Understanding acute alcohol effects on sexual behavior

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Record: 3Title: Understanding Acute Alcohol Effects on Sexual Behavior.

Author(s): George, William H. Stoner, Susan A.

Source: Annual Review of Sex Research; 2000, Vol. 11, p92, 31p

Document Type: Article

Subject(s): ALCOHOLISM SEX crimes

Abstract: Evaluates the scientific evidences about whether acute alcohol intoxication has a causal impact on sexual behavior and outcomes. Effects of alcohol on genital arousal, sexual risk taking and sexual assault; Alcohol expectancy model; Alcohol myopia model.

Full Text Word Count: 14081

ISSN: 10532528

Accession Number: 4384796

Database: Academic Search Elite

UNDERSTANDING ACUTE ALCOHOL EFFECTS ON SEXUAL BEHAVIOR

Alcohol has been implicated as having a causal role in a variety of sexual processes and outcomes. We review nonexperimental research illustrating the nature of alcohol's association with sexuality. Methodological considerations limiting causal assertions permissible with nonexperimental data are discussed. We also review findings from experiments, mostly analogue paradigms, examining the effects of alcohol on genital arousal, sexual risk taking, and sexual assault. In each case, it is observed that alcohol can exert a causal effect on one or more of the constituent responses undergirding these phenomena. We conclude that alcohol does appear to have a causal impact on many sexuality indices studied in laboratory conditions. Both alcohol expectancy and alcohol myopia models have been applied to explain these causal linkages. Expectancy models seem to account well for postdrinking sexual reactions and perceptions. Overall, myopia analyses seem to offer the most persuasive explanations of postdrinking expressions of sexual risk taking and sexual assault.

Key Words: alcohol intoxication, sexual arousal, sexual assault, sexual behavior, sexual perception, sexual risk taking.

Alcohol and sexuality mix well; in fact, alcohol is widely regarded as a very effective formula for loosening sexual inhibitions. For instance, cultural images fusing alcohol and sexuality are so commonplace that the link seems axiomatic. Examples include champagne on the wedding night, wine with the romantic dinner, beer-thirsty sports fans vying for attractive women, tropical drinks and bikini beaches, and co-ed fraternity keggers. Our cultural lore is replete with such alcohol-sexuality images. The manifest message, at least in advertising, seems to be that alcohol and sexuality are complementary themes. The latent message is that alcohol consumption can foster and enhance sexual activities. Can alcohol generate such effects? That is, a key question posed by these considerations becomes: Is alcohol capable of exerting an authentically causative influence on sexual responses and outcomes? Perhaps alcohol is merely an accomplice serving as scapegoat to truer causes of postdrinking sexual activity, such as lack of parental supervision, youthful

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adventuresomeness, peer pressure, marital ardor, and permissive bar -room or party settings. If alcohol is capable of causal influence, a second question emerges: Is this causation robust, systematic, and subject to coherent descriptions and rational explanations? From a scientific viewpoint, these elemental questions stand as insistent and weighty compass points. Surprisingly the answers to these questions--at least scientifically speaking--are remarkably inconclusive.

Posing such questions does not require casting the alcohol-sexuality linkage--even if causal--as necessarily problematic. The use of alcohol to relax sexual inhibitions or to enhance romantic and sexual feelings is normally not a problem; it is a delight. Nevertheless, it should be noted that alcohol has also been implicated in numerous problematic sexual outcomes, including unwanted pregnancy, sexual dysfunction, sexual assault, and sexually transmitted diseases (including HIV/AIDS). Thus, it seems that alcohol has ties with a variety of sexual outcomes. However, the linkage to problematic outcomes (especially sexual assault and AIDS-related sexual risk taking) infuses urgency into scientific striving to understand alcohol and sexuality. In fact, addressing these problematic outcomes has become a unifying mission in shaping and motivating much of the recent and current alcohol -sexuality research. Nevertheless, despite a dramatic rise in pertinent scientific investigations generated by the AIDS crisis, alcohol's relationship with sexual behavior continues to elude a definitive scientific understanding. The reasons for this elusiveness are multiple and complex.

Generally, our purpose is to describe and evaluate the scientific evidence about whether acute alcohol intoxication has a causal impact on sexual behavior and outcomes. In weighing and critiquing the evidence for such causality, we will review representative survey data illustrating the co-occurrence of intoxication and sexual behavior, but we will concentrate primarily on examining experimental data addressing causality. In addition, we will identify important knowledge gaps and promising directions for future experimentation. Finally, we will propose a preliminary synthesis explaining the effects of alcohol intoxication on sexual behavior.

Alcohol and Self-Reported Sexual Behavior

The research literature regarding alcohol and sexuality is extensive (e.g., see reviews by Cooper, 1992; Crowe & George, 1989; Donovan & McEwan, 1995; Fortenberry, 1995; George & Norris, 1991; Halpern-Felsher, Millstein, & Ellen, 1996; Lang, 1985; Leigh, 1990; Leigh & Morrison, 1991; Leigh & Stall, 1993; Norris, 1994; Rosen, 1991; Wilsnack, 1984; Wilsnack, Plaud, Wilsnack, & Wilsnack, 1997; Wilson, 1977, 1981). Alcohol is generally associated with heightened rather than diminished sexual responding. In global correlation surveys, measures of past and current drinking practices correlate positively with measures of past and current sexual activity (e.g., Wilsnack et al., 1997). However, these types of findings do not permit even the simple determination that the drinking and sexual activity co-occurred on the same day. Consequently, they have very little import for causality. In situational covariation surveys inquiring about alcohol and sexuality, substantial percentages of respondents report having drunk prior to sexual activities, and this drinking is perceived as having lowered sexual inhibitions (e.g., Wilsnack, Wilsnack, & Klassen, 1984) and enhanced sexual enjoyment (e.g., Athanasiou, Shaver, & Tavris, 1970). Though such findings are an improvement over correlated global indices, they nevertheless remain weak indicators of causality because they are highly vulnerable to noncausal interpretations. For instance, the classic "third variable" problem exists whereby both drinking and risky sex are mutually determined by other forces (e.g., unconventionality or sensation-seeking).

In event-based surveys, respondents are asked about alcohol consumption during a specific sexual experience. In such studies, reported alcohol consumption was associated with an increased likelihood that intercourse had occurred during adolescents' and college students' first dates (Cooper & Orcutt, 1997; Dermen & Cooper, 2000).

In expectancy surveys using a variety of instruments, respondents generally expect that alcohol enhances or disinhibits sexual experiences (e.g., Fromme, Stroot, & Kaplan, 1993; George, Cue, Lopez, Crowe, & Norris, 1995; George, Dermen, & Nochajski, 1989; Leigh & Stacy, 1993). In studies specific to sex expectancies, investigators have substantiated these expectancies and identified subdomains of the alcohol-stimulates-sex belief (Abbey, McAuslan, Ross, McDuffie, & Zawacki, 1999; Dermen & Cooper, 1994a; Leigh, 1990). In vignette experiments contrasting drinking versus nondrinking persons, the drinking person is expected to be more sexually available and willing to engage in sex (George, Gournic, & McAfee, 1988; George et al., 1995, 1997), and as having more sexual initiative (Corcoran & Thomas, 1991) and intent (Abbey & Harnish, 1995).



