Exploring the alcohol--sexual assault link: pathways from alcohol to assault.

Dear Editor:

In considering the amalgam of alcohol-related information being contributed in areas of mental health and education, as well as for public awareness, it is important to recognize the contributing role of alcohol in other focal areas such as interpersonal trauma. Many studies estimate that over one half of all sexual assaults involve alcohol use by the victim, perpetrator, or both. With this recognition, it is additionally important to educate counselors, students, and high-risk individuals about the potential dynamics and consequences. The relationship between alcohol use and sexual assault is complex and likely reflects the contributions of many variables that may differ from incident to incident. Presented within this article is a brief overview, based upon recent and key literature, of the numerous indirect routes by which alcohol may influence sexual assault risk, as well as moderating contextual variables and findings of increased alcohol use following sexual victimization.

Perhaps the best place to begin is with an understanding of the physical and psychological effects of alcohol and consideration of how such effects may interact with the social environment to elevate sexual assault risk. It is generally accepted that alcohol use, especially heavy alcohol use, results in both cognitive and physical impairments. It is suggested that the cognitive limitations or perceptual narrowing which occur with alcohol use may cause women to engage in situations or behaviors that put them at higher risk for sexual assault, as well as reducing their ability to detect danger cues in such situations (Abbey, 2002). High-risk sexual behaviors, shown to be associated with the use of alcohol, may correlate with behaviors constituting an increased risk for sexual assault. For example, a high-risk behavior such as engaging in sexual activity with a partner one has just met may also increase risk of sexual assault by increasing exposure and vulnerability to sexually aggressive men, (i.e., a woman who is intoxicated and leaves a social event alone with a man she has just met may be at increased risk for sexual assault if she is unwilling to engage in sexual intercourse). Similarly, the physical effect of alcohol may result in a reduced ability for the victim to defend herself against sexual aggression, which would explain the higher proportion of completed to attempted rapes in sexual assaults involving victim alcohol use (Harrington Cleveland, Koss, & Lyons, 1999). Alcohol consumption presents a risk due to the pharmacological properties and expectancy effects, but may not be perceived as a risk cue due to the normative nature of alcohol consumption in many social situations. Alcohol use is identified as an ambiguous risk factor rather than a factor women clearly associate with risk for sexual assault. Expectations of positive social outcomes associated with consuming alcohol, such as increased ease of socializing and reduction of social anxiety, may lead women to dismiss or overlook the increased risk for assault which alcohol use presents (Norris, Nurius & Graham, 1999).

The perceptual narrowing that occurs with alcohol intoxication appears to be the primary mechanism of at least one route of increased risk for sexual assault. "Alcohol myopia" is a term often used to refer to such cognitive narrowing. There is a tendency to focus on environmental cues that are consistent with the individual's pre-conceived notion of a situation and the individual's desired outcome. Hence, when impaired by alcohol, an individual is likely to attend most closely to those aspects of the environment that confirm their current agenda, making it less likely that they will recognize more subtle cues that challenge their perceptions of the situation. Considering the effects of alcohol on cognitive processing and judgment, poor sending and receiving of friendly and sexual cues is likely with heavy alcohol use. It is the role of alcohol, contributing to misperceptions during the process of negotiating a social/sexual interaction that many researchers have identified as key.

There is a normative degree of ambiguity to many of the sexual cues used by both women and men in the social dating/mating dance. The ambiguity serves a purpose, mitigating potential embarrassment or rejection. When misperceptions occur in the interpretation of these ambiguous social/sexual cues, the potential for negative outcomes is increased. While a drinking man may interpret ambiguous social cues as indicative of a woman's consent or desire for sexual activity, an interpretation consistent with his own desire for sexual activity, a woman who is drinking may overlook the cues indicating the man's sexual intent, particularly if she does not perceive the interaction as potentially sexual. The alcohol myopia that contributes to these conflicting perceptions may play a strong role in the progression of sexual assault (Abbey, 2002).

Once a woman becomes aware of the discrepancy between her sexual intent and that of her partner or the male with whom she is interacting, she must decide how to respond. The gender-based norms of our society may limit a woman's perceived range of responses. Due to social norms, direct confrontation may be uncomfortable, especially if the woman hopes to continue the relationship. This may lead to equivocal or indirect communication, which is easily dismissed by the man as the expected social interplay, and a signal that she may be receptive if he continues to pursue sexual activity (Abbey, 2002). The cultural view of women as sexual gatekeepers and men as sexual initiators has contributed to the evolution of an unspoken, but commonly accepted negotiation during social/sexual interactions, with the expectation that women should not express sexual interest initially, else they be labeled with any number of derogatory gender-based sexual judgments. Knowing this standard, men are often expected to continue to pursue sexual interaction, allowing the woman to give in after a sufficient protest to establish her respectability or worth by society's sexual standards (Abbey, 1991). When this dynamic is considered in the context of misperception and reduced inhibitions, common with alcohol use, the risks for sexual assault are amplified. Additionally, the woman's ability to resist unwanted sexual advances may be decreased as alcohol diminishes her ability to generate potential coping responses including verbal and physical resistance (Abbey, 1991).

