Journal of Substance Use

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Associated factors of alcohol and alcoholism

among tertiary students
Felix Elvis Otoo, Barbara Gyebi & Sampson Wireko-Gyebi
To cite this article: Felix Elvis Otoo, Barbara Gyebi & Sampson Wireko-Gyebi (2016): Associated
factors of alcohol and alcoholism among tertiary students, Journal of Substance Use, DOI:
10.3109/14659891.2016.1140236
To link to this article: http://dx.doi.org/10.3109/14659891.2016.1140236

Published online: 25 May 2016.

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www.tandfonline.com/ijsu
ISSN: 1465-9891 (print), 1475-9942 (electronic)
J Subst Use, 2016, 00(00): 111
2016 Taylor & Francis Group, LLC. DOI: 10.3109/14659891.2016.1140236

ORIGINAL ARTICLE

Associated factors of alcohol and alcoholism among tertiary students

Felix Elvis Otoo

, Barbara Gyebi, and Sampson Wireko-Gyebi

Downloaded by [Christ Apostolic University College] at 03:17 26 May 2016

Department of Hospitality and Tourism Management, Christ Apostolic University College, Kumasi, Ghana

Abstract

Keywords

Alcohol easily presents itself as the most commonly used and abused substances among
young individuals. The phenomenon of alcoholism has been associated with college students,
though research in this area is often limited to the developed world. This paper identifies and
explores the influences of alcohol use among 636 tertiary students in the Kumasi Metropolis of
Ghana. Psychological, social, and behavioral/enhancement factors were identified to influence
alcohol consumption among tertiary students. Various degrees of statistically significant
differences were observed between these factors and sociodemographic as well as drinking
traits of respondents.

Abuse, alcohol, binge, college/university,

students

Introduction
Substance abuse has increasingly become an issue of vast
research interest. A more worrisome trend is its prevalence
among young adults. In fact, the use of psycho-addictive
substances is one of the main causes of misdemeanor
among young adults (Collins & Lapsley, 2007; Graham &
Homel, 2008). Alcohol is correlated with higher degree of
involvement in crime (both as a perpetrator and as a victim) among college-age individuals (Carpenter, 2007;
Horvath & LeBoutillier, 2014). A number of attributes
make young individuals an interesting research target.
First, Anderson et al. (2009) observe that young adults
have greater vulnerability to substances such as alcohol
than others. These authors aver that aside being smaller
in size, young adults lack the experience of drinking and its
effects and have built little tolerance to alcohol. Such views
have also been echoed by Park et al. (2009) who emphasized that the exorbitant consumption of alcohol and problem drinking has largely been a phenomenon of young
adulthood.
One of the powerful environments that influences the
use or abuses of substances are college or university environments. Shore et al. (1983) have long noted that campus
factors can affect addictive habits of tertiary students.
Researchers point to the fact that alcohol is one of the
most common substances abused by young individuals in
colleges or universities. For example, McCabe et al. (2005)
write that substance use, particularly alcohol, continues to
increase among young individuals who enroll in college for
the first time. The authors also write that college students
in general tend to drink more heavily than their noncollege

Correspondence: Felix Elvis Otoo, Department of Hospitality and Tourism

Management, Christ Apostolic University College, P.O. Box 15113,
Kumasi, Ghana. E-mail: felixotoo@gmail.com

History
Received 29 September 2015
Accepted 14 December 2015
Published online 16 March 2016

peers. Brown et al. (2007) also write that one area of

concern in the social development of college students is
high-risk drinking behaviors.
Turner et al. (2000) posit that the experience of an individuals freshman year of college may be an opportunity to integrate and adapt to high level of heavy drinking. Lo and Globetti
(1993) also found that for about 27% of students who entered
universities as nondrinkers, half began to drink after they had
started college. Although some research suggests that the
Freshman year (which is important for the establishment of
patterns of behavior) is an opportunity to start drinking
(Glindemann & Geller, 2003; Jackson et al., 2001; Wood
et al., 1997), there is a decent amount of support for the hypothesis that college drinking represents for many a continuation of
an established behavior, which may be expanded upon in the
Freshman year. To that end, studies have found that pre-collegiate drinking is one of the strongest predictors of college drinking
(Baer et al., 1991; Sher & Rutledge, 2007).
Liang and Chikritzhs (2013) advance that individuals who
commenced drinking at younger ages were more susceptible
to increased heavy episodic drinking (HED). For example, a
student who feels he/she has a problem with alcohol (anxiety)
is more likely to be involved in HED. Similarly, a student who
drinks with friends (extraversion) will also engage in HED.
For many jurisdictions, including Ghana, the legal age for
drinking is pegged at 18. Park et al. (2009) posit that 18 is the
characteristic age of induction into a college or university and
the onset of drinking habits.
The incidence of problematic drinking among college students can be linked to a host of damaging consequences. In
the United States, a survey conducted by American College
Health Association (2015) on college students found that
within 30 days prior to the study, 19,406 (26.1%) of college
students undertook a regrettable action after consuming alcohol, whereas 17,224 (2.2%) forgot where they were. Another

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F. E. Otoo et al.

