Guest Editor’s Introduction

Preventing Alcohol-Related SA: Focus on the Victim

Although sexual victimization ultimately must be seen as the responsibility of the aggressor, the relative paucity of effective interventions for reducing men’s sexually aggressive behavior suggests the importance of research that focuses on augmenting women’s ability to reduce their own risk of victimization, especially insofar as helping women to understand their own drinking behavior and increase their SV risk perception (Gidycz, McNamara, & Edwards, 2006) and resistance (Ullman, 2014), may be empowering. A number of studies have examined a range of variables linked to women’s risk of SV, including victims’ difficulty in recognizing risk (Soler-Baillo, Marx, & Sloan, 2005; Yeater, Treat, Viken, & McFall, 2010), victims’ popularity concerns (Yeater, Treat, Viken, & Lenberg, 2015), and difficulties in choosing effective responses to risky situations (Yeater & Viken, 2010; Yeater, McFall, & Viken, 2011).

Importantly, the SV victim’s alcohol use is another major factor in victimization (e.g., Abbey, 2002; Abbey, Zawacki, Buck, Clinton, & McAuslan, 2004), as those who have consumed alcohol may fail to recognize cues suggesting an imminent SA, which may result in failure to extract themselves from high-risk situations (K. C. Davis, Stoner, Norris, George, & Masters, 2009; Testa, Livingston, & Collins, 2000; Testa, Vanzile-Tamsen, Livingston, & Buddie, 2006). The influential alcohol myopia theory (AMT; Steele & Josephs, 1990) suggests that intoxicated persons tend to focus their attention on more salient, instigatory (e.g., sexual) cues in a sexual situation while experiencing a limited ability to process less salient, often inhibitory cues (e.g., obstacles to leaving an unsafe situation). Alcohol administration studies generally have shown that moderate-to-high alcohol doses (>0.05 g/kg) impair women’s decision-making about when to try to stop a potentially coercive interaction (e.g., K. C. Davis et al., 2009).

The first study included in this issue, by Yeater et al., sought to identify groups of at-risk college women as a first step in the development of effective preventive interventions for campus SV. The authors use latent profile analysis to identify risk profiles of 481 freshman women based on their alcohol consumption and sociosexuality (i.e., willingness to engage in sexual activity outside of a committed relationship). Analyses resulted in three profiles, labeled low alcohol use-low sociosexuality, high alcohol use-medium sociosexuality, and high alcohol use-high sociosexuality. Baseline victimization was found to predict latent profile membership, and more severely victimized women were more likely to be in the high alcohol-high sociosexuality profile than in the other profiles. At follow-up, high alcohol-high sociosexuality women had higher mean levels of victimization severity than did those in the other profiles. Coupled with Yeater and colleagues’ prior work with at-risk women (e.g., Yeater et al., 2010), these findings suggest that cognitive training programs for college women who report elevated levels of alcohol use and sociosexuality might be useful in providing explicit instruction on victimization risk cues as well as feedback on their risk judgments.

In the next article in this issue, Gilmore and colleagues examine the indirect effect of a combined alcohol use and SA risk reduction program on SA severity through HED, alcohol-induced blackouts—that is, periods of memory loss after heavy drinking, which are relatively common among college students (LaBrie, Hummer, Kenney, Lac, & Pedersen, 2011)—and incapacitation. An alcohol use reduction program, SA risk reduction program, and combined alcohol use and SA risk reduction program were compared with a control condition. This study found that the SA risk reduction content reduced blackouts and incapacitation, whereas the combined alcohol use and SA risk reduction program reduced alcohol-induced blackouts. Only incapacitation was associated with reduced SA severity at follow-up. Results suggest that reducing incapacitation and alcohol-induced blackouts is possible with a brief, web-based intervention, and that reducing incapacitation may be one viable strategy within larger SA prevention programming efforts.

