Jason Kilmer, PhD, associate professor of psychiatry and behavioral science, University of Washington; assistant director of health and wellness for alcohol and other drug education, Division of Student Life, University of Washington.

Joan Masters, MEd, senior coordinator, Partners in Prevention, University of Missouri Wellness Resource Center; area consultant, The BACCHUS Network.

Ann Quinn-Zobeck, PhD, former senior director of BACCHUS initiatives and training, NASPA - Student Affairs Professionals in Higher Education (peer education initiatives addressing collegiate health issues at US colleges).

Pierre-Paul Tellier, MD, director of student health services, McGill University, Quebec.

Ryan Travia, MEd, associate dean of students for wellness, Babson College, Massachusetts; founding director, Office of Alcohol & Other Drug Services (AODS), Harvard University.

American College Health Association. American College Health Association–National College Health Assessment II: Reference Group Undergraduates Executive Summary Fall 2015. Hanover, MD: American College Health Association; 2016.

Borsari, B., & Carey, K. B. (2001). Peer influences on college drinking: A review of the research. Journal of Substance Abuse, 13, 391–424. Retrieved from https://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.602.7429&rep=rep1&type=pdf

Borsari, B., & Carey, K. B. (2006). How the quality of peer relationships influences students’ alcohol use. Drug and Alcohol Review, 25(4), 361–370.

Crawford, L. A., & Novak, K. B. (2007). Resisting peer pressure: Characteristics associated with other-self discrepancies in college students’ levels of alcohol consumption. Journal of Alcohol and Drug Education, 51(1), 35–62.

Harrington, N. G. (1997). Strategies used by college students to persuade peers to drink. Southern Communication Journal, 62(3),  229–242. Retrieved from https://www.tandfonline.com/doi/abs/10.1080/10417949709373057?journalCode=rsjc20

Kilmer, J., Cronce, J. M., & Logan, D. E. (2014). “Seems I’m not alone at being alone:” Contributing factors and interventions for drinking games in the college setting. The American Journal of Drug and Alcohol Abuse, 40(5),  411–414.

Neighbors, C., Lee, C. M., Lewis, M. A., Fossos, N., & Larimer, M. E. (2007). Are social norms the best predictor of outcomes among heavy-drinking college students? Journal of Studies on Alcohol and Drugs, 68, 556–565.

Neighbors, C., Jensen, M., Tidwell, J., Walter, T., Fossos, N., & Lewis, M. A. (2011). Social-norms interventions for light and nondrinking students. Group Processes & Intergroup Relations, 14(5), 651-669. doi: 10.1177/1368430210398014

Palmeri, J. M. (2016). Peer pressure and alcohol use among college students. Applied Psychology Opus, NYU Steinhardt. Retrieved from https://steinhardt.nyu.edu/appsych/opus/issues/2011/fall/peer

Perkins, H. W., Linkenbach, J. W., Lewis, M. A., & Neighbors, C. (2010). Effectiveness of social norms media marketing in reducing drinking and driving: A statewide campaign. Addictive Behaviors, 35, 866–874.

Seigel, S. (2011). The four-loko effect. Perspectives on Psychological Science, 6(4), 357–362.

Student Health 101 survey, July 2016.

Turner, J., Perkins, H.W., & Bauerle, J. (2008). Declining negative consequences related to alcohol misuse among students exposed to social norms marketing intervention on a college campus. Journal of American College Health, 57, 85−93.

Wechsler, H., Nelson, T. E., Lee, J. E., Seibring, M., Lewis, C., & Keeling, R. P. (2003). Perception and reality: A national evaluation of social norms marketing interventions to reduce college students’ heavy alcohol use. Journal of Studies on Alcohol, 64, 484–494.

How invitations can set the tone and expectations

Set the tone
How you talk about a party can go a long way in helping your guests imagine what it will be like. What’s the tone or vibe you want for your party? For example:

• If you don’t want people throwing up on your couch, don’t advertise the party with lots of alcohol images.
• Party themes can be fun—if they’re inclusive and thoughtful. Themes based on racial or gender stereotypes set up the party for failure.
• Consider how many guests you can realistically handle: the  more people, the more potential for problems.

Set expectations
Are there “house rules” you want your guests to know about? For example:

• You’d like to know in advance if they’re bringing friends
• Certain spaces in your venue are off-limits
• Behavioral tip-offs:
• “Costumes are optional; respect for everyone is required”
• “Please help us with cleanup before you leave”

“Oh, hi there!” Why it helps to have a designated greeter

Set a friendly tone
Consider explicitly assigning someone (or a few people) the task of greeting guests and inviting them in.