In sum, these self-report data show that people generally view alcohol as enhancing and disinhibiting sexual feelings and behaviors. They experience this as true for self and for others, as true in the past, and as likely to be true in the future. Nevertheless, for several reasons, these findings do not establish that alcohol truly causes these sexual changes. First, the findings are largely cross-sectional and correlational, thus not demonstrative of causality. Second, these are self-report data. Consequently, independent of alcohol's actual impact, respondents could report that alcohol has these effects because of exposure to widely held cultural stereotypes about alcohol as an aphrodisiac. Third, most of these data are retrospective; consequently recollections could have been systematically biased. For instance, respondents could have been motivated to misattribute causation to alcohol in order to deflect responsibility from themselves. Finally, these findings did not involve alcohol administration and are largely nonexperimental. Consequently, the true ordering of events, alcohol intoxication first then sexual activity, has not been definitively established. Any and all of these internal validity threats weaken causal inferences.

Alcohol Expectancies and the Balanced Placebo Design

Alcohol expectancies are defined as the expected effects of drinking alcohol. Evidence from multiple methodological paradigms indicates that alcohol expectancies are important determinants of drinking and of the sexual outcomes that follow drinking.

The power of alcohol expectancies was first demonstrated in a landmark anthropological study (MacAndrew & Edgerton, 1969). It was found that alcohol's effects were highly heterogeneous across different cultures and longitudinally within the same culture. Emphasizing the lack of homogeneity in alcohol's effects expected from biological causation, these investigators were the first to argue scientifically that alcohol's influence on behavior is not due entirely to pharmacological processes as had been previously thought. This conclusion was corroborated by experiments showing that the mere belief that alcohol had been consumed was sufficient to "disinhibit" sexual responding (e.g., Wilson & Lawson, 1976b). In subsequent surveys, it was shown that, indeed, people maintain relatively stable expectancies about alcohol's effects on behavior (Brown, Goldman, Inn, & Anderson, 1980; Southwick, Steele, Marlatt, & Lindell, 1981). Eventually, the idea that postdrinking changes in sexual behavior were attributable solely to alcohol's pharmacological properties became untenable. Alcohol expectancies needed to be considered in any experimentation on alcohol and sexual behavior.

The Balanced Placebo Design (BPD) has become a method for controlling expectancies experimentally, in which two properties of drinking are manipulated systematically in the laboratory: perceived alcohol content (expectancy set) and actual alcohol content. Led to expect alcoholic or nonalcoholic drinks, half the subjects receive alcohol and half do not. Thus, the design has four groups: (a) expect alcohol/receive alcohol, (b) expect alcohol/receive none, (c) expect no alcohol/receive none, and (d) expect no alcohol/receive alcohol. Use of drink "look/taste alikes" (e.g., vodka-tonic vs. tonic or beer vs. nonalcoholic beer) make the deception necessitated in groups 2 and 4 possible. The BPD protocol involves a rigorously controlled and tightly choreographed procedure. To ensure internal validity, several precautionary steps are taken to enhance credibility of the beverage protocol. Drinks are poured from ostensibly intact bottles, mouthwash is used to blunt taste acuity. To minimize awareness of proprioceptive cues indicative of intoxication status, externally focused distraction tasks (e.g., magazine reading, picture completion, etc.) are administered during consumption and absorption periods and participants are prohibited from standing up and moving about. After drinking, participants complete breathalyzer tests periodically and are given feedback that is consistent with the condition assignment. At the end of the experiment, participants complete instruments inquiring about what was consumed, how much, and how intoxicated they became. During debriefing, they are asked directly about deception. Often a small percentage of participants fail these manipulation checks, and their data are omitted from the analyses.

An important shortcoming of the BPD is that it limits the alcohol dosage to relatively low levels (with .06 as an approximate ceiling). Despite this and other debatable shortcomings (Collins & Searles, 1988; Knight, Barbaree, & Boland, 1986), the BPD studies nevertheless have divulged much about alcohol's enhancement effects on sexual behavior.

Evidence Regarding Alcohol and Sexual Arousal



Alcohol's effects on sexual arousal are complex. Each half of the alcohol -sex fusion, the sexual response sequence and the acute response to alcohol, is complex in its own right and enjoys a voluminous scientific literature attesting to its complexity. This is due, in part, to the bidimensionality of both alcohol and arousal. In other words, some of the complexity stems from each response being characterized and determined synergistically by both physiological and psychological processes. As we have described, alcohol is divisible into pharmacological (content) versus psychological (expectancy) effects. Sexual arousal is divisible into objective (physiological) versus subjective (self-report) responses. The combined alcohol-sex response multiplies this complexity, thereby further complicating efforts to discern definitive descriptions and explanations. However, bifurcation of the available findings based on pharmacological versus psychological effects yields clearer analyses.

Alcohol's Pharmacological Effects on Objective Indices of Genital Arousal

Although gender differences are common in alcohol-sex research, men and women seem to share two effects. First, as noted earlier, both believe--to some extent--that alcohol enhances sexuality. Second, alcohol decreases both men's and women's genital reactions. In five seminal experiments reported during the 1970s, men's postdrinking genital arousal was investigated under laboratory conditions. In each experiment, men were administered alcoholic or nonalcoholic drinks and presented with explicit sexual stimuli while penile tumescence was assessed using a strain gauge to measure circumference. The findings revealed that, except at very low dosages, alcohol suppressed penile tumescence (Briddell & Wilson, 1976; Farkas & Rosen, 1976; Ruben & Henson, 1976; Wilson & Lawson, 1976b; Wilson, Lawson, & Abrams, 1978) and increased male orgasm latency (Malatesta, Pollack, Wilbanks, & Adams, 1979). Similarly, alcohol suppressed vaginal blood volume (Wilson & Lawson, 1976a, 1978) and increased female orgasm latency (Malatesta, Pollack, Crotty, & Peacock, 1982). Furthermore, these effects increased with alcohol dosage and were interpreted as driven by alcohol's pharmacological properties. After this pioneering work, alcohol suppression of genital arousal became axiomatic. Three subsequent reports included evidence that alcohol suppressed penile tumescence (Cooper, 1994; Wilson, Niaura, & Adler, 1985; Wormith, Bradford, Pawlak, Borzicki, & Crim, 1988). Generally, however, systematic experimentation into alcohol's pharmacological effects on genital arousal came to a standstill. Attention shifted instead to alcohol expectancy effects.

Men and Alcohol Expectancy Effects on Objective and Subjective Sexual Arousal

Using the BPD to manipulate alcohol (actual beverage) and expectancy set (apparent beverage) separately, researchers found that expectancy set increased men's arousal. Compared to expect -no-alcohol controls, expect-alcohol men have exhibited greater penile tumescence (Briddell et al., 1978; Wilson & Lawson, 1976b; Wilson et al., 1985) and subjective arousal (George & Marlatt, 1986; Lang, Searles, Lauerman, & Adesso, 1980; Lansky & Wilson, 1981). One explanation for this expectancy enhancement is the self-fulfilling prophecy idea that a priori belief in alcohol's capacity to heighten arousal leads men to experience more arousal. Consistent with this idea, George, Stoner, Norris, Lopez, and Lehman (2000) found that high believers in the alcohol -stimulates-sex expectancy reported more sexual arousal after consuming placebo drinks than did low believers. Another explanation for the expectancy enhancement effect has been the deviance-disavowal idea. According to this reasoning, expect -alcohol men respond as though they believe that alcohol intoxication provides a viable excuse for behavior, which might otherwise be subject to negative social sanction. Consistent with this idea, investigators have found that the expectancy set effect strengthens with more deviant (rape and violent erotic depictions) sexual material (Briddell et al. 1978; George & Marlatt, 1986). Both these explanations are rooted in the social learning framework and contend that a man's increased arousal after "drinking" is mostly a product of what he believes about alcohol.

