Targeting Alcohol Misuse

A Promising Strategy for Reducing Military Sexual Assaults?

by Coreen Farris, Kimberly A. Hepner

This Article

RAND Health Quarterly, 2015; 4(4):6

Abstract

On the 2012 Workplace and Gender Relations Survey on Active Duty Service Members, 23 percent of female and 4 percent of male service members indicated that they had experienced a completed or attempted sexual assault during their military service. In addition, official numbers show no decline in sexual assaults, despite the implementation of sexual assault prevention programs across the U.S. Department of Defense (DoD). Alcohol misuse is also a problem in the military: One-third of active-duty service members reported binge drinking, a rate that compares unfavorably with that of their civilian counterparts. DoD has invested considerable resources in universal sexual assault prevention programs and social media campaigns, but evaluation results are not yet available, and the effectiveness of these programs is unclear. Research on civilian populations—particularly college students, who share some characteristics with junior enlisted personnel—could provide insights for DoD. For example, the research indicates a connection between alcohol and aggression, including sexual aggression. Alcohol can also have a range of effects on the risk of victimization—from a reduced awareness of risk indicators to incapacitation or unconsciousness. An extensive review of the existing research provides some guidance for how DoD can implement and evaluate efforts to reduce alcohol misuse as part of a larger strategy to reduce the incidence of sexual assault among members of the armed forces.

For more information, see RAND RR-538-OSD at https://www.rand.org/pubs/research_reports/RR538.html

Full Text

Since 2005, with the support of the armed services, the U.S. Department of Defense (DoD) Sexual Assault Prevention and Response Office (SAPRO) has worked to prevent sexual assault in the U.S. military and to improve programs to respond to the needs of sexual assault victims.* Unfortunately, despite these and other efforts, the rate of sexual assault in the military has not declined over the past decade. Further study of the epidemiology of sexual assault, the implementation and evaluation of innovative prevention approaches, and continued policy and fiscal support will be crucial to addressing military sexual assault. Alcohol misuse, which ranges from risky drinking to alcohol dependence (Saitz, 2005), has also been a high-priority area, with growing concern about alcohol-related incidents involving military personnel (e.g., motor vehicle accidents, suicides). DoD may be well served by an examination of the link between alcohol and sexual violence among service members, and, where appropriate, consideration of policies to reduce alcohol misuse as a part of a strategy to prevent sexual assaults as well as a broader strategy to address alcohol use problems.

This study relies on research on the role of alcohol in the processes that lead to sexual assault perpetration and risk of victimization in order to evaluate the extent to which alcohol misuse may be a viable target by which to reduce the rate of sexual assault.

Sexual Assault and Alcohol Misuse Are Ongoing Problems in the U.S. Military

In 2012, a confidential survey of 22,792 service members showed that an estimated 23 percent of female and 4 percent of male service members had been sexually assaulted during their military service (Rock, 2013). In a separate national study, the Centers for Disease Control and Prevention reported that the risk of sexual assault among service women is similar to the risk faced by civilian women (Black and Merrick, 2013). Among service members who reported being sexually assaulted in the previous year (6.1 percent of women and 1.2 percent of men), nearly half of the women and one-fifth of the men indicated that either they or the perpetrator had been using alcohol prior to the assault (Rock, 2013). Moreover, alcohol misuse is common among military service members. In response to the DoD Health Related Behaviors Survey, one-third of active-duty service members reported binge drinking—defined as consuming five or more drinks for men and four or more drinks for women within two hours or on the same occasion (NIAAA, 2004)—at least one time per month, and 20 percent reported binge drinking at least weekly (Barlas et al., 2013; Bray et al., 2009). Among young service members, the proportion reporting weekly binge drinking was even higher (26 percent). This rate compares unfavorably with that of their civilian counterparts, 16 percent of whom reported binge drinking on a weekly basis (Bray et al., 2009).**

Alcohol Misuse Has Been Linked to Sexual Assault Perpetration

Understanding the role that alcohol plays in sexual assault perpetration may help guide prevention and intervention efforts. Evidence from controlled laboratory studies shows that alcohol use and intoxication are causally linked to increased general aggression in young men—particularly among men who are predisposed to behaving aggressively (Bushman and Cooper, 1990; Chermack and Giancola, 1997; Ito, Miller, and Pollock, 1996). Although sexual violence cannot be studied directly in the laboratory for ethical reasons, indirect evidence suggests that alcohol use increases the risk of committing a sexual assault. Young men who consume alcohol in a controlled laboratory setting are more likely to misperceive the sexual intent of women depicted in study materials (Farris et al., 2008), take longer than men who have not consumed alcohol to identify that a sexual encounter in an audio track has turned into a date rape (Gross et al., 2001; Marx, Gross, and Adams, 1999), and are more likely to indicate that they would sexually assault someone in a situation similar to a hypothetical date rape scenario (Davis, 2010; Davis et al., 2012; Norris et al., 2002). Most of this research has been conducted with heterosexual college men. Although they share some demographic characteristics with junior enlisted personnel, the extent to which the findings can be generalized to a military population is unknown.

