Introduction

Alcohol is a common feature in many sexual assaults, particularly those committed in a social context. Although there is extensive research on the link between alcohol and sexual assault, there is a lack of clarity about the exact role that alcohol plays. In the ACSSA research report Insights Into Sexual Assault Perpetration: Giving Voice to Victim/Survivors' Knowledge, alcohol was seen as a tool, commonly used by perpetrators (Clark & Quadara, 2010). The report will be referred to throughout this paper as Giving Voice.

The findings from Giving Voice identified a variety of ways in which alcohol was used by perpetrators in social interactions and settings in order to perpetrate sexual assault. These included: taking advantage of the social use of alcohol to enable and facilitate the assaults; as a method of increasing perpetrator confidence; excusing their perpetrating behaviour after the assault; and enabling manipulation of the effects of alcohol for the purposes of reinterpreting the assault or women's memories of it - alcohol has the effect of creating a barrier to the reporting of sexual assault as women often see their own intoxication or drinking behaviour as contributing to the assault.

This Issues paper aims to review research around alcohol use in sexual assaults that are perpetrated in circumstances of socialising and sexual interactions. It will highlight key points from the literature that provide relevant information for prevention. This paper also discusses 14 transcripts from interviews with victims of sexual assault in which alcohol was present. These interviews were originally undertaken as part of the Giving Voice report (Clark & Quadara, 2010). The report was originally conceived as a step towards enhancing understanding about sexual assault perpetration. This Issues paper builds on one aspect of the findings from that report - namely that alcohol is often present when sexual assault is perpetrated. The aim of drawing on the Giving Voice transcripts that highlighted the presence of alcohol was to gain some insight into alcohol's role in sexual assault facilitation and seeing whether this insight accords with the wider literature on alcohol.

What is the association between alcohol consumption and sexual assault?

The relationship between alcohol and sexual assault is multidimensional and diverse issues are taken up in research studies. Some key examples include:

• histories of drinking behaviour, particularly heavy drinking, among victim/survivors and perpetrators (prior to the incident) (Mann & Farmer, 2013; Ullman & Najdowski, 2010);
• the relationship between a history of child sexual abuse victimisation and alcohol consumption (Walsh et al., 2013);
• beliefs about alcohol and expectations about the effects of alcohol on confidence, sexual desire, and sexual availability (Benson, Gohm, & Gross, 2007);
• deliberate alcohol or drug facilitated sexual assault, (i.e. when there is the "covert or forcible administration to a victim" of drugs or alcohol by an assailant for the purposes of sexual assault) (Neame, 2003; Beynon, McVeigh, McVeigh, Leavey, & Bellis, 2008)
• opportunistic, drug-facilitated sexual assault (i.e. when an assailant engages in sexual activity with a victim who is profoundly intoxicated through voluntary consumption of alcohol) (Littleton, Grills-Taquechel, & Axsom, 2009);
• the role that alcohol plays in physical and cognitive impairment (e.g., increased aggression, physical impairment); (Giancola, 2013); and
• associated risk factors such as younger age, "risky settings" (e.g., parties, licensed premises) (Advisory Council on the Misuse of Drugs, 2007; Fileborn, 2012).

These represent quite specific dimensions of the relationship between alcohol and sexual assault. As such, there is variation in research populations (e.g., university students compared to incarcerated offenders), methodology, purpose of research and, therefore, findings. Further, across the research, there is no agreed standard on how the presence of alcohol should be measured. Studies variously explore simply whether alcohol was consumed, the number of drinks consumed, the frequency of alcohol consumption, or blood alcohol levels. In addition, studies often combine alcohol and other substances in their analyses. In short, it is difficult to draw firm conclusions about what role alcohol has in sexual assault.

This Issues paper focuses on the consumption of alcohol in social settings such as private parties, after-work drinks, functions (e.g., weddings), licensed premises, and other social occasions, and its relationship to incidents of sexual assault. Relevant research literature published since 2000 that examines the relationship between alcohol consumption and sexual assault was reviewed. The most common sources of data drawn on in these sources were:

• community-based populations (generally through surveys); and
• forensic toxicology analysis of blood alcohol levels following an incident of sexual assault.

Other sources of information include police report data. The findings from these studies are described below.

Findings from the research

Forensic toxicological analyses

Benyon and colleagues undertook a systematic review of studies published between 1996 and 2005 to examine the evidence linking alcohol consumption and sexual assault (Beynon,et al., 2008). This review was done in the context of debates occurring both in Australia and internationally, about a perceived increase in the occurrence of the covert administration of alcohol or drugs to facilitate sexual offending (Neame, 2003). They identified seven articles that examined the use of alcohol and drugs in incidents of sexual assault.¹ Alcohol was detected in 35-47% of forensic samples. One study, which back-calculated blood alcohol levels, found that 60% of 1014 samples had blood alcohol concentrations (BAC) >150mg/100m (0.15) and 36% had BAC >200mg/100mls (0.2) (Scott-Ham & Burton, 2005).²

Another study reviewed toxicology reports from 1999-2005 extracted from the Forensic Science database in Northern Ireland (Hall, Goodall, & Moore, 2008). Alcohol or alcohol and other drugs were detected in 36-66% of samples, with an overall trend of an increase in samples detecting alcohol (although this increase was not statistically significant). Average blood alcohol concentrations ranged between 0.17 and 0.21, with 5 years showing the highest blood alcohol concentrations to be greater than 0.3.