1,339 students indicated that someone had sex with them

without their consent. About 12,000 of the respondents in
the survey also noted that they engaged in unprotected sex.
These figures have some resemblance with those reported by
Hingson et al. (2005), who noted that 696,000 physical
assaults, 97,000 sexual assaults, and 1,717 unintentional
injury deaths were caused between 1998 and 2001 under the
influence of alcohol. Huchting et al. (2011) also note that
tertiary student population reflected more social problems
related to alcohol, described by incidences of unplanned
sex, drunk driving, and other illicit activities.
Many studies have examined how personality factors, the
social environment (e.g., Greek affiliation, athletic involvement, religiosity, descriptive and injunctive norms), demographic variables, and psychological factors (e.g., drinking
motives and alcohol expectancy) affect college student drinking (Baer, 2002; Borsari et al., 2007; Ham & Hope, 2003).
Researchers (including Pace & McGrath, 2002; Wechsler &
Nelson, 2008) have however alluded that many prevention
programs and research to find methods to effectively reduce
binge drinking rates have had varying and nonconclusive
results.
Rehm et al. (2003) have observed that the negative health
and social consequences of alcohol use are moderated by the
quantity of alcohol consumed and the pattern of use over
time. More research is needed to further explore the possible
differences between students alcohol consumption and the
likely influences of their drinking traits. The present studys
aim is to identify the factors that influence the drinking of
alcohol among undergraduate students of selected tertiary
institutions in the Kumasi Metropolis of Ghana. The study
further explores the differences of the identified factors across
background characteristics of respondents. Additionally, the
study explores differences of the factors across a number of
drinking traits. much literature has been devoted to outcomes
related to prior tertiary drinking behavior. This paper therefore focuses on college-level education. Masterman and Kelly
(2003) have suggested that the effectiveness of prevention lies
in knowing who high-risk drinkers are. This is particularly
relevant given that alcohol is a common element in the
environments of most college campuses (Wechsler et al.,
2000). This is in light of the fact that studies on drinking
motives are still rare outside North America (Kuntsche et al.,
2006).

Literature review
Despite its apparent usage in literature and society, concepts
of alcohol, drinking, and binge drinking have been slippery in
definition. For example, the use of moderate and excessive
drinking by Lo (1995) leaves much to be asked regarding
how much is too much. Other researchers have also argued
that gender-specific definitions of binge drinking are as problematic as single definitions (e.g., Ford, 2001; Smith et al.,
1999). Irrespective of these debates, a gendered approach to
binge drinking appears to have considerable support in literature as the two sexes have different tolerance levels for
alcohol.
Johnston et al. (2007), Wechsler and Nelson (2008) have
suggested that high-risk drinking is the consumption of the

J Subst Use, 00(00): 111

equivalent of five or more drinks in a row for men and four

for women on one or more occasions during the two weeks
prior to being assessed in a survey. The present studys scope
of binge drinking is defined as consuming more than the
upper limit (five for men and four for women) at least once
in the two weeks prior to the survey. This approach is
grounded in previous studies (Syre et al., 1997; Weschler
et al., 1998). The term is used interchangeably in this study
with heavy episodic drinking (HED).
According to Lorant et al. (2013), a drink is defined as a
glass of any alcoholic beverage (beer, wine, spirits, other),
assuming that a standardized glass of beer, wine, or spirit
contains a similar quantity of alcohol. Likewise, Niedermayer
(1990) defines alcoholism as a physical addiction or psychological dependence/habituation on ethanol that results in a
prolonged and noticeable reduction in the persons ability to
function psychologically, socially, or occupationally, or otherwise negatively affects the areas of the individuals family,
health, or financial security.
The literature on influence of alcohol has often been
bracketed into three broad thematic areas. Researchers consider issues from biological (such as genetic influence), psychological (cognitive responses such as anxiety), and
sociological (such as sociodemographic and socioeconomic)
influences. The ensuing review focuses on psychosocial
dimensions.
In a review from a psychological perspective, Kuntsche
et al. (2006) identified personality issues, situational context,
and cultural context to be the key motives of alcohol use. Cox
and Klinger (1990) observe that personality factors are influential to alcoholism as they associate with drinking motives.
Three personality constructs (enhancement, extraversion, and
anxiety or coping) relevant to this study are discussed.
Kuntsche et al. (2006, p. 1847) defined enhancement motivations for drinking as drinking to enhance positive emotion.
This was measured by statements such as drinking for excitement or fun. Similarly, this was found to correlate with high
levels of extraversion (defined as gregariousness, sociability,
and high levels of activity and excitement seeking). Stewart
and Devine (2000) have reasoned that persons who are extraverts are sensitive to positive affective stimuli and more likely
to involve in enhancement-motivated alcohol consumption.
Anxiety as a personality construct is characterized by
display of fear regarding potential adverse effects of alcohol use. Responses such as fear of physical illness, social
embarrassment, or loss of mental control are items under
this construct. A number of studies (including Stewart &
Zeitlin, 1995; Stewart et al., 2001) report that drinking to
manage undesirable emotionality associates with high anxiety sensitivity.
Sociodemographic variables have also been important in
understanding the motives of drinking. Kuntsche et al.
(2006, p. 1845) concur that such variables allow researchers to delineate specific risk groups in terms of the combination of drinking motives and personality characteristics.
From a gendered perspective, Cooper (1994) found stronger
increase in social and enhancement motives for drinking
among boys of ages 18 and 19 than those below. Jerez and
Coviello (1998) also observed that males endorsed social
and enhancement motives more strongly than females.

