DURHAM, N.C. -- A survey of more than 422,000 college freshmen found that students who identified as transgender were more likely than their cisgender peers to experience negative consequences from drinking, including memory blackouts, academic problems and conflicts such as arguments or physical fights.

The 989 students who identified as transgender were also more likely than their cisgender peers to cite stress reduction, relationship troubles or the sedating effects of alcohol as motivation for drinking, according to an analysis of the survey published March 21 in the journal Alcoholism: Clinical & Experimental Research.

The results suggest transgender college students may be particularly vulnerable to alcohol abuse, which can negatively affect their academic standing and their physical health, said Scott Swartzwelder, Ph.D., senior author of the analysis and professor in the Department of Psychiatry and Behavioral Sciences at the Duke University School of Medicine.

“For people who work with this age group, it’s important to understand that these students are drinking at levels that are quite dangerous,” Swartzwelder said. “A blackout is a serious neurological event that occurs when you drink enough to impair the parts of your brain that encode new memory. The last thing you want to do as a college student is disrupt your memory.”

Students took the survey in 2015 through the alcohol abuse prevention program called AlcoholEdu for College, which includes a web-based questionnaire before beginning the course. The data did not represent a random sample, but included data from 370 U.S. colleges and universities that elected to offer the course to incoming students.

More than 64 percent of survey respondents reported having at least one alcoholic drink within the previous year. Students who reported drinking in the previous two weeks were asked to complete a more detailed description of those activities.

More than a third (36 percent) of transgender students said they had consumed so much they forgot where they were or what they did at least once in the previous two weeks as compared to 25 percent of cisgender students, the analysis showed.

Additional details from the analysis (see Table 3 in manuscript):

• 26 percent of transgender students said they had passed out from alcohol use during the previous two weeks, as compared to 13 percent of cisgender students
• 21 percent of transgender students said they drove after consuming five or more drinks as compared to 4 percent of cisgender students
• 19 percent of transgender students said they got in trouble with authorities as a result of drinking, as compared to 4 percent of cisgender students
• 21 percent of transgender students said they deliberately vomited in order to continue drinking as compared to 5 percent of cisgender students
• 19 percent of transgender students said they had been taken advantage of sexually due to drinking during the previous two weeks compared to 8 percent of cisgender students

Among transgender students, those transitioning from a male to female identity reported the highest incidence of negative consequences and high-risk behaviors from using alcohol.

Forty-six percent of male-to-female transgender students reported at least one memory blackout in the two weeks before taking the survey, as compared to 36 percent of transgender students overall. This subgroup also reported the highest incidences of missing classes, becoming argumentative, drinking and driving or riding with someone who had been drinking, and getting into trouble with authorities and other issues, according to the analysis.

“The results tell us we have a lot more to learn about transgender people and about the specific challenges they face,” Swartzwelder said. “The outcomes of the study also tell us that college students who are transgender represent a vulnerable population with respect to alcohol abuse and its negative consequences. That suggests college administrators and clinicians who interact with these students should be prepared to provide them with better and more effective coping strategies.”

The researchers plan to continue investigating the motivations and consequences of above-average alcohol use of transgender students as compared to their cisgender peers.

“Why do these students drink more, and what’s making them more vulnerable to these negative consequences of drinking?” Swartzwelder said. “These are very important social questions we hope to answer.”

In addition to Swartzwelder, study authors included lead author Larry A. Tupler, and contributors Daniel Zapp, William DeJong, Maryam Ali, Sarah O’ Rourke, and John Looney.

The research was supported by a grant from the National Institutes of Health (2U01AA019925) and a Senior Research Career Scientist award to Swartzwelder from the U.S. Department of Veterans Affairs, where he holds a joint appointment. All authors are affiliated with the Duke Consortium for the Study of the American College Student.

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