Community samples

Community-based samples can provide more information about the contexts in which alcohol was consumed and whether both the perpetrator and the victim/survivor were drinking. Overall, this research suggests that alcohol is most likely to be present in sexual assaults where the victim and perpetrator are casual acquaintances. A common estimate is that it is present in approximately 50% of incidents; research conducted with college students in the US suggests that at least 50% of sexual assaults are associated with alcohol use (Abbey, 2002; Abbey, Zawacki, Buck, Clinton, & McAuslan, 2001).

Gunby, Carline, Bellis, and Beynon (2012) conducted an online survey with 1,110 university students in England and Wales, which asked about experiences of alcohol-related non-consensual sex. The survey used the sexual experiences survey to measure ‘non-consensual oral, anal or vaginal sex since the age of 14' and the Alcohol Use Disorder Identification Test (AUDIT) to measure alcohol consumption. Of specific interest was whether there were gender differences in these experiences. Almost a third (30.7%, 329 women and 55 men) had experienced alcohol-related non-consensual sex. The study further found that 82.2% of women who had experienced alcohol-related non-consensual sex were "hazardous drinkers" compared to 62.9% who drank at lower levels.³

A New Zealand study of 2,548 university students across six university campuses also used a web-based survey to find out about "harmful sexual experiences" (Connor, Gray, & Kypri, 2010). Compared to men, women were more likely to report experiencing unwanted sexual advances (21% vs 12%) due to someone else's drinking. However, according to this survey, men and women experienced similar levels of regretted sex (9.1% and 8.4%) and sexual assault or date rape (0.6% and 0.5%).

Brecklin and Ullman (2010) conducted research with 1,084 non-college female participants who had experienced sexual assault and who were recruited from Wave 1 of a longitudinal study on sexual assault recovery. Approximately 37% of respondents reported that their perpetrator had consumed alcohol either on its own or in conjunction with other substances prior to the assault (similar numbers of respondents did not know whether alcohol or drugs had been used). The study did not ask about the quantity of alcohol or other substances consumed. They found that victims and perpetrators have both consumed alcohol (and other substances) in incidents of sexual assault. This was particularly the case where victim/survivors were assaulted by an acquaintance (compared to a relative or husband/boyfriend). Additional injury was more likely when only the perpetrator had been consuming alcohol.

Summary

While it is possible to locate published studies that report on the presence of alcohol in sexual assault incidents, it is difficult to know what to make of the findings. There are several reasons for this. First, the studies vary in terms of what is being assessed. Studies looking at "alcohol and drug-facilitated sexual assault" often do not distinguish between voluntary and involuntary or coercive alcohol consumption. For example, the systematic review by Benyon and colleagues found that 7 out of 8 studies did not distinguish between voluntary and involuntary consumption (Beynon et al., 2008; Bosman, Verschraagen, & Lusthof, 2011; McBrierty, Wilkinson, & Tormey, 2013).

Second, as noted earlier, the way in which alcohol consumption is defined and measured varies across the research. Some studies refer to "alcohol-related" or "alcohol-involved" sexual assault. These studies tend to be conducted with community or university student samples about their experiences of consensual and non-consensual sexual activity (Abbey, 2002; Abbey, Boyd, Grey, McCabe, & Young, 2008; Abbey, Zawacki, et al., 2001). Alcohol consumption can be one component of the survey, using measures such as a how many days in a typical month participants drink alcohol; how many standard drinks they usually have; and their largest amount of alcohol consumed on one occasion during the prior year (e.g., Zawacki, Abbey, Buck, McAuslan, & Clinton-Sherrod, 2003). This means that it is hard to know how alcohol is being used in these incidents or what meaning is attributed to its consumption. Other research refers to "alcohol-" or "drug-facilitated" sexual assault (Beynon et al., 2008; Bosman et al., 2011; McBrierty et al., 2013). This terminology is more suggestive of circumstances in which individuals are significantly intoxicated and are highly vulnerable or incapacitated such that they are unable to freely consent to sexual interaction.

Third, the populations differ across the studies. As noted, some research involves university populations. Drinking practices and social contexts among these groups may be quite different compared to the broader population. On the other hand, toxicology reports are based on people who have reported a sexual assault. As well demonstrated in the research, only a small proportion of victims report sexual assaults to police or emergency services.

Alcohol and aggression

There are physical and cognitive impacts related to alcohol consumption. These include impaired motor skills, memory, the ability to process information, and learning and attention deficit issues (Schweizer & Vogel-Sprott, 2008). Some of these effects of alcohol have been the basis of theories about the link between alcohol and aggression. Most of these make the connection to aggression more broadly than specifically in relation to sexual assault. What must be kept in mind when considering the theories is that alcohol doesn't necessarily have the same effect on all people and not everyone who becomes intoxicated becomes aggressive.

Disinhibition theory

Upon consumption of alcohol, the concentration of alcohol in the blood rises, and higher levels of blood alcohol concentration are associated with decreased ability to inhibit inappropriate behavioural responses (Schweizer & Vogel-Sprott, 2008). Theories around disinhibition incorporate the fact that alcohol acts pharmacologically on the brain to disarm the part associated with impulse control and inhibition (Giancola, 2013). However, this theory cannot be applied across the board as an explanation for aggression because it doesn't explain why only some people become aggressive when drinking (Giancola, 2002)

Alcohol myopia theory

"Alcohol myopia" is a term coined to describe the effect of alcohol consumption that decreases the ability to detect certain outlying cues in the surrounding environment or multiple aspects of a situation, instead only focusing attention on the most immediate aspects or prominent cues (Benson et al., 2007; Giancola, 2002; Steele & Joseph, 1990). Labelling this effect "alcohol myopia", Steele and Joseph described it as when "superficially understood, immediate aspects of experience have a disproportionate influence on behaviour and emotion" (Steele & Joseph, 1990, p. 923). Further to this, in a situation of conflict or provocation, the myopia will focus the inebriated person's attention on the provocative aspects of the situation. The processing of information from the immediate environment is distorted, with less attention paid to more remote environmental cues while immediate interactions or experiences may be over-emphasised to influence actions or emotions (Steele & Joseph, 1990; Gunby et al., 2012).