House rules
If there’s stuff your guests need to know, like when this thing is shutting down, consider posting it in the entryway.

Check in with arriving guests
Are they arriving alone? Slurring their words? Wobbly on their feet? You might want to check in with someone’s friends, get them medical attention, or not serve them any more alcohol.

Send people home safely
Make sure your guests have a safe way to get home. Check in with them as they leave. Post info about taxi and ride services, as well as medical response resources in case of accidents or alcohol poisoning.

Give certain people a heads-up

Here’s why that works out better for you:

Check in with your neighbors

• Let them know you’re planning a party. Better yet, invite them! Let them know the day and time of the party (start to end).
• Give them your phone number. Ask them to call or text if they have any concerns. Ideally, any noise complaints would be communicated to you first, rather than to the police. Don’t forget to pay attention to your phone during the party.

Check in with your campus security department

• They will get in touch with you if something happens in your area that you and your guests should know about.
• They may give you a call if they get a noise complaint rather than showing up and shutting the party down.
• They may be able to help people get to and from the party safely.

Check campus policies and state laws

• For example, if alcohol is being served and you do not have a liquor license, it may be illegal to collect money at the door—for any reason.

Why parties need several spaces and options

Not everyone has fun the same way all the time.

Dance space
When you’re putting together the playlist or choosing entertainers or DJs, think about how well they fit your values and priorities for the party. Avoid music that seems derogatory or aggressive.

Chill space
Provide a quieter, more well-lit space where your guests can hang out, catch their breath, and talk. Play softer music. It’s a good idea to stock this space with cold water bottles and low-salt, high-protein snacks.

A set-up that makes room for conversation will help your guests communicate more clearly. This is especially important if two people are considering going home together.

Think about adding activities (apart from dancing) that don’t involve alcohol, like Jenga®, board games, and trivia.

What to do about isolated spaces

If there are isolated spaces in your party venue, decide whether or not to keep them open and accessible.

If not: Lock the door, rope off the space, and/or hang signs saying the space is closed.

If you keep isolated areas open, assign someone the task of checking in on those spaces throughout the party.

How to trouble shoot at parties

Get medical help in case of alcohol poisoning
Take a moment to familiarize yourself with the medical response resources available on your campus or in your community. If everything goes according to plan, your guests will drink safely and won’t need to use them.

Any of the following symptoms indicates alcohol poisoning
Call for medical help immediately:

• Can’t walk unassisted
• Unconscious and unresponsive
• Vomiting continuously

Handle difficult guests
Keep your cool. Controlling tone and body language can be tricky, but it’s crucial to prevent the situation from escalating further.

• Make clear “I” statements. Telling someone that they are too drunk or too aggressive invokes defensiveness. Try something like “I’m sorry but I can’t give you another drink” or “I’m going to have to ask you to leave.”
• Ask for help. If the situation seems volatile, enlist the help of others: your co-hosts or close friends, or friends of the person causing trouble (ask them to take their friend home).

How to be the party-thrower of party-goers’ dreams

Make yourself noticeable
Pick a certain color, a silly hat, or a large pin (“Here to help!”). This lets guests know where to turn if anything comes up. If a large group is throwing the party, consider trading off “hosting duties” through the evening.

Model supportive social dynamics
Party-throwers are especially attuned to the general mood. You get to take the lead on looking out for one another and treating guests with respect. If you drink alcohol, stop after one or two.

Make the rounds
Introduce people and troubleshoot issues as they come up.

Check isolated spaces, such as bedrooms, closets, and yards.

Subtly disrupt uncomfortable situations
Maybe a guest is getting unwanted attention or someone is pressuring others to drink. It’s your party: You can check in whenever you notice something, no matter how small. The most effective interventions happen early and subtly. Distract people, change the topic, make a joke or an introduction.

How to help your guests make mindful choices

If you plan to serve alcohol, aim for an environment in which everyone can make mindful, deliberate choices about whether they want to drink and how much. A successful party does not have to involve alcohol.