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DOI: 10.3109/14659891.2016.1140236

Bloomfield et al. (2008) similarly found that other than age

and sex, classical socioeconomic variables play little role in
establishing drinking patterns. There however appears to be
deficit in research into sociological influences of binge
drinking as many of the existing studies tend to focus on
age and sex (e.g., Cooper, 1994; Kuntsche et al., 2006;
Simons et al., 2000).
Other factors may influence not only tendency to drink
but also to association with others who condone such
behavior. Caudill et al. (2006) have noted that the consumption of alcohol is used to forge connection between
people, strengthening friendship, and create bonds between
them. Such social motives have been identified in some
studies (Cooper, 1994; MacLean & Lecci, 2000). Park
et al. (2009) also iterate that the environment provided by
Greek housing allows those who have histories of drinking
to not only continue but also increase their levels of alcohol consumption during transition to college. Under such
conditions, it is common and ordinary for students who
drink to influence others to start drinking or drink more.
From a theoretical perspective, Oei and Morawska
(2004) have lamented the paucity or, at best, limitedness
of theoretical approaches into research of binge drinking
and alcohol use in general. In spite this realism, a number
of theories have been espoused by these few researchers.
For example, Durkin et al. (1999) have utilized social bond
model (SBM) in examining binge drinking. Per SBM,
social bonds refer to the connection between the individual
and society and that deviant behaviors such as binge drinking occur in a weak or lacking social bond. Oei and
Morawska (2004) however critique the model as it tends
to describe what does not characterize binge drinkers rather
than what does.
Norman et al. (1998) also examined binge drinking from
the perspective of the Theory of Planned Behavior (TPB).
TPB outlines three major influences on behavior: attitude,
subjective norm, and perceived behavioral control. The
authors found that frequent binge drinkers were more likely
to have a positive attitude to binge drinking. They also
found that there were only two significant predictors of
binge drinking: behavioral control and positive control
beliefs. Among others, a significant limitation of this theory is that influences such as personality and demographic
variables are not factored within the model.
Another theory that has gained use in studies of drinking is the social learning theory (SLT) (Akers, 1973). The
SLT includes behavior modeling, differential reinforcement,
differential association, and favorable and unfavorable definitions. Behavior modeling, for example, involves the
learning of behavior through the observation and mimicking of anothers actions, in that a student, for example, will
mimic the drinking habits of important influences such as
parents. Differential reinforcement emerges if such parents
frequently drink. The student is more likely to receive
positive reinforcement from them for engaging in the
same activities (White et al., 2008). Akers (1973) thus
posits that drinking traits are sustained primarily by the
influencers such as parents or peers. A limitation of this
theory is the failure to incorporate important variables on
intrapersonal relationships or intrinsic motivations.

Conceptual framework
The theory of triadic influence (TTI) was proposed by Flay
and Petraitis (1994) and has the strength of incorporating
several of the earlier discussed theories. Flay et al. (2009)
have noted that the TTI provides an integrative theoretical
orientation toward behavior. The TTI also proposes that theories and variables can be arranged into three relatively distinct types or streams of influence; each of which acts
through the levels of causation: Intrapersonal, which are
intrapersonal characteristics that contribute to ones self-efficacy regarding specific behaviors; Interpersonal social, which
are the social situation/context or microenvironment that contribute to social normative beliefs about specific behaviors;
and culturalenvironmental influences are multiple-sociocultural macroenvironmental factors that contribute to attitudes
toward specific behaviors.
For a suitable theoretical framework, we propose an adaptation of the TTI. First, intrapersonal variables are essential in
influencing students drinking habits and serve as intrinsic
motivation to continue the behavior. Such intrapersonal factors as feeling dependent on alcohol, taking alcohol for fun,
and needing alcohol to feel good could constitute psychological dependency on alcohol use or abuse. Secondly, interpersonal or social variables such as the influences of peers,
relatives, and parents (White et al., 2008) have been identified
to have significant impact on alcohol consumption. For example, students could withdraw from consuming alcohol if there
is disapproval from their peers.
Chassin et al. (1996) have observed that when relatives
(parents) are nonfrequent drinkers or abstainers, adolescents
are more likely to do likewise. This variable has also been
referred to as norms by Lo (1995) who described participants
perception of parents and peers feelings toward moderate and
excessive drinking. Additionally, there are other environmental
factors such as media and proximity or access to alcohol.
Another key strength of the TTI for the study is its ability to
incorporate sociodemographic variables such as age, sex, education, and religion; all of which have been noted to have
influences on alcohol consumption (Degutis, 2008; Dowdall
et al., 1998; Patock-Peckham et al., 1998; Pols & Hawks, 1992).

Methods
As the capital of the Ashanti region, Kumasi is the most important economic city only next to the national capital Accra. There
are a number of features that make the metropolis an important
educational hub in Ghana. First, its central location makes it an
important alternative for students from the various regions in
Ghana. Second, the metropolis houses arguably the largest tertiary institution in the country (Kwame Nkrumah University of
Science and Technology (KNUST)). The metropolis also houses
a disproportionate number of tertiary educational facilities, making it ideal for a study of this nature. In line with these, the study
was conducted in three tertiary institutions in the metropolis;
KNUST, Kumasi Polytechnic (K. Poly), and Christ Apostolic
University College (CAUC).
Tremblay et al. (2010) found specific times in the year in
which drinking was high or low among students. Such times
as the later parts of second semesters (April) often record

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F. E. Otoo et al.

