Elsevier

Aggression and Violent Behavior

Volume 8, Issue 5, September–October 2003, Pages 471-486
Aggression and Violent Behavior

A critical review of field studies on the link of alcohol and adult sexual assault in women

https://doi.org/10.1016/S1359-1789(03)00032-6Get rights and content

Abstract

This article reviews field studies examining two central questions regarding the link between alcohol and sexual assault. First, evidence is reviewed to evaluate whether there is a distal relationship between alcohol and risk of sexual assault victimization. Specifically, studies are examined to determine whether drinking may affect the risk of being victimized and how victimization may contribute to subsequent drinking. Second, evidence for a proximal role of drinking prior to a sexual assault victimization incident (by either victim and/or offender) is examined to determine alcohol's role in rape and injury outcomes to victims. Critical theoretical and methodological issues in these two types of studies are discussed with regard to the extant literature. Paralleling the two areas of research reviewed, two theoretical models are proposed to guide future research on (1) the global associations of drinking and sexual assault risk across the life span (macrolevel model) and (2) the role of drinking in the outcomes of actual sexual assault incidents (microlevel model). Suggestions are made for future research and intervention in this area.

Introduction

Researchers studying alcohol's role in sexual assault have attempted to examine the nature of this robust association. Alcohol is clearly related to one's risk of sexual assault and is actually present in a large proportion (one-half to two-thirds) of sexual assault incidents Abbey, 1991, Pernanen, 1991. Research is much less clear, however, on the exact nature of alcohol's role. The purpose of this literature review is to examine recent nonexperimental field studies addressing these questions and to suggest directions for future research on the role of alcohol in sexual assault. Previous reviews have appeared focusing on alcohol and sexual aggression in offender populations (Seto & Barbaree, 1995), social psychological factors affecting men's perpetration of alcohol-related sexual assault Abbey et al., 1994, Abbey et al., 1996a, and experimental laboratory studies of alcohol and violence that included sexual assault Bushman & Cooper, 1990, Hull & Bond, 1986. Two additional reviews have examined alcohol and physical assault victimization more generally (Martin & Bachman, 1997) and the role of women's drinking in sexual assault specifically (Testa & Parks, 1996). Finally, Abbey (in press) recently reviewed studies of alcohol and sexual assault in college students; however, the nature of alcohol's role in sexual assaults in this selective portion of the population may not generalize to community-residing women.

Since these reviews appeared, several field studies have been published on alcohol and sexual assault using representative samples of women. Furthermore, several studies using longitudinal designs have been published, which can better address the issue of ‘directionality’ of the alcohol–sexual assault association. Therefore, the current review focuses on these recent studies of nationally representative samples and specifically examines how these studies, in addition to other field studies on this topic, can inform research and prevention efforts addressing the risk of sexual assault victimization in women.

The reason a separate review is currently warranted focusing on field studies only is that mounting evidence suggests that results of experimental laboratory-based studies, already reviewed elsewhere, do not generalize to field studies. By reviewing these field studies, many of which were published after past reviews or were not included in the scope of prior reviews, and presenting theoretical models on the relationship of alcohol and sexual assaults against women, future field studies may be grounded in theory and empirical results to date.

First, cross-sectional studies of the distal relationship of drinking and sexual assault victimization are reviewed, followed by a review of longitudinal studies of alcohol and sexual assault risk. A macrolevel theoretical model is proposed to guide research on the relationship of drinking and sexual assault across the life span. Second, studies of the role of drinking in sexual assault incidents are reviewed with a focus on how drinking contributes to risk of completed rape and physical injuries in the context of other situational and behavioral risk factors Ullman, 2002, Ullman & Knight, 1993. A microlevel theoretical model is proposed that integrates alcohol with other situational and behavioral risk factors known to influence the outcomes of sexual assaults. Finally, implications are drawn from these field studies in terms of the current state of knowledge and directions for future research and intervention efforts.

Section snippets

Drinking and adult sexual assault risk

There are several ways that drinking and sexual assault may be related. Recent victimization theories posit that a convergence of risky situations, potential victims, and motivated offenders, occurring in the absence of capable guardians, increase victimization risk (see Meier & Miethe, 1993, for a review). Based on these theories, a first possibility is that drinking may precede and contribute to sexual assault risk potentially by increasing one's contact with motivated perpetrators and risky

Mediators and moderators of the sexual assault–alcohol relationship

Further research is also needed to understand mediators and moderators of the alcohol–sexual assault association. Given that results are inconsistent from studies of the relationship of risk of sexual assault and alcohol consumption/drinking problems, researchers need to examine other possible mediators in multivariate models that include precursors such as child sexual abuse and factors such as attachment style, number of sexual partners, and psychological symptoms (Gold, Sinclair, & Balge,

Summary and proposed preliminary macrolevel theoretical model

To summarize, the relationship of drinking and sexual assault is likely bidirectional with child/early sexual victimization leading to drinking to cope and other risky behaviors and situations that may contribute to risk of adult sexual assault, and subsequent drinking problems (see Fig. 1). Both mediators and moderators must be identified and evaluated in studies of the relationships of drinking and sexual assault over time. Some likely candidates already mentioned in this review of current

Alcohol's role in sexual assault incidents

A variety of situational and behavioral factors are associated with more severe outcomes to victims (e.g., rape completion, physical injuries) during sexual assaults (see Ullman, 1997, Ullman, 2002, for reviews). A number of studies have examined the role of both offender and victim drinking prior to assault in relation to the outcomes of sexual assault incidents. One of the more studied risk factors is alcohol, which is clearly present in approximately one-half to two-thirds of sexual assaults

Summary and proposed theoretical model of the relationship of drinking and sexual assault outcomes

Based on these studies of the role of drinking in outcomes of sexual assault incidents, a tentative model can be posited specifying the relationships of situational and behavioral factors with rape and injury outcomes to women (see Fig. 2). Although no single past study has tested all of the proposed links in the model, support for some pathways has been obtained with the exception of the physical injury outcome variable in two studies of college students Ullman et al., 1999a, Ullman et al.,

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