|Year : 2015 | Volume
| Issue : 1 | Page : 71-75
An exploratory study assessing reasons behind initiation, continuation or stoppage of alcohol after first use
BS Chavan, Subhash Das, Tanuja Kaushal, Sumant Arora, Nitin Gupta
Department of Psychiatry, Govt. Medical College and Hospital, Chandigarh, India
|Date of Web Publication||3-Aug-2015|
Prof. B S Chavan
Department of Psychiatry, Block D, Level V, Govt. Medical College and Hospital, Chandigarh
Source of Support: None, Conflict of Interest: None
Objective: Few studies have investigated the reasons for alcohol initiation and continuation. The present study examined reasons for trying alcohol for the first time and its subsequent use. Furthermore, the study attempted to discover the possible predictors that make an individual vulnerable to alcohol use. Methodology: A total of 280 first-year college students from six different colleges were contacted. Using the method of equal probability, every third subject from each class was selected. All the selected subjects were interviewed and administered semi-structured questionnaire for gathering information regarding their experience with alcohol. Results: In our study, experimentation and peer pressure were found to be the main reasons for both alcohol use and its re-use. The first time drinkers differed a lot from those with multiple users in terms of reasons for trying alcohol, the effect of alcohol, family history of alcohol use, and self-view about alcohol use. The results depicted that the gender, educational stream, and family history of alcohol use are the factors that make an individual vulnerable to alcohol use. Conclusion: First-year of college is a unique transitional period. First-year students with high levels of sensation seeking may be especially at high-risk to begin or escalate heavy drinking. Studying the nature of alcohol initiation may not only be helpful in planning awareness programs but also in preventing underage drinking and alcohol abuse.
Keywords: Alcohol, alcohol initiation, alcohol intake
|How to cite this article:|
Chavan B S, Das S, Kaushal T, Arora S, Gupta N. An exploratory study assessing reasons behind initiation, continuation or stoppage of alcohol after first use. Indian J Soc Psychiatry 2015;31:71-5
|How to cite this URL:|
Chavan B S, Das S, Kaushal T, Arora S, Gupta N. An exploratory study assessing reasons behind initiation, continuation or stoppage of alcohol after first use. Indian J Soc Psychiatry [serial online] 2015 [cited 2019 Jul 15];31:71-5. Available from: http://www.indjsp.org/text.asp?2015/31/1/71/162030
| Introduction|| |
Alcohol consumption patterns are causing significant public health and safety problems in almost all the countries. Moreover, hazardous and harmful drinking patterns have been rising among adolescents and young adults.  This is not a very good scenario and has detrimental consequences. Reports indicate that initiation of the substance of abuse at an early age leads to increase in morbidity and criminality, and decrease in productivity. 
Studies have reported that the initiation of alcohol use, as well as its gradual increase, often occurs during the college years,  and the peer group has an important role in determining whether a person will try a dependence-producing drug or not.  A national report on context and consequences of alcohol (2002), however, pointed out that the drinking patterns of some college students is actually the continuation of behavior, which had been present earlier and as they emerge at age 18 or 19, they are labeled "college problems," when actually they are "high school" or "middle school problems." Even then, research studies do indicate the possibility of certain college environments, which might be responsible for drinking among students.  Another bothersome factor is the fact that there has been a decline in the age of initiation of the substance of abuse.  The hypothesis that there are aspects (environmental/others) that tend to support drinking behavior by college students and the associated negative consequences of alcohol use among youngsters warrants further study.
