Objective: The purpose of this study was to examine drinking levels, related harms, and secondhand effects of alcohol use at heavy drinking colleges between 1993 and 2005 at colleges with high levels of drinking in 1993. Method: Students attending 18 colleges with high levels of heavy episodic drinking (50% of students or more) from the 1993 Harvard School of Public Health College Alcohol Study were surveyed in 2005 (n = 4,518). Data collected through mailed and Web-based questionnaires were compared with responses from students at the same schools in 1993, 1997, 1999, and 2001 (N = 13,254) using time trend analyses. Results: Overall, levels of alcohol consumption, experience of problems, and levels of secondhand effects remained high among students attending heavy drinking colleges. More than four of five students at these schools drank alcohol (range: 85%-88%), and more than half engaged in heavy episodic drinking (range: 53%-58%). The stability of drinking behavior occurred among subgroups of students as well. The few statistically signifi cant changes occurred mainly between 1993 and 1997. A decline in driving after any drinking between 1997 and 2005 was observed, but no similar decline was found in two other measures of drinking and driving. Conclusions: Heavy drinking and associated problems continue unabated, with few exceptions, at colleges that are most in need of intervention: those with high levels of heavy episodic drinking. Addressing student alcohol use at heavy drinking colleges may require stronger, more consistent, and more comprehensive approaches, with increased emphasis on the alcohol environment.