Effects Alcohol Consumption Has on Risky Sexual Behavior

¶ … Alcohol Consumption Has on Risky Sexual Behavior

Since the ancient days of Bacchanalian celebratory worship of the Greek pantheon, the consumption of alcohol and risky sexual rites have gone hand in hand. Both drinking and sex are considered to be pleasurable activities, and conservative or religious portions of the population may consider them to be sinful or immoral on varying scales. Regardless of whether alcohol and sexual activities have a negative social stigma within a certain social group, peer group, or subculture, these activities are inevitably associated with some risk. Physical, emotional, and social well-being are put on the line when partaking in drinking or sexual modern rituals. The combination of these activities may increase the level of risk associated with them, and likewise they may also be contributing factors to the likelihood that the other will occur (e.g., drinking may increase the chance of sexual activity). However, despite the social stigma that may be associated with certain drinking and sexual behavior activities and patterns, there remains strong social and peer pressure to participate in both activities. It can be seen, for example, in the prevalence of sexual imagery that is used extensively in advertising, and in advertisements for alcoholic beverages in particular (Nilewide 2004), that there exists a strong cultural connection. The consumption of alcohol, sexual activity, and these behaviors happening concurrently begins at relatively young ages in our culture, and even children and young adolescents are affected. Studies have shown that alcohol certainly affects the sexual choices that are made by both men and women. The following review of literature explores research, statistics, postulation, and recommendations regarding the connection between sexual activity and alcohol. Specifically, high-risk sexual behavior among various age and social groups, will be addressed, including sexual rebellion and conformity, compulsive or uneducated choices, exposure to sexually transmitted diseases, and sexual assault, and the role which alcohol may play in each of these scenarios.

The University of Arkansas for Medical Studies has found that attitudes about appropriate sexual behavior, as well as those regarding appropriate alcohol consumption, are formed in youth at a very young age, and by the preteen years children have already developed a unique attitude regarding these subjects. A Thomson Healthcare Company (2004) report reveals that risky behavior may be minimized in adolescents and young adults if parents were to discuss standards and beliefs on sexual and other issues with children at a younger age, because relating these values to older children is not as effective. Alcohol use has been shown to lead to early initiation of sexual activity, as well as being related to the number of sexual partners that preteens and adolescents will have, particularly in high-risk groups. These high-risk youth groups include inner-city females, males in detention homes, and gay and bisexual males. Alcohol is not the only substance that is prevalent in these high-risk groups; marijuana is also associated with altered sexual statistics. Intervention treatment for youths to help curb consumption of alcohol may also help delay sexual activity, or decrease the number of sexual partners and overall risk associated with sexual activity, are encouraged as early as 9 to 12 years of age.

The link between alcohol and sexual behavior is not unique to preteens, adolescents, or young adults; this link appears to be consistent throughout the majority of the population according to most studies. Joseph LaBrie (2000) deals with the overall subject of alcohol consumption correlating with sexual behaviors in his Journal of Sex Research article, "Sexual Risk Behaviors and Alcohol." Researchers dealing with sexually transmitted diseases, in particular, are interested in finding a correlation between alcohol and sexual behavior in an attempt to isolate and eliminate as many high-risk factors as possible to reduce the overall occurrence of these diseases. Many studies have strongly confirmed the connection between these factors, while others have only been able to loosely connect them, or even failed to do so. However, base drinking rates and actual sexual behavior are very difficult to determine with certainty, which leads to inaccuracy in the results of studies. New evidence may show that base drinking rates are actually higher than previously believed, which could mean that the association between drinking and risky sexual behavior is even stronger than previously believed. Problems in collecting accurate data have to do with the private nature of sexual behavior, and because most studies rely on self-reporting methods for data collection, people may hesitate to answer truthfully about behaviors they believe might be looked down upon by others. So, in addition to drinking rates being underestimated by the majority of studies, the rates of high risk sexual behavior may also be higher than the statistics reveal. LaBrie's less intrusive form of data collection "revealed almost twice the percentage of persons engaging in risky sexual behavior after drinking as did the conventional self-report survey." (LaBrie 2000) His study also revealed that many people who participate in high-risk sexual behavior, such as not using a condom during intercourse, are reluctant to report this even when granted full anonymity because of the social stigma placed on this behavior. Drinking alcohol may lower a person's resolve to use condoms, or one might drink specifically to remove the responsibility of negotiating the use of or providing condoms for the encounter. When inebriated, one might also attempt to use a condom, but not use it properly. Therefore interventions should approach the fact that being under the influence of alcohol does not remove the safe sex responsibility in any way.

