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Alcohol and Substance Use Among College-Age Students

Jonathan Avery, M.D. discusses what parents should know about alcohol and substance use among college students. He also discusses how recent drinking trends like BORGs or hard seltzers have been impacting college campuses. He discusses the influx of alcohol-free drinks as alternatives in the beverage market. He highlights successful ways for harm reduction, mitigating risks, and how families can keep open lines of communications around these topics.

To schedule with Dr. Jonathan Avery 

Alcohol and Substance Use Among College-Age Students
Featured Speaker:
Jonathan Avery, MD
Jonathan Avery, MD is an Associate Professor of Clinical Psychiatry & Associate Attending Psychiatrist in NewYork-Presbyterian/ Weill Cornell Medical Center.

Learn more about Jonathan Avery, MD

Melanie Cole (Host): There's no handbook for your child's health, but we do have a podcast featuring world-class clinical and research physicians covering everything from your child's allergies to zinc levels. Welcome to Kids Health Cast by Weill Cornell Medicine. I'm Melanie Cole. And joining me today is Dr. Jonathan Avery. He's the Vice-Chair of Addiction Psychiatry at Weill Cornell Medicine, and he's here to highlight for us alcohol and drug use in college-aged teens. And we're going to address some of the viral trends out there.

Host: Dr. Avery, it's always a pleasure to have you join us. Can you speak to begin with about the normalization of binge drinking and certainly since COVID how alcohol use in society has really kind of hit a peak where social media has really painted a mighty rosy picture? We've seen in commercials and on the media. Tell us a little bit about what you've seen as far as teens and college-aged kids and alcohol use.

Dr Jon Avery: To start, thanks for having me back. It's always great to be here and this is such an important topic. I think when people think about alcohol use disorder or alcohol addiction, they often imagine the middle-aged person drinking every day, losing out on a lot of the benefits of life. But really, it's binge drinking that is going to get most people in trouble in this life. And especially our young kids, the high school kids and heading into college where they're not going to be drinking every day and it's not going to be obvious trouble all the time. But we know high school and college kids binge drink a lot. And we know that binge drinking really gets people in trouble more than, I think, is commonly understood.

Guest: And when we're talking about binge drinking, we're talking about, you know, drinking more than three to five drinks on a given night for men. Binge drinking in women is actually considered around two to four drinks. And an evening out on a college campus, they can, you know, double and triple those numbers sometimes, and that leads to a lot of trouble. And in fact, about half the deaths that are related to alcohol use disorder are from consequences of binge drinking, about 40,000 a year. And so, it's a serious problem that we're paying more and more attention to. And you mentioned social media, which sort of makes it worse, because now there's all these binge drinking trends. You know, I'm here to, I believe, talk about one of them, Borg, but it's really been normalized, popularized in ways that's concerning.

Host: Well, it is. And before both my kids went to college, we had long talks about binge drinking specifically because I'm like, you could set eight shots of tequila in front of you and drink them and get away with it. But then 20 minutes later, you've alcohol poisoned yourself and you'll end up in the hospital. And we talked about it a lot, probably ad nauseum, but they both heard those kinds of things from me, and that communication was so important. So, we see, as you mentioned, social media and TikTok has this trend called Borgs or black out rage gallon. Tell us a little bit about what this is.

Guest: So, there's a little bit of controversy around Borg or the black out rage gallon. in terms of if it's a harm reduction method, how safe is it. Basically, it's when kids often in a milk gallon or some other large container mix water with alcohol, often some different flavorings, even hangover remedies as part of the drinks, like Pedialyte. And by mixing it all together, they're trying to avoid in a smart way, some of the downfalls of drinking too much. They're trying to avoid dehydration, you know, trying to mix water with the drink and so they're not drinking a ton of alcohol all at once.

And so, on the surface, it sounds like it might be a hangover remedy or it might be a safe way to consume alcohol, where you're not just consuming alcohol, but there is water and other nutrients involved. The problem though is that this trend gives permission for folks to drink a ton of alcohol. Like, these gallons of Borg or they have a lot of other names, they can contain as many as 15 drinks. And even if you're drinking slowly, 15 drinks in a course of a week is too much. In one night, that can cause a lot of trouble and we're seeing this. In a college campus, I think they had a party one night where everyone was doing it and 40, 50 people ended up in the emergency room. I'm seeing my patients, my young kids ending up in medical trouble from trends like these. They think they're drinking in a safer way, but they end up with alcohol poisoning as you described or liver damage or it leads to psychiatric consequences from poor sleep and a vicious hangover. And so, it's not as benign and fun as it might seem in.

Host: Well, I have mixed reactions as well. I can see why there is controversy, because on one hand it sounds like our kids are trying to make a smarter choice. Not only that, but keeping these gallons and they're sealed can be a little bit safer for females specifically. But yeah, I mean they're loading them up with a lot of stuff. When we talk to our children about this specific trend, what do you want us to say? Because what if they come back with, "But I put water or a Pedialyte and, you know, I'm putting all these things in it. I'm hydrating," what do we say to them?

Guest: I think we have to highlight their good intentions in a way. Like, I think when you're talking to kids about how to drink safely, you want them to limit the drink number, limit the speed with which they consume. And so, alternating alcohol with water, with other drinks to avoid drinking a lot all at once, which can be especially toxic. So, we can applaud those efforts.