The alcohol myopia may affect victims as well as perpetrators. It could function to make it more difficult for women to recognise signals of risk (Abbey, Zawacki, Buck, Clinton, & McAuslan, 2004).

Alcohol expectancies theory

An "alcohol expectancy" is a belief held about the effects of alcohol on behaviour (Corbin, Bernat, Calhoun, McNair, & Seals, 2001). If a consumer of alcohol holds the belief that consuming alcohol is related to aggression, then this theory contends that they will then behave more aggressively. According to this theory, it is, therefore, the belief rather than the actual properties of alcohol that will cause the aggression (Giancola, 2002).

Alcohol expectancies in relation to sex

Alcohol expectancies in relation to sex are the beliefs one holds in relation to how the consumption of alcohol will affect their sexual behaviour. These beliefs may be tied in with social scripts around gender roles in relation to alcohol and sexual behaviour. For example, a perpetrator may hold the belief that women who drink are more sexually available and that sexual activity is enhanced by alcohol. This can relate to the idea that alcohol will increase the sexual availability of women (Mann & Farmer, 2013).

Alcohol expectancy can be linked to patterns of an individual's alcohol consumption in that holding certain expectancies could be a motivation to drink more. For example, expectancies around alcohol enhancing social experiences and social abilities could see an increase in consumption, particularly if these enhancements were more likely to lead to sex. This belief could also influence sexual behaviour following consumption (Corbin et al., 2001).

The past experiences of victims and perpetrators with alcohol and sexual assault can shape their future alcohol expectancies. Previous sexual experiences associated with alcohol can strengthen expectancies, particularly if they are repeated (Kalmakis, 2010). Women who reported a history of sexual victimisation reported that their alcohol consumption would make it more difficult for them to remove themselves from a sexually risky situation (Corbin et al., 2001).

A US study of 350 college students also found that increased alcohol consumption was associated with beliefs that alcohol enhances sex drive, and their own vulnerability to sexual aggression (Benson et al., 2007). Another recent US study of 218 students that looked at perceptions of risk and alcohol expectancies found that there appears to be a connection between experiences of sexual victimisation and sexual perpetration and the expectancies regarding their vulnerability or likelihood of perpetrating (Untied, Orchowski, & Lazar, 2013). In addition, the more that females expected alcohol to increase their sexual vulnerability, the more they endorsed passive responses to sexual threat (Zawacki et al., 2005).

Alcohol and sexual aggression

In addition to being linked to other types of interpersonal violence, alcohol seems to feature very strongly in sexual aggression and play a part in facilitating or enhancing opportunities for sexual assault to occur (Testa, 2002). Identifying the exact nature of the link between alcohol and sexual assault is difficult because alcohol is a socially sanctioned and legitimate part of the social interaction between genders including the courtship process. Alcohol as an accompaniment to social gatherings, dining, and other forms of relaxation is widely accepted. In some cases, alcohol can be a factor in the pathway to consensual sex, so it is important to understand the differences in interactions where sexual assault takes place.

One possibility is that alcohol consumption causes sexual aggression; another, that the desire to commit sexual aggression causes the alcohol consumption. This refers to the idea that drinking or being drunk offers an excuse for committing certain behaviours, The third possibility is that the relationship is not causal in either direction and that other characteristics link the two, such as impulsive personality traits (Abbey, 2011).

The intensity of alcohol consumption is also a factor in predicting sexual aggression, as is consideration of the fact that sexual aggression can constitute a broad range of behaviours, for example verbal or physical aggression. This means that pinning down the nature of the link to alcohol is difficult because some aspects may be more influenced by alcohol than others (Testa, 2002).

The desire to sexually offend as the causal agent

This is the situation where the desire to sexually offend may encourage the perpetrator to drink in order to use intoxication as an excuse for their behaviour. The use of alcohol by perpetrators as an excuse for sexually aggressive behaviour was one particular strategy identified in ACSSA's Giving Voice report into sexual assault perpetration (Clark & Quadara, 2010). However, Abbey (2011) noted that sexual assault perpetrators are diverse and will have different motives and use different strategies for their sexual aggression. It may be that a variety of causal factors will be present in different contexts whether alcohol is present or not.

Other correlates

In some cases, the fact that alcohol and sexual aggression occur simultaneously may be attributed to other factors, such as life experiences or more aggressive personalities. These may be behind the motivations to drink as well as to commit sexual assault so that neither of the two is the direct causal agent (Abbey et al., 2004).

Another way to consider alcohol's presence in sexual assault perpetration is to consider distal factors and proximal factors (Abbey, Zawacki, et al., 2001). Distal factors are those features that are not immediate but may relate to personality traits, general drinking habits and life experiences of the perpetrator and victim. The more specific proximal factors include specific features of a sexual assault, such as the relationship between the two parties, the setting where the assault takes place and the amount of alcohol consumed (Abbey, Zawacki, et al., 2001; Testa, 2002).

In her review of studies around sexual aggression (defined as male's attempts to coerce, threaten or force a woman to engage in sexual acts against her will) Testa (2002) examined the link between alcohol consumption and a history of sexual aggression perpetration. According to this review, sexual assault is diverse in its characteristics and the role of alcohol varies in how it impacts on sexual aggression. Specific personal characteristics and situational factors are also relevant in influencing the perpetration of sexual aggression.