If you serve alcohol:

• Keep it in one place. This way, your guests drink only if they’ve made an active choice to do so. Having alcohol in multiple places suggests that drinking (and often drinking heavily) is the default.
• Have ice on hand. Your cocktails and mocktails (nonalcoholic cocktails) will feel fancier and your guests will take their time sipping their drinks.
• Use narrow cups and proper measuring tools. If you’re serving hard liquor, use a 1 oz. shot glass.
• Offer one or two nonalcoholic mocktails; promote them on signs or posters. Look online for recipes.

Why it helps to have a designated server

For guests, this set up makes drinking an active choice rather than a default. It’s easier for people to count their drinks over the course of the evening.

Designated servers are awesome at these party skills:

• Mixing tasty cocktails that complement the party theme, or just serving beer or wine.
• Not over-pouring drinks.
• Keeping an eye out, noticing who needs to switch to something nonalcoholic.
• Offering nonalcoholic options, including mocktails.

Many campuses and community organizations offer classes on bartending skills and safe serving practices—often for free.

Pay attention to the invitation

Notice the tone 
The invitation (whatever form it takes) should give you some idea of what your hosts have in mind. Big house party? Chill get-together?

Respect their house rules 
Validate the hosts’ trust in you. They might want to keep certain areas off-limits, or they may need to end things at a certain hour.

Plan ahead
Think about what you want out of the party. If alcohol will be served: Do you want to drink? How much? You can have a great time at any party without drinking any alcohol. If you do plan to drink, a good rule of thumb is one standard drink every hour or 1½ hours.

Be a good sport about the theme 
If your hosts have gone through the trouble of coming up with a theme, do your best to play along. A good theme will make room for everyone to participate in whatever way they feel comfortable, so feel free to find your own.

• Does something about the theme seem off to you? Playing to racial or gender stereotypes is unlikely to end well. If the theme raises a red flag, bring that up with the hosts ahead of time. They would probably prefer to tweak things early on than end up with a lousy party.

Touch base with the host in advance

Get in touch with your host at least a day in advance. Do they need help setting up? Or staying late to help clean up? This a great way to show your appreciation.

If you want to bring something, consider snacks (preferably low-salt and high-protein ones, like Greek yogurt dip or hummus with veggies) or mixers. These go quickly at parties, and your hosts will appreciate having extras.

Say hi to the host and the newbies

Find the host when you arrive
You’re here to see them, and they’ll be happy to know you made it. Ask if they could use a hand with anything.

If you don’t know many people there, tell your host
They want you to have fun. They probably have a good sense of who you’ll get along with, and can introduce you.

If you see new faces in the room, say hello
Offer to show them around, and introduce them to other guests. You’ve been that newbie—remember the relief when someone made you feel welcome in a new space.

If you’re the newbie, branch out

• Parties are a great place to meet new friends. Foolproof conversation starters: “How do you know [the host]?” and “Got any tips or intel for rookies about life at [this school]?”
• Trust your instincts. You may be new to this particular space, but you’re very good at knowing when you’re having fun and feeling welcomed. If you’re feeling pressured or getting an uncomfortable vibe from someone, pull a third person into the mix or come up with an excuse to leave the interaction.

Respect other people’s limits – and your own

Fun means different things to different people. Some people would rather hang out and talk than spend the night on the dance floor. Some people will be more comfortable getting physical than others. Whatever it is, pay attention to the cues you’re getting, and respect them.

• Most of us are very good at reading the subtle communicative cues we get from other people—including in romantic and sexual situations.
• We can tell when someone is engaged and enthusiastic versus disengaged and uninterested. We notice things like whether the other person is leaning in or pulling away, intensifying or slowing down.
• Ideal encounters happen when there is mutual enthusiasm. If you encounter anything less than that, take a step back and reassess. Hold out for a better situation.

Look out for yourself and others

If you notice a troubling dynamic, think about how best to step in
Perhaps you notice someone experiencing unwanted attention or being pressured to drink more than they want to. Maybe you see some broken glass or someone in need of medical attention.

Whatever it is, there’s always something you can do
This is your community, and you play an important role in making it a positive and supportive one. You could:

• Check in: Say hello, ask a question, ask for help. A small distraction like that can give someone the out they need.
• Engage the hosts: Let the people who are throwing the party know sooner rather than later. The sooner you spot potential trouble, the easier it is to redirect things unobtrusively.
• Find the friends: If you don’t know the people involved, you can find their friends and see if they can intervene.

If you’re worried that your friend is pressuring others
This can be a great opportunity for a stealthy intervention—for example, by joining a conversation or people on the dance floor. If you’re close to your friend, you can always demand that they consult you about something important in the other room.