Alcohol Misuse Can Heighten Vulnerability to Sexual Assault

It is important to recognize that a victim's alcohol use cannot cause a sexual assault; victimization always occurs as the result of someone else's actions. However, alcohol use can increase vulnerability if it occurs in a setting with a nearby potential perpetrator. When this condition is met, alcohol use may increase vulnerability to that potential perpetrator via a variety of mechanisms. At high doses of alcohol, users may be incapacitated or even unconscious and thus may have few means by which to resist or avoid an assault (McCauley et al., 2009; Mohler-Kuo et al., 2004). At lower doses, alcohol use may reduce attention to risk indicators (Davis et al., 2009; Testa, Livingston, and Collins, 2000), thereby decreasing the likelihood that the user will exit a risky encounter while escape is still possible. Finally, individuals observing someone drinking alcohol attribute more sexual intentions to that person than they do to someone who is not drinking alcohol, and this social misperception increases the risk of offending (Corcoran and Thomas, 1991; DeSouza et al., 1992; Garcia and Kushnier, 1987; George, Gournic, and McAfee, 1988). Note that these findings from the civilian literature focus on female victims. It would be unwise to use findings about civilian women's risk of sexual assault victimization to make inferences about military men's risk of victimization. Generalizing to military women may be more appropriate because alcohol use in social settings could be similar for both groups of women, but unique features of the military system must always be considered.

Efforts That Target Alcohol Misuse May Contribute to a Military Sexual Assault Prevention Strategy

The clear link between alcohol misuse and the risk of both sexual assault perpetration and victimization suggests that efforts to reduce alcohol misuse could contribute to a strategy for reducing the incidence of sexual assault. However, little research to date has explored such approaches. In one exception, a team of researchers showed that a parent-based intervention designed to reduce drinking among young women during their first year of college not only reduced their rates of alcohol misuse, but it also cut their risk for incapacitated rape during their first semester from 12 percent to 8 percent (Testa et al., 2010).

There are effective interventions for reducing alcohol misuse and alcohol-related problems among young adults (Jonas et al., 2012). For example, screening for alcohol misuse followed by brief behavioral counseling for patients who screen positive is effective in reducing the number of drinks consumed per week (3.6 fewer drinks on average) and heavy drinking episodes among adults (12 percent of adults reported consuming fewer drinks). Screening also has demonstrated effectiveness specifically among young adults and college populations (Jonas et al., 2012). These approaches present an opportunity to reduce alcohol-related problems while also offering the potential to prevent sexual assaults.

Based on our analysis, we recommend several avenues for additional research and intervention development that would provide the necessary information to best direct DoD's sexual assault prevention strategy as it relates to alcohol misuse:

  • Determine the characteristics of alcohol-involved military sexual assaults and the role that alcohol plays in military sexual assault perpetration and victimization.
  • Increase routine screening for alcohol use problems among service members, and implement evidence-based brief (five- to 15-minute) interventions to reduce problem drinking. Brief interventions include personalized feedback about drinking, discussion of goals, and advice to drink less or to abstain.
  • Develop and evaluate interventions that target alcohol misuse as a strategy by which to prevent military sexual assaults.

In public remarks, Secretary of Defense Chuck Hagel has called military sexual assault “a stain on the honor of our men and women who honorably serve our country, as well as a threat to the discipline and the cohesion of our force.” DoD has invested considerable effort and resources to reduce the incidence of military sexual assault, but as with any large undertaking, there is more to be done. SAPRO has implemented a variety of DoD-wide sexual assault prevention programs, many of which include content on the link between alcohol use and sexual assault. In addition to continued efforts to evaluate these direct sexual assault prevention programs, we recommend that DoD invest in research on alcohol misuse prevention programming as a strategy by which to also prevent military sexual assaults.

Key Findings

  • Between 2006 and 2012, sexual assaults among U.S. service members did not decline despite the implementation of prevention programs across the U.S. Department of Defense.
  • Alcohol misuse is common in the military: One-third of active-duty service members report binge drinking, a rate that compares unfavorably with that of their civilian counterparts.
  • Research has linked alcohol misuse to sexual aggression and heightened vulnerability to sexual assault.
  • Efforts that have targeted alcohol misuse in other populations may contribute to a military sexual assault prevention strategy. The most extensive body of research on the connection between alcohol misuse and sexual assault comes from studies of college students, a group that shares some similarities with junior enlisted military personnel.

