William H. George

Understanding acute alcohol effects on sexual behavior

Abstract 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 alcohols 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.

Relapse prevention for addictive behaviors

The Relapse Prevention (RP) model has been a mainstay of addictions theory and treatment since its introduction three decades ago. This paper provides an overview and update of RP for addictive behaviors with a focus on developments over the last decade (2000-2010). Major treatment outcome studies and meta-analyses are summarized, as are selected empirical findings relevant to the tenets of the RP model. Notable advances in RP in the last decade include the introduction of a reformulated cognitive-behavioral model of relapse, the application of advanced statistical methods to model relapse in large randomized trials, and the development of mindfulness-based relapse prevention. We also review the emergent literature on genetic correlates of relapse following pharmacological and behavioral treatments. The continued influence of RP is evidenced by its integration in most cognitive-behavioral substance use interventions. However, the tendency to subsume RP within other treatment modalities has posed a barrier to systematic evaluation of the RP model. Overall, RP remains an influential cognitive-behavioral framework that can inform both theoretical and clinical approaches to understanding and facilitating behavior change.

Indirect Effects of Acute Alcohol Intoxication on Sexual Risk-taking: The Roles of Subjective and Physiological Sexual Arousal

Three experiments supported the idea that alcohol fosters sexual risk-taking in men and women, in part, through its effects on sexual arousal. In Experiment 1, increasing alcohol dosage (target blood alcohol levels of .00, .04, .08%) heightened men’s and women’s risk-taking intentions. Alcohol’s effect was indirect via increased subjective sexual arousal; also, men exhibited greater risk-taking than women. In Experiment 2, an extended dosage range (target blood alcohol levels of .00, .06, .08, .10%) heightened men’s risk-taking intentions. Alcohol’s effect again was indirect via subjective arousal. Physiological sexual arousal, which was unaffected by alcohol, increased risk-taking via increased subjective arousal. In Experiment 3, alcohol increased women’s risk-taking indirectly via subjective arousal, but alcohol-attenuated physiological arousal had no effect on risk-taking. Implications for alcohol myopia theory and prevention interventions are discussed.

Victim Blaming in Rape: Effects of Victim and Perpetrator Race, Type of Rape, and Participant Racism

Stereotypes about Black sexuality fostered hypotheses that racial factors and racism influence rape victim blaming. Predominantly White and Asian college students (170 men, 162 women) completed the Modern Racism Scale and evaluated a rape vignette varying victim race, perpetrator race, and rape type. As predicted, racial factors determined victim blaming. Compared to intraracial rapes, interracial rapes were less uniformly judged as “definitely rape” and were judged as having more culpable and less credible victims, and less culpable perpetrators. For men, racism scores positively predicted victim blaming in all rapes. For women, racism scores moderated victim blaming in interracial acquaintance rapes. In our conclusions, we emphasize the durability of racial stereotypes about rape and their influence on discriminatory adjudication outcomes.

Alcohol use, expectancies, and sexual sensation seeking as correlates of HIV risk behavior in heterosexual young adults.

Most theoretical models of HIV risk behavior have not considered the role of personality factors, and few studies have examined mechanisms accounting for dispositional influences on sexual risk taking. This study elaborated on a conceptual model emphasizing sexual sensation seeking, alcohol expectancies, and drinking before sex as key predictors of HIV risk (S. C. Kalichman, L. Tannenbaum, & D. Nachimson, 1998). Multiple groups structural equation modeling was used to determine whether gender moderated relationships among these variables in a sample of 611 heterosexual, young adult drinkers (49% women, 76% Caucasian, mean age = 25 years). The model provided an excellent fit to the data, and gender differences were not substantiated. Sexual sensation seeking predicted HIV risk directly as well as indirectly via sex-related alcohol expectancies and drinking in sexual contexts. Findings suggest that expectancies and drinking before sex represent proximal mechanisms through which dispositional factors influence sexual risk outcomes. Moreover, these relationships appear to be similar in men and women. Interventions could benefit from targeting alcohol expectancies and drinking before sex in individuals with a dispositional tendency toward sexual risk taking.