high instances of drinking among students than later parts of

first semesters (December), perhaps because of end of academic year and pregraduation parties organized by students.
Conversely, first semesters (early September and January)
record lower drinking among students. Taking cue from
these discussions, the study was conducted within the last
two months of the second semester (AprilMay, 2015). It is
assumed that during this period, drinking experiences of
students will be higher. Additionally, Gilbert (2014) notes
that during a typical week, drinking increases from Tuesday
through Saturday, peaks on Saturday, and declines on
Monday. It is again assumed that during this period, students
are more likely to have experienced drinking and as such
more capable of remembering, for example, the number of
drinks taken. In view of this observation, the study was
conducted from Wednesdays through to Saturdays. In establishing the drinking habits of students, a two-week drinking
pattern was employed (Johnston et al., 2007; Liang &
Chikritzhs, 2013; Wechsler & Nelson, 2008).
Permission was sought from the three institutions and
lecturers before the study was carried out. A sample size of
650 was calculated for KNUST, 500 for K. Poly, and 350 for
CAUC. This allocation was partly influenced by the size of
the institutions. It suffices to mention that emphasis for the
study was not the institutions but on the responses of students.
The students were systematically selected after their lecture
from 10 am to 3 pm at the main lecture halls of the institutions. Employing systematic sampling, every fifth student was
selected prior to their exit from the lecture halls. Students
who declined participation were replaced before the next
count. This was done till the estimated sample was exhausted.
Though 1500 students were targeted for the study, 636
(42.4%) acknowledged taking alcoholic drinks. This sample
was thus used for the study.
Questionnaire administration was employed relying on
existing literature (including Caudill et al., 2006; Cooper,
1994; Kuntsche et al., 2005, 2006) in the assessment of
influences of alcohol consumption. This approach was opted
over self-reporting approach to data collection since the latter
had the limitations of potential validity problems. The questionnaire was structured in three modules. The first solicited
data on respondents drinking attributes and included such
questions as drinking pattern, weekly consumption, and distance between sales-point and residence. Ashton and Kamali
(1995) similarly investigated drinking habits and estimated
weekly consumption figures from a questionnaire that examined personality characteristics and lifestyle variables. The
second was structured on a three-point Likert scale and
included dimensions from studies including Lorant et al.
(2013), Ashton and Kamali (1995), Cook and Moore
(1993), and Palmqvist et al. (2003). The third module solicited questions on respondents sociodemographic characteristics such as sex, age, marital status, level, religion, and
residence.
The collected data were subjected to SPSS analytical software (IBM SPSS). Independent sample t-test was employed
for variables that were measured on dichotomous scale such
as sex, marital status, drinking pattern and nature of high
school attended. Similarly, one-way analysis of variance
(ANOVA) was used for variables (such as age, tertiary

J Subst Use, 00(00): 111

level, residence, and age at first drinking) measured along

an interval scale.
Care was also taken to ensure that ethical issues were
addressed. For example, respondents were assured of confidentiality of their responses prior to answering the data.
Further, the instrument was devoid of any information that
could lead to identifying respondents.

Results
Profile of the sample
In all, more males (63%) were involved in this study. The age
of respondents ranged between 17 and 40 years, with 41%
falling between the ages of 20 and 25. Those between the
ages of 26 and 29 formed 21%, whereas 19% were below 20
years. respondents above 40 years constituted 18% of the
sample. Out of the total 636 respondents, more than twothirds (77%) were unmarried, whereas 23% were married.
With respect to religion, the respondents were dominated by
Christians (76%). Muslims formed 15%, while Traditionalists
and Atheists also constituted 4% each. Level 200 students
dominated the sample for the study (32%), while Level 100
and 300 students formed 24% each and the least being level
400 students (20%). Again, the responses suggest that nearly
half (47%) of the respondents resided in private hostels, while
those living in their homes were 42%. Only 10% were living
in halls of residence. With the exception of residence, the
above sociodemographic trend is depictive of statistics on
tertiary institutions across the country.
A number of traits were also employed to further explore
influence of alcohol use among the selected sample. Thirtysix percent acknowledged living about 100 meters (m) from
where alcoholic drinks were sold. This was closely followed
by 35% who reside 200 m and 29% residing over 200 m from
the point of sales. In exploring the differences in the drinking
influences, the nature of secondary school attended were also
examined. Clearly, more than half of the respondents (62%)
attended mixed schools. The results proved that about 27% of
the students were into HED. Also, more than half of the
respondents (54.9%) took their first drink below age 18.
Sixty-three percent of the sample acknowledged drinking
below 18 units per week, whereas 17% drank between 18
and 20 units per week and 20% above 20 units per week.
Factors influencing alcohol consumption among tertiary
students
In ensuring a robust analysis, data from the field were subjected to factor analysis (FA). In testing for the suitability of
the data for this analysis, a number of statistical measures
were employed. First, Bartletts test of sphericity (2 =
6693.558; degree of freedom = 325) was significant at p =
0.000. Pallant (2005) recommends that for suitability of a data
set for FA, Bartletts test should be significant (p 0.05).
Likewise, the KaiserMeyerOlkin (KMO) value of 0.884
was significant; above the recommended minimum of 0.6.
Thus, the use of FA was considered appropriate. In further
ensuring the robustness of the data, 21 statements on influences of alcohol were subjected to principal components

Alcohol and alcoholism among tertiary students

DOI: 10.3109/14659891.2016.1140236

Table 1. Factors influencing consumption of alcohol.