While the alcohol and risky sexual behavior correlation is applicable to everyone, it can be a particularly important issue to address with the adolescent because of the developmental significance of this age group. In a Perspectives on Sexual and Reproductive Health article by C. Coren (2003), specific patterns of substance abuse during adolescence were shown to be a predicting factor not only of the sexual behavior at that time, but also the future sexual behavior of the adolescent. More than 800 adolescents in Seattle were studied for a full decade, spanning the ages of ten years to twenty-one years, surveying the use of alcohol, cigarettes, marijuana, and other drugs at specific intervals throughout the teenage years. At the age of twenty-one, the participants were asked about their safe sex practices, sexual activity, age of first sexual encounter, and current relationship status. Seventy percent of those studied did not have any binge drinking at any time during the study, however binge drinking was an issue for thirty percent of the adolescents involved. Three percent of those had chronic binge drinking habits throughout adolescence. When, at age twenty-one, asked about the number of sexual partners with whom each participant was involved in the past year, those who had no alcohol binge drinking during the teenage years averaged the lowest number, 1.7 partners. Those with chronic binge drinking during adolescence reported the highest number of sexual partners, an average of 3 partners. Other substances, such as tobacco, marijuana, and hard drugs, did not show such a significant difference in the number of sexual partners. Additionally, ninety percent of those who had chronic binge drinking behavior during adolescence reported inconsistent use of condoms, and once again other drugs did not have nearly that significant of an impact on the sexual behavior. These results further emphasize the importance of specifically addressing alcohol consumption with youth in order to help prevent risky sexual behavior throughout adolescence and into adulthood.

While intoxicated by alcohol, an individual's perception of a situation and his or her own actions are altered, which leads to risky sexual behavior even if a person "knows better" when sober. A study reported in the Archives of Sexual Behavior (Maisto et al. 2004) revealed specific information about the attitudes and behavioral skills relevant to sexual health among young adult males when under the influence of alcohol. A total of 48 heterosexual males were involved in this study, which used a control, alcohol, or placebo condition for each over the course of two laboratory sessions. The experiment was designed to help determine the behavior such males would exhibit regarding "attitudes toward condom use, intention to engage in risky sex, and condom use negotiation skills. The results of this study were monumental, according to the authors of this article, not only because of the implications for intervention and sexual risk prevention, but also because it reveals information to help develop theories about the potential of controlled experiment settings to be used to explain the alcohol-sex relationship. The use of opinion surveys, videos, and role playing techniques were utilized for this study. The results showed that participants who consumed alcohol had poorer negotiation skills and greater intention to engage in risky sex compared to participants who did not drink alcohol. " (Maistro et al. 2004) Alcohol did not seem to affect the attitude of the individual male regarding condom use in general. However, attitudes regarding whether or not condoms would detract from the enjoyability of sex were affected by the consumption of alcohol. In addition, the participants who were under the influence of alcohol exhibited much poorer negotiation skills regarding condom use, meaning that they were far easier to persuade to not use protections. Alcohol also made the participants far more likely to engage in risky sexual behavior, and it may even be extrapolated that the influence of alcohol made the males intent to participate in risky sexual behavior. This study certainly backed up previous research showing that alcohol consumption is related to risky sexual behavior. Approximately 20-25% of the variance among males was related to personal attitude, and used in conjunction with level of alcohol consumption, this can be used to develop a surprisingly accurate prediction of risky sexual behavior. There is also evidence from this study that supports theories that perceived alcohol consumption has a significant effect on confidence and sexual behavior decisions, in addition to actual alcohol consumption.