Sexually aggressive college males: empathy as a moderator in the “Confluence Model” of sexual aggression

We replicated the findings of Malamuth, Linz, Heavey, Barnes, and Acker [Malamuth, N. M., Linz, D., Heavey, C. L., Barnes, G., & Acker, M. (1995). Using the confluence model of sexual aggression to predict mens conflict with women: a 10-year follow-up study. Journal of Personality and Social Psychology, 69,2 (1995) 353] by using the Confluence Model to predict sexually aggressive behavior (SA) in a sample of undergraduate males. Hierarchical multiple regression analyses demonstrated that Hostile Masculinity (HM) and Impersonal Sex (IS) interact to predict SA. We extended the Confluence Model by adding a measure of generalized empathy to predict SA. Empathy moderated HM and IS in predicting SA, such that high-risk males (high HM and high IS) with low empathy reported higher rates of SA than all other males, while high-risk males with high empathy reported rates of SA comparable with those of all lower-risk males. The implications for multidimensional models of sexual aggression and the limitations of measuring rates of sexual aggression are discussed.

Alcohol and Sexuality Research in the AIDS Era: Trends in Publication Activity, Target Populations and Research Design

Research addressing relationships between alcohol and human sexuality has proliferated, due in part to efforts to characterize alcohol’s role in HIV risk behavior. This study provides a descriptive review of the alcohol–sexuality literature, using abstracts from 264 identified studies to estimate changes in publication activity, target populations, and the prevalence of HIV-related studies over time. We also examine methodological trends by estimating the prevalence of experimental vs. non-experimental studies. Findings show considerable increases in research activity and diversity of populations studied since the mid-1980’s and highlight the emergence of HIV-related studies as a focal point of alcohol–sexuality research efforts. Results also demonstrate a substantial decline in the proportion of studies utilizing experimental methods, in part because of frequent use of non-experimental approaches in studies of alcohol and HIV risk behavior. We discuss implications and review the role of experiments in evaluating causal relationships between alcohol and sexual risk behavior.

Women's condom use assertiveness and sexual risk-taking: Effects of alcohol intoxication and adult victimization

This experiment examined relationships among adulthood victimization, sexual assertiveness, alcohol intoxication, and sexual risk-taking in female social drinkers (N=161). Women completed measures of sexual assault and intimate partner violence history and sexual assertiveness before random assignment to 1 of 4 beverage conditions: control, placebo, low dose (.04%), or high dose (.08%). After drinking, women read a second-person story involving a sexual encounter with a new partner. As protagonist of the story, each woman rated her likelihood of condom insistence and unprotected sex. Victimization history and self-reported sexual assertiveness were negatively related. The less sexually assertive a woman was, the less she intended to insist on condom use, regardless of intoxication. By reducing the perceived health consequences of unprotected sex, intoxication indirectly decreased condom insistence and increased unprotected sex. Findings extend previous work by elucidating possible mechanisms of the relationship between alcohol and unprotected sex - perceived health consequences and situational condom insistence - and support the value of sexual assertiveness training to enhance condom insistence, especially since the latter relationship was robust to intoxication.

Women's Responses to Unwanted Sexual Advances: The Role of Alcohol and Inhibition Conflict

In this study we investigated how alcohol consumption affects womens responses to unwanted sexual advances in a hypothetical dating situation. Sixty female social drinkers participated in a 2 × 2 between-subjects experiment, which examined the effects of moderate alcohol intoxication and relationship characteristics on behavioral responses to unwanted sexual advances. Hypotheses were tested regarding the influence of inhibition conflict on intoxicated participants. As predicted, intoxicated women were more likely than sober women to consent to their dating partners sexual advances in high conflict situations. Additionally, alcohol consumption increased womens estimated likelihood of responding passively. These findings aid in explicating the relationship between alcohol consumption and womens increased vulnerability to sexual assault.

Prediction of Response to Treatment in a Randomized Clinical Trial of Marital Therapy

This study investigated demographic, intrapersonal, and interpersonal predictors of treatment response in a randomized clinical trial of 134 distressed married couples, which examined traditional (N. S. Jacobson & G. Margolin, 1979) and integrative (N. S. Jacobson & A. Christensen, 1996) behavioral couple therapy. Results based on hierarchical linear modeling revealed that interpersonal variables were the strongest predictors, but their effects were largely limited to predicting initial marital dissatisfaction; greater individual mental health was also associated with less distress initially. Couples who were married longer demonstrated stronger treatment gains, and exploratory analyses suggested that sexually dissatisfied couples showed slower initial, but overall more consistent, gains in the integrative versus the traditional approach. Findings are considered in light of the previous literature on predicting response to marital therapy.