Considerable research attention has been given to the problem of heavy episodic or binge drinking among young adults in college in the United States. However, despite its common use and stability in repeated surveys, the binge measure has been controversial. In this study, aggregated data from four national cycles of the Harvard School of Public Health College Alcohol Study (CAS) conducted in 1993, 1997, 1999, and 2001 were used to examine whether the prevention paradox could be observed for alcohol consumption and related harms among college students. By describing the balance of harms according to drinking levels in the population, the hope was to identify targets and strategies for intervention efforts. Case study data were also utilized to describe how environmental prevention programs may be reducing harms in select college communities participating in the A Matter of Degree (AMOD) program. The AMOD program is intended to reduce binge drinking and harms in college. The study showed that the bulk of drinking-related harms reported by college students accrued to drinkers who consumed at extreme levels. However, it was found that most drinkers did not consume extreme amounts of alcohol. The abundance of drinking-related harms in college resulted from a combination of low to moderate individual risk multiplied by the large number of non-extreme drinkers. The findings suggest targeting the entire population using environmental prevention strategies. This would yield substantial community-wide reductions in harm. References