A Truth of College Life
College life is often associated with memorable experiences and substance experimentation. However, an alarming phenomenon has taken root on college campuses: "blacking out." Miller et al. (2018) note that 49% of college students who drink experience alcohol-induced blackouts.[1] In a society where excessive alcohol consumption has become commonplace among college students, it is crucial to explore the associated underlying influences and mental health issues, in addition to spreading support to those affected.
Understanding Blacking Out
Blacking out refers to a state of temporary amnesia triggered by excessive alcohol consumption, in which memories from experiences of heavy alcohol consumption cannot be recovered. Binge drinking (i.e., excessive drinking in short periods of time) is as prevalent as alcohol-induced blackout experiences among college students.[2] This indicates the link between college cultures of normalized, excessive drinking and frequent blackout experiences. In her memoir, “Blackout: Remembering the Things I Drank to Forget,” University of Texas alumni Sarah Hepola shares that through her research and interactions with current college students, she discovered that blacking out is now considered more casual than it once was 40 years ago, when she was attending UT.[3] In many college cultures, blacking out is often perceived as an inevitable rite of passage, trivializing its potential dangers as it is employed through peer pressure or initiations, particularly in fraternities and sororities.[4]
The National Institute on Alcohol Abuse and Alcoholism (NIAA) notes that blackouts can be separated into two categories:[5]
1. Fragmentary Blackouts - Fragmented memories from events during alcohol consumption exist, but without the ability to connect them.
2. Complete Amnesia - Memories from events during alcohol consumption cannot be recovered.
It is crucial to differentiate between occasional alcohol-related memory lapses and chronic blackouts, which might indicate underlying alcohol use disorder (AUD). Identifying these distinctions early-on can significantly impact an individual's mental well-being and prevent future difficulties with alcohol addiction. It is also important to distinguish blacking out from passing out following alcohol consumption. While “passing out” is the loss of consciousness or falling asleep from excessive drinking, “blacking out” refers to the loss of memories and the inability to create new memories while in a state of excessive alcohol consumption.[6] While a person can blackout and subsequently pass out, it’s also possible to blackout while still remaining completely awake (but unaware).
Your Brain When You Blackout
The amount of alcohol that one's body can withstand depends on blood alcohol concentrations (BACs). The NIAA reports that BACs of about 0.16 percent (about twice the legal driving limit) and above can induce blackouts.[7] However, this value can vary and become lower among:[8]
Those who consume anti-anxiety medications
Those who consume common anti-inflammatories (e.g., Advil/ibuprofen)
Those who consume alcohol more frequently (indicative of a tolerance)
Many other substances like opioids and antidepressants, in combination with alcohol, can lessen the BAC threshold as well, increasing risks related to these drugs or medications (e.g., overdose or liver failure).[9]
This excessive amount of alcohol results in the temporary block of the transfer of memories, or memory consolidation, from short-term to long-term memory storage via brain structures including the hippocampus.[10,11] Specifically, blackouts lead to anterograde amnesia: the prevention of the formation or storage of new memories.[12] Banerjee (2014) notes that alcohol’s interaction with neurons in the brain leads to the enhancement of inhibitory neurotransmitters and pathways like GABA while lowering the function of excitatory neurotransmitters like glutamate.[13] Such processes lead to heavy intoxication symptoms of poor motor function, altered reward systems, slurred speech, impulsive behavior and poor memory.