Sexually transmitted diseases, unwanted pregnancies, and emotional regrets are not the only dangers involved when alcohol affects the risky sexual behavior choices of an individual. Alcohol is often a factor involved in sexual victimization and sexual assault. In the Journal of Youth and Adolescence, the article "The nature and predictors of sexual victimization and offending among adolescents" (Maxwell et all 2003) describes the risk factors which are associated with sexual aggression among adolescents. Among the high school students surveyed, almost half of the females responded that they had been sexually assaulted in some way. Additionally, a full third of male high school students admitted to committing acts of sexual aggression. The results of this study were intended to help improve sexual assault educational programs that would deal with sexual assault, date rape, and intimate partner violence. These problems extend to the college years, as well as through adulthood, so dealing with them during the adolescent years is vital to prevention. Alcohol has been shown to increase the chance of sexual victimization and offending, especially among adolescent acquaintances. Females who frequently become intoxicated are more likely to become the victim of sexual assault of some kind. The consumption of alcohol by both the victim and offender has also been shown to increase the severity of the assault. Thirty percent of all rapes and sexual assaults are attributed to offenders who are under the influence of alcohol. The consumption of alcohol also increases the chances of any kind of partner abuse, such as physical violence with a dating partner. This particular study found that "about 3 in 10 students reported having sex while they or their partners were 'very drunk, very stoned, or unconscious.' " (Maxwell et all 2003)

The social phenomenon of drinking games are also heavily responsible for risky sexual behaviors, including sexual aggression. The Journal of General Psychology article "Sexual experiences associated with participation in drinking games" (Johnson & Stahl 2004) reports that both men and women report being taken advantage of sexually during or after drinking games. One of the most common risky sexual behaviors is having sex with someone while too drunk to give consent, or having sex with another person who is too drunk to give consent. Very few females report being the perpetrator of such acts, but being the perpetrator of this act of sexual aggression is reported often by men who have participated in drinking games. The more alcohol that is consumed during drinking games, the higher the chance that risky sexual encounters will take place, and more alcohol correlates with more sexual encounters total. By analyzing the motivation of the males that play drinking games, it is relatively easy to determine the likelihood of the individual becoming a perpetrator of sexual aggression. When considering the relationship between alcohol and high-risk sexual activities and encounters, one must remember to address social activities like drinking games which are often overlooked in treatments and interventions. This needs to be a particular area when dealing with sexual victimization prevention and counseling. "A variety of sexual behaviors, from kissing to intercourse, occur during or after drinking games. Some such behaviors may be considered sexual harassment... whereas others are more clearly acquaintance rape... Some men may view drinking games as a way to target others for sex, and many men who admit to having been perpetrators report multiple instances of such perpetration." (Johnson & Stahl 2004)

Some percentage of unwanted or risky sexual occurrences happen because one or both sexual partners are unable to communicate due to the influence of alcohol. An article in the Western Journal of Communication, "Resistance, persistence, and drinking: examining goals of women's refusals of unwanted sexual advances" (Lannutti & Monahan 2004) discusses the results of a study on the communication barriers caused by alcohol that lead to risky behavior. Many studies have shown that alcohol consummation is a positive predictor of sexual assault, whether consumed by the victim or perpetrator of the crime. In addition to cases of blatant harassment, assault, or rape, alcohol is identified as a risk factor for sexual encounters becoming more intimate than the woman involved had planned, due to the misunderstandings and mistakes that occur when under the influence. Women under the influence of alcohol have reported being less aware of the threat that a date would use force to rape her, because her sense of danger or threat cues was dampened. Studies have also shown that an intoxicated woman will perceive a dangerous man as less dangerous than she would if sober, and the threat of sexual violence appears less severe in both men and women when under the influence of alcohol. A woman's ability to send proper refusal messages to an undesired advancing sexual partner is negatively impacted when affected by alcohol. When on a date, a woman may attempt to convey a refusal message that does not alienate, offend, or misrepresent, and attempts to create a socially "appropriate" message may be particularly ineffective when abilities are dampened by alcohol. "We theorized that women refusing an unwanted advance would attempt to accomplish a primary goal of clearly refusing the request while also addressing secondary goals of protecting self-image, the requester's image, and the relationship. Our self-report manipulation check confirmed that these goals were on women's minds while refusing. Type of request did influence the degree to which the goals were addressed." (Lannutti & Monahan 2004) The conclusion of the study was that alcohol most likely has the greatest influence on sexual resistance to unwanted sexual advances during the perception phase, when the victim would normally be able to detect a danger or threat if sober rather than intoxicated.