The reality is that the relationship between alcohol and sexual assault is unlikely to be able to be definitively pinned down, due to the influence of a range of situational factors, perpetrator and victim characteristics and social experiences that interact when sexual assault happens. All of these factors contribute in a particular situation, and it may be that alcohol provides a catalyst or amplification for some of the behaviours that lead to sexual assault.

Alcohol and perpetrators of sexual aggression

Perpetrators of sexual assault are responsible for their behaviour and it must be reiterated that the presence of alcohol in no way diminishes that responsibility. What is interesting is the way in which perpetrators have been able to use alcohol to their advantage. In various guises, alcohol becomes a tool used against the victim to disable the victim's ability to resist, challenge the victim's memory of events post-assault, and even contribute to victim blame for the victim being intoxicated. For the perpetrator, alcohol is also used to excuse or limit their own liability and enhance courage to fuel their perpetration.

Physical and cognitive effects of alcohol on perpetrators

As noted earlier, alcohol impacts on a person's physical abilities, such as motor skills, as well as their cognitive skills, such as the ability to process information (Abbey et al., 2004; Schweizer & Vogel-Sprott, 2008; Giancola, 2002).

The adverse impact of alcohol on cognitive processes includes a negative effect on the ability to recognise inhibitory cues, consider consequences of behaviour, and correct errors in behaviour (Mann & Farmer, 2013). These effects seem to be more pronounced in people who already have some of the traits associated with sexual offending such as those with issues controlling impulsivity and anger and with being aware of and inhibiting their own behaviour (Mann & Farmer, 2013). Alcohol also seems to increase sexual risk taking (Davis, Stoner, Norris, George, & Masters, 2009; Mann & Farmer, 2013; Wilsnack & Wilsnack, 2013). As discussed earlier, risk-taking behaviour may be emphasised by alcohol consumption more obviously in males due to gender differences, possibly due to socialisation, that may see males inherently more likely to take risks regardless of the presence of alcohol or not (Wilsnack et al., 2005). It has also been observed that differences in risk-taking propensity impact on drinking behaviour and correspond with heavier drinking (Wilsnack et al., 2005).

Personality traits and characteristics of the perpetrator

Regardless of alcohol's presence, perpetrators of sexual assault tend to have certain personality traits that are different to non-perpetrators in regards to impulsive behaviour, aggression, beliefs around sexual behaviour, social stereotypes and beliefs around alcohol (Zawacki et al., 2003).

These include personality traits, such as impulsivity, narcissistic personalities and a lessened ability to empathise (Abbey, 2011). It seems that alcohol may interact with these characteristics to increase the likelihood of them perpetrating a sexual assault. This is a combination of having a particular predisposition to commit sexual assault and the right environment or scenario for the perpetrator to do so. The alcohol myopia theory is relevant here as cues that may normally inhibit their behaviour may become secondary to the more prominent feelings related to sexual behaviour and entitlement.

A US study of over 350 college males considered various characteristics of perpetrators that are linked to sexual assault, regardless of the presence of alcohol (Zawacki et al., 2003). The study looked at three groups, perpetrators who had committed sexual assault without alcohol, those who had committed sexual assault with alcohol and those who had not committed sexual assault. A self-administered questionnaire considered perpetration behaviour, personality traits, beliefs and behaviours. The study showed that there were similarities between the men who perpetrated sexual assault when sober and those that perpetrated sexual assault when drunk. The presence of alcohol appeared to relate to the circumstances in which the sexual assault was committed. Perpetrators of alcohol-involved sexual assault were shown to have held stronger beliefs about alcohol and sex, and reported greater alcohol consumption in sexual interactions.

Attitudes and social norms

Men who reported perpetrating sexual assault have been found to be more likely to have beliefs that are tied to traditional stereotypes about men, women and gender roles. They were also more likely than other men to have stronger sex-related alcohol expectancies and hold beliefs about women's drinking as a sexual cue (Abbey, McAuslan, Zawacki, Clinton, & Buck, 2001). They were more likely to see intoxicated women as sexually available (Testa, 2002) and more willing to participate in sexual activity (Benson et al., 2007; Zawacki et al., 2003).

These types of attitudes about sex and alcohol may influence perpetrators to act by making them feel more comfortable in showing sexually aggressive behaviour. If an attitude is so prevalent that it is considered socially "normal" there is a sense of social acceptability in the behaviour. This is consistent with the idea of excusing responsibility for their behaviour in the belief that it was alcohol that made them do it (Abbey et al., 2004).

One study of 359 women from randomly selected households, looked at intoxication of perpetrators and victims and its impact on sexual assault. This survey found that although intoxication of both parties impacted on the outcome of the sexual assault, the single biggest factor was whether the two parties had previously had a consensual sexual encounter (Testa, Vanzile-Tamsen, & Livingston, 2004). This suggests that social attitudes and norms around male sexual entitlement and female obligation in regards to sexual interaction and relationships influence the perpetration of sexual assault.

Alcohol and victims: Resistance to sexual aggression

Theories about the relationship between alcohol and victims of sexual aggression include that alcohol may diminish the ability of victims to resist sexual assault due to a combination of factors that alcohol impacts upon (Masters, Norris, Stoner, & George, 2006). Cognitive impairment due to intoxication can reduce a victim's ability to recognise risk of sexual aggression and respond to this information (Testa et al., 2004; Stoner et al., 2007). In addition to cognitive function, physical or motor skill impairment is linked to higher blood alcohol concentration (Schweizer & Vogel-Sprott, 2008). This could also contribute to a lessened ability to resist aggression and potentially, at very high levels of intoxication, leave the victim incapacitated, making them extremely vulnerable to sexual assault.