If you choose to drink, do so mindfully

People have different limits when it comes to alcohol
Many people make the decision not to drink alcohol at all. Pressuring someone to drink beyond their limit puts them at risk and creates more work for your host. That guest who drinks too much may get sick, need medical attention, or be unable to get home safely.

Trust your own limits
Be especially cautious if you are stressed or sleep-deprived, taking medication, have alcohol misuse in your family, or have diabetes. If you’ve chosen to drink alcohol, remember to pace yourself so that you’re sober enough to enjoy the party and the company of your friends. Tips for drinking safely:

• Think ahead to the party and decide if and how much you want to drink.
• Limit yourself to one drink per hour or 1½ hours.
• Hydrate! Alternate alcoholic drinks with water, seltzer, or soda.
• Ask and remind friends to support your decision about drinking limits.
• Avoid drinking games. “Drinking games are designed to have you fail and promote more drinking,” says Dr. Scott Lukas, a researcher in substance use and professor of psychiatry at Harvard Medical School.

Include people who don’t want to drink

• Offer nonalcoholic options if you’re offering to get the next round of drinks: “Does anyone want another beer or soda?”
• Suggest conversation and dancing—activities that don’t center on drinking. Think of something that everyone can take part in.
• Model reasonable drinking habits so that sober people feel comfortable being around you. Feel free to turn down a drink you don’t want with a quick “No thanks” or “Still working on this one.”

Check in again before you leave

Thank the host for a great party
Ask if they need anything before you head out: Can you lend a hand cleaning up? Can you walk someone home or give them a ride?

Don’t leave your host in the lurch
If your host is dealing with drunk or unruly guests, ask what you can do to help. Maybe you could suggest that everyone head out for pizza, help find the stragglers’ friends, or offer them a ride home.

Follow up the next day

Thank your host
They’ll be happy to hear what you enjoyed. If their party planning supported different ways to have fun, say how much you appreciated it.

Check in with anyone you may have been concerned about at the party

• If you weren’t able to act in the moment, don’t assume the opportunity has passed. You can always check in afterward: “I saw you at the party on Saturday. I was concerned. Did that work out OK?”
• This is especially effective if you are noticing an ongoing dynamic. You might get coffee with a friend to talk about their new relationship. You can also check in with a friend if their behavior has been a little pushy lately.
• If you are concerned about a friend’s behavior, it can be useful to talk to them later when there is time to sit down.
• Avoid taking an accusatory tone. Voice your concerns about the particular situation or pattern of behavior.
• Make sure your friend knows you’re bringing this up because you care about them and you want to look out for them. You can say something like: “I know you meant well” or “You know that I think you’re a great person.”
• You know your friend best: You’re equipped to figure out how to have a conversation about why it’s wrong to use pressure.

Melanie Boyd, PhD, assistant dean in student affairs at Yale University; lecturer in women’s, gender, and sexuality studies.

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Abbey, A. (2002). Alcohol-related sexual assault: A common problem among college students [Supplement]. Journal of Studies on Alcohol and Drugs, 14, 118–128.

Benson, B. J., Gohm, C. L., & Gross, A. M. (2007). College women and sexual assault: The role of sex-related alcohol expectancies. Journal of Family Violence, 22, 341–351.

Banyard, V. L., Plante, E. G., & Moynihan, M. M. (2004). Bystander education: Bringing a broader community perspective to sexual violence prevention.
            Journal of Community Psychology, 32(1), 61–79.

Bay-Cheng, L. Y., & Eliseo-Arras, R. K. (2008). The making of unwanted sex: Gendered and neoliberal norms in college women’s unwanted sexual experiences.
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Carmody, M. (2005). Ethical erotics: Reconceptualizing anti-rape education. Sexualities, 8(4), 465–480.

Hingson, R. W. & Howland, J. (2002). Comprehensive community interventions to promote health: Implications for college-age drinking problems.
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Lindgren, K. P., Pantalone, D. W., Lewis, M. A., & George, W. H. (2009). College students’ perceptions about alcohol and consensual sexual behavior: Alcohol leads to sex.
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Mohler-Kuo, M., Dowdall, G. W., Koss, M. P., & Wechsler, H. (2004). Correlates of rape while intoxicated in a national sample of college women.
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Sweeney, B. N. (2011). The allure of the freshman girl: Peers, partying, and the sexual assault of first-year college women. Journal of College & Character, 12(4).