Misperception of sexual intent appears to be a common phenomenon. Men are more likely than women to mistakenly attribute sexual interest or intent to a woman than vice versa, though it occurs in both genders. Considering the effect of alcohol consumption on a person's ability to accurately perceive and process information, perceptions of heightened sexual arousal due to expectancy effects, and decreased inhibition, it becomes easy to envision how such misperceptions may contribute to the perpetration of sexual assault, as well as explaining the large discrepancy which often occurs between the perpetrator, seeing the incident as consensual or possibly coercive, but not assaultive, and the victim who experiences the event as a sexual victimization. Though this process of misperception is clearly important in understanding the dynamics of alcohol-related sexual assault, it in no way mitigates or excuses forced sexual activity.

While the process of misperception suggests that, impaired by alcohol, a man is less likely to distinguish between his expectations of his partner's sexual willingness and her actual behavior, a more malevolent possibility is the use of alcohol to justify behavior, as in cases where sex is intended regardless of the partner's willingness, but with the expectation that intoxication will provide the perpetrator with an excuse from the responsibility of the unacceptable actions (Abbey, 1991). Men may be more likely to drink alcohol in situations where they want to feel more sexual or aggressive, such as social situations or dating encounters. Alcohol or drugs may be used, either deliberately or unintentionally, to increase perceptions of the woman's sexual availability and consent and provide a sense of justification or decreased sense of responsibility for the perpetrator (Harrington Cleveland, Koss, & Lyons, 1999). The issue of decreased accountability can be somewhat unclear, with questions of whether alcohol use presents an increased risk for violence or provides an excuse for behavior following violence, though both scenarios are likely.

Both women's and men's alcohol expectancies, their perceptions of the effects of alcohol use on social interaction, sexuality, vulnerability, and responsibility for one's actions, have significant implications when examining the role alcohol may play in many sexual assaults. Studies have generally found that alcohol is expected to increase men's aggression and sex drive, while women are expected to experience more alcohol-related sexual affect and vulnerability to sexual coercion. Such differences are consistent with traditional gender role perceptions, emphasizing social and emotional (romantic and affective) factors for women and instrumental (sexual and behavioral) factors for men. These expectations demonstrate gender role stereotypic beliefs about the effects of alcohol. This in turn is related to perceptions of women as more sexually available or promiscuous and consequently more responsible for forced sexual advances when drinking. It also tends to normalize sexual aggression in drinking men (Norris, George, Cue Davis, and Martell in Abbey et al. 2002). At the least, alcohol expectancies may set the stage for the misperceptions discussed above, as both men and women perceive consensual sexual intercourse as more likely on dates when alcohol is used.

Demonstrating the power of alcohol expectancies and culturally influenced views of alcohol use, a recent alcohol administration study carried out in a simulated bar setting by Parks and Kennedy (in Abbey et al., 2002), assessed perceptions of heterosexual social interactions mediated by alcohol. Both the women involved and male research confederates, who had been trained to rate women's sexual and non-sexual behaviors during the staged interaction, rated the women's responsiveness or receptivity to several sexually suggestive probes. Within the high alcohol dose group, the male confederates rated the women as more responsive to the sexual suggestions, viewing them as more sexual and engaged in the interaction. Contrary to the men's perceptions, while more expressive during the total interaction, observation of nonverbal behaviors during the probes found more closed and neutral body positions. The contradiction of observational coding with the confederate ratings suggested that even when trained to objectively observe the interaction, men tended to interpret friendliness as sexual interest in drinking women. An additional consideration for this finding: the male confederates were not drinking and were in fact attempting to be objective. In typical social settings, such as a real bar, cognitive deficits associated with alcohol consumption by the man would likely increase the degree of misperception. Also, as with many alcohol administration studies, the BAL (.08) of subjects in the "high" alcohol group is not necessarily equivalent to and may be significantly lower than the level of alcohol consumption in which participants would likely engage given a less controlled setting.