At any rate, this expectancy enhancement effect on arousal was somewhat of a breakthrough. The effect of "drink" on arousal could now be seen as consistent with the general sexual disinhibition outcomes understood as commonplace in conventional wisdom and frequently observed with nonphysiological measures. However, there were two problems. First, in real world sexual disinhibition, people drink real drinks. Therefore pharmacologically driven suppression remained unreconciled with the anecdotal lore and empirical trends attesting to postdrinking sexual disinhibition. Second, women did not exhibit the effect.

Women and Alcohol Expectancy Effects on Objective and Subjective Sexual Arousal



There are several difficulties in drawing conclusions about alcohol and women's arousal (see reviews by Beckman & Ackerman, 1995; Leigh, 1990; Norris, 1994). First, the preponderance of alcohol and arousal studies has been done with men; thus, the fund of experimental data about women is very small. Second, the few reported studies with women samples have produced confusing data that have proved difficult to interpret. For example, Wilson and Lawson (1978) found that expectancy set did not affect vaginal arousal, whereas alcohol content reduced it; yet, subjective arousal correlated positively with estimates of intoxication level. Furthermore, under alcohol, women's objective and subjective sexual arousal indices tended toward being desynchronous (Malatesta et al., 1982; Wilson & Lawson, 1976a, 1978). Available data have indicated little or no correspondence between women's postdrinking self-report of being aroused in the laboratory and their simultaneously assessed vaginal response. Overall, given the paucity of studies, little can be stated definitively about alcohol and women's sexual arousal, at least in the laboratory setting. Nevertheless, three points seem evident: (a) straightforward expectancy effects found in men do not occur in women, (b) the relationship between objective and subjective arousal seems synchronous in men but desynchronous in women, and (c) more work is needed to expand the fund of data and to investigate the solidity of the existing empirical trends.

Unresolved Issues Concerning Alcohol and Sexual Arousal

With regard to alcohol's effects on genital arousal, the shift from studying alcohol suppression to expectancy enhancement (in men) has been useful to theory advancement. There has been a cost however. The shift to an expectancy emphasis has prematurely truncated important lines of inquiry, such as the nature of persistent null effects, specification of a mechanism for suppression, and biphasic BAC curve effects. As a consequence, evidence that runs counter to the suppression rule has been left unpursued and important questions about the topography of sexual arousal across the blood alcohol concentration (BAC) curve have never been examined. Thus, several significant unresolved and unexamined issues about postdrinking arousal remain. Research into these and other issues could prove valuable in identifying critical boundary conditions for the suppression effects observed in the initial experiments.

Persistent null effects. Null effects have been reported in several studies of men. In five BPD studies, alcohol did not suppress penile tumescence (Abrams & Wilson, 1983; Bridell et al., 1978; Lansky & Wilson, 1981; Wilson & Lawson, 1976b; Wilson & Niaura, 1984). Usually these null effects have been attributed to the low BACs (.03-.05 mg%) required in BPD studies. However, alcohol suppression of penile tumescence has been observed at these dosages (Bridell & Wilson, 1976; Farkas & Rosen, 1976). Furthermore, null effects have occurred in two studies where higher BACs were achieved: .056 mg% (Abrams & Wilson, 1983) and .104 mg% (Langevin et al., 1985). Finally, in a study evaluating the highest dose reported to date (.15 mg%), alcohol suppression of penile tumescence was not evident (Morlet et al., 1990). The persistence of negative data suggests that alcohol suppression is far from universal and further research is needed to clarify these discrepancies.

Langevin et al. (1985) noted systematic differences between studies producing suppression effects versus null effects. When suppression effects occurred, investigators had used within -subject designs, repeated the same erotic stimuli across conditions, and obtained confounding order effects. These problems suggest that, in some cases, observed suppression may have been artifactual to habituation processes. Careful attention to these methodological concerns and systematic consideration of biphasic effects could illuminate and clarify this pattern of null effects.

Undetermined mechanism for alcohol-induced suppression. The underlying mechanism for alcohol-induced suppression has not been determined. The mechanism has been assumed to be characterized by strict physiological processes devoid of conscious mediation. This assumption bolsters the impression that suppression is universal. However, investigations of nocturnal penile tumescence (NPT) have challenged this assumption.

Alcohol does not reliably suppress NPT. In a single case study, Cooper (1994) reported some evidence of NPT suppression. Alcohol (.12 mg%) was administered to a 51-year-old man prior to bedtime on some nights but not others. Eight NPT measures were assessed during sleep. Cooper found that, compared to no alcohol nights, alcohol caused suppression on four of eight measures. Morlet et al. (1990) reported on two studies: a study of 11 young men (mean age = 24.7) and a nonhuman investigation with dogs. In the human study, alcohol (.15 mg%) was administered prior to bedtime on one of three nights. There was no reliable



evidence of NPT suppression on the alcohol night compared to the two control nights. Moreover, in the follow-up study using dogs, the investigators administered alcohol and electrically stimulated the pelvic nerve to evoke penile tumescence; again they found no evidence of alcohol-induced suppression. This lack of suppression fits with rat data using comparable dosages (e.g., Scott, Ettenberg, & Olster, 1994). Morlet et al. (1990) concluded, based on both human and canine data, that there was no support for their initial hypothesis that "alcohol depresses the peripheral motor pathway underlying erectile function" (p. 403).

Based on the available data, no specific physiological mechanism that would account for alcohol -induced suppression of penile tumescence has been documented. The alcohol-induced suppression effect seems less feasible in the absence of evidence attesting to a clear physiological mechanism capable of mediating the effect. Morlet et al. (1990) suggested that suppression effects observed in wakeful men are perhaps due to impairment of "cognitive or perceptual processes concerned with the interpretation of erotic stimuli" (p. 404). This suggestion implies much more plasticity in alcohol's suppressant effects than was previously assumed. Because more plasticity is logically feasible, persistent null effects begin to resemble a pattern seeking coherent explanation rather than merely being an anomaly subject to dismissal. Consideration of alcohol's biphasic nature may illuminate these discrepancies and suggest an explanation.

Biphasic alcohol effects. It is known that, after alcohol ingestion, changes in BAC follow a biphasic trajectory. In the first phase or ascending limb of the trajectory, alcohol is absorbed and BAC rises. In the second phase or descending limb, alcohol is eliminated and BAC falls. Biphasic effects refer to ascending-versus-descending response differences occurring at equivalent dosages, and they have been reliably documented on several response dimensions (see Newlin & Thompson, 1990; Pohorecky, 1977). Specific ascending mood effects include increases in vigor (Moss, Yao, & Maddock, 1989), elation (Babor, Berglas, Mendelson, Ellingboe, & Miller, 1983), positive feeling (Sutker, Tabakoff, Goist, & Randall, 1983), extraversion (Jones & Vega, 1972), and stimulation (Connors & Maisto, 1979) and simultaneous decreases in fatigue (Babor et al., 1983), depression (Smith, Parker, & Noble, 1975), and tension (Moss et al., 1989). Conversely, mood effects on the descending limb include increases in fatigue (Babor et al., 1983), depression (Babor et al., 1983), and tension (Moss et al., 1989), and decreases in vigor (Moss et al., 1989) and stimulation (Giancola & Zeichner, 1997). Generally, ascending mood effects are characterized as activating/stimulating and descending mood effects are characterized as sedating/depressing (Martin, Earleywine, Musty, Perrine, & Swift, 1993).

