World Health Organization Risk Drinking Levels Among Mandated College Students: Associations With Alcohol Use, Mental Health, and Academic Performance

The World Health Organization (WHO) uses risk drinking levels (low, moderate, high, and very high risk) as a measure for reducing alcohol consumption in clinical trials. However, these levels have not been specifically evaluated for students who are required to undergo intervention due to their drinking behavior. This study aimed to validate whether WHO risk levels can effectively distinguish between students’ alcohol-related outcomes, depressive symptoms, and academic performance. Researchers also compared two ways of defining risk—by typical drinks per drinking day versus drinks per day—and explored gender differences.

Method:

Researchers analyzed baseline data from three intervention trials involving 1,436 students who were required to participate and were not abstinent. WHO risk levels were adjusted based on gender and then categorized with low risk as the reference group. Regression models were used to examine how these risk levels related to positive scores on the Alcohol Use Disorders Identification Test (AUDIT), peak drinking, alcohol-related consequences, depressive symptoms, and grade point average (GPA).

Results:

• Defining risk by drinks per drinking day spread students more evenly across risk categories, while defining it by drinks per day placed most students in the low-risk group.
• More women than men were classified as very high risk under both definitions.
• Students in the low-risk group had significantly lower scores on the AUDIT, lower peak drinking, and fewer negative consequences compared to those in higher-risk categories.
• WHO risk levels did not effectively differentiate students based on depressive symptoms, and differences in GPA were inconsistent depending on the risk definition used.

Conclusions:

WHO risk drinking levels were effective in distinguishing between levels of alcohol use and related consequences, suggesting they are useful for clinical purposes and for measuring reductions in drinking among college students required to undergo intervention.