Factor

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II

III

Variables included in the factor

Psychological (anxiety)
I feel unable to stop drinking
Told to cut down drinking
I have a problem with alcohol
Had withdrawal symptoms
I feel dependent on alcohol
I try to control my drinking
I spend too much money on alcohol
Social (extraversion)
I take alcohol to blend in
I try new drinks out of curiosity
Likely to drink when with friends
I take alcohol when partying
Likely to drink during outing
Behavioral (enhancement)
For academic performance
For sexual performance
I take alcohol to release stress
I take alcohol if I can afford the price
I try new drinks advertised on media
Likely to drink on a date (ego)
I take alcohol to feel good

Factor loading

Eigen values

Variance explained (%)

Cronbach alpha

0.789
0.779
0.777
0.731
0.728
0.696
0.552

6.850

32.618

0.869

0.793
0.744
0.710
0.695
0.497

2.834

13.493

0.826

0.719
0.625
0.617
0.569
0.583
0.566
0.507

1.368

6.514

0.776

Total

analysis using varimax rotation. Of these, 19 variables with

factor loadings above 0.4 were retained for further analysis.
The excluded statements were Percentage of alcohol influences my drinking; engine value = 0.251 and I need alcohol
to feel good; engine value = 0.138. A final measure
employed for data reliability was Cronbachs alpha. Only
factors with alpha values above the recommended minimum
(0.700) were retained for the analysis.
As depicted in Table 1, the results indicate that four factors:
psychological (32.6%; alpha = 0.87), social (13.5%; alpha =
0.83), and behavioral/enhancement (6.5%; alpha = 0.78) were
factors associated with alcohol consumption among tertiary
students. These factors together explained 53% of alcohol consumption influences among tertiary students.
Factor 1, which was labeled Psychological, had seven
items, notably: feeling unable to stop drinking, spending
too much on alcohol, told to cut down drinking, had
withdrawal symptoms, trying to control drinking, feeling dependent on alcohol, and I have a problem with
alcohol. The factor accounted for 32.6% of factors influencing alcohol consumption among tertiary students.
With an Eigen value of 2.83, Factor 2, labeled as social,
explained 13.5% of the factors influencing alcohol consumption among tertiary students. This factor had five
variables, namely, taking alcohol to blend in, taking alcohol
when partying, drink alcohol when with friends, first took
alcohol out of curiosity, and likely to take alcohol during
outing.
The last factor, behavioral/enhancement, consisted of
seven items: taking alcohol for sexual performance, taking
alcohol for academic performance, taking alcohol with
relatives, drinking based on price, trying new drinks advertised, likely to drink on a date, and taking alcohol to feel
good. Behavioral/enhancement factor had an Eigen value of

52.625

1.39, accounting for 6.5% of the factors influencing alcohol

consumption.

Influence on alcohol consumption across background

characteristics
Within the literature, sociodemographic or background
variables have been observed to have influence on alcohol
consumption patterns. Table 2 depicts the extent to which
the influences differ across the background groupings of
respondents using ANOVA and t-test. The statements were
captured on a three-point Likert scale (11.49 = Agree,
1.502.49 = Neutral, 2.503 = Disagree) to simplify interpretation of data. Thus, a smaller mean suggests a greater
tendency toward agreement and vice versa. Given that the
estimation of series of t-test and ANOVAs separately for
each dependent variable coupled with a relatively large
sample size could lead to overestimation of the significance
of the results, the Bonferroni adjustment was applied to
that alpha value to guard against this possibility (Cameron
& Trivedi, 2013; Pallant, 2005; Tabachnick & Fidell,
2013). This involved dividing the 0.05 alpha value by the
number of dependent variables, which were three.
Theoretically, this implies a more stringent and reliable
probability threshold for comparison of the mean differences. Thus, the adjusted threshold of significance was p
0.017.
The background variables produced important patterns when
contrasted against influences of alcohol. Considering sex, for
example, the result of the t-test revealed a significant difference
between males and females regarding psychological (p = 0.004).
Thus, males appeared more likely to be influenced by psychological (mean = 2.10) than their female colleagues (mean = 2.25).

F. E. Otoo et al.

J Subst Use, 00(00): 111

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Table 2. Influences for alcohol drinking by background characteristics.

Background characteristics

Number

Psychological

Social

Behavioral

Sex
Male
Female

398
238

2.0997
2.2525
P = 0.004*

1.6164
1.6723
P = 0.318

1.8794
2.0140
P = 0.022

Marital status
Unmarried
Married

488
148

2.2181
1.9566
P = 0.000*

1.5908
1.7905
P = 0.002*

1.9279
1.9358
P = 0.905

Age
< 20
2025
2629
> 29

124
260
136
114

2.1129
2.2414*
2.1064
2.0150*
P = 0.016*

1.5903*
1.6531*
1.6235*
1.9649*
P = 0.000*

1.9585*
2.0813
1.9895*
2.2130*
P = 0.004*

Religion
Christian
Muslim
Traditionalist
Atheist

486
94
28
28

2.2414*
1.9068*
1.9898*
1.5000*
P = 0.000*

1.6893
1.5617
1.9429
1.8429
P = 0.023

2.0929
1.9453
1.9796
1.9898
P = 0.120

Tertiary
Level
Level
Level
Level

150
206
150
130

2.3086*
2.0814*
2.1295
2.0938*
P = 0.009*

1.7760*
1.5252*
1.7387*
1.7877*
P = 0.000*

2.0590
1.9847
2.0533
2.1956
P = 0.018

68
300
268

2.2143
2.1924
2.0842
P = 0.112

1.4294*
1.5760*
1.8799*
P = 0.000*

1.8361*
2.0305*
2.1535*
P = 0.000*

level
100
200
300
400

Residence
Hall
Hostel
Home

Significant difference occurs at P 0.017.

