Last fall President Judith Rodin introduced a University Council discussion of alcohol and civility, pointing to a nationwide concern about binge drinking and alcohol-related assaults on college campuses. (For a transcript of remarks by ten panelists at the October 17, 1997, Council meeting, see Almanac Supplement December 16/23, 1997). In January, Dr. Rodin named a special committee whose members were asked to "use their special expertise to review the issues and the suggestions made thus far," and to make recommendations toward a coordinated set of initiatives.
Following is that committee's report.
Report of the President's Special Committee on Alcohol Abuse
The use of alcohol to excess has been common among adolescents and young adults in all cultures where alcohol is available ever since observations of drinking have been recorded. Recent history of the American college population suggests that there are secular trends in our society that correlate with increases and decreases in the use of all drugs including alcohol. Such trends tend to vary over decades. The most that any single university can expect to accomplish is to reduce the abuse of alcohol along this national curve. To ignore the problem would invite increases above the national curve.
In the course of our four committee meetings, we have discussed drinking problems at the University of Pennsylvania from the differing perspectives each of our members represents. We have compared policies and procedures that our respective offices and responsibilities bring to bear on the problem. While we are concerned about the prevalence and impact of under-age drinking, we believe that excessive drinking by students of any age represents a far more serious problem and accordingly, we have focused the majority of our conversations on this topic. We are also concerned about the "second hand" effects of excessive drinking by a relatively few students on the vast majority of students who drink responsibly or do not drink at all. In presenting our recommendations, we are adopting a public health approach. The approach is organized into primary and secondary prevention programs. The primary prevention programs attempt to change the conditions that may encourage drinking, increase education about alcohol and change the attitudes of the University community. The secondary prevention programs deal with students whose problems have come to the attention of University authorities. Secondary prevention includes therapeutic and/or disciplinary means to prevent the re-occurrence of problems.
While there are already programs in place to deal with alcohol problems on campus, a key component of our recommendations is the need to better coordinate these efforts.
1. Data collection and analysis. We are concerned that we do not have sufficient data to understand the extent of excessive drinking among Penn students-and faculty for that matter-and believe we need to supplement the statistics available from the Harvard study with more directed questions for the Penn constituency. Our sense is that the problem may be as much a matter of perception-what is accepted as the norm-as of actual drinking habits, with the tolerance and expectation for what is normal behavior very skewed. We recommend a campus-wide data collection project on the perceptions of excessive drinking and actual usage patterns. Heavy drinking that does not lead to violent or disruptive behavior will produce health effects over years, but would not usually be identified as a problem on campus. Thus we are focusing on drinking that creates problems for the student drinker or for the campus community rather than defining a specific quantity of alcohol as excessive.
This data collection program should incorporate both quantitative and qualitative approaches. It also should examine the personal meaning of drinking to various constituencies of students. There should be particularly careful study of existing creative collaborative prevention projects involving university and community members at other institutions. We believe a data collection process will be essential in helping us evaluate what preventive strategies can actually have an impact.
2. Educational efforts for students. With better data in hand on both the perception and the reality of drinking, we recommend an educational approach that aims at changing the culture of excessive drinking and its widespread acceptance. Such an effort would be directed at both the general student body and at those who already use alcohol excessively. A crucial part of this approach would be to affirm the rights of students who do not drink to excess. We were impressed by the data on the extent of "second hand" effects of alcohol on the quality of life of those students who must live on a campus with alcohol abusing students. Social marketing and health promotion media campaigns have been effective strategies used on other campuses and we believe resources should be allocated to allow the staff and students in the Office of Health Education to expand these efforts at Penn.
We believe strongly that Penn students should be educated on the pharmacological effects of the drug called ethyl alcohol. This includes knowledge about the history of alcohol use, the benefits of moderate alcohol use, the effects of alcohol on the brain, the effects of binge drinking, the reasons why five drinks in a row were arbitrarily defined as a "binge" by the Harvard study, the meaning of a "black out" and the effects of varying doses of alcohol on memory, coordination, sexual arousal and other brain functions beginning at low levels and increasing with the level of alcohol in the blood. We accept the fact that many students will not be interested in the pharmacology of alcohol through the traditional alcohol education formats and would encourage appropriate faculty to integrate this type of information into courses and seminars. We believe that in a society where alcohol use is almost universal, an educated person should know basic scientifically demonstrated facts rather than hearsay about the drug that they ingest. Another possible mechanism for initiating discussion of responsible use of alcohol would be the Penn Reading Project. A list of possible books was generated through the Alcohol and Other Drug Task Force and the Student Affairs Committee and was submitted for consideration.
