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

Objective: World Health Organization (WHO) risk drinking levels (i.e., low, moderate, high, or very high risk) have been used as a drinking-reduction endpoint in clinical trials. Yet, prior work has not attempted to quantify reductions in WHO risk levels among mandated students, who may also benefit from reduced drinking. We sought to validate WHO risk drinking levels in differentiating students' alcohol-related outcomes, depressive symptoms, and academic performance. Defining risk via typical drinks per drinking day versus drinks per day was compared, and gender differences were examined.

Method: Baseline data were drawn from three intervention trials for students mandated to intervention and who were not abstinent (N = 1,436). Sex-specific WHO risk levels were generated and dummy coded, with low risk as the reference. Regression models examined associations of risk levels with positive Alcohol Use Disorders Identification Test (AUDIT) scores, peak drinking, consequences, depressive symptoms, and grade point average.

Results: Defining WHO risk via drinks per drinking day evenly dispersed students across categories, whereas drinks per day categorized most students as low risk. More women than men were classified as very high risk across definitions. Students classified as low risk differed from those classified as moderate, high, and very high risk in screening positive on the AUDIT, peak drinking, and consequences. WHO risk levels did not differentiate depressive symptoms. Differences in grade point average were inconsistent across risk definitions.

Conclusions: WHO risk drinking levels differentiated alcohol use and consequences and, therefore, hold promise for clinical use and for quantifying drinking reductions among mandated college students.