Biphasic effects also characterize motor and cognitive responding. Specifically, alcohol-induced impairments on the ascending limb are greater than those on the descending limb for measures of abstract reasoning (Jones & Vega, 1972), memory (Jones, 1973), motor functioning (Savoie, Emory, Moodie, & Thomas, 1988), reaction time (Nicholson et al., 1992), and flight simulator performance (Morrow, Leirer, Yesavage, & Tinklenberg, 1991). In addition, research on biphasic effects in human aggression revealed that alcohol-induced aggression was evident on the ascending BAC limb but not on the descending limb (Giancola & Zeichner, 1997).

These biphasic phenomena can be explained by acute tolerance or the Mellanby effect. This position posits that, at equivalent BAC levels, alcohol effects occurring on the descending BAC limb are weaker than those on the ascending limb due to adaptation processes (e.g., Kalant, LeBlanc, & Gibbins, 1971). Considering subjective intoxication, for example, a drinker who reports feeling intoxicated at a certain ascending BAC level would report feeling less intoxicated at the equivalent descending BAC. In essence, the drinker has become tolerant to an alcohol effect within the confines of this particular drinking episode. This explanation fits the pattern of findings obtained for biphasic investigations of motor and cognitive responding and of activating/stimulating mood responses. With regard to sedating/depressing mood responses, alcohol effects appear stronger on the descending than ascending limb. However, if these effects are interpreted as merely the opposite of activating/stimulating effects, then these data fit the Mellanby explanation as well.

Applying this acute tolerance logic to sexuality, any alcohol-induced suppression of sexual responding observed on the ascending limb should weaken and dissipate on the descending limb. This could potentially explain some of the aforementioned null effects. In most studies, investigators intended to assess arousal on the ascending limb or at the peak. However, it is possible and likely that BAC had peaked and begun declining before dependent measures were assessed. Two considerations support this possibility. First, in some studies (e.g., Rubin & Henson, 1976), there was only one postdrinking BAC assessment, thus rendering any estimates about BAC location of the arousal assessment entirely speculative. Even in the



best-controlled studies to date (e.g., Lansky & Wilson, 1981), there were only two postdrinking BAC assessments, one premeasure and one postmeasure. These data typically provided some confidence that the dependent measure was gathered near the top of the curve (either on the ascending or descending side). Second, no control for limb effects has ever been employed in these studies. That is, there has never been a clearly located arousal assessment on the ascending limb that was systematically compared to a clearly located arousal assessment on the descending limb. Such a comparison would require at least four postdrinking BAC assessments.

In sum, the possibility that, in previous studies, arousal was assessed on the descending limb cannot be definitively ruled out. Careful examination of alcohol's biphasic effects on sexual arousal is essential to resolve the discrepancies in previous findings. To date, no such investigations have been undertaken. Recent advances in study designs (e.g., Giancola & Zeichner, 1997) for capturing biphasic phenomena have provided and prompted new opportunities for clarifying these effects and for furthering our understanding of alcohol and sexual arousal.

Impaired ability to inhibit arousal. Regarding men's genital arousal, another paradoxical finding has emerged: Alcohol may simultaneously suppress and disinhibit arousal. That is, although there is evidence that alcohol suppresses penile tumescence, there is co-occurring evidence that alcohol impairs the ability to inhibit or control arousal. Rubin and Henson (1976) introduced erotica presentations by instructing participants (21-29-year -old men) first to "relax and enjoy" and later "to avoid becoming sexually excited." The relax-minus-avoid arousal differences were significantly larger under sober and low intoxication conditions than under moderate and high intoxication conditions. Wilson and Niaura (1984) instructed participants (undergraduate men) "to suppress sexual arousal" and found that alcohol expectancy set had no effect on arousal. However, compared to no-alcohol controls, low-dose participants exhibited lower latencies both for onset of tumescence and for arrival at peak tumescence. Together, these findings suggest that alcohol impairs men's capacity to control penile reactions. In other words, when men consciously intend to suppress arousal in the face of erotic stimulation, alcohol reduces their effectiveness in doing so. Thus, when intoxication and sober conditions are compared under such counter -arousal instructions, alcohol promotes rather than suppresses penile tumescence.

This question of impaired control has also been examined with respect to deviant sexual arousal (penile responses to stimuli indicative of either rape, child molestation, or nonsexual assault). Unlike in the above experiments, the instruction to inhibit arousal is implicit rather than explicit in the deviance studies. When sober, nonrapists exhibit less arousal to nonconsenting than consenting erotica. However, this discrimination shrinks during alcohol intoxication (Barbaree et al., 1983). This reduced discriminative arousal to deviant versus nondeviant erotica while drinking also occurs with sex offenders (Keltner & Doyle, 1986; Wormith et al., 1988). The nature of this shrinkage in discrimination is variable. With nonrapists, nondeviant arousal appears to decrease, whereas deviant arousal appears unchanged by alcohol (Barbaree et al., 1983). With sex offenders, deviant arousal appears to increase, whereas nondeviant arousal appears unchanged by alcohol (Wormith et al., 1988).

This counter-arousal pattern observed with normals and offenders is interesting and important for several reasons. First, it controverts the suppression axiom. Second, it supports the conventional wisdom about alcohol as disinhibiting sexuality. That is, the counter -arousal pattern "is consistent with the popular assumption that alcohol renders men more prone to lose control of voluntary sexual restraint" (Wilson & Niaura, 1984, p. 223). Third, because some sexual assaults involve intoxicated men who experience sexual arousal when they should not, it may contribute to illuminating alcohol's role in sexual assault.

Fourth, in terms of potential explanatory analyses, the counterarousal pattern lends itself to interpretation by Steele's alcohol myopia model of drunken social behavior (Steele & Josephs, 1990). The model argues that intoxication generates more excessive outcomes than sobriety only when the person faces high conflict between instigatory and inhibitory motives. In the counter -arousal paradigm, there exists such conflict. The propensity to become aroused by the erotic stimulation conflicts directly with the explicit or implicit (as in the presence of deviant stimuli) motive to suppress arousal. The counter -arousal findings fit the model's prediction. Alcohol disrupts the capacity to abide the inhibition motive thereby fostering instigation outcomes.

Finally, with regard to sexual arousal, many risky sex opportunities may also be construed as counter -arousal experiences. Analogous to the counter -arousal paradigm, an individual presented with an



opportunity for risky sex may experience contradictory pressures. On one hand, he may feel situationally prompted urges toward sexual arousal. However, on the other hand, he may also experience situationally prompted injunctions against gratifying that arousal and perhaps even against experiencing it. For instance, while feeling sexually attracted to and aroused by a potential new partner, an individual may also feel restrained by the recognition that unprotected intercourse with this person may constitute a risky venture. However, when intoxicated rather than sober, this person may experience the same reduced effectiveness at stemming his arousal that was exhibited by alcohol subjects in the counter-arousal studies. Furthermore, like the counter -arousal paradigm, risky sex opportunities share a susceptibility to being cogently explained by Steele's alcohol myopia model (e.g., Cooper & Orcutt, 1997).

In sum, these findings of reduced arousal control under counterarousal conditions may suggest a synthesis of various trends. Simultaneous consideration of sexual arousal paradigms, risky sex paradigms, and response conflict formulations may illuminate alcohol's effects on sexual outcomes. Even without alcohol in the equation, there is evidence that experiencing sexual motivation (and presumably potential sexual arousal) affects sexual risk appraisals (Blanton & Gerrard, 1997). The myopia model would predict that alcohol would resolve the conflict between sexual motivation and inhibiting risk concerns by fostering an inattention to inhibitions, thus resulting in a risky sexual outcome. However, this intersection of arousal, alcohol, and risk has not yet been investigated experimentally.