a. We encourage the continuing visible leadership from the President, as noted above, to emphasize that Penn is not a "drinking school," to be reflected in both admissions literature and statements on-campus. This responsible message can be presented without damaging the desirable aspects of Penn's reputation as the "social Ivy."
b. We believe a social marketing campaign that affirmed the rights of non- and moderate drinkers and publicized the prevalence of a different standard of behavior would help change student expectations and support different life styles among students.
c. We acknowledge that faculty actions can have an impact on the university culture in the area of alcohol drinking on campus. There should be an educational program for faculty to explore ways that the faculty can influence students' attitudes and knowledge about excessive drinking. Campus traditions such as the scheduling of few classes on Fridays should be reconsidered in the light of the message that this sends to students about starting their weekend drinking on Thursday night. Of course, there are other reasons why classes may not be scheduled on Fridays or Mondays, but it must be recognized that extending the weekend in this manner encourages some students to use the time to drink excessively and implies faculty facilitation of this behavior. Departments should be specifically encouraged to use Fridays as frequently as any other day of the week to schedule classes.
Similarly, there should be a limit on the number of evening courses that a full-time undergraduate student can take. It has come to the committee's attention that some undergraduates take many of their courses with evening students in the College of General Studies to make it more convenient to stay up late at night drinking and then "sleep in" the next morning. We have no quantitative data on the frequency of this phenomenon, but to the extent that it occurs, it is detrimental to the individual student and to the learning atmosphere of the student community.
We therefore recommend a reexamination of class scheduling to be sure that classes are held on Fridays as appropriate. We recognize that changing a long-standing tradition of three day weekends is difficult and will require the cooperation of all departments, but we consider this to be an issue of credibility. As a university, we should not speak against excessive drinking, while tacitly supporting it by our class scheduling.
d. We strongly support a full review of the availability of both social and recreational spaces on campus and recommend that steps be taken to ensure that there are places on campus for large groups of students-dark, noisy, crowded, open late at night, for students in groups, music available-that do not depend on or revolve around alcohol. We are aware of plans to renovate Houston Hall, but alternative and even additional recreational space should be identified for use during the time that Houston Hall is unavailable.
We were impressed by the success of "There's No Place Like Penn," "Spring into SPEC," and the "pancake breakfast" following spring fling, which showed that there was substantial interest in non-alcohol-related activities for students, even very late at night. We encourage all groups to work together to create more frequent events of this kind. Similarly, we should work more closely with and support the efforts of local businesses that are attempting to deal responsibly with under-age and excessive drinking. We should be sure that, in so far as the University works with new businesses to locate near the campus, we encourage a mix of businesses and do not rely exclusively on bars to enrich Penn's social life.
e. Similarly, we recommend that there be an effort to refocus "class" oriented social activities away from alcohol. Such activities can, instead, be focused on community-building among students, such as shared art, service, casual athletic projects, etc.
f. We see an important opportunity to strengthen freshman orientation programming through having the Penn reading project focus on alcohol use (discussed above). We also strongly support the idea of a credit-course that provides a general introduction to Penn and college life, and begins to address the underlying causes of drinking: stress, anxiety and depression, sexual discomfort, etc. We suggest that a life skills framework be used, one that addresses risk behaviors, personal growth, and interpersonal needs and skills as a whole. A rigorously-evaluated prevention program such as the life skills training (Gilbert B. Botvin. Ph.D.), while designed for younger adolescents, might be a highly appropriate framework among college freshmen in particular.
g. We suggest that, beyond freshman orientation, the University should provide more consistent education about alcohol, through academic, social, extra-curricular avenues. This could include encouraging faculty members to incorporate more of their research on alcohol-related issues into their courses; providing better information about the history of alcohol and science of addiction.
h. We should find ways to provide broader support and outlets for students facing stress and social discomfort, so they do not have to rely on alcohol to relieve their anxieties.
i. We must communicate with parents about our concerns and the seriousness of drinking as an issue for college students.
4. College Houses. In the fall of 1998, Penn's new College House system will give every student living on campus a structured community with a higher degree of staff and faculty involvement. Faculty masters, faculty fellows, faculty associates, and graduate associates will all be part of campus life in sharply increased numbers. The opportunities for formal and informal interaction will make new space in which conversation and good example can help create an environment more hospitable to safe drinking habits. Existing substance-abuse education programs will also function more effectively when linked through the college houses. Although each college house will have its own identity, it will be important that the programs and policies outlined in this document be followed uniformly. Therefore faculty, resident advisors and counselors in the new college houses should receive training from representatives from student health, health education and counseling and psychological services in ways to initiate conversations about drinking and ways to approach students who are observed to be having alcohol problems.