Pronounced significant differences also existed in respondents marital status and psychological (p = 0.000), and social
(p = 0.002) influences on alcohol consumption. A closer
examination of the mean scores suggests that whereas psychological influences (mean = 1.96) were more prominent
among married students, their unmarried counterparts were
more prone to social influences (mean = 1.59).
As with the above, significant differences existed between
age and psychological (p = 0.016), social (p = 0.000), and
behavioral/enhancement factors (p = 0.004). Bonferronis
post-hoc test indicates that students above 29 years have a
greater predisposition toward being influenced by psychological factors (mean = 2.02) than those between 20 and 25
years (mean = 2.24). Behavioral/enhancement influences
appeared to also be more observable with students less than
20 years (mean = 1.96). With respect to social factors, the test
established differences between respondents below 20 years
(mean = 1.59) and the remaining age categories.
With respect to religion, significant differences were
observed for psychological (p = 0.000). As evident from
Bonferronis post hoc, Atheists were more prone to be influenced by psychological factors (mean = 1.50) compared to
the other religious sects.
The ANOVA test returned significant differences between
tertiary level and psychological (p = 0.009) and social (p =
0.000). In fact, Bonferronis post hoc comparison suggests that
for both social (mean = 1.56) and psychological (mean = 2.08),
sophomores were more influenced than those in the other levels.

For residential status, two factors (social and behavioral/

enhancement) were found to be significant at p = 0.000 each.
Evidently, students who reside in university halls are
observed to be more likely influenced by social (mean =
1.43) and behavioral/enhancement factors (mean = 1.82).

Influence on alcohol consumption across drinking traits

In examining the influence on alcohol consumption, the four
factors were further explored across five drinking traits. Both
independent sample t-test and ANOVA were performed in this
regard. Here again, in controlling for type 1 errors that could lead
to inaccurate results and misleading inferences, the Bonferroni
correction was applied for repeated analyses and repeated
hypotheses. As observed from Table 3, only behavioral/enhancement factors (p = 0.008) exhibited distinct trends toward significance across distance between residence and alcohol salespoint. Specifically, Bonferronis post hoc indicates that students
who resided about 200 meters from an alcohol sales point were
more likely to be influenced by behavioral/enhancement factors
(mean = 1.97). Though psychological factors did not quite reach
significance, students who resided over 200 meters (mean =
2.09) were more likely to be influenced by this factor.
One variable that is likely to play an influential role in
alcohol consumption is the nature of high school attended.
Just at the threshold of significance, the independent sample
t-test showed differences between the nature of high school
attended by tertiary students across behavioral/enhancement

Alcohol and alcoholism among tertiary students

DOI: 10.3109/14659891.2016.1140236

Table 3. Influences on alcohol by drinking traits.

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Drinking traits

Number

Psychological

Social

Behavioral

Sales-residence distance
About 100 meters
About 200 meters
Over 200 meters

230
222
184

2.2293
2.1193
2.0854
P = 0.069

1.7522
1.6523
1.6522
P = 0.175

2.1453
1.9717
2.0652
P = 0.008*

High school attended

Single sex school
Mixed school

240
396

2.0998
2.1915
P = 0.097

1.6438
1.6334
P = 0.853

1.8451
1.9811
P = 0.017*

Drinking pattern
Non-HED
HED

462
174

2.2833*
1.8233*
P = 0.000*

1.6869*
1.5057*
P = 0.003*

2.0227*
1.6830*
P = 0.000*

Age at first drinking

Below 18 years
18 years to 21 years
Above 21 years

315
128
131

2.1848*
2.0268*
1.8084*
P = 0.000*

1.5162
1.6000
1.6351
P = 0.062

1.9605
2.0000
1.9640
P = 0.780

Weekly consumption
Below 18 units
1820 units
Above 20 units

402
106
128

2.2987*
1.8986*
1.9226*
P = 0.000*

1.6737
1.4953
1.6406
P = 0.056

2.0274*
1.8333*
1.7031*
P = 0.000*

Motivation for drinking

Family
Friends
Media

76
322
184

2.1880
2.0060
2.1320
P = 0.025

1.9000*
1.5261*
1.5000*
P = 0.000*

2.0376
1.9929
1.9161
P = 0.178

Significant difference occurs at P 0.017.

factors (p = 0.017). The mean scores suggest that students

who had attended single-sex schools were more likely to be
influenced by this factor.
Obvious significant differences were observed in the pattern of drinking across all three factors: psychological (p =
0.000), social (p = 0.003), and behavioral/enhancement (p =
0.000). HED was operationalized as taking more than four
drinks in a row for men, and more than three drinks in a row
for women in one time period. Indeed, students who were into
HED were observed to be more influenced across all three
factors compared to those who were occasional drinkers.
Age at first drinking was found to have significant psychological influence (p = 0.000) on the respondents involved in
the study. Bonferronis post hoc test points to the fact that for
this factor, respondents who started taking alcohol prior to the
age of 21 were less influenced by psychological factors.
Though clear statistical significance failed to emerge, keen
observation of the mean values suggest that respondents who
consumed alcohol prior to 18 years were more influenced by
social (mean = 1.52) as well as behavioral/enhancement
factors (mean = 1.96).
With the exception of social factors, a strong trend of
statistically significant differences existed for the quantity
of alcohol consumed weekly in terms of psychological and
behavioral/enhancement influences (p = 0.000 each). In
line with Tukeys post hoc comparison, students who consumed 18 to 20 units of alcohol weekly were more influenced by psychological factors (mean = 1.90), whereas
those who consumed upward of 20 units weekly were
more influenced by behavioral/enhancement factors (mean
= 1.70).