Evidence Regarding Alcohol and Erotica Interest

Another researched area of sexuality has been erotica interest. Assessed behaviorally in laboratory paradigms, the measure operationalizes the pursuit and enjoyment of exposure to explicit sexual materials. Increasing interest in such materials indicates increased desire and willingness to experience sexual arousal.

In several experiments, researchers have investigated the effects of alcohol variables on erotica interest. Often, the balanced placebo design (BPD) has been used to differentiate physiological and psychological properties of drinking: alcohol (actual beverage content) and expectancy set (apparent beverage content). In six of seven experiments, alcohol variables affected erotica interest. Compared to expect -no-alcohol controls, expect -alcohol men waited longer to watch more erotic film (Abrams & Wilson, 1983) and viewed erotic slides longer (George & Marlatt, 1986). Expect -alcohol men who were high in sex guilt also viewed erotic slides longer than controls (Lang et al., 1980). McCarty, Diamond, and Kaye (1982) and Lauerman (reported in Lang, 1985) found very circumscribed evidence that actual alcohol increased erotica viewing for both men and women. George et al. (2000) used a dyadic version of these paradigms, in which men were paired with a coparticipant ostensibly undergoing alcohol consumption and exposure to sexual materials. Men viewed erotica longer when accompanied by a drinking coparticipant rather than a nondrinking coparticipant (George et al., 2000). The one experiment reporting null effects was complicated by multiple procedural differences (Lansky & Wilson, 1981).

In sum, all but one of these studies showed that either apparent or actual drinking increased participants' interest in experiencing exposure to erotic material. These findings make some key points. First, in contrast to survey data, these findings constitute clear causation: Situationally manipulated alcohol variables directly increased a sexually oriented behavior in real time. Second, alcohol's relationship to sexually oriented behavior is not strictly based on physiology. Nonpharmacological processes pertaining merely to what drinkers think about their beverage can influence postdrinking sexuality. Third, because viewing was assessed surreptitiously and experimenters were blind to experimental conditions, these behavioral findings cannot be attributed to artifacts of self-report, social desirability, or demand characteristics. Finally, the findings seem externally valid because they are generally compatible with anecdotal, clinical, and survey data indicative of postdrinking sexual disinhibition.

Evidence Regarding Alcohol and Sexualized Social Perception

Vignette alcohol manipulations provide another strategy for studying the alcohol-sexuality link. In this paradigm, respondents are presented with a depiction of a person and are required to evaluate him or her. Garcia and Kushnier (1987) found a female student was rated as more sexual if she drank alcohol than if she did not. In a slightly more elaborate version of this procedure, the vignette will describe actors on a date



or engaged in a social interaction. In order to vary alcohol consumption systematically, alternative versions of the depiction are created in which the actor(s) drinks alcoholic or nonalcoholic beverages. Unlike with instruments assessing alcohol expectancies, participants are not directly asked to rate alcohol's sexual effects per se; rather, they evaluate a drinking or nondrinking person. In three such studies, we have found that a drinking woman was rated as more sexually available and willing to engage in foreplay and intercourse than a nondrinking counterpart (George et al., 1988, 1995, 1997). The drinking man has been perceived similarly (Corcoran & Bell, 1990; George et al., 1997). Furthermore, increasing the target person's intoxication/dosage level led participants to perceive monotonic increases in the target person's sexual availability and willingness (George et al., 1997). Others have reported that drinking actors, compared with nondrinking actors, were rated as being more sexy (Leigh, Aramburu, & Norris, 1992), showing more sexual initiative (Corcoran & Thomas, 1991; Velez-Blasini & Brandt, in press), and having more sexual intent (Abbey & Harnish, 1995). These findings demonstrate a postdrinking sexual inference whereby third-party raters ascribe more sexual responsiveness to a drinking person than to a nondrinking one. Thus, when all other factors are equal, people will perceive someone as more sexual based merely on the knowledge that the person has been drinking.

These sexual inferences are not artifactual to vignette methodology but generalize to live dyadic encounters. In the George et al. (2000) experiment, men were led to believe they were consuming either alcoholic or nonalcoholic drinks (no alcohol was administered). They then rated an alcohol -drinking or nondrinking coparticipant on sexual disinhibition, and then viewed erotic slides with the coparticipant. Manipulation checks completed postexperimentally confirmed that participants believe the beverage manipulations. The results were that men rated drinking female coparticipants as more sexually disinhibited than nondrinking female coparticipants. Furthermore, coparticipant "drinking" heightened erotica viewing directly and indirectly (via perceived sexual disinhibition). Abbey, Zawacki, and McAuslan (in press) conducted an experiment in which each of 88 unacquainted male -female dyads interacted for 15 minutes after consuming drinks according to the four BPD conditions. They found that, when actual alcohol was consumed by a member of the dyad, male and female participants were perceived as behaving more sexually and in a more disinhibited fashion. Together, these findings extend our earlier vignette findings by indicating that postdrinking sexual inferences about others transcend perception and generalize to how one behaves toward others.

This inference effect parallels the BPD pattern resembling a third-person case of the self-fulfilling prophecy phenomenon: Convinced alcohol was consumed, participants responded higher on sexual indices. But rather than being convinced they themselves had drunk, participants were convinced someone else had drunk. Likewise to the BPD pattern, this sexual inference effect lends itself to a self-fulfilling prophecy explanation: Because alcohol-vignette participants believed the target person had drunk and then rated the target as more sexual than did controls, they must have expected alcohol to heighten sexual responding and, in turn, perceived the target accordingly.

Evidence Regarding Alcohol and Risky Sex

With emergence of the HIV/AIDS crisis, the alcohol and sexuality research landscape has shifted significantly. Its scope has narrowed and intensified around sexual behaviors pertinent to disease transmission. A primary research emphasis has been to establish whether alcohol use increases the likelihood of engaging in risky sex (i.e., sexual behaviors that increase the risk of contracting HIV). For instance, important behavioral outcomes have included intercourse without condom protection, with multiple partners, and with partners of unknown HIV status. There also has been a shift in method emphasis as well. Prior to the AIDS crisis, the preponderance of alcohol and sexual behavior studies relied primarily on experimental methods. Since then, the majority of studies have been conducted almost exclusively using survey methods. As a consequence, constructs readily amenable to survey methods (e.g., knowledge, attitudes, or personality style) have received considerable attention. Other constructs better assessed by experimental methods, such as sexual arousal, have received less attention. Hence, sexual arousal, which seems critical to understanding the relationship between sexual behavior and decision-making, has been seriously underinvestigated within the alcohol and risky sex literature. However, important empirical trends about alcohol and risky sex have begun to emerge.

Nonexperimental Findings



Survey studies investigating the relationship between alcohol and risky sex have been extensively reviewed and have generated several consistent points (Cooper, 1992; Dingle & Oei, 1997; Donovan & McEwan, 1995; Fortenberry, 1995; Leigh & Morrison, 1991; Leigh & Stall, 1993; Halpern-Felsher et al., 1996). First, global correlation studies and situational covariation studies reveal a positive association: Alcohol use and abuse predicts risky sex. Second, this finding is consistent with both causal and noncausal interpretations such as folk wisdom and determination by "third variables" (e.g., unconventionality or sensation-seeking). Third, in surveys with methods thought to afford stronger causal inferences, such as event -based and diary assessments, support for the causative claim weakens (Dingle & Oei, 1997). In event -based analyses, respondents are asked about whether drinking occurred prior to a specific sexual episode that is specifiable across all respondents (e.g., first intercourse with the most recent partner). In diary assessments, participants are asked to record drinking and sexual activity on a daily basis (e.g., Leigh, 1993). Even with the most rigorous use of these methodologies (e.g., Cooper & Orcutt, 1997; Dermen & Cooper, 2000; Derman, Cooper, & Agocha, 1998; Testa & Collins, 1997), the demonstration of a causal link between drinking and sexual responding is less direct and definitive than in a laboratory experiment. Fourth, survey methods are beset with inherent design and measurement shortcomings that seem insurmountable in the quest to ascertain causal linkages (Catania, Gibson, Chitwood, & Coates, 1990; Leigh & Stall, 1993). In sum, survey data have established an alcohol -risky sex link and have identified numerous demographic and personality cofactors of this link (e.g., Kalichman, Tannenbaum, & Nachimson, 1998). However, to clarify the viability of causation analyses, survey data require substantiation from controlled experiments.