The unwritten social attitudes and cultural beliefs about female alcohol use provide the context within which to examine other constructs such as alcohol expectancies, and perceptions of decreased accountability. Wilsnack (1991) noted an ideological link throughout history, suggesting that women who broke societal norms by engaging in heavy alcohol consumption were viewed as more likely to break societal norms restricting women's sexual behavior as well, leading men and women alike to view drinking women as more sexually promiscuous or sexually responsive. Numerous studies have shown that men report less favorable perceptions of women who drink heavily, while perceiving them as more sexually available. In such an environment, with less respect and a greater expectation of the right to sex, there is an increased likelihood of coercion and sexual assault if sexual interaction is denied. Common endorsement of the use of alcohol to obtain sex from a date or acquaintance by men in research studies has established the perception of social legitimacy in getting a date drunk as an acceptable means of obtaining sex. Sexual coercion in the form of verbal pressure may be combined with alcohol or drug use and perceived, in some cases by both the perpetrator and the victim, as an interaction falling within the normative expectations given the relational, social, or sexual context. Additionally, forced intercourse with an intoxicated woman is far less likely to be described as rape than forced intercourse with a sober woman (Abbey, 1991). With such perceptions or stereotypes of women who drink comes an enhanced sense of responsibility for being raped while intoxicated. Women who are under the influence of alcohol when sexually assaulted are often perceived as more responsible for the assault by others, and often see themselves as more responsible as well, having failed to prevent the unwanted advance due to their alcohol use during the incident. This may result in a reluctance to categorize the experience as sexual assault, and frame it as a socially acknowledged consequence of intoxication for women (Abbey, 1991).

Just as alcohol interacts with the ambiguity of the social/sexual cues discussed within the pre-assault risk factors above, the presence of alcohol may create greater ambiguity in interpreting the course of events during a sexual assault, and may perhaps even blur the line between sexual assault, coercion, and consensual intercourse. Aside from the perceptions of those directly involved (victim and perpetrator), the perceptions of others in the individual's social group and culture will have an impact on the understanding of the events and the meaning ascribed to them.

One area of contention has been the inclusion of sexual intercourse via alcohol or drug intoxication in the definition of rape. Some detractors have claimed that this stance essentially labels bad dates as rape, pointing to remorse after the fact as the psychological basis for reinterpreting the event as a sexual violation. This position suggests that a woman has control and choice regarding the amount of alcohol she imbibes, and is therefore responsible for maintaining a level of sobriety sufficient for self-protection or responsible sexual decision-making. Some have even argued that since many of the women do not define their experiences as rape, it is not rape, just a bad sexual experience. The closeness of the relationship may also influence the perception of sexual assault, where sexual assaults occurring within dating relationships create an even more ambiguous context for evaluating the events.

Researchers addressing this criticism support the assertion that the large majority of rape victims are "hidden victims" who do not identify themselves as victims of sexual assault, report the assault, or seek psychological services following the assault. It may be that alcohol-related date rapes have been established as an almost normative event in our culture. Regardless of whether the women identified their experience as rape, they often experience levels of psychological distress equivalent to those raped by force, but are less likely to be accepted as a "real rape" victim by others, removing much needed support at a crucial time (Schwartz & Leggett, 1999).

Aside from the potential pathways linking alcohol use to sexual assault risk at the front end, increased alcohol use has frequently been identified as a behavior differentiating sexual assault victims from non-victims. In a two-year longitudinal study, Kilpatrick, Acierno, Resnick, Saunders, and Best (1997) found that sexual assault, both lifetime prevalence and new assaults occurring within the period of the study, predicted increased likelihood of both alcohol and drug use. The primary explanation for such findings points to self-medication of psychological distress / negative affect following sexual assault as the motivation for increased alcohol consumption. Negative reinforcement, (i.e., distress / tension reduction via alcohol's physical and psychological effects) may be a mediating factor in the observed increase in alcohol use documented in many samples of women with sexual assault histories. Other sources suggest that, while not predicting alcohol consumption, sexual assault predicts alcohol related problems post-assault, perhaps reflecting the maladaptive use of alcohol as a coping mechanism.

This post-assault self-medication presents a further complicating factor, as it in turn increases the risk for re-victimization. Thus, alcohol use heightens risk for sexual assault. The assault victim drinks more often and heavily as a way to manage the negative affect and psychological distress resulting from the assault. This in turn puts her at greater risk for being assaulted again, creating a vicious cycle, with steadily worsening ramifications for mental health.

Lastly, there is substantial literature on the prevalence of alcohol related problems in adult survivors of childhood sexual abuse. Differentiations must be made between childhood and adult sexual victimization, as the dynamics of childhood and adult assaults are not equivalent and may involve significantly different risk factors, perceptions of the event, compensatory coping behaviors, and subsequent problems. It is possible that different patterns of alcohol use and associated problems are linked to different patterns of victimization.