Finally, the ANOVA test returned significant differences

between motivators for drinking and social influences on
drinking (p = 0.000). Friends were clearly influential psychologically (mean = 2.01), whereas the media accounted for
social influences (mean = 1.50).

Discussion
The college/university segment of population is indeed an
important research target for alcohol and substance abuse.
Gottfredson and Wilson (2003) conclude that the effectiveness of school-based substance abuse prevention lies in
greater effectiveness of targeting higher-risk youths than of
targeting the general population. Overall, the three factors
identified to influence alcohol consumption have their antecedents in literature. These have been acknowledged, at least
in part, as anxiety (psychological), extraversion (social), and
behavioral/enhancement. Juxtaposing the variables from the
TTI, intrapersonal factors were more inclined to explain psychological influences, whereas interpersonal tends to explain
social factors. Micro-environments such as date drinking, and
media adverts had some resemblance with behavioral
influences.
The present study suggests that males were more likely to
be influenced by psychological issues in drinking. Aside this,
even with social and behavioral/enhancement influences
where obvious significant differences were not established,
the mean scores still suggested similar trends. This finding
mirrors previous studies with similar results that found
greater alcohol intake among males (French et al., 2014;
Harrell, & Karim, 2008). Studies have also suggested a

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F. E. Otoo et al.

greater coping and resistance to alcohol among females than

among males. For example, Stewart and Zeitlin (1995) found
that coping motives was stronger among female than among
male college students in Canada.
While studies have suggested that alcohol consumption
declines after transition to marriage (Power et al., 1999;
Prescott & Kendler, 2001), the psychological motives for
drinking tended to be stronger among married students. The
results of this study thus are consistent with literature only in
the discourse of social motives or influences for drinking. It is
novel that contrary to previous studies, psychological influences play an important pull to drinking among the married.
A plausible explanation could be the fact that stress of having
to combine marriage, schooling, and/or work induces a psychological burden (anxiety) on these students. Alcohol has
been found to be used to cope with stress in some studies,
with a number of these studies registering declining consumption of alcohol with the transition into marital life.
Age has been an important predictor of alcohol consumption (Kuntsche et al., 2006). In this study, clear differences
were recorded across all age categories and influences for
drinking. Cooper (1994) found that prior to age 20, alcohol is
more socially endorsed and enhancement motives more prevalent among boys. This could have resulted in respondents
from single-sex schools being more influenced by enhancement motives than those from mixed-sex schools.
Worth mentioning is the fact that students above 29 years
had greater inclination to be influenced by psychological
motives. Conversely, Palmqvist et al. (2003) observe that
anxiety motives such as drinking to cope with bad feelings,
to relieve stress, or to avoid social rejection lessened, while
enhancement motives (e.g., drinking to feel good, to get
drunk, or just for its own sake) increased with age.
Religion/religiosity has been adduced to induce the consumption or otherwise of alcohol. While literature lacks in
establishing reasons for this trend, a cautious assumption
could be made regarding religious tolerance and/or acceptance for drinking. Koenig et al. (2011) have suggested that
though not always significant, factors such as childhood religious affiliation may continue to affect alcohol use even into
adulthood. Holt et al. (2012) have also noted that even among
members of the same religion, alcohol use may differ based
on affiliation. Contrary to the findings of Ndom and
Adelekan (1996), the present results suggest that Muslims
are more likely to be influenced in drinking than Christians
and other beliefs. Koenig and Alshohaib (2014) however aver
that 9 out of 12 studies suggest the contrary.
The transition from high school into colleges or universities is often marked by a sudden initiation into a less authoritarian environment, greater freedom, and less constrained
behaviors. Students who were previously under rigid supervision of their guardians and high school teachers come face
to face with the reality of freedom in decision making and
choice. Lo and Globetti (1993) in their study have found that
about half of university students who did not engage in
drinking began to do so after their first year. This appears
to be consistent with the present study, which identifies across
all three influencing factors (even with behavioral/enhancement where clear significance was not detected), level 200s
(sophomores) were more influenced to drink. The influences

J Subst Use, 00(00): 111

appear to have weaned in their subsequent years of tertiary

education.
McCabe et al. (2005) and Park et al. (2009) have both
hinted that the subculture of drinking created by the enabling
environment of Greek system of housing common in many
university halls is likely a contributing factor to binge-drinking behaviors. Thus, this study reflects the fact that social
(extraversion) and behavioral drinking (enhancement) are significant influences among students who reside in university
halls. Indeed, other reasons may include the presence of
fraternity and sorority groups in such residences. Such occasions as hall week and students week celebrations, which are
characteristic of tertiary institutions in Ghana where students
often participate in week-long programs, are likely to have
influenced this trend.
Two factors not discussed in previous studies (sales-residence distance and nature of high school attended) were
examined to establish their influence on drinking. The result
depicts a tendency for greater psychological dependence on
alcohol. Thus, distance did not constrain students who resided
farther from pubs where alcohol was sold. Perhaps more
interesting is the fact that only behavioral factors significantly
influenced alcohol consumption. Similarly, only behavioral
factors had significant influence on alcohol consumption.
Kuntsche et al. (2005) suggested that in addition to
people who experience stress, heavy drinking is particularly
common for those whose friends drink heavily and who
drink for social motives themselves. As expected, students
who acknowledged HED two weeks prior to the study were
more likely to be influenced by psychological, social, and
behavioral/enhancement factors. Underneath the statistics,
evidence from this study also suggests that approximately
55% of the students sampled had their first alcohol use
prior to the legal drinking age. studies (including Dawson
et al., 2008; DeWit et al., 2000) have suggested that early
drinking age has a corresponding risk of alcohol use
disorders.
Though establishing a safe limit for drinking has been
subject to debate and contestations, a random search on
many websites of health organizations place the upper safe
limit of alcohol consumption per week within 18 to 20 units.
Thus, consuming above 20 units of alcohol per week is
considered dangerous or high risk. Weekly consumption figures from the study suggest that some 20% of students engage
in high-risk drinking. This category of students are noted to
be influenced by behavioral or enhancement motives such as
taking alcohol for sexual and academic performance, date
drinking, and taking alcohol to feel good. While students
may be aware of adverse consequences of high-risk drinking,
they may still persist in this behavior. Cox and Klinger (1988)
write that the expected pleasure or relief of present drinking
state may dwarf the more remote negative emotional consequences. Students found within the upper safe limits of alcohol consumption were also influenced by such psychological
or anxiety motives as feeling unable to stop drinking and
spending too much on alcohol.
Individuals family background has previously been found
to influence drinking behavior. Walls et al. (2009), for example, found that students who considered parents to disapprove
of heavy drinking were considerably less probable to become