Experimental Findings

Experimental paradigms are better suited for affirming causal analyses. However, for obvious practical and ethical reasons, actual sexual interactions are subject neither to random assignment nor laboratory observation. Consequently, applications of experimental paradigms to the alcohol-risky sex question have been slow to evolve.

Recently, several experimental reports have appeared. In a series of three experiments, MacDonald, Zanna, and Fong (1996) investigated the effects of acute intoxication on intentions to have unprotected intercourse with a casual partner. Intentions were assessed in an analogue procedure involving a video of a couple on a date. Based on Steele's inhibitory conflict model of alcohol myopia (Steele & Josephs, 1990; Steele & Southwick, 1985), these investigators hypothesized and found that intoxicated participants exhibited stronger intentions to have unprotected intercourse and expressed more agreement with justifications for unprotected intercourse than did sober controls. In a subsequent series of four experiments, MacDonald, Fong, Zanna, and Martineau (2000) found again that intoxicated participants were more likely than sober participants to report intentions to engage in unprotected intercourse. However, when exposed to a strong inhibiting cue, intoxicated participants were less likely to report such intentions. They concluded that alcohol's capacity to cause risky sex depends on the availability and salience of cues that impel versus inhibit risk taking.

In two experiments, Gordon et al. (Gordon & M. Carey, 1996; Gordon, M. Carey, & K. Carey, 1997) investigated the effects of acute intoxication on risky sex antecedents derived for the information-motivation behavior model (J. Fisher & W. Fisher, 1992). Briefly, the model postulates that information (about HIV transmission and its prevention), motivation (to change HIV risk behavior), and behavioral skill (at performing preventive acts) jointly determine preventive behaviors such as condom use. Though exhibiting equivalent risk knowledge, intoxicated men expressed more negative attitudes about condom use, more concern about reduced pleasure from condom use, more embarrassment about negotiating and using condoms, and less appreciation for condom use advantages than did sober men.

Murphy, Monahan, and Miller, (1998) used the BPD to investigate alcohol effects on women's willingness to date risky men. Potential dates were depicted on video and were varied systematically with respect to instigatory (or impelling) cues (attractiveness) and inhibitory risk cues (e.g., past promiscuity). Based on Steele's alcohol myopia model, Murphy et al. predicted and found that intoxicated women rated the high conflict man (both attractive and promiscuous) as having greater potential for a sexual relationship than did sober women.

Finally, in two experiments, Fromme, D'Amico, and Katz (1999) investigated the effects of acute intoxication on risk-related judgments associated with sexual behavior. In the first experiment, they found that intoxicated



young men and women -- compared with placebo controls and no-alcohol controls -- indicated that negative consequences were less likely to occur and would be less likely to influence their decision-making about having sex with a new partner. In a second experiment, participants watched a videotape of a couple engaging in foreplay and contemplating intercourse without a condom. Afterwards, participants were asked to list potential consequences of continuing on to intercourse. Intoxicated participants listed fewer negative consequences than did placebo and no-alcohol controls. Fromme et al. concluded, consistent with the alcohol myopia model, that alcohol influences sexual risk-taking by diminishing appreciation for potential negative consequences that might otherwise inhibit risk -taking.

This initial wave of experimentation on alcohol and risky sex is striking in three respects. First, these studies provide clear evidence of causal linkages between acute alcohol intoxication and variables thought pertinent to risky sex. Impressively, this support for causal linkage emerged from three independent teams across 11 separate experiments including both laboratory and field studies. This replication across different protocols and laboratories strengthens confidence in the linkage. Second, aspects of the data from each research team were consistent with interpretations derived from Steele's inhibitory conflict model. This pattern of support for the inhibitory conflict model coincides with findings and interpretations derived from a rigorously executed event-based survey (Cooper & Orcutt, 1997). Third, a pressing concern with experimental methods is external validity. Confronted by the limitations on studying sex in the laboratory, each investigative team has instead studied elements of sexual decision-making. Each team identified self-report indicators relevant to sexual decision-making. The conceptual relevance of these indicators to risky sex was established through various strategies: use of instrumentation judged valid and reliable in survey work, use of measures derived from theory-driven constructs, and the presumption of face validity of hypothetical scenarios. In sum, these studies attest to the feasibility of credible laboratory experimentation capable of advancing theory-driven causal analyses about the effects of alcohol on risky sex.

Unresolved Issues Concerning Alcohol and Risky Sex

Virtually nothing is known scientifically about the intersection of alcohol, sexual arousal, and risky sex. As described earlier, this is largely because alcohol -arousal inquiry was prematurely truncated and because alcohol-risky-sex inquiry has emphasized survey methods and dispositional variables at the expense of experimentation-derived knowledge about situational variables. Admittedly, the experimental manipulation of situational alcohol and arousal-related variables while assessing objective sexual arousal and risky sex-related outcomes is complicated and somewhat daunting procedurally. To date, not a single experiment has been reported addressing this intersection. Yet this intersection forms the logical departure point for evaluating and advancing our current knowledge in this area.

At present, we know that alcohol variables (alcohol, expectancy, and expectancy set) influence both sexual arousal and risky sex. Prototypically, engagement in a risky sexual outcome (such as unprotected intercourse) is immediately preceded by the experience of being sexually aroused. Therefore, it is logical to hypothesize that alcohol's effects on risky sex are moderated or mediated by postdrinking sexual arousal. To date, no theories have been put forth to explain the relationship from alcohol through sexual arousal to risky sex. However, based on theory formulations concerning the alcohol to arousal link and the alcohol to risky sex link a set of working hypotheses can be forged. In particular, based on the above analyses of postdrinking arousal under counterarousal conditions, myopia theory is a very pertinent framework for understanding the alcohol, sexual arousal, and risky sex interaction (MacDonald, MacDonald, Zanna, & Fong, 2000).

