Understanding acute alcohol effects on sexual behavior

Annual Review of Sex Research, 2000 by George, William H, Stoner, Susan A

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 post-- drinking sexual activity, such as lack of parental supervision, youthful adventuresomeness, peer pressure, marital ardor, and permissive barroom 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; HalpernFelsher, 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).