Alcohol Consumption and Risky Sexual Behavior: A Review

Introduction: Alcohol, Sex, and Social Risk

Since the ancient days of Bacchanalian worship in the Greek tradition, the consumption of alcohol and risky sexual behavior have gone hand in hand. Both drinking and sex are considered pleasurable activities, and conservative or religious segments of the population may regard them as sinful or immoral to varying degrees. Regardless of whether alcohol and sexual activity carry a negative social stigma within a particular 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 behavior. The combination of these activities may increase the level of risk associated with each, and they may also serve as contributing factors to the likelihood that the other will occur — for example, drinking may increase the chance of sexual activity occurring.

Despite the social stigma that may be attached to certain drinking and sexual behavior patterns, strong social and peer pressure to participate in both activities persists. This is evident, for example, in the prevalence of sexual imagery used extensively in advertising, and in advertisements for alcoholic beverages in particular (Nilewide, 2004). The consumption of alcohol, sexual activity, and the concurrent occurrence of these behaviors begins at relatively young ages, and even children and young adolescents are affected. Studies have shown that alcohol significantly affects the sexual choices 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 is addressed, including sexual rebellion and conformity, compulsive or uneducated choices, exposure to sexually transmitted diseases, and sexual assault — along with the role alcohol may play in each of these scenarios.

Adolescent Alcohol Use and Early Sexual Activity

Research has found that attitudes about appropriate sexual behavior, as well as those regarding appropriate alcohol consumption, are formed very early in youth. By the preteen years, children have already developed distinct attitudes regarding these subjects. A Thomson Healthcare Company (2004) report reveals that risky behavior may be minimized in adolescents and young adults if parents discuss standards and beliefs on sexual and other issues with children at a younger age, because conveying these values to older children is less 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 facilities, and gay and bisexual males. Alcohol is not the only substance prevalent in these high-risk groups; marijuana is also associated with altered sexual behavior statistics. Intervention treatment for youth to help curb alcohol consumption — which may also help delay sexual activity or decrease the number of sexual partners and overall risk — is encouraged as early as ages 9 to 12.

The link between alcohol and sexual behavior is not unique to preteens, adolescents, or young adults; it appears consistent throughout the majority of the population according to most studies. Joseph LaBrie (2000) addresses 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 are particularly interested in finding a correlation between alcohol and sexual behavior in order to isolate and eliminate as many high-risk factors as possible, thereby reducing the overall occurrence of these diseases. Many studies have strongly confirmed this connection, while others have only loosely connected the factors or failed to do so entirely.

Base drinking rates and actual sexual behavior are very difficult to determine with certainty, which introduces inaccuracy into study results. 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 stronger than currently estimated. Problems in collecting accurate data relate to the private nature of sexual behavior; because most studies rely on self-reporting methods, people may hesitate to answer truthfully about behaviors they believe might be judged negatively. 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, due to the social stigma associated with such behavior.

Drinking alcohol may lower a person's resolve to use condoms, or one might drink specifically to remove the responsibility of negotiating condom use for the encounter. When intoxicated, one might also attempt to use a condom but fail to do so properly. Interventions should therefore address the fact that being under the influence of alcohol does not remove safe-sex responsibility in any way.

While the alcohol and risky sexual behavior correlation applies to everyone, it is a particularly important issue to address with adolescents because of the developmental significance of this age group. A Perspectives on Sexual and Reproductive Health article by C. Coren (2003) showed that specific patterns of substance abuse during adolescence predict not only sexual behavior at that time but also future sexual behavior. More than 800 adolescents in Seattle were studied over a full decade spanning ages ten to twenty-one, with surveys on alcohol, cigarettes, marijuana, and other drug use conducted at specific intervals throughout the teenage years. At age twenty-one, participants were asked about their safe-sex practices, sexual activity, age at first sexual encounter, and current relationship status.