The third article in this issue, by Bonomi et al., examines SV among college students with disabilities, including physical and sensory impairments as well as mental and learning disorders. This little-studied group of students, comprising 11-20% of the college population (Auerbach et al., 2016; U.S. Department of Education, National Center for Education Statistics, 2016), are at elevated risk of intimate partner violence (IPV) and SV exposure prior to starting college. Such trauma histories may influence behaviors, including alcohol misuse, that contribute to continued vulnerability to IPV/SV victimization (Johnson & Johnson, 2013; Lalor & McElvaney, 2010; Messman-Moore, Ward, & Zerubavel, 2013). Indeed, some research suggests that IPV and SV are at least twice as prevalent among college students with a disability as among those without a disability (M. L. Anderson & Leigh, 2011; Scherer, Snyder, & Fisher, 2016). Moreover, some research (e.g., Mitra, Mouradian, & McKenna, 2013; Pilapil & DeLaet, 2015) has found disabled students to be at increased risk of HED and excessive alcohol use compared with students without a disability (Grant et al., 2015). Few studies, though, have focused on the relationship between IPV/SV and alcohol use patterns among students with disabilities.

The qualitative study by Bonomi and colleagues explores connections among alcohol, SV/IPV, and mental health disability among college women. Respondents describe heavy drinking or alcohol dependence in their family of origin, their own drinking problems associated with SV/IPV and normalized as part of college culture, and abusive partners and SV perpetrators who use alcohol as a mechanism for coercive control. Such accounts illustrate how these women’s mental health disabilities often triggered drinking to cope, which sometimes led to subsequent IPV/SV victimization that, in turn, exacerbated the underlying mental health condition. Thus, the heavy alcohol use common on American college campuses may be particularly harmful for students with disabilities, putting them at elevated risk of IPV/SV victimization.

Preventing Alcohol-Related SA: Focus on the Perpetrator

Although women comprise at least three fourths of rape and SA victims in the United States, the overwhelming majority of SV perpetrators—against both females and males—are men (Tjaden & Thoennes, 2000). While no single factor describes the motives of all perpetrators on all occasions, variables that have been linked to men’s increased risk of sexual aggression include acceptance of rape myths (Abbey & Jacques-Tiura, 2011), a history of impersonal sex and hostile attitudes toward women (Abbey, Jacques-Tiura, & LeBreton, 2011; Hoyt & Yeater, 2011), and impoverished processing of women’s initial sexual-interest cues (Farris, Treat, Viken, & McFall, 2008a; Farris, Treat, Viken, & McFall, 2008b).

Again, however, it is important to note that many SV perpetrators report that they had been consuming alcohol at the time of—or just prior to—the coercive event. Estimates of the prevalence of perpetrators’ alcohol consumption during sexually aggressive incidents range from 30-75% (see Abbey, 2011; Abbey et al., 2004; Testa, 2002, for reviews) and daily diary studies indicate that men are four times more likely to perpetrate a SA on a drinking day relative to a nondrinking day (Shorey, Stuart, McNulty, & Moore, 2014). Abbey (2002, 2011) has suggested that intoxication increases the likelihood of sexual aggression at both an early stage in a potential sexual interaction—where cognitive impairments induced by alcohol encourage a man who is sexually attracted to a woman to focus on cues consistent with his sexual interest while minimizing disconfirming ones (Abbey, Zawacki, & McAuslan, 2000; Abroms, Fillmore, & Marczinski, 2003)—and later in the interaction where, should his advances be rejected, his state of intoxication encourages an aggressive response, particularly in cases where he feels provoked by his (mis)perception of earlier encouragement (Abbey, McAuslan, & Ross, 1998). Research also suggests that heavy alcohol consumption increases the risk of SA to a greater degree than does nonheavy alcohol use (Abbey, Ross, & McDuffie, 1994), while heavier drinking on the part of the perpetrator is associated with more serious assault incidents (e.g., involving physical force; Abbey et al., 2003) that result in more severe outcomes for victims (Parkhill, Abbey, & Jacques-Tiura, 2009).

For some time now, alcohol’s precise role in SA perpetration has been examined in surveys with both victims and perpetrators. One line of investigation using survey research has examined the characteristics of SAs that are associated with the perpetrator’s alcohol consumption (Parkhill et al., 2009); another line has examined perpetrators’ use of the victim’s intoxication as a primary tactic for obtaining unwanted sex (see, for example, Abbey & Jacques-Tiura, 2011; Kaysen, Neighbors, Martell, Fossos, & Larimer, 2006; Kilpatrick et al., 2007). A third line has considered whether—and how—intoxicated perpetrators differ from sober perpetrators and nonperpetrators (Abbey, Parkhill, BeShears, Clinton-Sherrod, & Zawacki, 2006; K. C. Davis, Schraufnagel, George, & Norris, 2008; Parkhill & Abbey, 2008).

