular game involves playing ping pong in some fashion with the addition of beer. Games stimulate competition.

• Beer pong (or Beirut)• Speed• Flip cup (i.e., sports-like competition)

Verbal skills games Long or difficult words and phrases are repeated; if errors are made, the player drinks; if the round is error free, the task increases in difficulty.

• Animal• Add-a-word• Fuzzy duck• The name game• Never have I ever

Sources. Borsari (2004); Zamboanga, Calvert, O’Riordan, and McCollum (2007).

Journal of Psychosocial nursing • Vol. 48, no. 2, 2010 19

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short-term consequences include driving while under the influence, risky sexual behaviors, illicit drug use, violence, and even death due to alcohol intoxication (Hing-son, Heern, Winter, & Wechsler, 2005). Many factors may influence the potential negative effects of the alcohol (e.g., amount and type of alcohol, length of time of drinking episode). Long-term consequences are those associated with contin-ued alcohol use and abuse. Heavy drinking can cause academic prob-lems such as missed classes and assignments, failed examinations, and further unsuccessful school performance. Of serious concern, students who participate regularly in drinking games may develop a pattern of heavy drinking that can be carried through the college years and into early adulthood.

suMMAryThis article, the first of two,

describes the risky binge drink-ing behavior called drinking games and the serious conse-quences faced by U.S. college students who engage in such behavior. Although this dis-cussion did not include inter-national research findings, this risky behavior does not appear to be exclusive to American college students. Part 2—to be published in the April 2010 is-sue—will include implications for community and mental health nurses.

reFereNcesBorsari, B. (2004). Drinking games in

the college environment: A review. Journal of Alcohol and Drug Educa-tion, 48, 2694-2705.

Borsari, B., Bergen-Cico, D., & Carey, K. (2003). Self-reported drinking-game participation of incoming col-lege students. Journal of American College Health, 51, 149-154.

Borsari, B., & Carey, K.B. (2001). Peer influences on college drinking: A review of the research. Journal of Substance Abuse, 13, 391-424.

Capone, C., Wood, M.D., Borsari, B., & Laird, R.D. (2007). Fraternity and sorority involvement: Social influences, and alcohol use among college students: A prospective ex-amination. Psychology of Addictive Behaviors, 21, 316-327.

Grossbard, J., Geisner, I.M., Neighbors, C., Kilmer, J.R., & Larimar, M.E. (2007). Are drinking games sports? College athlete participation in drinking games and alcohol-related problems. Journal of Studies on Alco-hol and Drugs, 68, 97-105.

Hingson, R., Heern, T., Winter, M., & Wechsler, H. (2005). Magni-tude of alcohol-related mortality and morbidity among U.S. college students ages 18-24: Changes from 1998-2001. Annual Review of Public Health, 26, 259-279.

Johnson, T.J. (2001). College students’ self-reported reasons for why drink-ing games end. Addictive Behaviors, 27, 145-153.

Johnson, T.J., & Cohen, E.A. (2004). College students’ reasons for not drinking and not playing drinking games. Substance Use and Misuse, 39, 1137-1160.

Johnson, T.J., & Sheets, V.L. (2004). Measuring college students’ motives for playing drinking games. Psychol-ogy of Addictive Behaviors, 18, 91-99.

National Advisory Council on Alcohol Abuse and Alcoholism. (2002). A call to action: Changing the culture of drink-ing at U.S. colleges (NIH Publication No. 025010). Retrieved from http://www.collegedrinkingprevention.gov /NIAAACol legeMater ia l s /TaskForce/TaskForce_TOC.aspx

National Institutes of Health. (2007). What colleges need to know now: An update on college drinking re-search (NIH Publication No. 07-5010). Retrieved from http://www.collegedrinkingprevention.gov/1College_Bulletin-508_361C4E.pdf

Presley, C.A., & Pimentel, E.R. (2006). The introduction of the heavy and frequent drinkers: A proposed clas-sification to increase accuracy of alcohol assessment in postsecondary education settings. Journal of Studies in Alcohol, 67, 324-331.

Reitman, I. (Producer), Simmons, M. (Producer), & Landis, J. (Direc-tor). (1978). Animal house [Motion picture]. United States: Universal Pictures.

Sharmer, L. (2005). Campus living ar-rangements as a risk factor for par-ticipation in drinking games among undergraduates. Journal of College and University Student Housing, 33(2), 37-43.

Simons, L., Klichine, S., Lantz, V., Ascolese, L., Deihl, S., Schatz, B., et al. (2005). The relationship be-tween social-contextual factors and alcohol and polydrug use among college freshmen. Journal of Psycho-active Drugs, 37(4), 415-424.

Wechsler, H., Davenport, A., Dow-ell, G., Moeykens, B., & Castillo, S. (1994). Health and behavioral consequences of binge drinking in college: A national survey of stu-dents at 140 campuses. Journal of the American Medical Association, 272, 1672-1677.

Zamboanga, B.L., Calvert, B.D., O’Riordan, S.S., & McCollum, E.C. (2007). Ping-pong, endurance, card, and other types of drinking games: Are these games of the same feath-er? Journal of Alcohol and Drug Edu-cation, 51(2), 26-39.

Zamboanga, B.L., Rodriquez, L., & Hor-ton, N.J. (2008). Athletic involve-ment and its relevance to hazard-ous alcohol use and drinking game participation in female college ath-letes: A preliminary investigation. Journal of American College Health, 56, 651-656.

Dr. Ahern is Assistant Professor, and Dr. Sole is Professor, College of Nursing, University of Central Florida, Orlando, Florida.

The authors disclose that they have no significant financial interests in any product or class of products discussed directly or indirectly in this activity, including research support.

Address correspondence to Nancy R. Ahern, PhD, RN, Assistant Professor, University of Central Florida, College of Nursing, 4000 Central Florida Boulevard, PO Box 162210, Orlando, FL 32816-2210; e-mail: nahern@mail.ucf.edu.

Posted: January 22, 2010doi:10.3928/02793695-20100108-03

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