How we know about the alcohol placebo effect
Most people have heard about the placebo effect when it comes to medications. In studies, people who think they are taking a medicinal drug, but who are actually taking an inert substance (a “sugar pill”), report that it alleviates their symptoms of illness.

The placebo effect is just as powerful in our experience of recreational drugs. We’ve known this for decades. In the 1970s, researchers opened a specially designed “bar lab,” a drinking setting that allowed them to study the effects of alcohol, at the University of Seattle. This has been replicated at many colleges around the world. In 1981, a review of the literature on alcohol and placebo by G. Alan Marlatt, founder of the original bar lab, established that our response to alcohol is influenced by our expectations.

Drinking fake booze can even make us slur our words and become physically or socially clumsy, provided that we believe the alcohol is real, according to the review in Addictive Behaviors (1981).

Students’ Stories:

“My friends knew I had never drunk alcohol before. They told me they bought a beer for me to try, knowing I wanted to be around people I trusted the first time. I drank the beer and started feeling very drunk. I got hot and became more outspoken than I ever had. Later they told me that it was a nonalcoholic drink. I was confused as to why I [experienced] those effects.”
—Jamie N., Indiana Institute of Technology

“I feel like whenever I have drunk nonalcoholic drinks, it does have [intoxicating] effects. I don’t know if that’s because there is a [certain] mindset when drinking this sophisticated drink.”
—Minna D., Clemson University, South Carolina

In familiar places, we may have more alcohol tolerance
Your brain doesn’t like surprises (perhaps because, over the course of evolution, surprises have tended to be negative). As a result, your brain rapidly associates specific environments with certain expected experiences.

This affects your drinking. If you typically drink in one place, the cues associated with that place—like the smell of beer, or the sight of bottles glowing behind the bar—become linked with alcohol. These environmental cues tend to make you more tolerant of alcohol in that setting, according to a 2011 study in Perspectives on Psychological Science. Over time the effect may diminish, unless you drink more. (Feeling “less drunk” can mask some effects, like slower reaction times; you may still be unsafe to drive.)

In unfamiliar places, we can get more drunk on the same amount
In contrast, drinking in a new situation tends to lower our tolerance. That’s because the brain doesn’t know what to expect without these familiar environmental cues. This means that if you are drinking somewhere new, it’s especially important to pace yourself. You may get much more intoxicated than you would in your usual setting.

With other drugs, like prescription painkillers and heroin, this can have deadly effects, because the usual dose taken in a new setting can become an overdose.

We may get more drunk on unfamiliar drinks
Drinking different types of alcohol may also lower our tolerance, because the novelty of the unfamiliar taste interferes with the cues that ordinarily make us more tolerant.

Studies have shown that people get more intoxicated on the same quantity of alcohol when the flavors and colors of their drinks are changed, again probably because the new drinks don’t provide the usual cues for tolerance (Perspectives on Psychological Science, 2011).

Students’ Stories:

“I was in Brazil drinking [local] wine. The flavor was more watered down than the wine that we sell in the US, so I thought it was not as strong. I thought I could handle it, but I ended up blacking out.”
—Charlie C., University of Maryland

“Sometimes two glasses of wine makes me sick, sometimes I can drink up to four. You can’t really have a number of drinks you say your body can handle, because there’s a lot of variables involved in drinking that people just don’t think about.”
—Kita N., University of Alaska Anchorage

Alcohol amplifies our existing traits
Alcohol also affects how you see yourself. Alcohol does not typically change your personality. Instead, it exaggerates or suppresses your existing traits, particularly the ones that you expect it to enhance or diminish.

If you can be charming and witty after a few drinks, you can be charming and witty sober. It just takes belief in the possibility and an appropriate setting.

If you find that you can’t get there without drinking—or if drinking unleashes your less flattering characteristics—seek help. These are risk factors for serious drinking problems. Your college counseling center is a good place to start.

Alcohol makes us see others as more attractive
Yes, science confirms that alcohol makes potential sex partners look more attractive. In a 2011 study of 80 heterosexual college drinkers, those who were mildly or moderately drunk rated pictures of opposite-sex strangers as more attractive than did those who were sober. Perceived attractiveness increased in parallel with the participants’ blood alcohol concentration (BAC), according to the Journal of Social Psychology. 

Two main drinking styles were identified initially in relationship to the geography of Europe, according to a 2003 study published by the National Institutes on Alcohol Abuse and Alcoholism.