For successful efforts to limit premature and excessive drinking among young population, it is necessary to understand the antecedents and etiology of drinking behavior. In this regard, there have been studies to investigate the reasons for alcohol initiation and experimentation. However, there is a paucity of studies exploring the reasons for the continuation of alcohol use. Many times, the personal experiences of alcohol users indicate that when they used the alcohol for the first time, the taste, and the effects were unpleasant. However, despite unpleasant first experience, many of them try to re-use it again. The research is silent about the reasons of reuse of alcohol by youngsters who had unpleasant taste and effects with first use. However, it is important to understand the factors, which prompt these persons to try it again. These factors might be intrinsic or extrinsic. On the other hand, there are also individuals who do not use it for the second time. It makes good clinical sense to understand these two classes of persons as such an understanding will contribute to prevention strategies. Therefore the present study, in addition to examining the reasons for initiation of alcohol use, attempted to explore the factors associated with subsequent use/continuation of alcohol use. Furthermore, the study attempted to discover the difference between students who try to use alcohol and a second group of students who never use alcohol in their lifetime.
| Methodology|| |
The objectives of the study were: (i) To identify the profile and possible reasons for trying alcohol for the first time, (ii) to identify differences if any among students who use alcohol "single-time" versus "subsequent multiple users" and (iii) to identify factors which deter the students from trying alcohol even once in their lifetime.
First-year students from six different colleges of Chandigarh formed the sampling frame for the study. Every batch comprised of 100-150 students on an average. Thus, the total population for drawing the representative sample was around 890 students.
First-year college students from six different colleges were approached with the aim of exploring reasons for first and subsequent use of alcohol. To have a representative sample, six colleges of Chandigarh were randomly selected using cluster sampling. These six colleges represented six different streams, that is, medical, engineering, art, commerce, psychology, and law. Of each of these colleges, 1 st year students (who just entered into the college after 10+2) were selected for test administration. Using the method of equal probability (K = N/n) (K = N/n, K = Sampling interval, N = total population (890), n = sample size (280)), every third element from each class was selected. After obtaining informed consent, all the subjects were interviewed and administered semi-structured questionnaire for gathering information regarding their first experimentation with alcohol, their experience/effects with first use and the reasons of re-use. In case, the student being interviewed had ever tried alcohol, the complete interview was conducted. However, students who said "no" to "ever use of alcohol" were interviewed on selective questions. Total sample comprised of 280 subjects screened during the period of July 2012 to December 2012. In this way, we ended up having three groups: First and only once alcohol users (n = 30), subsequent users (n = 96), and nonusers (n = 154).
The data were collected using a questionnaire specially designed for the study. It was prepared with the aim of gathering information about drinking behaviors of college students. The questionnaire was developed by psychiatrists based on their clinical expertise and experience.
The data so generated were analyzed using the SPSS (Version 16.0; SPSS Inc,Chicago, IL, USA). Descriptive and inferential statistics (using Chi-square and t-test analysis) were applied.
| Results and Observation|| |
[Table 1]: Majority of the subjects recruited were about 18-19 years of age. Results show that the average age for those who were multiple users was more (19.48 years) as compared to single-users (18.83 years) and nonusers (18.33 years) and the difference was statistically significant. Gender differences were found to be significant (P < 0.0001) when the males and females in the three groups of multiple users, single-users and nonusers were compared. As can be seen, males outnumbered both the group of multiple users and single-users, whereas numbers of females (57.79%) who chose not to drink at all was more than males (41.55%). When the stream of the study was considered, it was found that there were significant differences (P < 0.0001) in the three groups of multiple users, single-users, and nonusers. There are more subjects in the category of recurrent drinkers from art stream as compared to the other streams.
While exploring reasons for first alcohol experimentation, it was found that no significant differences existed between the group of recurrent users and single-users.
[Table 2]: When the effect of the first use of alcohol (positive, negative, mixed or none) was assessed, the group of multiple users and single-users differed significantly (P = 0.001). In about 68% of all the users, the effects of first drink were described as positive or pleasurable effects (pleasant taste, feeling high, feeling relaxed, etc.,) whereas 22% of the users experienced negative effect (bitter taste, feeling drowsy, headache, and hangover in the morning, etc.,) and the others had mixed or no effect. It is important to note here that out of the users who experienced negative effect, half of them used alcohol again despite the negative or undesirable effects at the time of first drink. When the reasons for continuing alcohol in this group (i.e., those experiencing negative effect in the recurrent users) was evaluated, it was found that experimentation (35.7%), peer pressure (21.4%), stress (14.3%), and other factors (22.4%) compelled them to try alcohol once again.
|Table 2: Comparison of recurrent drinkers and single-time users on various parameters |
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About 8.73% (11 out of 126) ever users (those who have used alcohol) also abused some other substances besides alcohol and about 23.8% of the single-users had used only alcohol and that too only once at the point of study period.