In addition to cognitive and physical impairments, victim responses to sexual aggression will be influenced by social factors such as gendered social scripts about appropriate behaviour and personal victimisation histories. Studies of US college students indicate that women who have been sexually or physically victimised by a dating partner were more likely to have experienced sexual assault (Krebs, Lindquist, Warner, Fisher, & Martin, 2009). This was regardless of alcohol use. Expectancies about their ability to resist were also likely to be influenced by victimisation experience. Compared to women who had not previously been victimised, those who had, self-reported that embarrassment, fear of rejection and alcohol would impede an assertive response to resisting sexual aggression (Stoner et al., 2007).

Research findings indicate that rape completion is associated with victim alcohol consumption at the time of the assault (Benson et al., 2007; Testa et al., 2004). A study of 132 US college women found that the more alcohol a female had consumed, the less aggression was used by perpetrators. This may have been because alcohol diminished female resistance, and so less force was required achieve their goal (Abbey, Clinton, McAuslan, Zawacki, & Buck, 2002).

The socialising environment in which alcohol is consumed may create a decreased perception of risk because of the common experiences of social interaction in a shared place and the normality of alcohol as a social facilitator. A recent Irish report of findings from focus groups and online surveys of students, describes a similar idea that:

• alcohol is seen as facilitating fun, adventure and excitement; and
• not taking part in the drinking culture would mean exclusion from friendship networks (MacNeela, Conway, Kavanagh, Kennedy, & McCaffrey, 2014).

As sexual assaults where alcohol is involved often occur after people have been socialising together and therefore have a degree of acquaintance, a victim's feeling of threat may decrease as intimacy between the two of them increases (Davis et al., 2009). In some instances, the venue may have been specifically selected as a place with the potential to meet sexual or intimate partners, with venues often identified on the basis of the type of socialising young women are looking for on that particular occasion (de Crespigny, 2001; Lindsay, 2006; Fileborn, 2012). Some venues more explicitly market themselves as providing an opportunity for sexualised interaction and as appealing to particular types of people (Lindsay, 2006). This could add to the lack of clarity around social or sexual intentions and lead to difficulties in interpreting what social signals mean.

In a study that considered the differences in perpetrator and victim drinking, findings indicated that there are different outcomes and features of sexual assaults depending on which parties are drinking. For example, compared to victims of sexual assaults where alcohol was not present, victims where the perpetrator only had been drinking were found to use more assertive resistance strategies (Ullman & Najdowski, 2010).

Alcohol and social scripts: Assigned roles, ambiguity and miscommunication

Ambiguity of social cues adds to the potential for sexual assault in situations of socialising such as drinking venues or parties. There are many features of the male/female interaction that are ambiguous and that appear socially acceptable on the surface, including the presence of alcohol. The settings, gathering of groups for social interaction and the drinking of alcohol set the same scene for both consensual sex and sexual assault (Horvath & Brown, 2007). This makes targeting the alcohol link for prevention purposes difficult, as it is necessary to pinpoint the factors that lead to the different pathways.

The idea of social scripts evolves from the notion that sexual behaviour and social interaction is learned and ingrained through socialisation into gender roles, often with the male role being that of initiator and the female as being passive but holding the "yes" or "no" role with regards to sexual activity (Masters et al., 2006). If sexual conquest is perceived as part of masculine social behaviour, this could influence the perpetration of sexual aggression. However, it should be noted that additional levels of influence, such as the immediate social group that an individual associates with, may increase or decrease the strength of adherence to socially scripted behaviour.

Social interactions, particularly in situations where there is a possibility of progressing to sex, are often interlaced with ambiguous cues and non-verbal messages between the parties. One of the advantages of this ambiguity is that it can negate the potential for one party to be embarrassed by rejection, so there is less to lose than with a direct approach (Broach, 2004). However, it can also create confusion and a lack of clarity around the intentions of both parties. Combined with the effects discussed earlier of alcohol myopia, each party may be reacting to cues that have been incorrectly interpreted.

Intoxicated perpetrators may be more focused on the immediacy of their own sexual desires or their need for power and control, than on seeing and responding to negative cues or even a neutral response from the intended victim. The victims may miss cues about sexual intent and risk. Gendered beliefs and social roles also play into this type of social interaction. There are areas of overlap in the scripts of seduction and the scripts of rape or sexual assault that provide information as to the rules around the interaction and the roles played by each participant (Littleton & Axsom, 2003). This overlap allows ambiguity in how the scripts are followed or interpreted.

Women in their socially more passive role of sexual gatekeepers may be less likely to assert overtly sexual intent while men are seen as the pursuers and initiators of sexual interaction. Masculinity scripts that celebrate sexual conquest mean that social roles about sexual interaction play an important part in encouraging men to keep up the pursuit by casting them as the active player or hunter (Broach, 2004).

Horvath and Brown (2007) contended that women's behavioural responses in the face of having to negotiate sex in a public social setting are shaped by social norms. The traditional scripts of male initiator and female gatekeeper limit women's negotiating scope in this context, particularly when combined with the physical, cognitive and social effects of alcohol on both parties such as related expectancies and alcohol myopia.

Further constraining women is the idea that deviation from the script of what is acceptable female behaviour in a social situation will result in a punitive response from society. It has been shown, for example, that victims who are intoxicated are blamed more for the sexual assault (Grubb & Turner, 2012). This relates to constructs of social roles around alcohol itself, for example that alcohol consumption as a behaviour is more consistent with masculinity while women's social scripts in relation to alcohol relate to limiting alcohol consumption. Criminal justice responses to women who have been sexually assaulted while drunk are notoriously harsh, with their believability being impaired at all stages of the process, from reporting to police to their reliability in the mind of prosecutors and juries (Heenan & Murray, 2006; Jordan, 2004; Kelly, Lovett, & Regan, 2005; Lievore, 2004).