Pegram et al.’s cross-sectional survey of 548 men presented in this issue adds to this literature as it seeks to understand the attributes of men who sexually assault drinking women compared with men who sexually assault sober women and nonperpetrators. This study includes a computer-simulated date that was completed by a subset of the 548 men. The authors find that 35% of the young, single men in their study had committed at least one sexually aggressive act since age 14. Those men who reported that they had previously assaulted a drinking woman provided their simulated date with more alcohol to drink and perceived her as being more disinhibited than did those perpetrators who had reported only sober victims and nonperpetrators. These findings suggest the power of alcohol expectancies and stereotypes that may lead some men to assume that women who drink alcohol in public are seeking casual sex, with subsequent misperceptions—especially among those who hold firm to sex-related alcohol expectancies and stereotypes about drinking women—about the woman’s degree of sexual interest (Abbey, McAuslan, Zawacki, Clinton, & Buck, 2001). Such findings suggest the value of universal SA prevention programs that can counteract societal messages that link alcohol and consensual sex and that foster harmful stereotypes about women who drink.

The next article in this issue, by Davis and colleagues, examines—in an alcohol administration experiment with a community sample of 321 male nonproblem drinkers—male condom use resistance (CUR) through their use of coercive tactics. There is some evidence that condoms are infrequently used in alcohol-involved SAs (K. C. Davis et al., 2012; K. C. Davis et al., 2008), which has clear implications for HIV transmission and pregnancy risks. Results of the Davis study demonstrate that men with more severe sexual aggression histories display stronger in-the-moment power and control responses, which is associated with greater coercive CUR and unprotected sex intentions. These findings highlight the relationship between sexual aggression and sexual risk behaviors and suggest the importance of targeting these constructs in future prevention efforts.

The final article in this issue, by Orchowski and associates, details the theoretical framework, content, and piloting of a SA prevention program for college men who engage in heavy drinking. In this intervention, male facilitators delivered the three-session Sexual Assault and Alcohol Feedback and Education (SAFE) program to 25 heavy-drinking college men. Session 1 comprised a 60-min individually administered review of personalized normative feedback (PNF) regarding alcohol use, sexual activity, alcohol-related sexual consequences, understanding of consent, and engagement in bystander intervention, delivered in a motivational interviewing (MI) style. Session 2 was a 2½-hr group-based SA prevention workshop focusing on social norms, empathy, masculinity, consent, and bystander intervention. Session 3 was a 90-min booster group session that reviewed previous topics and included the active practice of bystander intervention skills. Analyses of postsession assessments of utility, alliance, and satisfaction—as well as examination of alcohol use and SA-related outcomes from baseline to 2-month follow-up—support the apparent feasibility and acceptability of the SAFE program.

Future Directions for Research on Alcohol-Involved SA

The six articles in this special issue cover a broad range of cutting edge research investigating alcohol-related SA. Future research in this field is likely to utilize new research methods, new models to guide the empirical research, and new intervention approaches for preventing and treating violence as it occurs in an expanded list of at-risk populations. Regarding the latter, for instance, the investigation included here by Bonomi and colleagues of SV among college women with disabilities suggests that, even within the campus environment, some at-risk groups remain relatively understudied. Moreover, sexual and gender minority students also are at particularly high risk for SA on college campuses, as 29.5% of such students report nonconsensual contact and 12.6% report nonconsensual penetration involving force or incapacitation during college (Cantor et al., 2015), while transgender students are more likely to experience SA victimization than are cisgender students (Coulter et al., 2017). Nevertheless, SV prevention programs for gender and sexual minorities are not abundant on college campuses.