Where drinking is “heavenly or demonic”
The “Northern” or “dry” European countries—like the UK, Ireland, and the Scandinavian nations—traditionally view drinking as a masculine activity that takes place in bars and pubs, not at home. Getting drunk is often the goal, and alcohol tends to be viewed as either heavenly or demonic, according to the geographical “drinking styles” analysis.

Where drinking is part of family life
In contrast, countries like Italy and France see drinking (wine, particularly) as a part of family meals. Obvious drunkenness is discouraged and shamed. In these “wet” or “Southern” drinking cultures, alcohol is seen as a food, which is neither extremely bad nor good; instead, people who become drunk are seen as lacking self-control. Daily drinking is seen as acceptable in moderation.

Where the US sits in all this
The US tends to have a more “Northern” perspective. Here, drinking is commonly associated with aggression. In part as a result, our policies around alcohol tend to swing between moral opposition (Prohibition being the most obvious example) and more permissive. Daily drinking is viewed skeptically, even if it’s moderate.

How our beliefs about alcohol and aggression affect us
Some studies suggest that the “Northern” belief in alcohol increasing aggression itself leads to more violent behavior by drunk people. However, it’s more complicated than that. Additional research has found that these beliefs affect actions only in certain circumstances, and that larger amounts of alcohol increase drinkers’ aggression regardless of their beliefs.

In a 1995 study, alcohol increased aggression in those who thought it would, but only if they were provoked, according to the Journal of Studies on Alcohol and Drugs. That said, there’s no doubt that drinking “for courage” can lead to disinhibited and potentially dangerous behavior. Healthier coping methods include physical activity, getting outdoors, playing or listening to music, and discussing your fears with a counselor or friend.

Callie* is a female fourth-year student at Empire State College in Saratoga Springs, New York

• People with lower body weight have a slightly higher Blood Alcohol Content [BAC] after drinking the same amount as heavier people.
• Most women have a lower ratio of muscle to fat than most men, meaning they have less blood and water to dilute the alcohol.
• Women typically have less alcohol dehydrogenase (an enzyme that breaks down alcohol).
• The sex hormones interact with alcohol: Alcohol is often more intoxicating just before menstruation.

How Callie handles it
“I make it known before everyone is under the influence that I’m either not drinking or will only have one alcoholic drink. I stick to what I say, so I’m taken seriously the next time.

“I avoid situations where I will feel pressured. Although this didn’t used to be the case when I was younger, I never go out in social situations where there is drinking on a whim. Sometimes I tell everyone that I’m the designated driver. More often than not, my friends are understanding.

“When I do drink, I pre-plan: I have plenty of fluids afterward, and make sure that I eat and get a good night’s sleep.”

Expert view
“Callie has high awareness, knows her limit, and already practices strategies to say no and reduce her drinking. She is managing her risk factor very effectively.” —NC

Red flags for small-bodied drinkers

• Hanging out with people you don’t know very well
• Hanging out with anyone who drinks excessively

Strategies that work

• “Being firm and sticking to a plan is the best strategy.” —SL
• “Practice saying ‘no’ prior to going out, maybe role-playing with a friend or counselor. Ask and remind friends to support your decision about drinking limits.” —NC
• Drink more slowly: Use a larger glass with added seltzer or soda.
• Choose lower-alcohol drinks, e.g., light beer, mixed drinks with only 1 shot of 80-proof liquor, or regular wine.
• Alternate with non-alcoholic drinks: “A ‘virgin’ pina colada or ‘virgin’ daiquiri often looks exactly like the mixed drink, which may take some of the pressure off.” —SL

Junot*, male, first-year student at Wake Technical Community College in Raleigh, North Carolina

• Interactions between alcohol and medication are common. Alcohol can amplify or reduce the effects of medication, and worsen your driving.
• “Alcohol does not mix well with any medication that is used to treat a psychiatric condition. The interactions are not always predictable, and they can change over time in the same person.” —SL
• Talk with your prescribing doctor or pharmacist about interactions between alcohol and medications, whether they are prescribed, over-the-counter, or herbal.
• Check for drug and alcohol interactions.

How Junot handles it socially
“I drink every weekend or every other weekend, usually locally-brewed wheat beers and white wines. I normally only have one or two, sometimes a little more if I’m not driving. Every once in a while I’ll have a lot to drink around close friends.”