Alcohol myopia models emphasize the importance of alcohol content over expectancy set. Drawing on the firmly established fact that alcohol impairs attention, cognition, and information processing, proponents of this view contend a "myopia" occurs for the intoxicated person who has a pressing opportunity to engage in disinhibited behavior (Pernanen, 1981; Steele & Josephs, 1990; Taylor & Leonard, 1983). This myopia is characterized by a falsely simplified or myopic vision of reality in which the immediate impulses to indulge in disinhibited behavior become influential because the more remote inhibitions against the indulgence recede into the background. Access to these inhibitory forces becomes hampered by alcohol -induced narrowing of attention. This is the unstipulated version of the model. Due to alcohol -induced myopic narrowing of attention to a smaller subset of situational cues, salient cues subordinate less salient cues in governing how to behave in a situation. Steele's model may be characterized as a stipulated version of myopia. It stipulates that the disinhibition opportunity needs to involve a high-conflict behavior involving instigatory cues and



inhibitory cues of equivalent strength (Steele & Josephs, 1990). If instead conflict is low (the strength of instigatory and inhibitory cues are of unequal magnitude or equally low magnitude), the intoxicated person would behave no differently than the sober person. Presumably, in high-conflict situations, the myopia enables the person to resolve the conflict between instigatory impulses and inhibitory restraints by plunging ahead into disinhibition. Supposedly, greater intoxication leads to greater myopia which in turn leads to greater disinhibition. Applying this logic to risky sex would suggest that in a social interaction an intoxicated person who felt motivated to pursue sexual contact with someone would be less attentive to and aware of internal (e.g., concerns about disease transmission) or external (e.g., messages that condoms are unavailable) cues signaling that he or she should resist sexual intercourse. Consequently, attention would narrow to salient cues signaling sexual quest, advance, progress, and consummation. Salient external cues might include the partner's attractiveness, sexual arousal, and encouragement. The person's own sexual arousal may constitute the most important internal cue. In this regard, MacDonald, MacDonald, et al. (2000) aggregated self-reports of sexual arousal from men who had participated in the seven experiments described earlier. They found that self-reported arousal predicted risk related attitudes and intentions in intoxicated men but not sober men. Though preliminary in nature, this finding that sexual arousal moderated the effects of alcohol on sexual risk judgments suggests myopic attention to impelling internal cues.

Alcohol and Sexual Assault

Alcohol has been implicated in sexual assault. Sexual assault is one form of sexual aggression. Broadly defined, sexual aggression includes sexual harassment, sexual coercion, sexual assault (exhibitionism, attempted rape, and rape), and child molestation. A central defining characteristic of sexual aggression generally and sexual assault specifically is that the perpetrator engages in nonconsensual sexual behavior with the victim. Numerous sources implicate alcohol use/abuse as either a cause of or contributor to sexual assault (e.g., Abbey, 1991; Abbey, Ross, & McDuffie, 1994; Benson, Charlton, & Goodhart, 1992; Berkowitz, 1992; Harrison, 1978; Rada, 1975a, 1975b; Richardson & Hammock, 1991; Seto & Barbaree, 1995). Across both the literatures on sexual assault and on alcohol's social effects, several lines of empirical data and theory-based logic suggest that alcohol is a contributing factor in sexual assault.

The literature on sexual abuse and assault is extensive. The present scope is limited to adult sexual assault involving a male perpetrator and female victim because the vast majority of adult sexual assaults involve this constellation. Within this scope, nonexperimental and experimental studies pertinent to alcohol and sexual assault will be reviewed. Conceptual developments in the sexual assault literature pertaining to alcohol involvement will also be considered.

Nonexperimental Data Linking Alcohol and Rape

Nonexperimental studies using various methodologies have been crucial in drawing attention to the involvement of alcohol in rape. One method has been to gather interview or case-record data from convicted rapists. Investigators using this approach have reported that in 40-63% of the cases studied the offender had been drinking at the time of the rape (Groth, 1979; McCaldon, 1967; Rada, 1975a; Rada, Kellner, Laws, & Winslow, 1978; Tracy, Donnelly, Morganbesser, & MacDonald, 1983). An alternative investigatory method has been to examine police records. Investigators using this approach have reported that in 34-72% of the cases studied either the offender, the victim, or both parties had been drinking at the time of the rape (Amir, 1967; Clark & Lewis, 1977; Johnson, Gibson, & Linden, 1978). Of course, numerous biases are inherent in data attained through the above methods, such as (a) reported rapes represent a small percentage (estimates range from 1025%) of all rapes, (b) convicted rapes represent an even smaller percentage of all rapes, (c) rapists may be motivated to implicate alcohol as a way of shifting blame and legal culpability away from themselves (Scully & Marolla, 1984), (d) victims may be motivated to implicate alcohol as way of documenting their incapacitation, and (e) systematic distortions resulting from police interrogation methods. Nevertheless, these data document a strong associational link between alcohol and rape in the subset of cases that come to police attention.

Another method has been to survey college samples inquiring about their experiences with sexual assault. Advantages of this method are that it expands the scope of cases to include unreported rapes as well as sub-rape instances of sexual aggression and that the anonymity of the response format encourages respondents to provide valid information. Also, because college students are at increased risk for sexual



assault by virtue of age, this method is not simply an instance of convenience sampling. Indeed, these studies have documented heretofore unrecognized high rates of sexual aggression on college campuses. For example, Koss, Gidycz, and Wisniewski (1987) reported that 28% of college women had experiences that met the legal definition of rape or attempted rape. Regarding alcohol involvement of victims, Muehlenhard and Linton (1987) reported that 55% of sexually assaulted women were under the influence of alcohol, and Koss and Dinero (1988) found that alcohol use was one of four strong predictors of being sexually victimized. Regarding alcohol involvement of perpetrators, alcohol use predicts sexual aggression in college men (Gray, Lesser, Rebach, & Hooks, 1988; Koss & Dinero, 1988; Koss & Gaines, 1993). Alcohol has also been associated with college campus reports of sexual coercion (Miller & Marshall, 1987) and gang rape (Ehrhart & Sandler, 1985). In sum, the college data also indicate a link between alcohol and sexual assault.

Another nonexperimental indication of the alcohol and rape link is the pervasiveness of the impression that alcohol itself can serve as a weapon in sexually overpowering women. College women have reported that the administration of alcohol and/or drugs was the method used by an assailant to force sexual intercourse (Finley & Corty, 1993; Koss et al., 1987; Martin & Hummer, 1989; Yegidis, 1986). Likewise, college men report having used alcohol for this purpose (Koss et al., 1987; Mosher & Anderson, 1986). In fact, more than 20% of adolescent boys believe it is justified to force sex on an intoxicated girl (Davis, Peck, & Storment, 1993).

The alcohol and rape link also emerges in surveys of noncollege samples including adolescents (Erickson & Rapkin, 1991) and community women (Russell, 1982). In sum, nonexperimental data based on a variety of samples and methods document a strong association between alcohol and rape.

Experimental Data Linking Alcohol and Rape

An experimental approach to investigating the effects of alcohol variables on rape-related phenomena has been to present subjects with fictitious depictions of rape scenes. The presence of alcohol cues is varied across different versions of the scene and later subjects' perceptions of the rape are measured. Richardson and Campbell (1982) found that subjects judged a drinking rapist to be less blameworthy than a sober rapist but judged a drinking victim to be more blameworthy than a sober victim. The perception of alcohol reducing the blameworthiness of a rapist was replicated in two other studies (Barbaree & Seto, 1991 as cited in Barbaree & Marshall, 1991; Hammock & Richardson, 1989, as cited in Richardson & Hammock, 1991). Thus, third party observers in these studies saw alcohol as influencing and thereby excusing the behavior of a rapist. Similarly, Norris and Cubbins (1992) found that subjects judged the behavior of an intoxicated rapist to be less indicative of rape than the behavior of a sober rapist when the victim was also intoxicated. In two studies, Marx, Gross, and Juergens (1997) and Marx, Gross, and Adams (1999) conducted college men through the BPD, and then measured their perceptions of an audiotape depicting date rape. In both studies, men who received or expected alcohol took more time to determine that the perpetrator should refrain from further advances than did controls. In another study involving this date rape, decision-latency paradigm, participants did not drink, but the perpetrator and victim were portrayed as drinking alcohol or not drinking alcohol (Bernat, Calhoun, & Stolp, 1998). Among sexually aggressive participants, men who heard the alcohol involved rape exhibited greater latency, that is took more time to determine that the perpetrator should refrain. Hence, according to these studies, college students judge alcohol -present rapes differently than alcohol -absent rapes, and their judgments seem to imbue alcohol with influential properties capable of causally affecting rape perpetration and victimization.