References

Barlas, Frances M., William Bryan Higgins, Jacqueline C. Pflieger, and Kelly Diecker, 2011 Department of Defense Health Related Behaviors Survey of Active Duty Military Personnel, Fairfax, Va.: ICF International, February 2013. As of June 4, 2014:
http://www.murray.senate.gov/public/_cache/files/889efd07-2475-40ee-b3b0-508947957a0f/final-2011-hrb-active-duty-survey-report.pdf

Black, Michele C., and Melissa T. Merrick, Prevalence of Intimate Partner Violence, Sexual Violence, and Stalking Among Active Duty Women and Wives of Active Duty Men—Comparisons with Women in the U.S. General Population, 2010, Atlanta, Ga.: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, March 2013. As of June 4, 2014:
http://www.sapr.mil/public/docs/research/2010_National_Intimate_Partner_and_Sexual_Violence_Survey-Technical_Report.pdf

Bray, Robert M., Michael R. Pemberton, Laurel L. Hourani, Michael Witt, Kristine L. Rae Olmsted, Janice M. Brown, BeLinda Weimer, Marian E. Lance, Mary Ellen Marsden, Scott Scheffler, Russ Vandermaas-Peeler, Kimberly R. Aspinwall, Erin Anderson, Kathryn Spagnola, Kelly Close, Jennifer L. Gratton, Sarah Calvin, and Michael Bradshaw, 2008 Department of Defense Survey of Health Related Behaviors Among Active Duty Military Personnel, Research Triangle Park, N.C.: RTI International, 2009.

Bushman, Brad J., and Harris M. Cooper, "Effects of Alcohol on Human Aggression: An Integrative Research Review," Psychological Bulletin, Vol. 107, No. 3, 1990, pp. 341–354.

Chermack, Stephen T., and Peter R. Giancola, "The Relation Between Alcohol and Aggression: An Integrated Biopsychosocial Conceptualization," Clinical Psychology Review, Vol. 17, No. 6, September 1997, pp. 621–649.

Corcoran, Kevin J., and Laura R. Thomas, "The Influence of Observed Alcohol Consumption on Perceptions of Initiation of Sexual Activity in a College Dating Situation," Journal of Applied Social Psychology, Vol. 21, No. 6, March 1991, pp. 500–507.

Davis, Kelly C., "The Influence of Alcohol Expectancies and Intoxication on Men's Aggressive Unprotected Sexual Intentions," Experimental and Clinical Psychopharmacology, Vol. 18, No. 5, October 2010, pp. 418–428.

Davis, Kelly Cue, Trevor J. Schraufnagel, Angela J. Jacques-Tiura, Jeanette Norris, William H. George, and Preston A. Kiekel, "Childhood Sexual Abuse and Acute Alcohol Effects on Men's Sexual Aggression Intentions," Psychological Violence, Vol. 2, No. 2, April 2012, pp. 179–193.

Davis, Kelly Cue, Susan A. Stoner, Jeanette Norris, William H. George, and N. Tatiana Masters, "Women's Awareness of and Discomfort with Sexual Assault Cues," Violence Against Women, Vol. 15, No. 9, September 2009, pp. 1106–1125.

DeSouza, E. R., T. Pierce, J. C. Zanelli, and C. Hutz, "Perceived Sexual Intent in the U.S. and Brazil as a Function of Nature of Encounter, Subjects' Nationality, and Gender," Journal of Sex Research, Vol. 29, No. 2, May 1992, pp. 251–260.

Farris, Coreen, Teresa A. Treat, Richard J. Viken, and Richard M. McFall, "Sexual Coercion and the Misperception of Sexual Intent," Clinical Psychology Review, Vol. 28, No. 1, January 2008, pp. 48–66.

Garcia, Luis T., and Karen Kushnier, "Sexual Inferences About Female Targets: The Use of Sexual Experience Correlates," Journal of Sex Research, Vol. 23, No. 2, May 1987, pp. 252–256.

George, William H., Susan J. Gournic, and Mary P. McAfee, "Perceptions of Postdrinking Female Sexuality: Effects of Gender, Beverage Choice, and Drink Payment," Journal of Applied Social Psychology, Vol. 18, No. 15, December 1988, pp. 1295–1317.

Gross, Alan M., Ted Bennett, Lawrence Sloan, Brian P. Marx, and John Juergens, "The Impact of Alcohol and Alcohol Expectancies on Male Perception of Female Sexual Arousal in a Date Rape Analogue," Experimental and Clinical Psychopharmacology, Vol. 9, No. 4, November 2001, pp. 380–388.

Ito, Tiffany A., Norman Miller, and Vicki E. Pollock, "Alcohol and Aggression: A Meta-Analysis of the Moderating Effects of Inhibitory Cues, Triggering Events, and Self-Focused Attention," Psychological Bulletin, Vol. 120, No. 1, July 1996, pp. 60–82.