Some universities have initiated substance-free dormitories that can be chosen by students who wish to live in a smoke-free environment that is also free of alcohol and other drugs. Although previous efforts at Penn were not well utilized, this option should be reconsidered for our university.
5. University reputation. The reputation of a university, even if it is an inaccurate reflection of the actual state of the campus, can have an important influence on the type of student who applies for admission and on the expectations of students once matriculated. What is written about Penn in various student guides to universities may not be the picture that we want to convey. Indeed, one member of the committee has voiced the opinion that, in his view, this is the single largest contributing factor to alcohol misuse patterns on campus: students enter Penn with a preconception of what is both standard and acceptable conduct and thus there is a disproportionate number of heavy drinkers seeking and gaining admission to the University. We should be doing all that we can to change that perception so that students who have already developed dangerous drinking habits in high school will be less likely to apply to our University. In this regard, the committee has the impression that the recent statements by the President and her editorial in The Daily Pennsylvanian have already had a positive effect. We consider these forthright pronouncements essential and hope that they continue. Such statements directly from the president should be part of the materials sent to prospective applicants and should be included in the orientation programs for new students.
6. Educational efforts for alumni. A large part of the University's reputation is derived from our alumni who also help to recruit new students. We should reach out to them through the Pennsylvania Gazette and other forms of communications with alumni to inform them of our campaign for responsible drinking. The message is that we are not trying to prevent students from having fun, but rather to learn to use alcohol responsibly.
Students are identified as having alcohol problems through several different mechanisms. Common ones include creating a disturbance or engaging in violent behavior, being taken to the emergency room because of alcohol overdose, or exhibiting deteriorating academic performance. A concerned friend or family member may also wish to help a student who is drinking out of control, but they often do not know how to access the system for helping with alcohol problems. At Penn there is an existing network of helping professionals who provide assistance to students who are noted to have problems with alcohol or other drugs. A wide range of professionals are available: student advisors in the dormitories, peer group counselors, academic advisers, residence hall advisers, counselors, student health physicians, health educators and peer health educators. It is the impression of the committee that these excellent decentralized efforts could be made more effective by the appointment of a coordinator who could work with staff involved in all aspects of University alcohol problems-from prevention to treatment and discipline. Students whose problems bring them to the attention of University authorities need long-term, mandated supervision. They should not be allowed to "fall through the cracks." Denial of the problem both to others and to oneself is a prominent part of the psychopathology of virtually all problem drinkers. They will not willingly come for help and will try to drop out of any program. Once identified, however, it should be the responsibility of the University to see that the problem drinker remains under supervision to the degree and duration required for each individual.
Coordinator for alcohol related problems. The supervision of problem drinkers requires a good deal of clinical judgment rather than specific rules and, we believe, should be administrated by a central coordinator. This would enable the integration of all University systems: academic, disciplinary and medical. The title for this coordinator depends on the exact job description and the administrative structure. We do not envision line authority over the current decentralized efforts, but rather a coordinating or consultative function. In other universities, an associate dean has been given this responsibility. We recommend a mature professional, qualified for a faculty level appointment, with experience in the treatment of substance abuse, knowledge of the recent research advances in this field and experience in the counseling of undergraduate students. Other qualifications might include: demonstrated ability to collaborate across disciplines and levels; an understanding of the potential role of activism (e.g., organizing students to protest "second-hand" effects); experience with and orientation toward full involvement of students in "ground-up" programming and policy. The exact professional discipline need not be specified as long as the requisite training and experience is present. A search committee should be appointed to screen applicants for this position. Evidence of the widespread recognition of the need for this coordination is that partial salary support for this position already has been spontaneously offered by two different University components: the Department of Psychiatry and the Medical Center's Council for Health Promotion and Disease Prevention. These offers were made to the committee chair during his efforts to collect information about existing means to deal with students identified as having problems. There is also potential interest from parent and alumni donors.
Specific Recommendations for Responding to Identified Problems. The Student Affairs Committee has been examining alcohol-related problems and the report of the chairman, Dr. Anthony Rostain, has been published in the December 16, 1997, issue of Almanac. We endorse these recommendations as well as those previously made by the Alcohol and Other Drug Task Force published in Almanac January 21, 1997. It is clear to us that these are good recommendations, but that the situation calls for better coordination by a person whose full time job is dealing with alcohol-related problems.