The alcohol use/SV prevention field also might profitably extend its focus to include more non-college populations. For instance, SV is a recognized problem in the U.S. military, as a 2012 Pentagon report estimated that 26,000 U.S. service members had experienced unwanted sexual contact in that year—up from 19,000 in 2010 (U.S. Department of Defense, 2013)—with 53% of these events involving attacks on men, mostly by other men (Dao, 2013). The role of alcohol in such attacks has been little studied. In addition, lifetime rates of SA victimization are higher among gender and sexual minority individuals than among heterosexuals (Heidt, Marx, & Gold, 2005), while lesbian and bisexual women experience more mental health symptoms after victimization—including higher rates of PTSD and depression—than do their heterosexual counterparts (Sigurvinsdottir & Ullman, 2016). Langenderfer-Magruder, Walls, Kattari, Whitfield, and Ramos (2016) found that transgender individuals were twice as likely as cisgender sexual minority individuals to experience SA victimization. Some research (e.g., Rhew, Stappenbeck, Bedard-Gilligan, Hughes, & Kaysen, 2017) suggests that these high rates of SA victimization among gender and sexual minorities in the United States may contribute to elevated levels of alcohol misuse.

The types of basic behavioral research presented here are likely to play a vital role as useful building blocks in the development of effective interventions for preventing and reducing alcohol-involved SA. Central to this process will be the guiding frameworks provided by one or more of several emerging models of the alcohol–aggression relationship. For instance, although the AMT has been influential for almost three decades as an explanation for alcohol-related aggression, myopia theory has not been clear in explaining why, given an array of potentially instigatory and inhibitory cues in a particular setting, some individuals are more likely to find certain instigatory cues to be salient while others are more likely to find a different set of inhibitory cues to be more salient. The “threshold model” of alcohol-related aggression (Fals-Stewart, Leonard, & Birchler, 2005; Leonard & Quigley, 2017) offers a response to some of these concerns, proposing that the effects of alcohol on aggression in an individual may be linked to both underlying traits and more momentary states. Thus, this model suggests that individuals low on traits such as trait anger likely will not be aggressive when drinking, whereas those who rank high on such a trait likely will be aggressive regardless of their level of alcohol consumption. Conversely, those high on inhibitory traits are not likely to be aggressive even when they are using alcohol, whereas those low on the same trait will be aggressive with or without alcohol use. Importantly, those who score in the midrange on either of these traits may be relatively more susceptible to the aggression-promoting properties of alcohol.

The past few years also have seen the development of the so-called I³ model (Finkel et al., 2012). The I³ model suggests that aggression is a consequence of Instigation (or provocation), Impellance (or dispositional tendency toward aggression), and a lack of Inhibition, or self-control failure. Attempts to integrate I³ Theory and the AMT are underway (see, for example, Parrott & Eckhardt, 2018). Another influential model, the Confluence Model (Malamuth, Linz, Heavey, Barnes, & Acker, 1995), also has undergone alterations in recent years as Abbey and colleagues (Abbey et al., 2011; Wegner & Abbey, 2016) have expanded the model to include both misperception of women’s sexual interest and heavy alcohol consumption as predictors of sexual aggression, in addition to other distal factors (childhood victimization, adolescent delinquency, and psychopathy traits) and other more proximal factors (hostile masculinity and impersonal sex).

Along with new and amended theoretical models, a new generation of methods for understanding the effects of alcohol use on aggression seem likely to gain in popularity in coming years. Much of what we know about individual and contextual risk of SV has been based on human laboratory studies, with such knowledge only rarely linked to real-world contexts. Ecological Momentary Assessment (EMA; Stone & Shiffman, 1994), a research methodology that assesses individuals in their own environment and in near real time, uses repeated measures of target behaviors at frequent intervals in key contexts, making it well suited for examining how these behaviors are influenced by contextual features of situations (Shiffman, Stone, & Hufford, 2008). While few, if any, published studies have used EMA to study proximal influences on the co-occurrence of substance use and victimization, the knowledge that might be gained in using this approach may be vital in subsequent intervention efforts aimed at reducing SV vulnerability. For instance, such detailed information about the context for specific risky activities might be useful in bystander interventions.