Drinking rates and sexual assault were found to be directly correlated especially on college campuses by studies discussed in the Campus Crime article "High-risk drinking and sexual assault go hand-in-hand" (Business Publishers 2004) and the America's Intelligence Wire report "Louisiana State U: Alcohol, sex crimes linked by study" (Yust 2004.) Recommendations are given that universities and colleges combat high rates of sexual assault and risky sexual activity by specifically targeting high-risk drinking on campus. Statistical reports included in this study show that the vast majority of rapes on campus involve the use of alcohol by the victim, perpetrator, or both. While the blame for the crime should never be placed on the victim, girls need to be educated about the fact that drinking will increase their chances of being sexually assaulted. This particular study, however, has been received with some amount of criticism for the focus it places on preventing rape-encouraging behavior among potential victims rather than working on preventing potential rapists from actually committing a crime. Some experts recommend that men simply avoid having sexual contact with a female who is under the influence of drugs or alcohol, or otherwise intoxicated or inebriated in any way, to ensure that no sexual misconduct occurs.

Sexual assault is a serious consequence of alcohol influence on sexual encounters, however even fully consensual sexual encounters pose a serious risk to those affected by alcohol. The Morbidity and Mortality Weekly Report published an article regarding the dangers of sexually transmitted diseases. "Alcohol Policy and Sexually Transmitted Disease Rates" (2000) evaluated the higher risk of adolescents and young adults in particular in regards to the acquisition and spread of sexually transmitted diseases, or STDs. Alcohol has been positively linked to the increased risk of sexually transmitted diseases from sexual activity for a number of reasons, including that a person under the influence of alcohol is less likely to abstain from sex. The influence of alcohol makes an individual more likely to participate in repeated sexual encounters and less likely to limit those encounters to a single sexual partner. Additionally, the influence of alcohol makes an individual less likely to insist on the use of protection during sexual activity, and when protection such as condoms are used during the encounter, being in an intoxicated state makes accidental misuse or improper application of protection methods far more likely. All of these factors significantly increase the likelihood that sexually transmitted diseases will be exchanged during sexual activity. Actions that would decrease the likelihood that alcohol will be consumed, or that would decrease the amount of alcohol that is likely to be consumed, would be an appropriate avenue to help reduce the risk of STD transmission and the occurrences of other risky sexual encounters. Certain actions that have been taken in attempts to prevent alcohol consumption, particularly by those under the legal drinking age, have been shown to have a positive effect in reducing the number of alcohol related problems. For example, raising the sales or sin taxes on alcohol, as well as raising the legal drinking age, have been statistically shown to reduce car-crash related deaths, lower suicide rates, curb occurrences of violent crimes, lower diagnosis of liver cirrhosis, and also lower rates of domestic violence.

This study specifically focused on the rates of gonorrhea in comparison to alcohol policies in the United States, over the course of fourteen years of statistics. Over this period, most increases in beer taxes were directly followed by a decrease in the occurrences of gonorrhea rates among certain age groups. Likewise, most raises in the drinking age were followed by a decrease in gonorrhea rates, among those who now fell under the legal drinking age. "The regression analysis suggested that a beer tax increase of $0.20 per six-pack co uld reduce overall gonorrhea rates by 8.9%."

Alcohol Policy..." 2000) The findings of this study were that higher alcohol taxes and higher minimum legal drinking ages are associated with lower STD incidence, and therefore this is an important factor to keep in mind when dealing with risky sexual behavior.

However, there has been some evidence that the consumption of alcohol does not always lead to higher rates of risky sexual behavior. In a report by the National Women's Health Network (2003), "contrary to popular belief, adolescents who consume alcoholic beverages prior to sexual intercourse are just as likely to use condoms as those who do not drink before sex, according to a study of 137 sexually active adolescents in Seattle," evidence is revealed that seems to contradict the findings of many other studies. Among sexually active adolescents that participated in this Seattle-based study which focused on multiple health behaviors including sexual encounters and alcohol consumption, alcohol was actually associated with a slightly higher rate of condom usage. "They found that those who did not drink before sex used condoms 54% of the time, versus 52% for those who did drink. " (National Women's Health Network 2003) However, far from being good news, the fact that only approximately half of all sexually active adolescents may be using condoms or practicing safe sex is very disturbing. This study does not contradict the findings of those which show a positive correlation between alcohol consumption and risky sexual behavior, but rather only reinforces that many factors must be considered in dealing with sexual education with youth and adolescents. Lowering the amount of alcohol consumption among teenagers will not be an instant fix for a society plagued by risky sexual behavior; it is only one step in a long process of changing social trends.