[Table 3]: Our study tried to see if those who had ever used alcohol wanted to continue with alcohol or wanted to stop or reduce the intake. Hence, the authors divided the users into two groups on the basis of "intention to continue" alcohol. Those wanting to continue were "Group X" and those wanting to stop/reduce alcohol were "Group Y" ([Figure 1]). An attempt was made to explore them under the following headings: (a) Reasons for intake which included peer pressure, experimentation, stress, and other factors (b) stream of study which included BA, BE, B.Com, Law, and MBBS (c) family history, whether present or absent (d) use of additional substance.
|Table 3: Comparison of Group X (subjects who wanted to continue alcohol) and Y (subjects who wanted to stop/ reduce alcohol) of ever users |
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The study found that differences existed in the two groups when reasons for intake were considered. About 60.8% of those who wanted to stop or reduce intake of alcohol attributed their reason for first intake to experimentation. Experimentation (42.1%) was also the dominant reason for first intake in the group which wanted to continue alcohol. There were also significant differences in the two groups (X and Y) when the stream of the study was considered. Few students BE (8.77%) stream were there in the Group X in comparison to students from other streams. Students from BE (43.37%) were also found to be the dominant ones in the group, which wanted to discontinue or reduce alcohol intake.
While assessing Group X and Group Y on the basis of presence or absence of family history, it was found that those who wanted to stop or reduce alcohol intake, 73.9% did not have a positive family history of alcohol use. When the use of other substances along with alcohol was assessed in both the groups, the group, which wanted to continue alcohol use, used other substances more often and there were significant differences. Moreover, it is important to note here that alcohol alone was the only substance of abuse in a huge majority of cases in both the group (X = 82.4% and Y = 97.1%).
| Discussion|| |
The present study found that 42% of the teenagers around the age of 18 years had already experimented with alcohol, and the average age of first intake was found to be 17.3 years. The studies carried out few years back in India had a higher age of first use of substances including alcohol. , A study from NIMHANS has revealed that in the past decade, the average age of first consumption of alcohol has fallen from 28 years to 19 years.  It is a major cause of concern that the age of first use of alcohol is coming down as evidence do exist which shows that earlier use of alcohol is linked to subsequent alcohol abuse and dependence, and its earlier usage increases the risk of alcohol abuse/dependence in adolescence and early adulthood as well as that of lifetime alcohol abuse/dependence.  In our study, 25% of females were recurrent users of alcohol. This new trend of increase use of alcohol by young girls is a major cause of concern for the country and the society. Since females are biologically different from males in terms of handling of alcohol by their body,  there are more chances of serious physical and psychological consequences.
When the reasons for first intake were explored, it was found that experimentation followed by the influence of peers were the dominant factors for the use of alcohol by the students for the first time. In a review article on peer influences, it was found that peers do play a considerable role in the development and maintenance of alcohol use among college students.  In the present study, it was interesting to note that of out of the ever-users, 23.8% of the students used alcohol only once and were not considering to use it again. Although the present study did not explore the reasons for not trying alcohol again, it is important to find out the factors, which might have discouraged these students from using alcohol again. This could be due to various reasons like the positive influence of peers; the students had done the so-called "experimentation," and did not like the effect of alcohol and so on. At the time of first use, as many as 50% of the single-users had negative or unpleasant effects of alcohol as compared to just 14.58% who had a negative effect on the recurrent users group. This unpleasant or negative effect itself might be a possible reason why many of them did not take alcohol again. In fact, our study has indeed documented that there was a statistically significant difference (P = 0.001) between the group of single-users and recurrent users when the effect of alcohol was considered.