A number of experimenters, employing predominantly college samples, have investigated the effects of alcohol on men's response to sexually aggressive stimuli. Compared to expect-no-alcohol controls, men who thought they had consumed alcohol (whether they had or not) were more physically aroused by depictions of forcible rape (Briddell et al., 1978) and were more interested in watching violent erotica (George & Marlatt, 1986). Norris and Kerr (1993) found that alcohol, but not expectancy set, increased men's willingness to behave like a rapist. In another study, Barbaree, Marshall, Yates, and Lightfoot (1983) reported that, whereas sober men were more genitally aroused by consenting sex scenes than rape scenes, intoxicated men were less discriminating in their arousal patterns.

Using men recruited from the general community, Norris and her colleagues have found that alcohol can have complex effects on responses to rape scenarios. In one instance, intoxicated men were less empathic



in their evaluation of a victim than sober men (Norris, George, Davis, Martell, & Leonesio, 1999). However, this tendency was moderated by participant's level of hypermasculinity, the presence of alcohol in the story, and the nature of the victim's response. In another study, they found that intoxicated men perceived the assailant in a rape more favorably than did sober men (Martell, Norris, & George, 2000).

In the only study to administer alcohol to a group of convicted rapists, Wormith et al. (1988) found that rapists did not show the alcohol-induced genital suppression effect shown by nonrapists. Furthermore, alcohol diminished rapists' tendency to respond differentially to assaultive versus consenting sex scenes. In a related study not involving alcohol administration, Dahl and George (2000) presented a stranger rape scenario to incarcerated sex offenders and found that low-empathy offenders self-reported more sexual arousal if the scenario involved alcohol than not.

These studies indicate that alcohol variables can disinhibit men's responding to sexually aggressive depictions. In a paper reviewing six models of how men's sexual arousal relates to rape (not just acquaintance rape), Barbaree and Marshall (1991) noted a role for alcohol. Specifically, they described their disinhibition model as a state model whereby "an emotional or cognitive state may increase the rape arousal of men who would otherwise show strong inhibition of rape arousal" (p. 626). The authors then identified alcohol intoxication as a state capable of disinhibiting rape arousal in nonoffender men.

In sum, though there is no direct evidence that alcohol causes rape, the sexual assault literature documents a frequent co-occurrence of alcohol consumption and sexual assault. This literature also provides empirical data and conceptual arguments suggesting that alcohol can influence victim and perpetrator behavior in sexual assault situations.

Unresolved Issues Concerning Alcohol and Sexual Assault

Correlational survey data attest to the frequent association between alcohol and sexual assault, especially acquaintance and date rape. Obviously, alcohol effects on sexual assault cannot be investigated directly under laboratory conditions. However, using a variety of analogue procedures, investigators have determined that alcohol variables do exert an influential impact on how sexual assaults are perceived. The findings suggest that alcohol variables foster assault congruent social perceptual processes. Most of these experiments have been oriented to analyzing and to explaining the perpetrator's perception and actions.

Recently, attention has been devoted to alcohol's effects on the victim. Indications are that alcohol reduces the victim's ability to detect the risk of rape and to extract herself from danger (Norris, Nurius, & Dimeff, 1996; Nurius & Norris, 1996). Cue, George, and Norris (1996) found that sober women do not perceive alcohol as a sexual assault risk factor. However, in a subsequent alcohol administration experiment, moderately intoxicated women were less able than sober women to perceive risk cues (Norris, George, & Davis, 2000). Furthermore, though perceiving less risk, intoxicated women indicated greater likelihood of involvement in risk-prone behaviors (Testa, Livingston, & Collins, 2000) and a reduced likelihood of using direct resistance to fend off an assault (Norris et al., 2000). Attention has also focused recently on the interactive nature of sexual misperception that may lead to acquaintance assaults (Abbey et al., in press).

In these areas, as in many other areas of alcohol and sexual behavior, the alcohol myopia model is emerging as dominant model. The argument is that alcohol focuses attention on instigatory cues, such as the desire for sex and/or intimacy, and away from inhibitory cues, such as declarations of nonconsent. More work is needed to specify the parameters and boundaries of myopia models as they may apply to sexual assault. However, there is an important caveat: Investigating the effects of alcohol on the behavior of potential victims does not imply that they are responsible for assaults that befall them. It is hoped that an improved understanding of alcohol's role in the complex processes leading to an assault will yield prevention implications applicable to both potential victims and potential perpetrators.

Conclusions

Alcohol and sexuality are closely linked in many cultures. A casual description of this link would suggest that alcohol has powerful aphrodisiac properties that can be used wittingly or unwittingly to encourage the reluctant mate or to unleash deviant sexual desires. In the present paper, we reviewed illustrative survey



data indicating that alcohol is positively associated with a variety of self-report indices related to sexual behavior. Furthermore, we reviewed and evaluated laboratory experiments pertaining to the question of whether alcohol's link to sexual behavior is a causal one. Circling back to this question, the answer seems to be a qualified yes. Whether alcohol has a causal impact depends on which aspect of alcohol (expectancy or pharmacology) and which sexual behavior index are being considered.

The expectancy aspect of drinking is very important. Survey evidence suggests the people who believe in alcohol's sexual effects are more likely to drink before a sexual experience. The available experimental evidence shows clearly that alcohol expectancy set (i.e., the belief that one has consumed alcohol) exerts a powerful effect on men's behavior. Regardless of whether alcohol had been consumed, men who thought they had been drinking became more genitally aroused and became more interested in sexually arousing material. Consistent with a self-fulfilling prophecy analysis, "believers" are more inclined toward postdrinking sexual disinhibition. Thus one potentially overarching causative scenario is that believers seek alcohol in anticipation of sexual encounters and, after drinking, they behave according to their beliefs. However, expectancies have not proven influential in many other domains of sexuality where alcohol pharmacology has been impactful. Also, at least in the laboratory, expectancies have never been reliably influential with women's postdrinking behavior. Consequently, the power of expectancy analyses alone to satisfactorily explain sexual responding will remain somewhat limited; they seem to apply mainly to sexual perceptions immediately after drinking.

The alcohol myopia model emerged as useful for understanding alcohol's effects in many of the major response domains we reviewed. This approach offers two distinct advantages in explaining alcohol's effects on sexual behavior. First, it builds on the well-established scientific observation that alcohol physiologically impairs cognitive processing of information. Consequently, the model avoids many of the conditionalities associated with expectancy-based models, which do not easily accommodate a physiological mechanism of explanation. The myopia model, instead, embraces and integrates the reality of physiological impairment. Second, across the numerous complexities affecting the alcohol-sexuality linkage, the myopia model affords a simplifying account that appears remarkably versatile and straightforward. When experiencing competing urges to engage versus not-engage in a desirable sexual behavior, alcohol promotes engagement. Alcohol does this by muting awareness of inhibitions and thereby tunneling one's vision to desirable urges. With regard to questions of arousal control, sexual risk taking, and sexual aggression, the myopia model seems to be paving the way for future work.

Correspondence concerning this article should be addressed to William H. George, Department of Psychology, Box 351525, University of Washington, Seattle, WA 98195-1525. ([email protected])

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By William H. George and Susan A. Stoner, University of Washington ison, McMaster University and Mary Koss, University of Arizona

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