Issues in prevention

The World Health Organization has observed that preventing violence associated with alcohol consumption requires cultural and societal environments that discourage hazardous drinking behaviour.⁵ This is also noted to be a challenge in a cultural environment where young people may drink specifically to get drunk (MacNeela, Conway, Kavanagh, Kennedy, & McCaffrey, 2014; WHO, 2005) or further to that, an environment where expectancies around alcohol are that they will enhance social interactions with potential sexual partners.

What is clear from consideration of the research in this field is that there are multiple factors that play into a sexual assault in a social scenario where alcohol is present. It is not just the alcohol itself but social factors and influences, personal traits and characteristics and individual life experiences that affect the behaviour of perpetrators and the responses of victims, thereby leading to sexual assault.

Horvath and Brown noted that the implications for prevention with regards to alcohol and sexual assault require acknowledging that voluntary consumption of alcohol by the victim is the most common scenario in a sexual assault. This implies that prevention should include education around healthier drinking habits for both sexes (Horvath & Brown, 2007). Focusing behaviour change on women's increased drinking will not address the cultural attitudes around sexuality and social scripting that affect the traditional format of men as aggressors and women as gatekeepers in the negotiation of sexual interaction.

The alcohol expectancy theory draws attention to perpetrators' alcohol expectancies and these beliefs become a possible target for change (Abbey, 2011). This encompasses aiming for attitudinal changes in men towards intoxicated women as vulnerable targets or women's drinking as equating to sexually availability (Horvath & Brown, 2007; Krebs et al., 2009). Prevention messages to men could include drawing attention to the effects that alcohol has on their treatment of women (Abbey, Parkhill, Jacques-Tiura, & Saenz, 2009). More fundamentally, prevention efforts will require a reflection on ethics and a focus on increasing the capacity for ethical negotiation in intimate relationships whether sexual or not (Chung, O'Leary, & Hand, 2006; Carmody, 2009).

If it is the pharmacological effects of alcohol on perpetrators that is emphasised in the perpetration of the sexual assault, for example, the alcohol myopia effects, then this is a different issue. This would require a focus on reducing the alcohol consumption of perpetrators or making them recognise the effect that alcohol has on them in relation to women (Abbey, 2011).

Prevention efforts around reducing violence more generally include limiting access to and availability of outlets and pricing of alcohol (WHO, 2009). Simply limiting access to alcohol with increased regulation may have some impact on violence but it doesn't address the social and cultural factors that influence behaviour in relation to social scripts and sexual interactions.