Jonas, Daniel E., James C. Garbutt, Halle R. Amick, Janice M. Brown, Kimberly A. Brownley, Carol L. Council, Anthony J. Viera, Tania M. Wilkins, Cody J. Schwartz, Emily M. Richmond, John Yeatts, Tammeka Swinson Evans, Sally D. Wood, and Russell P. Harris, "Behavioral Counseling After Screening for Alcohol Misuse in Primary Care: A Systematic Review and Meta-Analysis for the U.S. Preventive Services Task Force," Annals of Internal Medicine, Vol. 157, No. 9, 2012, pp. 645–654

Marx, Brian P., Alan M. Gross, and Henry E. Adams, "The Effect of Alcohol on the Responses of Sexually Coercive and Noncoercive Men to an Experimental Rape Analogue," Sexual Abuse: Journal of Research and Treatment, Vol. 11, No. 2, 1999, pp. 131–145.

McCauley, Jenna, Kenneth J. Ruggiero, Heidi S. Resnick, Lauren M. Conoscenti, and Dean G. Kilpatrick, "Forcible, Drug-Facilitated, and Incapacitated Rape in Relation to Substance Use Problems: Results from a National Sample of College Women," Addictive Behaviors, Vol. 34, No. 5, May 2009, pp. 458–462.

Mohler-Kuo, Meichun, George W. Dowdall, Mary P. Koss, and Henry Wechsler, "Correlates of Rape While Intoxicated in a National Sample of College Women," Journal of Studies on Alcohol, Vol. 65, No. 1, January 2004, pp. 37–45.

National Institute for Alcohol Abuse and Alcoholism, "NIAAA Council Approves Definition of Binge Drinking," NIAAA Newsletter, No. 3, Winter 2004, p. 3. As of June 4, 2014:
http://pubs.niaaa.nih.gov/publications/Newsletter/winter2004/Newsletter_Number3.pdf

NIAAA—See National Institute for Alcohol Abuse and Alcoholism.

Norris, Jeanette, Kelly Cue Davis, William H. George, Joel Martel, and Julia R. Heiman, "Alcohol's Direct and Indirect Effects on Men's Self-Reported Sexual Aggression Likelihood," Journal of Studies on Alcohol, Vol. 63, No. 6, November 2002, pp. 688–695.

Rock, Lindsay, 2012 Workplace and Gender Relations Survey of Active Duty Members, Alexandria, Va.: Defense Manpower Data Center, Survey Note No. 2013-007, March 15, 2013. As of June 4, 2014:
http://www.sapr.mil/public/docs/research/2012_Workplace_and_Gender_Relations_Survey_of_Active_Duty_Members-Survey_Note_and_Briefing.pdf

Saitz, Richard, "Unhealthy Alcohol Use," New England Journal of Medicine, Vol. 352, No. 6, February 10, 2005, pp. 596–607.

Testa, Maria, Joseph H. Hoffman, Jennifer A. Livingston, and Rob Turrisi, "Preventing College Women's Sexual Victimization Through Parent Based Intervention: A Randomized Controlled Trial," Prevention Science, Vol. 11, No. 3, September 2010, pp. 308–318.

Testa, Maria, Jennifer A. Livingston, and R. Lorraine Collins, "The Role of Women's Alcohol Consumption in Evaluation of Vulnerability to Sexual Aggression," Experimental and Clinical Psychopharmacology, Vol. 8, No. 2, May 2000, pp. 185–191.

U.S. Department of Defense Directive 6495.01, Sexual Assault Prevention and Response (SAPR) Program, January 23, 2012, incorporating change 1, April 30, 2013.

Notes

* Sexual assault: "Intentional sexual contact characterized by use of force, threats, intimidation, or abuse of authority or when the victim does not or cannot consent. Sexual assault incudes rape, forcible sodomy (oral or anal sex), and other unwanted sexual contact that is aggravated, abusive, or wrongful (including unwanted and inappropriate sexual contact), or attempts to commit these acts" (DoD Directive 6495.01). (The policy definition of sexual assault in DoD Directive 6495.01 includes rape, sexual assault, aggravated sexual contact, and abusive sexual contact, as defined by Article 120 of the Uniform Code of Military Justice.) Military sexual assault: Sexual assault of a military service member.

** The civilian comparison data were standardized to the sociodemographic distribution of service members by gender, age, education, race/ethnicity, and marital status.

This research was conducted within the Forces and Resources Policy Center of the RAND National Defense Research Institute, a federally funded research and development center sponsored by the Office of the Secretary of Defense, the Joint Staff, the Unified Combatant Commands, the Navy, the Marine Corps, the defense agencies, and the defense Intelligence Community.

RAND Health Quarterly is produced by the RAND Corporation. ISSN 2162-8254.