Prevalence of heavy episodic drinking and alcohol use disorder diagnosis among US college students: Results from the national Healthy Minds Study

•Alcohol use remains prevalent on college campuses overall.•There was variation in prevalence of alcohol use and heavy alcohol use by student demographics.•Programming should account for the diversity of students engaging in alcohol use.•Alcohol use disorder diagnoses were rare, suggesting opportunities for screening and treatment. Alcohol use is a common, recognized problem on college campuses. This study examined alcohol use in a national sample of US college students across 78 campuses. Using four waves of data from the Healthy Minds Study (2015–2019), we explored variations by student demographics in prevalence of recent: alcohol consumption, heavy episodic drinking (HED, 4/5 + drinks in one sitting), frequent HED (3 + HED events), and lifetime alcohol use disorder (AUD) diagnosis. Stratified analyses and logistic regression with response propensity weights were used. Two-thirds of students consumed alcohol and roughly-one-third engaged in HED in the past 2 weeks. Alcohol use was more common among students who: identified as cis women/men, bisexual or gay/lesbian/queer, white non-Hispanic, lived in Greek housing or off-campus, were not first generation, or those not rating religion as important. Prevalence of HED among recent drinkers was high (56.7%) but varied by gender identity, race-ethnicity, living situation, and religiosity. In addition, higher HED prevalence was reported among: international, undergraduate, and underage (under 21) students. There was little variation in HED by sexual orientation identity or first generation status among recent drinkers. In a sub-sample of students engaging in frequent HED, AUD diagnosis was uncommon (1.4%) and less likely among students identifying as: cis women/men, heterosexual, racial-ethnic minorities (particularly Asian/Asian American or Pacific Islander), international, religious, or living in Greek housing. Alcohol use continues to be a part of college life, while screening and treatment remains rare. There are opportunities for improved programming and outreach acknowledging college student diversity.