Over the 9th and 10th of November, 2012, the third International Conference on Survivors of Rape (ICSoR) was held at NUI Galway, hosted by the Rape Crisis Network Ireland. This conference drew together international experts, service-workers and survivors of rape and sexual violence to examine issues and responses to rape and sexual violence.

In this briefing the presentations of the panel on Assessing and Measuring the Impact of Drugs and Alcohol are considered. What is clear from this panel, and from the majority of presentations made at the conference, is the significant presence of alcohol in incidents of sexual violence throughout Europe and further afield. The studies presented suggest that drug facilitated sexual assault (DFSA) involving forced or surreptitious drugging are rare, while voluntary consumption of drugs, particularly alcohol, increases the risk of being targeted by perpetrators of sexual violence.

Three presentations were made in this panel by Maeve Eoghan, of the Rotunda Hospital and the Rotunda Sexual Assault Treatment Unit, Dublin, Ireland, Cecilie Hagemann of St. Olavs Hospital, Trondheim University Hospital, Norway and Ole Ingemann-Hansen of the Department of Forensic Medicine, University of Aarhus, Denmark.

Overview of the Presentations:
Cecilie Hagemann presented ‘Alcohol and drugs detected in urine/blood, background and assault characteristics and clinical findings in cases of drug facilitated sexual assault’. This presentation examined data from a study conducted at the Sexual Assault Centre at St. Olav’s Hospital Trondheim, Norway which compared background and assault characteristics of women who suspected drug-facilitated sexual assault against those who did not suspect their sexual assault was drug facilitated.

The study examined the evidence for the presence of drugs, including alcohol, in both sets of patients, comparing evidence of drugs in the patients system with the patient’s suspicion of having experienced DFSA.

Ole Ingemann-Hansen’s presentation, ‘Drug-facilitated sexual assault – spiking or voluntarily consumed’, revealed the findings from a study similar to that presented by Cecilie Hagemann based at the Sexual Assault Centre in Aarhus, Denmark, focussing on the frequency of drug-facilitated sexual assault and whether the drug(s) in question had been voluntarily consumed.

Maeve Eoghan presented an ‘Assessment of Alcohol Use using a Standardised tool in Patients attending a Sexual Assault Treatment Unit’. This was a pilot study based at the Rotunda SATU in Dublin, Ireland in which the extent of alcohol misuse by patients attending the unit was assessed using the Alcohol Use Disorders Identification Test (AUDIT), which places people in one of four zones to detect risky, harmful or hazardous drinking behaviour. The efficacy of delivering brief alcohol interventions at the follow-up visit for SATU patients was also considered.

Important Findings:
Both Hagemann and Ingemann-Hansen’s study provides similar evidence of the use of drugs and alcohol in rapes and sexual assaults by patients attending sexual assault centres, while Eoghan’s study provides further evidence of the prevalence of alcohol consumption by victims of sexual violence in Ireland. 

• Findings relating to alcohol consumption:
  • 84% of patients in the Danish study had consumed alcohol on the occasion of the assault.
  • 74% of patients in the Norway study had consumed alcohol on the occasion of the assault.
  • 60% of patients at the Rotunda SATU, Dublin, Ireland were deemed to have problematic or potentially problematic alcohol consumption.
    • The majority of these, approximately 50%, fell into the potentially hazardous or possibly harmful alcohol use category (zone 2 or zone 3).
    • Approximately 10% of patients demonstrated alcohol consumption that may require specialist treatment for alcohol dependency (zone  4).

• Findings relating to voluntary drug-use:
  • Approximately 18% of patients in the Danish study had voluntarily consumed drugs other than alcohol on the occasion of the assault.
  • Of 57 women who suspected drug-facilitated sexual assault in the Norwegian study, 13 tested positive for drugs; however, in 6 of these cases the drugs detected were voluntarily consumed while the other 7 cases involved patients with histories of drug-abuse and/or anxiety which may explain the presence of drugs in the system.

