Blame burdened Sally Meyers.
She blamed herself for drinking too much the night she was sexually assaulted. She blamed herself for losing the man she once called the love of her life, the man who accused her of cheating on him the night of the assault. She knew he was wrong but accepted the blame.
So she started drinking more. With each drink, she swallowed her blame, not knowing yet that she was a problem drinker, a label she now places upon herself.
Meyers, whose real name WUFT News agreed to withhold to protect her identity, drank once, sometimes twice a week, and only if she didn’t have an exam looming. It wasn’t often, she told herself. As a pre-med student with a near-perfect GPA and multiple extracurricular activities, including a volunteer gig at the hospital, she felt she had earned the right to let loose.
So she would slam back a shot at the pregame party, then toss back a second and a third, a fourth and a fifth. She’d down a mixed drink with another three shots of liquor, and she’d finish up to five drinks at the bar.
She weighed 115 pounds.
In just one night, Meyers sometimes downed enough alcohol to double the weekly amount of alcohol consumption for at-risk drinking, according to the National Institute of Alcoholism and Alcohol Abuse’s criteria.
“It’s like ok, we’re going to have a pregame where we drink before we go drink at the bar, and then we’re also going to pregame the pregame, and we’re literally going to drink as we get ready,” Meyers said. “You just think it’s super common and that everyone drinks too much in college.”
Back then, she didn’t know she was wrong, that evidence shows college students overestimate the percentage of their peers who drink excessively. She didn’t know that neither her drinking nor the sexual risks she was taking weren’t the norm for college students.
If she had known, she might have avoided the sexual assault and contracting herpes.
Researchers across the country are developing ways to help students view their alcohol use and the associated sexual risk-taking in more realistic ways. That research shows that helping students compare their drinking and risky sexual behaviors to peer norms can reduce both types of unhealthy behaviors.
Robert Leeman, Ph.D, an associate professor in the University of Florida’s Department of Health Education, described problem drinking on college campuses as a hot area in research.
“It’s an area that investigators know that certain improvements are needed,” Leeman said.
One of the investigators committed to making those improvements is the University of Washington’s Melissa Lewis. She is developing a brief web-based intervention that would help educate first-year college students, which she plans to offer for free one day.
By offering a free program, Lewis hopes to get empirically supported alcohol and sexual risk interventions into the hands of college administrators. She calls this bridging the gap between administrators and researchers.
“A lot of the [programs] that are marketed to college campuses are not well supported by strong research studies, and I think it’s really hard for college administrators to wade through all of the research,” she said.
The University of Florida’s current program is one that lacks researchers’ support. The web-based program, Think About It, is required for all freshman, but it’s solely an educational program. Leeman said there isn’t any empirical evidence to support that straight educational interventions work.
UF’s old program, eCHECKUP TO GO, was empirically supported. eCHECKUP TO GO was the most common form of education and early interventions for universities.
eCHECKUP TO GO’s empirical evidence rested on its use of personalized normative feedback, which shows students how their behaviors compare to those of their peers.
Dr. Bob Cook, a general practice doctor who holds a master’s degree in epidemiology, said giving normative feedback is an element of almost any effective college drinking intervention. He said research suggests although people are willing to drink as much as the “average” person in their peer group, they don’t want to drink more than what they perceive as “the norm.”
This becomes an issue, however, when students aren’t aware of what is normal.
“If people perceive the normative as a six-pack of beer every Friday, and they drink that amount or less, then they think they’re fine, when really, they’re not,” Cook said.
Data from the American College Health Association back Cook’s assertion. The group’s fall 2015 National College Health Assessment showed that only 57.2 percent of respondents said they drank in the last 30 days, but they perceived that 91.9 percent of students drink.
While eCHECKUP TO GO was once the primary form of education and early interventions for universities, the 2013 Campus SaVE Act prompted universities across the country, including UF and Yale, to switch to Think About It.
The act requires federally funded institutions to train students on how to identify and report sexual misconduct and to promote awareness of rape, acquaintance rape, domestic violence, dating violence, sexual assault and stalking through prevention and awareness programs.
eCHECKUP TO GO only focused on alcohol education, and the Campus SaVE Act created a need for a sexual component as well.
Meyers’ experiences, while not the norm, certainly illustrated the often problematic ties between excessive drinking and risky sex.
On a typical night of drinking, after getting to the black-out level of drunkenness, she would go home with a guy. It made sense to her. In fact, going home with someone was the goal drinking helped her achieve. The guy was drunk. She was drunk. And she was on birth control, so she felt she as acting responsibly.
Eventually, that pattern of behavior left her with a herpes infection. Meyers now has a new form of self-shame. She blames herself for the virus that will haunt her cells for the rest of her life.
“A good third of the people that I’ve slept with, I was blacked out when I did it,” Meyers recalled. “And with almost all of the people that I’d black out and sleep with, in the morning, I felt like I shouldn’t have done that.” She paused, and a tear rolled down her cheek as she added, in a whisper, “I would wish – so much – that I wouldn’t have done that.”