Expert views
Junot is right to be very cautious about driving: “If you drink while taking Lamictal, you can have increased dizziness, drowsiness, difficulty concentrating, and impaired judgment. Also, he still needs to set limits before he goes out with friends. If Junot enters a manic phase, he may not be able to control his drinking. Drinking at a bar is still risky unless he has a non-drinking buddy to watch over him. The effects can creep up quickly.” —SL

“Junot’s consistent medication use shows high commitment to his health and managing his mood symptoms. Nevertheless, he continues to practice habits that may put this health goal at risk (e.g., sometimes drinking in excess of two drinks).” —NC

Red flags for drinking while medicated

• Deciding to drink more than usual without close friends nearby
• Drinking unfamiliar alcoholic beverages, which may interact with your medication in unexpected ways
• A depressive phase, which raises the risk of self-medicating with alcohol

Strategies that work

• Brief counseling sessions can help you decrease the frequency and amount of alcohol use, and help you strategize around the conflict between good health and risky habits. —NC
• Instead of relying on your instincts about what’s a safe environment, come up with a written safety plan that addresses if, when, where, and how much to drink; e.g., “Two alcoholic drinks diluted with extra seltzer, drinking only if the environment seems safe, and leave by 12:30 a.m.” —NC

Sam* is a transgenderqueer student in the professional program at Hudson Valley Community College in Troy, New York

• Alcoholism can run in families, according to an extensive body of research.
• “If people in your family struggle with alcohol abuse, you’re not doomed. Up to 30 percent of an individual’s risk of alcoholism is genetic. The environment and your own experiences contribute 70+ percent.” —SL
• Researchers’ estimates of the genetic influence on alcohol use disorders is somewhat mixed. The National Institute of Alcohol Abuse and Alcoholism says genes are responsible for about 50 percent of the risk for alcoholism. The quality of parenting, which can be impaired by alcohol abuse, also affects children’s risk of developing an alcohol use disorder later.

How Sam handles it
“This has absolutely influenced my relationship with alcohol, as has watching people do stupid things while drinking. I refused to drive with anyone who has had even a sip. I am often the designated driver. I’ve called the cops on an ex who got behind the wheel while drunk.”

Expert views
“Both parents have a known alcohol-use disorder and there’s a history of interpersonal trauma. This places Sam at high risk for alcohol misuse, abuse, or dependence. However, Sam shows high awareness of how personal history contributes to risk and practices preventive habits, and is doing an excellent job.” —NC

“We often see the children of parents with an alcoholic-use disorder go to the extreme and never touch any alcohol, because they’ve lived through the devastation that excessive alcohol causes.” —SL

Red flags for people with a genetic susceptibility

• You may be especially sensitive to environmental triggers. “The smells of preferred alcoholic beverages are the primary cues. People, places, and even events are secondary cues. Seeing a drinking buddy unexpectedly can trigger the craving for alcohol.” —SL
• If there’s a history of trauma, you may be at greater risk for difficulties and stress in intimate relationships. —NC

Strategies that work

• “Knowing that you have a family history of alcoholism is key. And know your cues, which are specific to individuals: One person may crave beer and have no reaction to whiskey or vodka. If you used to go to a specific bar to drink, then go to a different establishment for dinner.” —SL
• “If you can’t easily cut down, switch to a different beverage; perhaps pick one that is not so tasteful. This strategy will help reduce the number of drinks per night.” —SL
• Put a limit on your drinking: Figure out your limit.
• Drink slower: “‘Savoring’ the drink spreads out the absorption over a longer period so that blood alcohol levels do not get dangerously high. Avoid ‘chugging’ or any drinking games. Drinking games are designed to have you fail, and they promote more drinking.” —SL
• Seek support from an individual therapist or a support group such as Adult Children of Alcoholics, Al-Anon, or Alateen.

Briona*, female, second-year student at a public university in Michigan

• Alcohol is a depressant. Its effects can be exaggerated when you’re fatigued, depressed, anxious, or stressed.
• “Alcohol can reduce the ‘perception’ of stress. But with increased use, continued drinking actually dampens your stress response mechanisms, and it becomes a cycle of dependency because heavy alcohol use causes a good deal of stress (worrying about withdrawal signs, getting sick, having an accident, etc.).” —SL

How Briona handles it
“I’m a pretty casual drinker. I have a beer at least two or three times a week when school is in session. During breaks from school, it’s not unusual for me to go on three- or four-day benders. Summertime is full of vacations that I take with friends, and we always have alcohol on us. If I’m stressed, drinking helps me forget about that stressor for a while. Alcohol doesn’t have that much of an effect on either my stress or fatigue levels.”

