Responding to Excessive Alcohol Consumption in Third-level (REACT) is an award and accreditation scheme for third-level institutions that carry out a set of activities to reduce alcohol-related harm among its students in Ireland.1,2,3 A new study has been published based on qualitative data collected as part of the programme’s evaluation, entitled ‘College students’ perspectives on an alcohol prevention programme and student drinking – a focus group study’.4

The REACT programme

In 2014, the Health Service Executive (HSE) commissioned a research team to develop a public health intervention to address alcohol use among third-level students. REACT is a multicomponent intervention which has established an award and accreditation system for institutions that make ‘significant changes within their campuses to tackle the growing issue of excessive alcohol consumption among students’ (p. 2).2 As such, it is an environmental rather than an educational initiative. Participating institutions are required to carry out activities from a suite of mandatory and optional action points.3 Examples of the mandatory action points are to develop a college alcohol policy; train relevant staff in brief intervention therapy on alcohol misuse; encourage incoming students to take an online brief intervention tool; and form a steering committee to be chaired by a senior college official with representation from students, staff, Gardaí, the local council, and the Local Drugs and Alcohol Task Force. By August 2019, some 10 institutions had received the REACT award.5

Study aim

When reviewing the national and international literature, Calnan and Davoren4 found limited previous research on students’ perspectives of interventions designed to reduce alcohol consumption and related harms among college students. However, they found growing consensus in the literature that good intervention development takes account of the views of the target audience to ensure the interventions are ‘engaging, relevant and useable’ (p. 2). Their study aimed to fill this gap by examining students’ perceptions of alcohol prevention measures and consumption more generally.

Methodology

Qualitative focus groups were carried out in two colleges participating in the REACT programme in 2018: one rural institute of technology and one urban-based university. Participants were purposively sampled to include young undergraduates, mature students, international students, and students who are members of a club or society. Purposive sampling as a method produces a sample that can map the range of experiences in relation to a certain topic, based on expert knowledge of the population and topic of interest. The authors selected the two institutions to capture the variation in college settings. Different categories of students were selected, as earlier research from the REACT evaluation found differences in alcohol consumption based on age and nationality of students, as well as their membership of a college club or society.

To inform the discussion, participants received information about the REACT programme prior to the focus group. Topics covered in the groups included the REACT programme, college drinking more generally, and what activities participants would recommend to address students’ hazardous drinking.

Theoretical framework

The authors placed the study’s findings within the context of the international literature on students’ alcohol use and prevention and the Irish alcohol policy landscape. While a detailed description of these is beyond the scope of this article, the theoretical framework adopted by the authors should be considered. A social-ecological model of prevention, as used by the Centers for Disease Control and Prevention (CDC),6 identifies four levels of influences:

• Societal (e.g. national policy on alcohol regulation, societal attitudes to alcohol)
• Community (e.g. easy availability of alcohol, institutional policies related to alcohol, college setting)
• Relational (e.g. peer group or family influences on alcohol-related behaviours)
• Individual (e.g. age, nationality, beliefs about alcohol norms).

This model recognises that the causes and solutions to college students’ excessive drinking require a comprehensive approach that takes account of each of the four levels outlined above.

Findings

The study’s findings illustrate the complex nature of alcohol use among college students, its role in Irish culture, and the challenges facing prevention interventions in the third-level context. Three broad themes were found in the analysis and some of the key findings are outlined below. 

1. Perceptions of student drinking

• Pervasiveness of alcohol: Drinking was perceived to be endemic in third-level institutions. It is facilitated by numerous community-level factors, such as easy access to cheap alcohol in supermarkets, a high density of pubs in the environs of campuses, and a tendency in some cases for underage drinking to go unmonitored.
• Transient nature of drinking: While endemic in college, heavy drinking was also perceived to be a transient phase for many students. Patterns of heavy use were not necessarily consistent throughout college and students described them as dynamic and open to change. Participants’ experiences highlighted the heterogeneity within the student population – while mature or international students tended to drink more moderately or not at all, some of the younger Irish undergraduates also had this pattern of use. Alcohol-free events had also been organised by some college societies. The authors suggest that this could indicate a possible shift in the drinking culture among this population and that there might be an openness to change.
• Intractable problem: Students recognised the need for alcohol prevention measures. However, some expressed doubts and scepticism that programmes like REACT, which focus on the college level, will have an impact. For example, they raised the issue of displacement. While college campuses may clamp down on the availability of alcohol, students will access drink elsewhere. Off-campus drivers need to be addressed as well, for example, the high density of alcohol outlets in the community and the growing culture of pre-drinking (drinking cheap alcohol at home before going out).