Indeed, the incorporation of the insights garnered from basic behavioral research into preventive interventions constitutes the ultimate payoff on the investment in basic behavioral research into alcohol use and SV. Interventions that can be shown to produce behavioral changes that reduce the risk of alcohol-related aggression are likely to be welcomed by a diverse set of institutions, including higher education and branches of the military, as well as by a wide variety of helping professionals ranging from alcohol treatment providers to marriage and family counselors. Most current SV prevention strategies attempt to change individual attitudes and behaviors, as is the case with the two interventions presented in this issue. Reducing drinking as a way of reducing SV is one such approach. Slightly under 40% of college students engage in binge or HED (Hingson, Zha, & Smyth, 2017), and college women’s HED is an established risk factor for SV, particularly IR (C. P. Krebs et al., 2009; Mohler-Kuo, Dowdall, Koss, & Wechsler, 2004; Testa & Hoffman, 2012). While HED rarely has been specifically targeted by earlier college rape prevention programs (C. P. Krebs et al., 2009), attempts to reduce individuals’ HED as a way of reducing SV is likely to receive further investigation in the years ahead. Thus, Testa and Livingston (2009), among others, have argued that the strong association between women’s HED and SV suggests that reducing HED, an important barrier to effective risk perception and the use of active resistance strategies (K. C. Davis et al., 2009; Norris et al., 2006; Stoner et al., 2007), is likely to lead to reductions in IR; indeed, some research shows that rates of IR are lower on campuses with lower rates of HED (Mohler-Kuo et al., 2004). The Brief Alcohol Screening and Intervention for College Students (BASICS) program (Dimeff, Baer, Kivlahan, & Marlatt, 1999)—which includes personalized feedback and MI to target harmful alcohol use—has been found to reduce alcohol use and related problems among mandated students to a larger degree than traditional, education-based alcohol interventions. A number of studies have shown that the effects of PNF on postintervention drinking are mediated via changes in perceived social norms (e.g., Carey, Henson, Carey, & Maisto, 2010; Larimer & Cronce, 2007).

Nevertheless, the SAFE intervention that Orchowski and colleagues developed and evaluated (introduced above) illustrates some of the limitations of an exclusive focus on reducing alcohol consumption. Following research that found that reduced alcohol use is associated with reductions in sexual aggression against intimate partners among adult men in substance use treatment (Stuart, O’Farrell, & Temple, 2009), as well as reductions in physical aggression against intimate partners among college students (Woodin & O’Leary, 2010), the SAFE developers targeted heavy alcohol consumption as a way of reducing assault perpetration. However, recognizing that a sole focus on reducing men’s alcohol use without addressing other intersecting factors (e.g., impulsivity, sexual compulsivity, sensation seeking, antisocial personality) that increase men’s risk for perpetrating SA (see, for example, Testa & Cleveland, 2017; Testa et al., 2015 Thompson, Kingree, Zinzow, & Swartout, 2015) likely would be insufficient in preventing SA, the SAFE intervention developers pursued their integrated approach to SA prevention.

Preventive Interventions for SV: Above the Individual Level

The articles in this issue reflect a research field in which alcohol-related SV is still most commonly attributed to specific qualities of the individual perpetrator and/or victim. Such an approach tends to minimize the role of social context as a factor in the expression of violence. Nevertheless, a greater appreciation of the role of social context in alcohol-related SV may be gaining traction. Routine Activities Theory (Felson, 1997; Mustaine & Tewksbury, 2002), for instance, provides a framework for understanding social context as a risk mechanism for SA. According to this theory, victimization risk is elevated when the routine activities of a person’s daily life include proximity to potential offenders (e.g., contexts that place a woman in close proximity to possible perpetrators), to vulnerable targets (e.g., factors that make a woman an attractive target to a perpetrator), and to incapable (e.g., incapacitated) guardians. Young adulthood—a time of increasing autonomy, expanding social networks, and experimentation with alcohol—brings together men and women, particularly in college contexts, in the types of social settings in which women may be exposed to perpetrators, placed at heightened vulnerability due to drinking, and surrounded by few capable guardians.