Expert view
“While Briona is aware of her stress levels and the conditions that exacerbate it, she doesn’t seem aware of the risk of managing stress through alcohol, and she demonstrates inconsistent behavior when trying to do this. She is not managing her risk factor very effectively.” —NC

Red flags for drinking while stressed or fatigued

• Increased stress, post-exam periods, breaks and vacations
• “Excessive drinking places you and your friends at greater risk for driving while intoxicated, getting into cars without a designated driver, arguments and fights, and poor sexual health decisions.” —NC
• “Thoughts like ‘Having a few drinks makes my troubles go away’ predict future alcohol dependency problems.” —SL
• Anxiety: “If you have an anxiety disorder, you are more than twice as likely as someone without an anxiety disorder to develop an alcohol dependency.” —SL

Strategies that work

• “Try counseling sessions with a specific focus on stress and alcohol misuse, healthy strategies, and stress-management tools.” —NC
• “To develop more consistent habits, monitor your alcohol use by keeping a diary. Set a goal for alcohol use, including places, frequency and amount, and how friends can help.” —NC
• “I know this sounds corny, but get plenty of sleep! The cycle of being tired all the time will increase stress, blood pressure, diabetes risk, depression, and a whole host of other problems that an individual might try to self-medicate with alcohol.” —SL
• Guide to managing your stress

Christophe,* male, fourth-year student at Mount Allison University in New Brunswick, Canada

• Most people with diabetes can safely consume alcohol in moderate amounts, according to the American Diabetes Association (ADA).
• It is very important to monitor your blood sugar and be alert for symptoms of hypoglycemia, which can be similar to those of intoxication.
• The ADA recommends a limit of one drink a day for women, two for men.
• “Alcohol increases triglyceride levels [a risk factor for diabetes and complications of diabetes] and can interfere with the positive effects of oral insulin products.” —SL
• Consult a doctor about managing your own situation.

How Christophe handles it
“I usually drink twice a week. Since alcohol brings down blood sugars, I will occasionally have a drink made with real sugar. I always carry sugar pills. My friends can tell if I look shaky and sweaty, and they come and ask if I’m OK.”

Expert view
“Christophe is aware of his health condition: He monitors it regularly, and he’s willing to adjust his behavior, but he is not managing the risk factor very effectively. Alcohol lowers blood sugars, but it’s more complicated than that. Over time, alcohol can reduce the effectiveness of insulin and raise glucose levels. He should consult his own health care providers about his. Christophe seems to act on good information when he has access to it.” —NC

Red flags for people with diabetes

• Socializing with people who may not know about your health condition.
• Deciding to drink more frequently and consuming increased amounts of alcohol.
• “Signs of hypoglycemia include: blurred vision, rapid heartbeat, pale skin color, sweating, shaking, and skin tingling. Other signs that will be apparent include: sudden mood changes, nervousness, fatigue, extreme hunger, and eventually a quick loss of consciousness.” —SL
• Drinks may have more hidden calories than Christophe realizes, and then he could be thrown into a dietary imbalance, increasing the risk of complications.”—SL

Strategies that work

• Talk to your doctor about safer alcohol use while managing diabetes.
• “Adhere to a rule about what types of drinks can be consumed safely, and then follow a strict limit.” —SL
• “Only individuals who have their diabetes and blood sugar well under control should consider social drinking. The calories provided by a single drink should be counted as two fat exchanges. Alcohol also stimulates appetite in many people; that can cause overeating and is a problem for people with diabetes.” —SL

Drink slower

• “Increasing the duration that it takes to finish a drink—‘savoring’ the drink—spreads out the absorption over a longer period so that blood alcohol levels do not get dangerously high.” —SL
• Impose limits, e.g., “I know I can handle one drink an hour after food, and I max out at two drinks a night.”

Try strategic counseling

• Brief counseling sessions can help you decrease the frequency and amount of your alcohol use, and address specific risk factors.
• Consider a support group, such as Adult Children of Alcoholics, Al-Anon, or Alateen.

Tools, calculators, and strategies: National Institutes of Health (NIH)

Drug interaction checker: Drugs.com

Info on alcohol absorption, strategies, & more: University of Notre Dame

Risk factors for alcoholism: Mayo Clinic