1. Role of Fraternities. The information provided to the committee, though not necessarily comprehensive, leads to the conclusion that fraternities have played a major role in a significant number of alcohol-related instances of misconduct or life-threatening alcohol overdose. Further, there appear to be rules preventing fraternity members under the age of 21 from acting as bartenders and these are not consistently being followed. There should be a review of all such rules and they should either be enforced or changed. The committee had extensive discussion on the advisability of prohibiting alcohol at on-campus parties. The majority view was that this would encourage more unregulated off-campus parties. While this may be true, it is clear that the current situation is problematic and, at a minimum, more education of fraternity members and enforcement of regulations is necessary. This issue may become moot because some observers at the national level believe that all chapters may be forced to become alcohol free due to the large legal judgments being assessed in those cases where fraternity behavior was blamed for alcohol-related deaths. We recognize that stronger enforcement may require additional staffing, and recommend that there be a general review of the staff support in this and other areas related to the Office of the Vice Provost for University Life.
One function of the alcohol coordinator could be to refer each major alcohol-related incident on campus to the appropriate office to determine whether disciplinary action should be taken against those who provided the alcohol and to follow-up to be sure that these investigations are completed. This responsibility of the server is the legal theory behind the "dram shop" cases wherein a host is held accountable for an auto accident caused by a guest who became intoxicated. We recommend that stricter sanctions be imposed on those individuals and collective bodies that are found to provide alcohol in violation of University policy. This includes fraternities and hosts of social events both on and off campus.
2. Response to alcohol-related incidents. The University's response should be primarily corrective and therapeutic rather than punitive. The current system has many good and effective features, but there are opportunities for improvement. We recommend:
a. Centralized database for alcohol related incidents. Currently there is little likelihood of early detection of a student who is having multiple minor problems related to alcohol in different components of university life-academics, dormitory, campus police, etc. Ideally such a student should be contacted and mandated for a counseling/educational program. It should not require failing grades, near death overdose or alcohol-related violence to bring a student into the remedial system. Early detection is usually more effective in correcting such problems although individuals typically resist treatment until a crisis occurs. Confidentiality is a priority, but such a database could be treated as a medical record and not be made available to outside inquiries. Further, the record could be expunged at the time of graduation.
b. Follow-through with students identified as having problems. Current practice is for students identified as having alcohol related problems to be referred for peer group counseling or for student health services or for small group health education specific to alcohol and other drug issues. A large proportion of students do not follow through with recommendations for further services and few of those with actual alcohol abuse receive satisfactory treatment. It appears that students are not mandated to continue. Most, as expected, deny that there is any need for counseling. Alcohol related problems tend to be chronic and require long term intervention. An alcohol coordinator could see that educational and/or therapeutic programs are followed as indicated, usually for a minimum of six months and perhaps longer. Such follow up should be seen as helpful rather than punitive, but still an absolute requirement.
c. Parental notification. Notification of parents whenever a student comes to the attention of the alcohol coordinator should be standard policy of the University. This is apparently desired by a majority of parents and must be made clear to students. Of course it will be important to communicate appropriately with parents in order to avoid causing undue alarm and to enlist the cooperation of the parent in the corrective measures, and we understand that there may be situations in which sensitivity and discretion may be needed-particularly where alcohol problems may be related to parental and family issues and pressures. Having an alcohol coordinator experienced in dealing with the families of those with drinking problems will be important.
d. Underage drinking. Alcohol consumption by those under age 21 is against the laws of the Commonwealth of Pennsylvania. University policies must support this legal requirement, but every case of underage drinking does not necessarily require that a student be mandated for the educational/counseling program to be administered by the proposed alcohol coordinator. Some sanctions, however, should always be applied in the case of underage drinking and repeated violations should engender progressive sanctions and referral for the educational/treatment program. An alcohol coordinator will see that the response to underage drinking is consistent across campus.
e. High risk behaviors. Certain behaviors call for "zero tolerance" and should produce immediate serious disciplinary consequences up to and including immediate suspension. These activities include drinking games, alcohol used in hazing rituals, rapid consumption methods such as beer funnels or gastric tubes, assaultive behavior while intoxicated, false identification cards, etc. Where permitted by University policy, alcohol violations occurring off-campus should be dealt with in the same manner as on-campus behavior.
The University of Pennsylvania is already making great efforts in addressing the problems associated with excessive drinking. This responsible approach can be further improved by attention to the suggestions indicated above. Recommendations that will entail costs not currently supported by the various department budgets are:
Almanac, Vol. 45, No. 3, September 15, 1998