College students face significant alcohol-related problems, with the average student experiencing over 100 consequences during their college years, and contrary to expectations of maturation, drinking and consequences actually increase from first to senior year rather than decrease. While drinking quantity predicts alcohol-related harms, research has identified additional cognitive and behavioral factors such as behavioral willingness to experience consequences and use of protective behavioral strategies that independently contribute to predicting and avoiding problems. However, previous studies examining these cognitive and behavioral factors have focused on younger samples, and the associations between these factors and repeated alcohol problems (RAPs) remain unexplored in senior-year college students. Therefore, the current study aims to examine the concurrent associations between drinking, cognitive and behavioral factors, and RAPs early in the senior year, as well as the prospective effects of RAPs on subsequent drinking behaviors and outcomes at the end of senior year.
The study recruited 4,000 students from a northeastern U.S. university with 2,690 (67.3%) completing baseline surveys and 2,024 (75.2%) meeting eligibility criteria, who were followed longitudinally from fall 2012 to spring 2016. Key measures included behavioral willingness to experience negative consequences (22 items), protective behavioral strategies (11 items on a 5-point scale), weekly drinking quantity via the Daily Drinking Questionnaire, and repeated alcohol problems (18 items mapped onto DSM-5 criteria). Data analysis included descriptive statistics and correlations, followed by longitudinal path modeling.
Approximately 52% of students reported experiencing two or more repeated alcohol problems (RAPs) each semester. Students who endorsed six or more RAPs demonstrated significantly greater behavioral willingness (BW) to accept negative consequences and reported lower use of protective behavioral strategies (PBS) compared to those with no RAPs. The path analysis indicated a good model fit and revealed significant concurrent associations: RAPs were positively associated with both BW and drinking behaviors, and negatively associated with PBS use. Similarly, drinking behaviors were positively associated with BW and negatively with PBS use. Longitudinally, prior RAPs significantly predicted subsequent increases in BW, drinking quantity, and future RAPs, as well as reductions in PBS use. These findings underscore the interrelated nature of cognitive and behavioral factors in perpetuating problematic alcohol use among college seniors and highlight the need for targeted interventions.
Takeaway: A reinforcing cycle between repeated alcohol problems, behavioral willingness to accept consequences, and drinking behaviors among college seniors, emphasizing the need for targeted interventions to prevent adult alcohol use disorders.