Alcohol and alcoholism among tertiary students

DOI: 10.3109/14659891.2016.1140236

heavy drinkers. Those who perceived their parents as a more

permissive authority in regard to alcohol use, however, were
more likely to become weekly users of alcohol, engage in
heavy drinking, and experience the negative consequences
that are associated with these activities. The media also constituted important social influence with respect to alcohol
consumption. The role of the media has in fact been espoused
in recent studies of Hoffman et al. (2014) and Siegel et al.
(2015).

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Conclusion and implications

College/university students have been identified to be a subgroup susceptible to high-risk drinking. The study thus sought
to identify and explore factors influencing alcohol consumption among tertiary students within the Kumasi Metropolis of
Ghana. The three influential factors are psychological, social,
and behavioral/enhancement. Psychological factors were
found to differ with sex, marital, age, religion, tertiary level,
drinking pattern, age at first drinking, and weekly consumption. Social factors were also found to differ for marital status,
age, tertiary level, residence, drinking pattern, and motivation
for drinking. On the other hand, behavioral/enhancement factors were also found to differ for age, residence, sales-residence distance, high school attended, drinking pattern, and
weekly consumption.
Novel patterns also emerged from the findings. For example, while studies have suggested that Christians are more
likely to drink than non-Christians, the present study suggests
a more obvious trend among Muslims and Atheists in terms
of influence to drink. Two variables, sales-residence distance
and high school attended, were both found to have significant
behavioral influences. Another interesting observation from
the study was the fact that age as well as drinking pattern
differed across all three factors. Clearly, these variables had
considerable influence on the drinking habits of students.
Methodologically, the application of numerous statistical
measures including Bonferroni correction only goes to support the robustness of the data.
A number of implications, from both theoretical and practical standpoints, could be drawn from the study. The strength
of the factor loadings suggests that social bonding is important in determining the influence of alcohol consumption
among students. While Oei and Morawska (2004) critique
the SBM for focusing on binging, the model may yet offer
explanations to social influences of drinking. Similarly, the
social learning theory may, to an extent, offer reasons for
variances in behavioral and social items such as taking alcohol with relatives, friends, and curiosity from seeing others
drink. The TTI offers a more holistic explanation of the
variables influencing alcohol use as identified in this study.
For example, intrapersonal variables such as feeling dependent on alcohol and inability to control drinking are observed
to have high factor loadings, implying higher strength of such
items to explain alcohol dependency. Again, interpersonal
variables such as taking alcohol to blend in were quite significant in this study. Students drinking behaviors are also
more likely to be influenced by the environment of the
individual. For example, some students are likely to drink
when on a date or for sexual enhancement.

From a practical perspective, while alcohol use may be

difficult to control, its abuse has been observed to have
detrimental effects to both users and nonusers (Weschler
et al., 1998). Though alcohol use was found to be more
prevalent among students who reside in hostels, the influence
of social and behavioral/enhancement factors was more pronounced among those residing in university halls. Clearly,
occasions like hall week celebrations need greater regulation
or control from school authorities. Evidently, high-risk drinkers are more influenced by such behavioral/enhancement
factors as drinking to enhance sexual and academic
performance.
The influence of peers can also not be neglected. The
study confirms greater peer influence in consuming alcohol
compared to media and family. Perhaps, the inadequacy of
education on the negative effects of alcohol use could have
contributed to this trend. Certainly, greater efforts in educating students on adverse impacts of alcohol to both users and
nonusers need to be emphasized. Studies have also suggested
approaches to curbing the prevalence of abuse. Marlatt and
Witkiewitz (2002), for example, suggest health promotion,
prevention, and treatment. Another critical issue worth mentioning is the fact that students who resided closer to alcohol
sales-point had greater inclination to be influenced by behavioral/enhancement factors. For at least those students residing in halls, such sales-point should be distant from their
residence.
While this study has unveiled a number of important
issues, it is not without its limitations. The study was a
cross-sectional survey carried out among students from
three tertiary institutions within Kumasi. Thus, a national
generalization may be problematic. Again, a longitudinal
study may have offered an explanation on how these
responses change over time. Incorporation of nondrinkers in
the study may have facilitated a comparison between drinkers
and nondrinkers. Finally, the use of tertiary students in this
study was limited to undergraduate students only. It is recommended that populations such as graduate and postgraduate
students could be included in subsequent studies.

ORCID
Felix Elvis Otoo

http://0000-0003-2803-3835

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