• Findings relating to involuntary drug use:
  • 2.4% of cases in the Danish Study meet the criteria for involuntary consumption drug-facilitated sexual assault.
  • 0 cases could be established as drug-facilitated sexual assaults in the Norwegian study.
  • Those who suspected they had been the victim of a drug-facilitated sexual assault were more likely to have been drinking and to have higher blood alcohol concentrations in both the Danish and Norwegian studies.

A minor role for drug facilitated sexual assault?
The studies presented by Hagemann and Ingemann-Hansen suggest that involuntary drug consumption plays a minor role in sexual violence in Denmark and Norway. This echoes findings from Ireland, in which RAJI found no concrete evidence of the forced or surreptitious use of drugs to incapacitate a victim. There are, however, some limitations to the studies, including the delay between experiencing the incident and testing for drugs in the patients’ system. There are a number of fast-acting drugs, notably GHB, that are implicated in drug-facilitated sexual assaults that may not be evident in the system after even a short delay. Further, detection of drugs is dependent on detection technology which may lag behind the development of new drugs and/or may not look for herbal or some synthetic drugs. Nevertheless, while it is quite possible that some cases of drug-facilitated sexual assault may be missed by such studies, it is unlikely that there are a significant number of such cases. Rather, forced or surreptitious consumption of drugs by victims of sexual violence remains an unusual occurrence.

Proactive vs. Opportunistic Drug Facilitated Sexual Assaults
On the other hand, voluntary drug use, and particularly the voluntary consumption of alcohol, demonstrates a strong relationship to sexual violence in all three States (Denmark, Norway, Ireland). This indicates that our understanding of drug-facilitated sexual violence should be expanded. Both Hagemann and Ingemann-Hansen distinguish between proactive DFSA, where drugs are forced or surreptitiously administered in order to incapacitate an intended victim, and opportunistic DFSA where victims are targeted due to their voluntary use of drugs. This distinction usefully allows us to recognise that DFSA can also occur when victims are voluntarily intoxicated by drugs, including alcohol. A better recognition of alcohol as a drug implicated in opportunistic DFSA is also necessary in designing rape prevention measures.

Opportunities to address alcohol involvement in sexual violence
Given the data presented at the ICSoR conference and available from other studies, there is a clear necessity to examine possibilities of reducing the prevalence and role of alcohol in sexual violence. While recommendations have been made in earlier briefings that target perpetrator alcohol consumption, Eoghan’s presentation of data gathered from the alcohol misuse study at the Rotunda SATU strongly suggests that disregarding victim alcohol consumption does not service victims of sexual violence; rather,  and as discussed in briefing 9 of this series, to improve recovery, prevent re-victimisation and limit additional health problems, alcohol misuse by victims of sexual violence needs to be identified and addressed.  This must, however, occur within a supportive environment that explicitly recognises that sexual violence is never caused by, or the fault of, the victim.

Eoghan’s study recommends the use of a screening tool for alcohol misuse at the follow-up visit for patients attending a SATU in Ireland. Where indicated, particularly for those who fall into the categories of ‘potentially hazardous’ (zone 2) and ‘possibly harmful’ alcohol consumption (zone 3), brief interventions such as a short alcohol counselling session delivered by knowledgeable non-experts or referral to specialised alcohol treatment programmes for those in Zone 4, are a very positive step in addressing the possible negative effects of victim alcohol consumption in recovery and decreasing the risk of re-victimization.

Across the three states considered by these presentations, alcohol presents as the most significant drug involved in rape and sexual violence.  While we cannot, and should not, exclude the realities of proactive drug facilitated sexual assault, voluntary alcohol consumption appears to present the greatest risk of sexual violence, followed by voluntary consumption of other drugs. The opportunistic rape of intoxicated and/or incapacitated individuals presents a major area of focus in the attempt to reduce the rate of sexual violence.

Overall, the panel drew our attention to the need for further studies into the interaction between drugs and alcohol and sexual violence and the possibilities of minimizing their impact for victims of rape. This requires also a focus on perpetrators and on the conditions, characteristics and attitudes that increase the likelihood of perpetrators targeting those who have voluntarily consumed alcohol or other drugs. Social norms about alcohol, sex and violence, as discussed in briefing 3 of this study, must not be overlooked as a facilitating element in such assaults.