Drinking game participation among high school and incoming college students

Zamboanga BL, Tomaso CC, Cloutier RM, Blumenthal H, Kenney SR, Borsari B. Drinking game participation among high school and incoming college students. J Addict Nurs. 2016;27:24–31.

Abstract

The transition from secondary education to university is characterised as a potentially vulnerable period due to less parental supervision and increased autonomy. This transition can increase the risk for taking part in high-risk behaviours such as drinking games (DGs), a social activity that encourages getting drunk and is associated with the negative consequences of alcohol abuse. To date, no narrative reviews of research on DG participation among high school and incoming college students have been identified, and therefore this paper provides an insight into this issue. The findings indicate that DG participation is consistently linked to negative consequences and other high-risk behaviours, such as drinking alcohol before attending social events. In addition, DG participation is linked to demographic (e.g., age, gender), psychological (e.g., personality, cognitions on alcohol) and contextual/cultural (e.g., university drinking culture) factors. These findings have implications for current prevention and intervention efforts and suggest promising directions for future research.

Commentary

Alcohol consumption by both adolescents and young people is a growing health problem. In addition, drinking has changed from generation to generation and new behaviours are emerging.^1–3 Therefore, it is important to know the new forms of alcohol consumption by adolescents and young people, especially those who are going through stages of transition, such as that from secondary education to university, as well as the factors that are related to this drinking. This can help in the design of future preventive nursing interventions that include these factors in order to increase their efficiency and effectiveness. Drinking games have been identified within these new drinking practices.⁴ They can be defined as a social activity in which some cognitive or motor gaming task is undertaken that involves drinking alcohol and is therefore associated with its negative consequences.^5,6

In light of the above, the article analysed addresses this important health problem. The study consists of a narrative review of the literature³ that established as its objective to examine DG beliefs, behaviours and risk factors among high school and incoming college students, as well as highlighting the implications for DG prevention and intervention; finally, guidelines for future research were presented. However, the methodology used for its development is not clearly shown, it is only stated that the literature search was conducted through research papers by colleagues examining DG in the United States, using the keywords: drinking game, game, alcohol, high school student, adolescent and incoming college student. The search strategy and selection criteria for the study design determined for the selection of this review are not reflected in the document. Only the period of publication of eligible articles is limited, January 2015, obtaining a total of 23 selected manuscripts, of which only 13 met the characteristics of the population.

These methodological limitations have an impact on the results of the review that suggests very general conclusions, indicating that DGs appear to be a multifaceted phenomenon in which a variety of factors are related to the practice, such as sociodemographic (age and sex), psychological (sensation-seeking, expectations about drinking (positive vs. negative), motives for drinking alcohol (social or hedonistic) and contextual or cultural (contextual control or entering the drinking culture). However, it is not explained in depth how these factors are presented, and therefore a broader approach to the scientific evidence showing the relationship, effect or prediction of risk factors associated with DGs is needed, as this is fundamental for the subsequent design and implementation of effective preventive strategies.

On the other hand, some strategies are identified, such as the implementation of alcohol-free social alternatives, as well as incentives to participate in these events, in addition to the implementation of preventive programmes, which can be used to reduce participation in DGs before and during this transition. However, it is not clear which strategies are the most effective in providing a solution to the problem identified.

In my opinion, the paper addresses in a very general way the presence of this behaviour. It would be of interest to include more extensive information on the subject, such as the rules within the games, as well as knowing the social spaces where they take place. It would also be important to know the risk factors or the motives, beliefs or behaviours that are directly related to DGs in adolescents. These aspects are not clearly visualised throughout the document; concise information should be included as this topic has been little addressed and little is known about this phenomenon.

It is also important to mention that in some parts of the manuscript, DG participation and binge drinking are used as synonyms. They should be distinguished, since problem drinking is characterised by the consumption of large quantities of alcohol (more than 4 drinks for females and more than 5 drinks for males) over a period of no more than 2 h. On the other hand, including only the US population limits the generalisation of the results, and it is advisable to investigate whether this phenomenon is occurring in other populations of adolescents and young people. In addition, some of the articles reviewed are old and the results could be outdated. Finally, contextual and cultural risk factors associated with DGs are mentioned. Within these factors, the internalisation of the drinking culture was identified, but it is not explained how it might influence alcohol consumption. This limits drawing solid conclusions about how these factors affect how this form of drinking develops.

Regarding the implications for prevention and intervention, I believe that educational institutions can influence the regulation of DGs by implementing programmes to detect and diagnose this type of risk behaviour in their students, as well as offering the most appropriate intervention programmes according to the characteristics of the population and the severity of the risk behaviour they present.

In conclusion, the article provides relevant information on this new form of alcohol abuse defined as DGs, there is little information on the phenomenon and its risk factors. However, it is being addressed in countries such as Australia⁴ and Nigeria,⁶ providing important data that could complement this paper. It is also considered relevant for new knowledge gaps to be addressed in the future, to focus on identifying the motives, beliefs and norms within drinking games, and being aware of the social spaces where they take place. And, of course, to evaluate the negative consequences resulting from DG participation to differentiate this practice from the general negative consequences of alcohol abuse and thus be able to raise awareness of this serious problem among health professionals and young people alike, through the implementation of preventive nursing interventions aimed at reducing DG, and to identify students who may be at risk for the negative consequences of this form of drinking.