From a long-term lens, Nunes et al. (2019) found that frequent blackouts and binge drinking can lead to degenerative and functional deficit trends in the brain through hippocampal and frontal brain damage.[14] Additionally, going to sleep intoxicated shortens the REM (Rapid Eye Movement) phase of sleep [15] which Peever & Fuller (2016) found is responsible for consolidating memories and information in the brain from that day.[16] Exacerbating the issue, this loss of REM sleep may contribute to both short-term and long-term memory/cognitive issues.[17]
Mental Health Consequences
In addition to impacting cognitive functioning, blackouts inflict significant effects on one’s emotional well-being. Miller et al. (2020) found that in heavy-drinking college students, blackouts were related to increased symptoms of depression.[18] Further, students who experience blackouts may already struggle with anxiety and depression, and abuse alcohol as a coping tool. For example, alcohol can often be employed as a social anxiety “buffer”, as alcohol alleviates behavioral inhibitions.[19] In a survey of 772 college students by White et al. (2002), increased frequencies of blackouts were associated with lower grades, increased heavy drinking and increased frequencies of high-risk behaviors like vandalism.[20] College student blackouts can also impact many aspects of a young person's life including academics, physical health, depression and anxiety risk, memory and cognition, sexual assault risk, and even suicide.[21]
Pertaining to the college cultures that promote the normalization of blackouts, Greek Life subpopulations are of particular interest. Turrisi et al. (2006) note that these organizations are linked to heavier alcohol consumption.[22] Further, Estaban et al. (2018) found that male fraternity engagement predicted high levels of binge drinking and other drug use in young adulthood as 45% of participants experienced alcohol use disorder (AUD) by age 35.[23] These rates were significantly higher when compared to non-fraternity-associated adults.[24] Additionally, as Cara Rosenbloom in The Washington Post (2019) remarks, eating disorder rates are increased for these college subgroups, and the term “drunkorexia” (purging before excessive alcohol consumption) has arisen on campuses.[25] This phenomenon has created tendencies of heavy and high-risk drinking to replace normal eating, particularly among women struggling with body image.[26] The lack of food in one’s system when consuming alcohol makes binge drinking even more dangerous, as it increases the rate of intoxication.
Shedding the Light on Blacking Out
Due to societal stigmas surrounding mental health, many students hesitate to seek help or support. Wombacher et al. (2019) add that most college students rationalize frequently blacking out while completely acknowledging that the habits are unhealthy.[27] It is crucial to normalize help-seeking behavior and offer accessible resources to those facing alcohol-related issues and potential mental health concerns. By promoting responsible drinking and educating students about the risks, universities can foster a safer environment conducive to positive mental health, both relevant to long and short-term life. Integrating mental health support into college curricula and readily available campus resources empowers students to address their concerns proactively.
Harm reduction approaches may target the engrained social norms on college campuses. In this way, resources may be provided to reduce high rates of negative consequences such as emergency room visits due to alcohol poisoning, anxiety and depression and dangerous behavior. Such educational approaches may spread information about:
Substances to avoid combining with alcohol
Ways to be mindful when partaking in alcohol consumption
Safe sexual practices like consent
Awareness to avoid situations of peer pressure
Accessibility to counseling and medical care
Bystander awareness training
Additionally, student accessibility to forms of psychotherapy would lead to beneficial effects for students struggling with alcohol use. For example, Ehman & Gross (2019) found that Acceptance and Commitment Therapy (ACT), a modality used to focus on awareness of mental states and thoughts, in addition to Motivational Interviewing (MI), lead to reductions in alcohol consumption and less heavy drinking in college students.[28]
Blacking out might be perceived by many as an “ordinary part of college life”, but its implications on physical, mental and cognitive health require urgent attention. By raising awareness about the normalcy and consequences of blacking out, it is possible to dismantle the harmful aspects of social cultures that perpetuate this behavior.
If one is experiencing excessive alcohol use, binge drinking, addiction, or blackouts that impair well-being and/or daily life, please reach out to a licensed mental health professional (e.g., a psychotherapist, psychologist or psychiatrist) for guidance and support.
Contributed by: Phoebe Elliott
Editor: Jennifer (Ghahari) Smith, Ph.D.
References
1 Miller, M. B., Merrill, J. E., DiBello, A. M., & Carey, K. B. (2018). Distinctions in Alcohol-Induced Memory Impairment: A Mixed Methods Study of En Bloc Versus Fragmentary Blackouts. Alcoholism, clinical and experimental research, 42(10), 2000–2010. https://doi.org/10.1111/acer.13850
2 Juergens, J. (2023, April 17). Binge Drinking. AddictionCenter. https://www.addictioncenter.com/alcohol/binge-drinking/
3 Walsh, K. (2015, November 25). UT Unspoken: Students Reflect on Blackout Drinking Culture. The Daily Texan. https://thedailytexan.com/2015/11/25/ut-unspoken-students-reflect-on-blackout-drinking-culture/
4 Ibid.
5 National Institute on Alcohol Abuse and Alcoholism. (2023 February). Alcohol’s Effects on Health: Research-Based Information on Drinking and its Impact. https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/interrupted-memories-alcohol-induced-blackouts
6 Ibid.
7 Ibid.
8 Ibid.
9 National Institute on Alcohol Abuse and Alcoholism. (2022, May 6). The Healthcare Professional’s Core Resource on Alcohol: Alcohol-Medication Interactions. https://www.niaaa.nih.gov/health-professionals-communities/core-resource-on-alcohol/alcohol-medication-interactions-potentially-dangerous-mixes#:~:text=Nonsteroidal%20anti%2Dinflammatory%20drugs%20(NSAIDs,alcohol%20significantly%20increases%20the%20risk.
