At least half of all acquaintance sexual assaults involve alcohol consumption by the perpetrator, the victim, or most commonly, both. Alcohol consumption can raise the risk of sexual assault through both physiological and learned, or expectancy, effects. Alcohol 'myopia' can focus attention on prominent social cues rather than ambiguous risk cues. Without the alarm that would arise from recognizing risk, a woman might not experience the anxiety or fear that would motivate her to leave a situation. So too because of intoxication she might experience a variety of psychological barriers that impede assertive resistance. Expectancies about alcohol effects might indirectly raise the risk of sexual assault through motivating a woman to drink excessively in order to experience anticipated beneficial effects of drinking or by increasing her belief that alcohol makes her more sexually vulnerable and therefore less able to resist.
Alcohol can also play a role in the aftermath of sexual assault, whether or not it occurred after drinking. Drinking to cope with the trauma can lead to problem drinking and increase the risk of being re-victimized. If a woman feels somewhat responsible for a sexual assault because she was drinking at the time, she may be less willing to disclose the attack to others, thereby making it considerably less likely that she will receive needed help to deal with its effects. Because child sexual abuse can also result in drinking to cope as an adult, women with this history are at increased risk for being re-victimized and suffering PTSD and negative consequences from problem drinking.
A multi-pronged approach is needed to make both risk reduction and victim treatment efforts more effective. Risk reduction and treatment efforts aimed at women need to convey how alcohol myopia can affect both risk perception and resistance. Similarly the role of expectancies needs to be addressed. Some programs have developed effective ways of challenging individuals' beliefs about alcohol effects as a means of changing drinking behavior. These efforts need to be increased and directed specifically toward sexual assault.
Risk reduction and treatment efforts also need to take into account that some women may be more vulnerable than others. Women who have previously experienced sexual victimization as a child, adolescent, or adult should receive information about how alcohol consumption can increase their vulnerability to revictimization. Service providers need to be especially sensitive to the issue of self-blame, which is a particular concern for women who were sexually assaulted when intoxicated. Providers also need to understand how phenomena such as dissociation and feelings of powerlessness resulting from earlier victimization might lead to drinking to cope and excessive alcohol consumption. This in turn can lead to lower assertive resistance during an assault and increased feelings of responsibility. Helping women to understand the underlying dynamics of their responses may aid their recovery.
At the societal level, widespread blaming of the victim for being sexually assaulted while intoxicated needs increased attention. This practice affects the way the victim is treated by police or other professionals and is internalized by the victim, leading to reticence to report this crime to the police, as well as to seek medical help and counseling. Alcohol-involved sexual assault is a crime and blame needs to be placed squarely on those who perpetrate it. Men need to receive strong messages that using alcohol to obtain sex is not appropriate and serious consequences will be imposed.