References

• Abbey, A. (2002). Alcohol-related sexual assault: A common problem among college students. Journal of Studies on Alcohol, SUPPL14, 118-128.
• Abbey, A. (2011). Alcohol's role in sexual violence perpetration: Theoretical explanations, existing evidence and future directions. Drug and Alcohol Review, 30(5), 481-489. doi: 10.1111/j.1465-3362.2011.00296.x
• Abbey, A., Boyd, C. J., Grey, M., McCabe, S. E., & Young, A. (2008). Alcohol-related sexual assault victimization among adolescents: Prevalence, characteristics, and correlates*. Journal of Studies on Alcohol and Drugs, 69, 39+.
• Abbey, A., Clinton, A., McAuslan, P., Zawacki, T., & Buck, P. (2002). Alcohol-involved rapes: Are they more violent? Psychology of Women Quarterly, 26, 99-109.
• Abbey, A., McAuslan, P., Zawacki, T., Clinton, A. M., & Buck, P. O. (2001). Attitudinal, experiential, and situational predictors of sexual assault perpetration. Journal of Interpersonal Violence, 16(8), 784-807. doi: 10.1177/088626001016008004
• Abbey, A., Parkhill, M., Jacques-Tiura, A. J., & Saenz, C. (2009). Alcohol's role in men's use of coercion to obtain unprotected sex. Substance Use and Misuse, 44, 1329-1348.
• Abbey, A., Zawacki, T., Buck, P. O., Clinton, A. M., & McAuslan, P. (2001). Alcohol and sexual assault. Alcohol Research & Health, 25(1), 43-51.
• Abbey, A., Zawacki, T., Buck, P. O., Clinton, A. M., & McAuslan, P. (2004). Sexual assault and alcohol consumption: What do we know about their relationship and what types of research are still needed? Aggression and Violent Behavior, 9(3), 271-303. doi: 10.1016/s1359-1789(03)00011-9
• Advisory Council on the Misuse of Drugs. (2007). Drug facilitated sexaul assault. London, UK: ACMD.
• Bellis, M., Hughes, K., Calafat, A., Juan, M., Ramon, A., Rodriguez, J. et al.. (2008). Sexual uses of alcohol and drugs and the associated health risks: A cross-sectional study of young people in nine European cities. BMC Public Health, 8.
• Benson, B. J., Gohm, C. L., & Gross, A. M. (2007). College women and sexual assault: The role of sex-related alcohol expectancies. Journal of Family Violence, 22(6), 341-351. doi: 10.1007/s10896-007-9085-z
• Beynon, C. M., McVeigh, C., McVeigh, J., Leavey, C., & Bellis, M. A. (2008). The involvement of drugs and alcohol in drug-facilitated sexual assault: A systematic review of the evidence. Trauma, Violence, & Abuse, 9(3), 178-188. doi: 10.1177/1524838008320221
• Bosman, I. J., Verschraagen, M., & Lusthof, K. J. (2011). Toxicological Findings in Cases of Sexual Assault in the Netherlands*. Journal of Forensic Sciences, 56(6), 1562-1568. doi: 10.1111/j.1556-4029.2011.01888.x
• Brecklin, L. R., & Ullman, S. E. (2010). The roles of victim and offender substance use in sexual assault outcomes. Journal of Interpersonal Violence, 25(8), 1503-1522.
• Broach, J. L. (2004). Exploring the alcohol-sexual assault link: Pathways from alcohol to assault. Journal of Alcohol and Drug Education, 48(2), 17-27.
• Carmody, M. (2009). Conceptualising the prevention of sexual assault and the role of education. Melbourne: Australian Institute of Family Studies.
• Chung, D., O'Leary, P., & Hand, T. (2006). Sexual violence offenders: Prevention and intervention approaches (ACSSA Issues No. 5). Melbourne Australian Institute of Family Studies.
• Clark, H., & Quadara, A. (2010). Insights into sexual assault perpetration: Giving voice to victim/survivors' knowledge (Research Report No.18). Melbourne: Australian Institute of Family Studies.
• Connor, J., Gray, A., & Kypri, K. (2010). Drinking history, current drinking and problematic sexual experiences among university students. Australian and New Zealand Journal of Public Health, 34(5), 487-494. doi: 10.1111/j.1753-6405.2010.00595.x
• Corbin, W. R., Bernat, J. A., Calhoun, K. S., McNair, L. D., & Seals, K. L. (2001). The role of alcohol expectancies and alcohol consumption among sexually victimized and nonvictimized college women. Journal of Interpersonal Violence, 16(4), 297-311. doi: 10.1177/088626001016004002
• Davis, K. C., Stoner, S. A., Norris, J., George, W. H., & Masters, N. T. (2009). Women's awareness of and discomfort with sexual assault cues: Effects of alcohol consumption and relationship type. Violence Against Women, 15(9), 1106-1125. doi: 10.1177/1077801209340759
• de Crespigny, C. (2001). Young women, pubs and safety. In P. Williams (Ed.), Alcohol, Young Persons and Violence (Research and Public Policy Report No. 35) (pp. 31-46). Canberra: Australian Institute of Criminology.
• Fileborn, B. (2011). Sexual assault laws in Australia (ACSSA Resource Sheet). Melbourne: Australian Institute of Family Studies.
• Fileborn, B. (2012). Sex and the city: Exploring young people's perceptions and experiences of unwanted sexual attention in licensed venues. Current Issues in Criminal Justice, 24(2), 241-260.
• Giancola, P. R. (2002). Alcohol-related aggression in men and women: The influence of dispositional aggressivity*. Journal of Studies on Alcohol, 63, 696+.
• Giancola, P. R. (2013). Alcohol and aggression. In M. McMurran (Ed.), Alcohol-related violence: Prevention and treatment, (First edition). Chichester, UK: John Wiley & Sons.
• Grubb, A., & Turner. (2012). Attribution of blame in rape cases: A review of the impact of rape myth acceptance, gender role conformity and substance use on victim blaming. Aggression and Violent Behavior, 17, 443-452.
• Guggisberg, M. (2010). Women, violence and comorbidity: The struggle with victimisation, mental health problems and substance use. Saarbrücken, Germany: Lambert Academic Publishing.
• Gunby, C., Carline, A., Bellis, M., & Beynon, C. (2012). Gender differences in alcohol-related non-consensual sex; cross-sectional analysis of a student population. BMC Public Health, 12(216).
• Hall, J., Goodall, E., & Moore, T. (2008). Alleged drug facilitated sexual assault (DFSA) in Northern Ireland from 1999-2005: A study of blood alcohol levels. Journal of Forensic and Legal Medicine, 15, 497-504.
• Heenan, M., & Murray, S. (2006). Study of reported rapes in Victoria, 2000-2003. Melbourne, Australia: Office of Women's Policy.
• Horvath, M., & Brown, J. (2007). Alcohol as drug of choice; Is drug-assisted rape a misnomer? Psychology, Crime & Law, 13(5), 417-429. doi: 10.1080/10683160601061117
• Jordan, J. (2004). Beyond belief?: Police, rape and women's credibility. Criminal Justice, 4(1), 29-59.