10 Wetherill, R. R., & Fromme, K. (2016). Alcohol-Induced Blackouts: A Review of Recent Clinical Research with Practical Implications and Recommendations for Future Studies. Alcoholism, clinical and experimental research, 40(5), 922–935. https://doi.org/10.1111/acer.13051
11 National Institute on Alcohol Abuse and Alcoholism
12 American Addiction Centers. (2023, July 12). Blackout Drunk: Signs, Causes, and Dangers of Blackout Drinking. https://americanaddictioncenters.org/alcoholism-treatment/blackout
13 Banerjee N. (2014). Neurotransmitters in alcoholism: A review of neurobiological and genetic studies. Indian journal of human genetics, 20(1), 20–31. https://doi.org/10.4103/0971-6866.132750
14 Nunes, P. T., Kipp, B. T., Reitz, N. L., & Savage, L. M. (2019). Aging with alcohol-related brain damage: Critical brain circuits associated with cognitive dysfunction. International review of neurobiology, 148, 101–168. https://doi.org/10.1016/bs.irn.2019.09.002
15 Brower K. J. (2001). Alcohol's effects on sleep in alcoholics. Alcohol research & health : the journal of the National Institute on Alcohol Abuse and Alcoholism, 25(2), 110–125.
16 Peever, J., & Fuller, P. M. (2016). Neuroscience: A Distributed Neural Network Controls REM Sleep. Current biology : CB, 26(1), R34–R35. https://doi.org/10.1016/j.cub.2015.11.011
17 Brower (2001)
18 Miller, M. B., DiBello, A. M., Merrill, J. E., Neighbors, C., & Carey, K. B. (2020). The role of alcohol-induced blackouts in symptoms of depression among young adults. Drug and alcohol dependence, 211, 108027. https://doi.org/10.1016/j.drugalcdep.2020.108027
19 Locco, A. (2021, March 15). Alcohol and Blacking Out. Resurgence Behavioral Health. https://resurgencebehavioralhealth.com/blog/alcohol-blacking-out/
20 White, A. M., Jamieson-Drake, D. W., & Swartzwelder, H. S. (2002). Prevalence and correlates of alcohol-induced blackouts among college students: results of an e-mail survey. Journal of American college health : J of ACH, 51(3), 117–131. https://doi.org/10.1080/07448480209596339
21 Juergens (2023)
22 Turrisi, R., Mallett, K. A., Mastroleo, N. R., & Larimer, M. E. (2006). Heavy Drinking in College Students: Who Is at Risk and What Is Being Done About It? The Journal of general psychology, 133(4), 401. https://doi.org/10.3200/GENP.133.4.401-420
23 Esteban, S., Veliz, P., & Schulenberg, J. E. (2018). How collegiate fraternity and sorority involvement relates to substance use during young adulthood and substance use disorders in early midlife: A national longitudinal study. The Journal of adolescent health : Official publication of the Society for Adolescent Medicine, 62(3 Suppl), S35. https://doi.org/10.1016/j.jadohealth.2017.09.029
24 Ibid.
25 Rosenbloom, C. (2019, March 11). New Concern on College Campuses: ‘Drunkorexia,’ a Combination Drinking and Eating Disorder. The Washington Post. https://www.washingtonpost.com/lifestyle/wellness/new-concern-on-college-campuses-drunkorexia-a-combination-drinking-and-eating-disorder/2019/03/08/093cf47c-4028-11e9-9361-301ffb5bd5e6_story.html
26 Ibid.
27 Wombacher, K., Matig, J. J., Sheff, S. E., & Scott, A. M. (2019). "It Just Kind of Happens": College Students' Rationalizations for Blackout Drinking. Health communication, 34(1), 1–10. https://doi.org/10.1080/10410236.2017.1384351
28 Ehman, A. C., & Gross, A. M. (2019). Acceptance and Commitment Therapy and Motivational Interviewing in the Treatment of Alcohol Use Disorder in a College Woman: A Case Study. Clinical Case Studies, 18(1), 36–53. https://doi.org/10.1177/1534650118804886