Any list of such high-risk settings on college campuses likely will include Greek Society social events (Franklin, 2010) as well as involvement in “hookups” (Flack et al., 2016; Paul & Hayes, 2002), which are commonly defined as one-time sexual encounters involving people who may be described as strangers or acquaintances (Lewis, Atkins, Blayney, Dent, & Kaysen, 2013; Paul, McManus, & Hayes, 2000). Some studies have found that college students drink in social contexts as a way of increasing the chances of hooking up (LaBrie, Hummer, Ghaidarov, Lac, & Kenney, 2014; Lindgren, Pantalone, Lewis, & George, 2009; Mewhinney, Herold, & Maticka-Tyndale, 1995; Paul & Hayes, 2002). A growing literature, however, suggests that having more sex partners or hookups increases the odds of SV (Fielder, Walsh, Carey, & Carey, 2014; Franklin, 2010; Messman-Moore, Coates, Gaffey, & Johnson, 2008; Testa, Hoffman, & Livingston, 2010). Indeed, Flack and associates (2007) found that three quarters of college SAs occurred within a hookup situation. Thus, insofar as hookups are a common context in which alcohol-involved SV occurs, reducing hookups may reduce SV risk, although this hypothesis largely remains untested.

Such a focus on drinking context or situations that elevate the likelihood of SV—rather than on the particular characteristics of SV perpetrators or victims—illuminates the potential role of “third parties” (i.e., bystanders) as prevention agents. Indeed, Federal (e.g., White House Task Force to Protect Students from Sexual Assault, 2014) and CDC guidelines (Basile et al., 2016) have recommended universal SA prevention using bystander approaches. Nevertheless, a focus on drinking context raises a host of research questions that will require answers before the SV prevention field can significantly advance. For instance, insofar as off-campus housing and Greek organizations constitute “hot spots” for college high-risk drinking (Barry, 2007; Miller, Borsari, Fernandez, Yurasek, & Hustad, 2016; Scott-Sheldon, Carey, & Carey, 2008; Tyler, Schmitz, Ray, Adams, & Simons, 2018), it will be important to identify the types of individuals who ordinarily are present in such settings who might be enlisted in SA bystander prevention programs, determine how the alcohol that is consumed at college underage drinking parties is obtained, and clarify the roles played by consumption of alcohol mixed with energy drinks and involvement in drinking games (e.g., “beer pong”) and fraternity events (e.g., tailgating) in episodes of SV occurring in and around Greek organizations. Despite their clear relevance for campus SV prevention efforts, such topics have received relatively little attention from researchers.

Despite the promise of the intervention approaches for alcohol-related SV outlined above, it should be noted that any widespread implementation of individual- and/or contextual-level SV prevention programs is likely to require a substantial outlay of resources (DeGue et al., 2012). Hence, environmental-level (or policy) measures to reduce violence related to alcohol use must be considered in any appraisal of potential directions for prevention work. A substantial body of research suggests that reducing alcohol availability—by, for example, increasing the price of alcoholic beverages, usually achieved through increasing taxes on alcohol—can reduce alcohol consumption (Chaloupka, Grossman, & Saffer, 1998; Skog, 2000; Wagenaar, Salois, & Komro, 2009). Conversely, expanded access to, or availability of, alcohol—in the form of, for example, lower minimum legal purchase age, reduced alcohol prices, drink specials, increased hours and days of sale, or proximity to dense concentration of alcohol outlets—has been associated with higher likelihood of alcohol use and/or alcohol use disorder (Kypri, Bell, Hay, & Baxter, 2008; Popova, Giesbrecht, Bekmuradov, & Patra, 2009), increases in alcohol-related mortality (Stockwell et al., 2011), and acute alcohol intoxication hospitalizations (Bloomfield, Rossow, & Norstrom, 2009). Although more research can help illuminate the extent to which alcohol availability constitutes a community-level risk factor for SV perpetration (DeGue et al., 2012), there is some reason to think that alcohol control policies that limit the number of alcohol outlets in close proximity to college campuses, access to high volumes of alcohol, and the availability of alcohol to underage drinkers may offer some promise in the effort to reduce campus SV (see Scribner et al., 2010; Xu et al., 2012). Indeed, research that investigates the impact of SV prevention strategies implemented at multiple levels of analysis—that is, individual, community, societal—is greatly needed.