One can understand that due to the operant reward mechanism those who had a positive effect are likely to continue with alcohol intake. However, the reward mechanism alone cannot explain the reason of reuse, as many students despite the negative effect of alcohol, used it again. We attempted to explore this area and found that the approximately 11% (14 out of 126) of the students who had negative effect at the time of first use wanted to experiment again, were influenced by peers, had stress and other reasons. In fact, out of 14 students who had negative effect at the time of first use, as many as 13 of them (i.e., about 93%) had positive effect after using it for the second time. Even among the students who reported mixed effect at the time of first use, three-fourth had a positive effect after the second time of alcohol use. Thus, it can be hypothesized that the users somehow develop tolerance to negative or unpleasant effects with continuous use. Furthermore, the moment these users experience some positive effect later on, the reward mechanism becomes operant again.
In our study, 54.80% youngsters expressed the desire to quit/reduce the use of alcohol. The authors feel that the intervention at this stage where the individual still has not become dependent on alcohol should be easier and more effective. However, in the absence of any school and college based intervention strategy, there is no way to reach out to these students and they might continue to use alcohol and might become dependent on it with continuous use. The desire to quit substance use including alcohol has also been reported in other studies ,, and therefore motivation on part of family, friends, and close ones could help the user to come out of this habit. However, the question arises that despite the high percentage of youngsters expressing desire to quit alcohol, what are the factors that hold them from doing so. In other words, what are the factors for continuing alcohol despite being aware of its harmful use and desire to quit it? For this purpose, we divided the sample of "ever users" on the basis of "intention to continue alcohol" (Group X-wanted to continue, Group Y-wanted to stop/reduce). Statistical analysis of these two groups showed that students who wanted to continue were more likely to be from medical, arts and law streams (33.33%, 33.33%, and 17.5%, respectively). However, this finding should be interpreted with caution as there might be a possibility of over-representation from these streams and under-representation of the other two streams (BE and B.Com). Even then the positive aspect of peer influence (hanging with those who never drink or those who want to stop/reduce) may be operant in these two streams, especially in the BE stream, which may open areas for possible intervention. Although, there are many studies on the use of alcohol by students, the authors could not find any study focusing on the stream of study and pattern of alcohol usage.
Those who wanted to continue alcohol use reported stress and other factors as main reasons for initial use. Furthermore, 49.2% of those who wanted to continue with alcohol use had one or more family members using alcohol actively. Further, in our study, the group, which wanted to continue the use of alcohol, also reported having used an additional substance with an initial intake of alcohol.
Research do indicate that both genetic and environmental components contribute to the risk of alcohol use.  In our study, approximately 10% of college students reported growing up in a home where a parent abused alcohol. It has been reported that the children of parents with alcoholism problems exhibit a bimodal pattern of drinking behavior and have higher than normal odds of past-year abstinence or binge drinking.  Furthermore, it has been suggested that these children of alcoholic parents may have more stimulating and stress-dampening effects of alcohol, and may be less sensitive to the delayed, subjectively assessed depressant, and motor effects of alcohol.  Thus, it may be said that stream of study, stress, family history of alcohol use, and using an additional substance with alcohol are strong determinants of continuing with alcohol usage.
| Limitations|| |
Drinking initiation, styles and patterns are highly influenced by cultural context. Our study sample is confined to specific cultural context and predominantly represents that of an urban setting. There is a lack of consensus in the literature on the definition of alcohol initiation, continuation or stoppage, which needs to be developed for operationalization of similar studies.
| Conclusion|| |
Despite the limitation, our study has been able to throw light on certain issues. Even negative or unpleasant effects of alcohol use at the time of first use do not deter the youths from trying it again, a finding that is probably never reported in any other Indian studies till date. In this group, further experimentation and peer pressure were the two major factors along with a positive effect following subsequent usage that resulted in continuing alcohol usage despite its initial negative effects on first use. Another very important and interesting observation of this study is the felt need of the students who have recently started using alcohol to quit it. If this felt need can be converted into the organized intervention approach, it might be possible to stop conversion from social use to dependent use.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]