She hates that she let herself become a statistic, she said.
Meyers’ risky sexual behaviors aren’t surprising, at least to researchers.
Excessive drinking increases the odds of risky sexual behaviors, which ranges from having multiple casual partners, to unprotected sex, to situations involving sexual assault.
College students are more likely to have sex, especially with casual partners, and are less likely to use condoms when they’re drinking, according to the American College Health Association. The ACHA’s fall 2015 assessment showed that one in five students reported having unprotected sex while drinking at least once in the past year.
As with excessive drinking, college students tend to assume that risky sexual behavior is normative.
“There’s been quite a few studies showing similar relationships – like we found with alcohol – that people tend to overestimate the risky sexual behaviors that their peers are doing or safety protection measures that their peers are using,” said the University of Washington’s Lewis.
Her own research shows, however, that personalized normative feedback interventions can help college students understand that excessive drinking and risky sex are not really the norm among their peers.
In one study, four different personalized normative feedback interventions were delivered online to 400 college undergraduates. One focused only on alcohol. One focused only on alcohol-related risky sexual behavior. One was a combination of those two, and one was a control group, which delivered a similar intervention on technology use. After examining treatment differences at three months and six months, Lewis concluded that the intervention had significant potential for reducing harmful behavior.
The study showed that the alcohol only and the combined personalized normative feedback interventions both produced significant reductions in students’ frequency and quantity of drinking, and the two interventions with sex content reduced outcomes regarding alcohol-related risky sexual behavior. However, the only intervention that successfully reduced both drinking and risky sex outcomes was the combination.
Lewis said the most encouraging outcome of the study was the reduction in both alcohol consumption and risky sexual behavior.
“We have a lot of interventions that focus on alcohol and that focus on risky sex, but we don’t have a lot of interventions that focus on the role of alcohol in sexual risk taking,” she said.
In fact, the interventions used in that trial were the first to focus on the tie between alcohol and risky sexual behavior. A later study of Lewis’s also demonstrated that the most effective interventions fully connect the relationship between alcohol and risky sex.
Because of these findings, the online program Lewis is developing differs from its predecessors in a big way. It will include a tie to risky sexual behavior. In doing so, it will fulfill the requirements of the Campus SaVE Act, while using an empirically supported method that has been successful in alcohol-only interventions for decades.
Meyers said such a program could be especially beneficial to college women like her, who face stigmas associated with being seen as either too promiscuous or too prudish.
“If women saw that people weren’t having as much as sex as they thought, they wouldn’t have to feel like a prude,” she said.
With so much information to deliver, though, there’s concern about how long these web-based programs can hold students’ attention and whether students will actually pay attention.
This is one area in which Think About It beats the competition. The program intermittently quizzes students, so it requires engagement with the material.
Researchers are still trying to determine the most effective way to make the interventions themselves shorter, Lewis said, because brief interventions, especially web-based, appeal to college administrators who are trying to reach every student.
“College students don’t want to come in for in-person sessions or do multiple sessions,” Lewis said. “They’re busy with a lot going on, and I think that finding the right dose of intervention is key, so I do think that brief interventions are something to focus on, especially when you’re talking about preventative interventions.”
The brief web-based intervention Lewis is working on, though, is also based on an older, in-person program.
The BASICS program, short for Brief Alcohol Screening and Intervention for College Students, is a preventative intervention that targets students who are either at-risk or have already experienced adverse consequences from drinking. It uses a harm reduction approach in which a counselor uses an empathetic, non-confrontational approach to encourage students to change their risky drinking patterns. The program has solid empirical support. Sixty-seven percent of students who received a BASICS intervention resolved their behavior, according to the Substance Abuse and Mental Health Services Administration.
The problem, Leeman said, is that the program doesn’t affect a large enough population. It only curbs the behaviors of the students who receive it, and that group is limited to students who have already experienced adverse consequences.
Leeman and Lewis agree the best thing about a web-based intervention is that it’s scalable.
While the Lewis program is promising for the future of college alcohol and sex education, isn’t available yet because she’s still studying ways to make it more effective. Unfortunately, she has found so far that the reductions in drinking and sexual risk taking are short-lived.
“I’m really trying to focus on how you can get those reductions to be longer lasting,” Lewis said.
Until then, she encouraged students to ask themselves if their peers are really doing what they think.
Meyers echoed Lewis’ sentiments, saying the key to avoiding risky behaviors is to recognize the unhealthy relationships being promoted with both alcohol and sex. She now knows that others don’t drink as much as she thought, and she says that sticks with her.
“I have herpes, and it’ll never go away,” Meyers said. “I have to take special precautions with child birth now, and I have to tell whoever the next person that I want to be intimate with that I have herpes.”
She stopped drinking after her herpes diagnosis but cautioned others against waiting until something bad happens to reevaluate their behavior.
“I’m not saying casual sex is bad because it’s not,” she said. “If you’re a person who is having casual sex, you can’t be doing it drunk. Somehow it’s going to end up affecting your life.”