• Kalmakis, K. (2010). Cycle of sexual assault and women's alcohol misuse. Journal of the Academy of Nurse Practitioners, 22,661-667.
• Kelly, L., Lovett, J., & Regan, L. (2005). A gap or a chasm? Attrition in reported rape cases (Home Office Research Study 293). London: HMSO.
• Krebs, C. P., Lindquist, C. H., Warner, T. D., Fisher, B. S., & Martin, S. L. (2009). The differential risk factors of physically forced and alcohol- or other drug-enabled sexual assault among university women. Violence and Victims, 24(3), 302-321. doi: 10.1891/0886-6708.24.3.302
• Lievore, D. (2004). Victim credibility in adult sexual assault cases (Trends & Issues in Crime and Criminal Justice No. 288). Canberra: Australian Insistute of Criminology.
• Lindsay, J. (2005). Drinking in Melbourne pubs and clubs: A study of alcohol consumption contexts. Melbourne: Monash University, School of Political and Social Inquiry.
• Lindsay, J. (2006). A big night out in Melbourne: drinking as an enactment of class and gender. Contemporary Drug Problems, 33(1), 29-61.
• Littleton, H., & Axsom, D. (2003). Rape and seduction scripts of university students: Implications for rape attributions and unackonwledged rape. Sex Roles, 49, 465-475.
• Littleton, H., Grills-Taquechel, A., & Axsom, D. (2009). Impaired and incapacitated rape victims: Assault characteristics and post-assault experiences. Violence and Victims, 24(4), 439-457.
• Locke, B. D., & Mahalik, J. R. (2005). Examining masculinity norms, problem drinking, and athletic involvement as predictors of sexual aggression in college men. Journal of Counseling Psychology, 52(3), 279-283. doi: 10.1037/0022-0167.52.3.279
• Lyons, A., & Willot, S. (2008). Alcohol consumption, gender identities and women's changing social position. Sex Roles, 59, 694-712.
• MacNeela, P., Conway, T., Kavanagh, S., Kennedy, L., & McCaffrey, J. (2014). Young people, alcohol and sex: What's consent got to do with it? Ireland: Rape Crisis Network Ireland.
• Mann, R., & Farmer, M. (2013). Treatment for alcohol-related sexual violence. In M. McMurran (Ed.), Alchohol-related violence: prevention and treatment. Chichester UK: John Wiley & Sons.
• Masters, N., Norris, J., Stoner, S., & George, W. (2006). How does it end? Women project the outcome of a sexual assault scenario. Psychology of Women Quarterly, 30, 291-302.
• McBrierty, D., Wilkinson, A., & Tormey, W. (2013). A review of drug-facilitated sexual assault evidence: An Irish perspective. Journal of Forensic and Legal Medicine, 20(4), 189-197. doi: http://dx.doi.org/10.1016/j.jflm.2012.09.009
• Neame, A. (2003). Beyond "drink spiking": Drug and alcohol facilitated sexual assault (ACSSA Briefing No.2). Melbourne: Australian Institute of Family Studies.
• Olszewski, D. (2009). Sexual assaults facilitated by drugs or alcohol. Drugs: Education, Prevention & Policy, 16(1), 39-52. doi: 10.1080/09687630802128756
• Parliament of Victoria - Drugs and Crime Prevention Committee. (2006). Inquiry into strategies to reduce harmful alcohol consumption: FInal report. Victoria: Parliament of Victoria.
• Scott-Ham, M., & Burton, F. C. (2006). A study of blood and urine alcohol concentrations in cases of alleged drug-facilitated sexual assault in the United Kingdom over a 3-year period. Journal of Clinical Forensic Medicine, 13(3), 107-111. doi: http://dx.doi.org/10.1016/j.jcfm.2005.10.006
• Schweizer, T., & Vogel-Sprott, M. (2008). Alcohol impaired speed and accuracy of cognitive functions: A review of acute tolerance and recovery of cognitive performance. Experimental and Clinical Psychopharmacology, 16(3), 240-250.
• Steele, C., & Joseph, R. (1990). Alcohol Myopia: Its prized and dangerous effects. American Psychologist, 45(8), 921-933.
• Stoner, S. A., Norris, J., George, W. H., Davis, K. C., Masters, N. T., & Hessler, D. M. (2007). Effects of alcohol intoxication and victimization history on women's sexual assault resistance intentions: The role of secondary cognitive appraisals. Psychology of Women Quarterly, 31(4), 344-356. doi: 10.1111/j.1471-6402.2007.00384.x
• Testa, M. (2002). The impact of men's alcohol consumption on perpetration of sexual aggression. Clinical Psychology Review, 22, 1239-1263.
• Testa, M., Vanzile-Tamsen, C., & Livingston, J. A. (2004). The role of victim and perpetrator intoxication on sexual assault outcomes. Journal of Studies on Alcohol, 65(3), 320-329.
• Ullman, S. E., & Najdowski, C. J. (2010). Understanding alcohol-related sexual assaults: Characteristics and consequences. Violence and Victims, 25(1), 29-44. doi: 10.1891/0886-6708.25.1.29
• Untied, A., Orchowski, L., & Lazar, V. (2013). College men and women's respective perceptions of risk to perpetrate or experience sexual assault: The role of alcohol use and expectencies. Violence Against Women, 19(7), 903-923.
• Walsh, K., Messman-Moore, T. L., Zerubavel, N., Chandley, R., DeNardi, K., & Walker, D. (2013). Perceived sexual control, sex-related alcohol expectancies and behaviour predict substance-related sexual revictimisation. Child Abuse and Neglect, 37(5), 353-359.
• Wilsnack, R., & Wilsnack, C. (2013). Gender and alcohol:consumption and consequences. In P. Boyle, P. Boffetta, A. Lowenfels, H. Burns, O. Brawley, W. Zatonski & J. Rehm (Eds.), Alcohol: Science, policy and public health. Oxford, UK: Oxford University Press.
• Wilsnack, R., Wilsnack, S. C., & Obot, I. (2005). Why study gender, alcohol and culture? In I. Obot & R. Room (Eds.), Alcohol, gender and drinking problems: Perspectives from low and middle income countries (pp. 1-23). Geneva: World Health Organization.
• World Health Organization. (2005). Alcohol use and sexual risk behaviour: A cross-cultural study in eight countries. Geneva: World Health Organization.
• World Health Organization. (2009). Violence prevention the evidence: Preventing violence by reducing the availability and harmful use of alcohol. Briefing. Geneva: WHO Press.
• Zawacki, T., Abbey, A., Buck, P. O., McAuslan, P., & Clinton-Sherrod, A. M. (2003). Perpetrators of alcohol-involved sexual assaults: How do they differ from other sexual assault perpetrators and nonperpetrators? Aggressive Behavior, 29(4), 366-380. doi: 10.1002/ab.10076
• Zawacki, T., Norris, J., George, W., Abbey, A., Martell, J., Stoner, S., et al.. (2005). Explicating alcohol's role in acquaintance sexual assault: Complementary perspectives and convergent findings. Alcoholism: Clinical and Experimental Research, 29(2), 263-269.