Towards a psychodynamic understanding of binge drinking behavior in first-semester college freshmen

The current exploratory study was designed to investigate the relationship between student characteristics and drinking behavior from a psychodynamic perspective. Respondents were 181 male and 196 female first-semester college students attending a small, private university in the northeastern United States. Subjects completed the following instruments: the Toronto Alexithymia Scale (Taylor, Ryan, & Bagby, 1985), the Rosenberg Self-Esteem Scale (Rosenberg, 1965), the Bell Object Relations and Reality Testing Inventory (Bell, 1991), and the College Alcohol Survey (Wechsler, 1997). Results revealed clear differences in the relationship between ego functioning and drinking behavior for men compared to women. Findings indicate that the meaning of alcohol use may differ for male and female students. Implications for methodology, theory, and practice are discussed.Alcohol abuse among college students has been described as the number one health problem plaguing our nation's campuses today (Treise, Wolburg, & Otnes, 1999). Almost half of all college students binge drink, a phenomenon associated with serious consequences for students' physical, academic, and socioemotional functioning (Wechsler, Davenport, Dowdall, Moeykens, & Castillo, 1994; Wechsler, Dowdall, Maenner, Gledhill-Hoyt, & Lee, 1998; Wechsler, Lee, Kuo, & Lee, 2000). Although binge drinking among college students has been widely researched, existing investigations have not been representatively conceptualized. Few, if any, studies have been grounded in psychodynamic theory.

Contemporary psychodynamic theorists view substance abuse as an adaptive attempt to compensate for impairments within the ego structure. Ego deficits most often associated with substance abuse include difficulties with affect regulation, self-esteem maintenance, and object relations. These interrelated ego functions develop in the interactive context of the caregiver-child dyad (Khantzian, 1994, 1995; Krystal, 1994, 1995). Broadly stated, when the caregiver-child relationship is harmonious, the child develops the ability to regulate affect, maintain self-esteem, and cultivate stable object relations. However, when the caregiver-child relationship is tumultuous, the child's ego function development is thwarted. From a psychodynamic perspective, this constitutional limitation is thought to predispose an individual to substance abuse.

According to psychodynamic theory, in healthy development, the primary caregiver is empathically attuned to his or her infant's physical and psychic needs. The newborn baby is helpless and unable to distinguish external from internal reality. Caregiver, infant, and the relationship between them are experienced as a unified whole (Mahler, 1968). The quality of this early experience hinges upon the caregiver's effectiveness in attending to the infant's need states by feeding, changing, and holding (Blatt & Lerner, 1983; Foehrenbach, Celentano, Kirby, & Lane, 1997).

When healthy development proceeds, the baby experiences inevitable empathic failures that teach him or her that the caregiver is an external source of gratification (Mahler, 1968). The caregiver is generally effective in mirroring and containing the infant's primitive affect and in regulating the child's distress by offering bodily contact and verbal soothing (Bowlby, 1988; Reckling & Buirski, 1996). Gradually, the baby internalizes the caregiver's protective, soothing, and calming capacities. The internalization of these functions serves as a precursor to effective and autonomous affect regulation.

The caregiver's ongoing attunement and responsiveness to the infant's emotional signals result in a sense of self-efficacy within the child (Silverman, 1998). The internalization of the caregiver's nurturing and protective functions evokes the feeling in the child that he or she is worthy of care, which serves as a precursor to the development of healthy self-esteem (Flynn Campbell, 1997).

Both affect regulation and self-esteem maintenance develop within an interpersonal matrix that progressively becomes more highly differentiated. As development proceeds, the baby internalizes information about both the self and the caregiver that slowly becomes more complex and refined (Hartley, 1993). This process of gradually integrating an autonomous identity relative to that of the caregiver is referred to as "separation-individuation" (Mahler, Pine, & Bergman, 1975). The caregiver represents a secure home base from which to explore the world and to which the baby may return as needed for emotional refueling. Ultimately, the child is able to internalize an image of the caregiver that can be called upon even when the caregiver is not physically present. The image of the self likewise emerges as more highly differentiated and solidified. These internalized representations of objects and the self serve as precursors to healthy object relations and affect the development of subsequent interpersonal relationships (Blatt & Lerner, 1983). In so doing, they reciprocally influence the capacities for affect regulation and self-esteem maintenance (Kernberg, 1997).