Should Alcohol Be a Part of Medical School Events?

Earlier this month, the surgeon general released an advisory on “Alcohol and Cancer Risk,” which recommended adding labels to alcoholic beverages to warn the public that alcohol is a known cause of at least seven different types of cancer. After tobacco and obesity, alcohol is the third most common cause of preventable cancer in the U.S., and the report highlights that nearly half of Americans are unaware of this risk.

There is an opportunity here for us to reassess how we nurture the next generation of doctors so they do not develop an unhealthy relationship with a known precipitant of cancer, dependence, and even suicidality. It is time for medical schools to tackle drinking culture during medical education, particularly by rethinking school-sponsored events that implicitly encourage drinking.

When I was in medical school, I was surprised by how tightly drinking was often woven into opportunities for students to socialize with each other, particularly at school events. While not officially encouraged, many students also leaned into binge drinking to unwind together after stressful experiences.

For example, in our first and second years, there were always school-sanctioned parties after our final exams at one of the local bars that included two free drink tickets, though many students did not stop there. After another event — our end-of-year formal that featured an open bar — one classmate received a DUI while driving home.

Meanwhile, studies have shown that medical students are at risk of alcohol use disorders. In a given year, approximately 10% of American adults meet diagnostic criteria for alcohol use disorder, and much like the general population, studies estimate that up to a third of medical students abuse alcohol.

Alcohol intoxication is also associated with suicide; approximately one-third of people who commit suicide have detectable levels of ethanol in their blood. Medical students are three times more likely to commit suicide than people of a similar age, and approximately 300 American physicians die by suicide annually. Since suicide prevention is a high priority for medical school administrators, we should ensure our efforts to help students navigate the stress inherent to medical training accurately reflect the link between intoxication and suicide.

The surgeon general’s call to action also serves as a timely reminder for us to think about making medical education more inclusive. Several of my peers — including Muslims, Mormons, and Seventh-day Adventists — abstained from alcohol on religious grounds and found events that inherently promoted alcohol consumption isolating. Others refrained from drinking for reasons such as personal values, pregnancy, or medical contraindications.

One student who overcame a problematic relationship with alcohol in college prior to matriculating into medical school confided that he felt like he had to constantly justify his decision not to drink at events. While he succeeded in maintaining sobriety, his concerns about the stigma he could face if he disclosed why he avoided drinking caused him to stop going to school events involving alcohol entirely.

To be sure, we cannot completely prevent medical students from ever overindulging or socializing around alcohol. Perhaps alcohol can still have a smaller role at some school events. But we can and should make sure that no event encourages binge drinking, and that all have options for those abstaining (non-alcoholic beverages, for example).

Of course, not every event will appeal to the entire student body, but reflecting on my time during medical school, some of the popular social events that did not lean so heavily on alcohol included: an overnight camping trip; a community service day in which we held free clinics followed by dinner together; an annual talent show; and a comedy night in which we made parody videos poking fun at various aspects of our medical training, often featuring hilarious performances and cameos from the faculty.

Under the mounting evidence of the many alarming risks associated with alcohol, we must revisit our approach to social gatherings and building connection during such an influential period of formation for future physicians.

If we want our patients to heed the advice of the surgeon general, we, as physicians and physicians in training, should lead by example. Medical students are an incredibly bright cohort of diverse individuals with many vibrant passions. There must be better ways for medical schools to help students connect with each other during training beyond events centered around drinking.

Alexis Cordone, MD, MPH, MHS-MEd, is a board-certified emergency physician and a Public Voices Fellow of The OpEd Project.