Studies have found high rates of childhood sexual abuse in both women and men in treatment for alcohol use disorders (Wilsnack, Vogeltanz, Klassen, & Harris, 1997; Wilsnack, 1991). Women with alcohol problems endorse higher rates of childhood sexual abuse than women without alcohol problems, even when demographic factors, involvement in treatment, and parental alcohol problems are controlled. Studies with national samples of women, have found that more than twice as many problem drinkers as non-problem drinkers report experiences of sexual abuse before the age of 18. When examining severity of childhood sexual abuse, the differences are more pronounced, with the alcoholic women more than 5 times as likely to report penetration. Sexual victimization has been related to younger age at first alcohol use, earlier onset of problem drinking, and higher scores on measures of alcohol-related problems, as well as other psychopathology and sexual dysfunction (Wilsnack, Vogeltanz, Klassen, and Harris, 1997). Women with histories of childhood sexual abuse reported higher rates of recent alcohol use and intoxication, alcohol-related problems, and symptoms of alcohol abuse or dependence, as well as use of other illicit substances. Again, the primary hypothesis for this relationship has focused on alcohol use as self-medication to manage negative affect. Obviously, when addressing the issue of childhood sexual abuse, there may be many possible intervening or moderating variables affecting the relationship. This is an important consideration for counselors working within the areas of chemical dependency treatment. Given the heightened incidence of sexual abuse within this population, assessment of female drinkers for prior sexual abuse is indicated to facilitate appropriate treatment planning and address the trauma underlying the current drinking problems.

In reviewing the literature, there is a glaring absence of research demonstrating the efficacy of, or even proposing, any well defined prevention programs. While many researchers make recommendations for future research studies and point to the complex relationship and the normative nature of both alcohol use and coercive or assaultive sexual interactions in our culture, nobody has much to say on how our society might effectively go about addressing this problem. Most recommendations suggest that education about risk factors is the primary preventative approach. However, it is unlikely this is the whole answer, given the findings suggesting that women recognize alcohol use as a risk factor for others, while minimizing the perceived risk to themselves (Norris, Nurius, and Graham, 1999). Other sources suggest the need to target alcohol use as an approach for the secondary prevention of sexual assault. One study cited a prevention program which linked a reduction in binge drinking after an intervention educating college students about normative drinking behaviors with a decrease in reported incidents of forced sexual touching and being taken advantage of sexually (Becket & Reilly, 1999). Development of prevention programs addressing alcohol use as a primary factor in reducing sexual assaults is clearly important. Studies examining the feasibility and efficacy of such prevention programs are a necessity in the future research in this area.

References

Abbey, A. (1991). Acquaintance rape and alcohol consumption on college campuses: How are they linked? Journal of American College Health, 39, 165-169.

Abbey, A. (2002). Alcohol-related sexual assault: A common problem among college students. Journal of Studies on Alcohol, 14, 118-28.

Abbey, A., Zawacki, T., Buck, P., Testa, M., Parks, K., Norris, J., Martin, S., Livingston, J., McAuslan, P., Clinton, M., Kennedy, C., George, W., Cue Davis, K., & Martell, J. (2002). How does alcohol contribute to sexual assault? Explanations from laboratory and survey data. Alcoholism: Clinical and Experimental Research, 26, 575-581.

Becker, J. & Reilly, D. (1999). Preventing sexual abuse and assault. Journal of Research and Treatment, I 1, 267-278.

Harrington Cleveland, C., Koss, M., & Lyons, J. (1999). Rape tactics from the survivor's perspective: Contextual dependence and within-event independence. Journal of Interpersonal Violence, 14, 532-547.

Kilpatrick, D., Acierno, R., Resnick, H., Saunders, B., & Best, C. (1997). A 2-year longitudinal analysis of the relationship between violent assault and substance use in women. Journal of Consulting and Clinical Psychology, 65, 834-847.

Norris, J., Nurius, P., & Graham, T. (1999). When a date changes from fun to dangerous: Factors affecting women's ability to distinguish. Violence Against Women, 5, 230-250.

Schwartz, M.D. & Leggett, M.S. (1999). Bad dates or emotional trauma? The aftermath of campus sexual assault. Violence Against Women, 5, 251-271.

Wilsnack, S. (1991). Sexuality and women's drinking. Alcohol Health

and Research World, 15, 147-150.

Wilsnack, S., Vogeltanz, N., Klassen, A., & Harris, R. (1997). Childhood sexual abuse and women's substance abuse: National survey findings. Journal of Studies on Alcohol, 58, 264-271.

Jennifer L. Broach

University of Rochester Medical Center 

Rochester, NY 14642