Examination of a Sex-Related Distress Self-Medication Drinking Model Following Sexual Victimization: Longitudinal and Event-Specific Studies

Thesis (Ph.D.)--University of Washington, 2020Women ages 18-24 are at the highest risk for sexual victimization (SV), with more than 20% of women affected during college. The self-medication model of alcohol use, whereby drinking is negatively reinforced through the reduction of distress, is widely supported as a method by which women with a SV history cope. Women with a history of SV, compared to without, engage more frequently in pre-sex drinking–drinking before or during sexual activity, and report more problems related to sexuality. Sexual health variables such as sex-related distress (i.e., distress related to sexual behavior or sexuality) and sex-related drinking motives (i.e., drinking to cope with sex-related distress) might mediate the relationships between SV and pre-sex drinking and between SV and negative sexual consequences, representing unique pathways. This dissertation examines the sex-related self-medication model in first and second year college women using two methodologies among one umbrella sample. The first (N = 379) uses an online, longitudinal survey (baseline, six weeks, and twelve weeks) and path analysis. Adult sexual assault (ASA) severity was indirectly associated with drinking to cope with sex-related distress through sex-related distress. In the same model, ASA severity was also indirectly associated with general drinking to cope through general distress. Thus, the sex-related self-medication model may function independently of the general self-medication model. In the second study, participants (n = 300) reported on their most recent pre-sex drinking experience within the past six weeks or otherwise, sexual experience. Results suggested that ASA severity and trait sex-related distress are likely risk factors for engaging in sex-related distress self-medication at the event-specific level. Among those who engaged in pre-sex drinking, event-specific sex-related distress was indirectly associated with negative sexual consequences through sex-related drinking to cope. Event-specific sex-related distress was not associated with number of pre-sex drinks or level of subjective intoxication during sexual activity. Findings highlight the importance of negative sexual consequences as an outcome associated with the sex-related drinking to cope motive as opposed to drinking behavior per se. Investigation of the self-medication model as applied to managing sex-related distress may inform prevention and intervention work targeting adaptive coping and decision-making following ASA