2. Importance of lived environment

A recurring theme was that there is a need for more alcohol-free spaces for students to socialise. Socialising was perceived to be core to the college experience and the study found ‘a genuine desire for alternative settings that are less predicated on the consumption of alcohol’ (p. 11). This related both to places to socialise and student accommodation. 

3. Responsibility for controlling student drinking

Students varied in who they thought was responsible for addressing students’ drinking patterns, and therefore the measures they proposed to address the issue. Younger students tended to focus on personal responsibility, while mature students focused on the college’s responsibility. Where younger students focused on personal responsibility, the authors suggest ‘these students may embody one of the central tensions of the so-called “neo-liberal social order”7 … having to navigate a world where alcohol is ubiquitous and aggressively marketed but still perceiving themselves as self-regulating, responsible consumers’ (p. 16).4 They note that it also resonates with the proliferation of the ‘responsible drinking’ messages characteristic of alcohol-industry-funded campaigns. Where students perceived the college to have responsibility for addressing problems associated with student drinking, the interventions suggested included a mandatory alcohol education module for students; monitoring absenteeism; enforcing the legal age limit for the sale of alcohol; and providing alcohol-free accommodation, social events, and settings.

Discussion

In their discussion, the authors note how participants collectively acknowledged the multiple layers of influence as laid out in the CDC framework on both student alcohol consumption and the interventions required to address it. Based on their findings, the authors suggest that stakeholders who want to reduce hazardous drinking among students need to reframe the question they ask:

… not how can they reduce excessive alcohol consumption, but rather how can they create or engineer environments that enable a diverse student population to connect and engage with each other, to express themselves and have fun, in spaces beyond the narrow confines of alcohol-infused environments’ (p. 17)4

Among the implications of their findings for the REACT programme are the following:

• There should be a focus not just on the college but also the wider community in which it is based. An optional action of REACT is to map the density of licensed premises. The authors suggest this would be useful information with which to lobby local authorities to reduce the high density and mitigate potential displacement effects among students.
• There should be more emphasis on establishing alcohol-free alternatives for student socialising settings and activities, as well as accommodation.
• When designing interventions, student representation is very important. REACT should broaden the student voice represented to reflect the heterogeneity among students.

Concluding comment

This study provides valuable insights into the heterogeneity within the student population in relation to drinking habits and therefore the required responses. It identifies opportunities to influence the endemic nature of drinking in colleges, with interventions such as those that provide more access to alcohol-free settings and activities, while remaining cognisant of the student need to socialise and connect. The REACT programme provides a valuable opportunity to learn about what works in third-level institutions, with a particular focus on environmental prevention. 

1  For further details on the REACT programme, contact Dr Michael Byrne, head of Student Health Services, University College Cork. M.Byrne@ucc.ie or visit https://www.ucc.ie/en/esprit/research/react/

2  Davoren MP, Calnan S, Mulcahy J, Lynch E, Perry IJ and Byrne M (2018) Responding to excessive alcohol consumption in third-level (REACT): a study protocol. BMC Health Serv Res, 18(1): 364. https://www.drugsandalcohol.ie/29015/

3  Dillon L (2018) Responding to excessive alcohol consumption in third-level (REACT): a study protocol. Drugnet Ireland, 67 (Autumn): 24–26. https://www.drugsandalcohol.ie/29937/

4  Calnan S and Davoren MP (2021) College students’ perspectives on an alcohol prevention programme and student drinking – a focus group study. Nord Stud Alcohol Drugs, Early online. https://www.drugsandalcohol.ie/34130/

5  Department of Education (2019) Minister Mitchell O’Connor opens the inaugural REACT (Responding to Excessive Consumption of Alcohol in Third Level) awards in DCU [Press release]. 28 August. Dublin: Department of Education. Available online at:
https://www.education.ie/en/Press-Events/Press-Releases/2019-press-releases/PR19-08-28.html

6  Centers for Disease Control and Prevention (CDC) (2002) The social-ecological model: a framework for violence prevention. Atlanta, GA: Centers for Disease Control and Prevention. https://www.cdc.gov/ViolencePrevention/pdf/SEM_Framewrk-a.pdf

7  Griffin C, Bengry-Howell A, Hackley C, Mistral W and Szmigin I (2009). ‘Every time I do it I absolutely annihilate myself’: loss of (self)consciousness and loss of memory in young people’s drinking narratives. Sociology, 43(3): 457–476.