I think the execution often, especially when there's tons of alcohol in these gallons, ends up being problematic. It ends up getting them to a spot they were trying to avoid, which is really intoxicated states that can lead to a lot of issues. And while, yes, it's true if you have your own container, it avoids contamination or people trying to spike it, we know when people are really intoxicated, it's one of the biggest risk factors for being in an assault, for being sexually assaulted, for having accidents that lead to bad outcomes. And so, there's a safety that seems like it's more safe, yet it may actually cause more trouble.

Host: So now, there's also, when we're talking about harm reduction, there's alcohol-free beverages. I see them myself, and I wanted to try the alcohol-free wine or one of the mixed drinks or something like that. And for our kids that are looking at that, I mean, it's obviously better they're not ingesting alcohol, but the behavior or is that okay if they're standing around at a party and they're holding a non-alcoholic beer?

Guest: Well, at least with those, there's no alcohol, so that's a positive. You know, I think sometimes with the Borgs or even with like flavored hard seltzers that have alcohol in it, there's sometimes a perception that those are safer than they are, when in fact they carry still risk because there's the alcohol and sometimes a lot of alcohol in them.

For these non-alcoholic drinks, at least it provides an alternative to kids in terms of what they can drink instead of the alcoholic beverage. My adults rely on it often in social settings. If not one of those, just a club soda. I think the general principle though for them, more important than what they're drinking is how to say no, how to stay safe and how to avoid being in a state you'd rather not be in. And for some folks, that can be to incorporate these non-alcoholic drinks. But for others, there's other strategies and including just drinking water and sometimes learning to just say no and be clear about what your boundaries are is as important as anything else.

Host: Well, that leads me to the next question then. How do we teach our kids to just say no? You know, wasn't that a drug awareness program? It was a while ago, Just Say No and all of that, and when they were doing DARE and all that. How do we teach our kids that? Peer pressure's strong.

Guest: I think the key with talking to your kids is to talk to them early on. They're recommending as early as age nine about drinking, where you let them know the risk-benefits. You let them know what their risk is for getting in trouble, what the family history of addiction is. We know people with a history of trauma and mental health issues are especially at risk for getting drinking. And as a family, you start early just having conversations about alcohol, what its risks are, how to drink safely, and you do that so you avoid having these conversations when people are in real trouble. You sort of give them a safe spot where they can sort of talk about their drinking, what's working, what's not.

For parents, they shouldn't be going around telling the kids to just say no and never drink because then kids, it's an opportunity to rebel and it's an opportunity to hide the drinking, right? If you know someone is saying, you know, "Just say no. There's no place in this house for any problematic behavior," then the kid's going to push it to the secrets and in the secrets is really where addiction survives.

And so, my hope with all these trends, and the good thing is that people are tweeting about it and TikTok-ing about it. And as many TikToks as there are about these sort of new drinking trends, there's a lot about how these drinking trends got people in trouble. And as these trends come in rapidly on social media, I've seen they go pretty quickly because kids are smart. They're hopefully having these conversations with their parents or at school and they can start to create content that results in even safer ways to consume alcohol. So, that's our hope.

Host: So, my last question to you is a trust issue. You say that, you know, in the secrets come that addiction and we want those lines of communication open with our kids. When they're at college though, it's a whole different deal. As this psychiatry guru that you are, do we trust our kids? Do we keep track of them? How do we, when they're at college feeling like they are grown young adults, try and sort of keep tabs on what they're doing as far as drugs and alcohol? Because that's the scariest thing for so many parents like me.

Guest: No, it's a real dance and it's one that's hard to do well because all this problematic drinking and high-risk behavior is happening at a time where the kid is looking to separate from their parents and find their own identity out in the world, understand what makes them tick and how they can be successful in this life and find what they're looking for. And so for parents, it's trying to maintain that connection as they grow up and separate, while at the same time fostering their independence, and that dance is really hard to do.

The hope is that you can keep them close enough in a positive way, that if they're struggling, that they know it's a safe spot to come with you to talk about those things. But it's hard because, you know, addiction, mental health issues, they come with a lot of shame. And even when we set that safe space, sometimes it's not enough and it's hard to get a grasp on our kids. And so, it's scary, it's hard, it's anxiety-provoking. I mean, thinking about my own kids entering college in a couple years, it frightens me. It's not easy for us to deal with as parents. But I say we do our best early on to just keep that relationship going, keep the communication open and non-judgmental and hope that, if they're struggling, that they'll lean on us.

But also, I think we should provide them with other options and opportunities. Like there's more treatments than ever for mental health and addiction these days. They're available in person certainly, and many colleges do have programs that address binge drinking now and certainly mental illness in person. But there's a bunch of telehealth options. There's medications that help people curb drinking. And so, maybe it's important to highlight that we care, but also to highlight other ways for them to seek help if they find themselves in trouble.

Melanie Cole (Host): Well, I couldn't agree with you more. And listeners, as a parent who had two kids in college, well, one is still there, but one graduated, I can tell you that what Dr. Avery is saying is 100% accurate. Lines of communication are what is most important. And if you've got those open lines, your kids will feel that they can call you if they're worried or if they're concerned, and there is so much telehealth and options out there. So, great advice, Dr. Avery. Something we can certainly all hear.

And Weill Cornell Medicine continues to see our patients in person as well as through video visits and you can be confident of the safety of your appointments at Weill Cornell Medicine. And that concludes today's episode of Kids Health Cast. We'd like to invite our audience to download, subscribe, rate, and review Kids Health Cast on Apple Podcast, Spotify, and Google Podcast. And for more health tips, go to and search podcasts. And don't forget to check out our Back To Health. I'm Melanie Cole.

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