Elsevier

Drug and Alcohol Dependence

Volume 167, 1 October 2016, Pages 42-48
Drug and Alcohol Dependence

Full length article
Students worry about the impact of alcohol on quality of life: Roles of frequency of binge drinking and drinker self-concept

https://doi.org/10.1016/j.drugalcdep.2016.07.031Get rights and content

Highlights

  • Binge drinkers have a higher level of impact of alcohol on quality of life than non binge drinkers.

  • Frequency of binge drinking is predictive of level of alcohol related quality of life in students.

  • Sleep, ability to work, expenditure, shame, and health-related concerns were the most impacted.

Abstract

Introduction

The aim of this study was to clarify the impact of binge drinking, its intensity and frequency, and drinker self-concept on health-related quality-of-life (HRQOL) in students.

Methods

This cross-sectional online survey included 16,930 students. We collected sociodemographics, environmental data, and drinking behaviors. We assessed HRQOL using the Alcohol Quality-of-Life scale, which explicitly explores the subjective negative impact on quality of life one attributes to his relationship with alcohol and the degree to which drinking is a part of an individual's self-concept. Data analyses were performed in 2015 and 2016. We described and compared binge drinkers and non-binge drinkers. Using a regression model we identified the independent factors associated with HRQOL.

Results

The impact on HRQOL attributed to alcohol was significantly greater among binge drinkers. Factors of impact on HRQOL subjectively attributed to alcohol by students were: AUDIT-C score, interaction between gender and AUDIT-C score, strong individual identity as a drinker, binge-drinking frequency, financial difficulties, being a foreigner, fewer years since diploma, chronic condition, recent use of cannabis, psychostimulant, poppers or gambling. Sleep quality, ability to work, expenditure on alcohol, shame, and health-related concerns were the most strongly impacted quality of life areas.

Conclusions

Binge-drinking frequency should be considered as an important target in prevention programs. In addition, integrating findings on students’ subjective perceptions of impairment of HRQOL by alcohol could enable the development of more acceptable and more relevant prevention messages.

Introduction

Binge drinking enjoys a positive representation among young people (McBride et al., 2014). Some authors have developed binge-drinking scores to describe involvements in this consumption pattern, including the concept of frequency of binge drinking (Townshend and Duka, 2002). Two factors seem to determine the consequences of binge drinking: intensity, namely maximum total amount of alcohol consumed during one binge-drinking session, and the frequency of binge drinking (Reich et al., 2015). As some students seem reluctant to stop binge drinking, differing consequences linked to intensity from, to frequency of, binge drinking could be useful in prevention. These two factors could weigh differently depending on the nature of the negative consequences. Acute consequences are extensively documented, particularly in terms of somatic complications, as well as risk of harm such as risky sexual or driving behaviors (Connor et al., 2010, White et al., 2015). Long term consequences of binge drinking are increasingly the focus of research, yielding, for instance, reports of cognitive impairments among young students indulging in binge drinking without a diagnosis of alcohol use disorder (Lannoy et al., 2014), influenced by both intensity and frequency of binge drinking (Maurage et al., 2011). However, findings on the relationship between binge drinking and quality-of-life are less documented and are inconsistent. Health-related quality-of-life (HRQOL) reflects people’s feelings and functioning in relation with their health status (Leplege, 2011). Some studies report more days with mental health problems among frequent binge drinkers (3 or more episodes in the previous month), and others find no association between binge drinking and quality-of-life (Mohamed and Ajmal, 2015, Okoro et al., 2004, Zahran et al., 2007). One explanation for these inconsistencies could be the use of generic HRQOL instruments, not specific to alcohol use disorders. It has been shown that generic HRQOL instruments can miss certain subjective concerns on the impact of alcohol consumption on quality-of-life (Luquiens et al., 2012). Therefore, a subject-reported outcome documenting the subjective assessment of negative impact of one’s relationship to alcohol, the Alcohol Quality of Life Scale (AQoLS), was recently developed and validated (Luquiens et al., 2014, Luquiens et al., 2015). A robust documentation on the negative impact of binge drinking on students’ quality of life using a specific to alcohol instrument, such as the AQoLS, was needed. In particular, it seemed critical to clarify the differential effects of binge-drinking intensity and frequency, in order to refine prevention program targets. Our hypothesis was that both frequency and intensity of binge drinking were correlated to higher subjective impact of alcohol on quality of life among students, but with frequency to a larger extent. Self concept is part of identity and refers to representations of self, derived from past experiences. Once established, it can be particularly difficult to change and can influence behaviors (Markus, 1977). “User” self-concept has been widely studied in the addiction field. For instance, “smoker” self-concept is a well known barrier to change in smoking, and a component of behavior reinforcement (Shadel and Mermelstein, 1996). In addition, a “partier” self-concept has been shown to mediate the association between binge drinking and several negative consequences of binge drinking, and could play the role of a risk factor (Reslan et al., 2011). Its relationship with quality-of-life has not been explored to date. In a context of highly-valued binge drinking among young people, it was important to study the role of the “drinker self-concept” in the relationship between quality-of-life and binge drinking. Our hypothesis was that students with a higher level of drinker self-concept would have a higher level of subjective impact of alcohol on quality of life.

Section snippets

Methods

BDmiE is a large cross-sectional anonymous online survey among students from French universities exploring alcohol consumption and in particular binge drinking and its relationship with HRQOL. BDmiE is for Binge Drinking among students, in French: “Binge drinking en milieu étudiant”.

Population

A flow chart is provided in Fig. 1. Participation rate was 8.5%, and varied from 0.5 to 50% of students, depending inversely on the size of the university and on the local announcement of the study. Data from 16,930 students aged 30 or under were retained for analysis.

Discussion

This large cross-sectional study confirmed a significantly higher level of negative impact on quality-of-life subjectively attributed to one’s relation with alcohol, among past-month binge-drinker students than among non-binge drinkers. Several factors were related to negative impact of alcohol on HRQOL as assessed subjectively by students, in particular the frequency of binge drinking, and high levels of drinker self-concept. The intensity of binge drinking was not an independent factor

Role of funding source

Nothing declared.

Contributors

All authors contributed to protocol writing, data analysis, manuscript writing and review.

Conflicts of interest

AL has received sponsorship to attend scientific meetings, speaker honoraria and consultancy fees from Lundbeck.

BF has been consultant for E. Lilly, BMS, Servier, SANOFI, GSK, HRA, Roche, Boeringer Ingelheim, Bayer, Almirall, Allergan,Stallergene, Genzyme, Pierre Fabre, Astrazeneca, Novartis, Janssen, Astellas, Biotronik, Daiichi-Sankyo, Gilead, MSD, Lundbeck, Stallergene, Actelion, UCB, Otsuka, Grunenthal, ViiV.

HJA has received sponsorship to attend scientific meetings, speaker honoraria and

Acknowledgements

Conférence des Grandes Ecoles, Mr G Majou, Conférence des Directeurs des Ecoles Françaises d’Ingénieurs, Mrs C Guiria, Conférence des Présidents d’Université, Mrs C Marseault, Association Des Services de Santé Universitaires, Dr A Perreve, and Dr Gerbault, Observatoire de la Vie Etudiante, Bureau National des Elèves Ingénieurs, Bureau Des Etudiants of Lorraine University, and all participating universities and students.

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