Seventy percent of those studied reported no binge drinking at any point during the study; however, binge drinking was an issue for thirty percent of the adolescents involved, and three percent had chronic binge drinking habits throughout adolescence. When asked at age twenty-one about the number of sexual partners in the past year, those with no binge drinking during the teenage years averaged the lowest number — 1.7 partners — while those with chronic binge drinking averaged the highest, at 3 partners. Other substances, such as tobacco, marijuana, and hard drugs, did not show as significant a difference in number of sexual partners. Additionally, ninety percent of those who had chronic binge drinking behavior during adolescence reported inconsistent condom use, whereas other drugs had far less impact on 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.

Alcohol, Condom Use, and Laboratory Evidence

While intoxicated by alcohol, an individual's perception of a situation and his or her own actions are altered, leading to risky sexual behavior even when the 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 participated in this study, which used a control, alcohol, or placebo condition for each participant over two laboratory sessions. The experiment was designed to 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 were considered significant by the authors — not only for the implications for intervention and sexual risk prevention, but also because they shed light on the potential of controlled experimental settings to help explain the alcohol–sex relationship. Opinion surveys, videos, and role-playing techniques were all utilized. 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" (Maisto et al., 2004). Alcohol did not appear to affect the general attitude of individual males regarding condom use. However, attitudes regarding whether condoms would detract from the enjoyability of sex were affected by alcohol consumption. Participants under the influence also exhibited much poorer condom negotiation skills — meaning they were far easier to persuade to forgo protection — and were far more likely to intend to engage in risky sexual behavior.

This study supported 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 when combined with level of alcohol consumption, this can be used to develop a surprisingly accurate prediction of risky sexual behavior. The study also produced evidence that perceived alcohol consumption has a significant effect on confidence and sexual behavior decisions, in addition to actual alcohol consumption.

Works Cited

(2000, April 28). Alcohol policy and sexually transmitted disease rates — United States, 1981–1995. Morbidity and Mortality Weekly Report.

Business Publishers. (2004, February). High-risk drinking and sexual assault go hand-in-hand, researchers find. Campus Crime, 14(2), 13.

Coren, C. (2003, January–February). Timing, amount of teenage alcohol or marijuana use may make future risky sex more likely. Perspectives on Sexual and Reproductive Health.

Chandra, P. S. (2003, February). High-risk sexual behaviour & sensation seeking among heavy alcohol users. Indian Journal of Medical Research.

Johnson, T. J., & Stahl, C. (2004, July). Sexual experiences associated with participation in drinking games. The Journal of General Psychology, 131(3), 304.

LaBrie, J. W. (2000, November). Sexual risk behaviors and alcohol: Higher base rates revealed using the Unmatched-Count Technique. Journal of Sex Research.

Lannutti, P. J., & Monahan, J. L. (2004, Spring). Resistance, persistence, and drinking: Examining goals of women's refusals of unwanted sexual advances. Western Journal of Communication, 68(2), 151.

Maisto, S. A., et al. (2004, December). The relationship between alcohol and individual differences variables on attitudes and behavioral skills relevant to sexual health among heterosexual young adult men. Archives of Sexual Behavior, 33(6), 571.

Maxwell, C. D., et al. (2003, December). The nature and predictors of sexual victimization and offending among adolescents. Journal of Youth and Adolescence, 32(6), 465.

National Women's Health Network. (2003, November–December). 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. The Network News, 28(8), 8.

Nilewide. (2004, September 12). Sex in alcohol ads. Nilewide Marketing Review.

Parsons, J. T. (2004, May). The impact of alcohol use on the sexual scripts of HIV-positive men who have sex with men. Journal of Sex Research.

Thomson Healthcare Company. (2004, January). Studies shed light on youth sex and drinking: Parents and teens don't see eye-to-eye. AIDS Alert, 19(1), 8.

Yust, K. (2004, March 2). [University]: Alcohol, sex crimes linked by study. America's Intelligence Wire.