Convergent Effects of Alcohol and Confluence Model Constructs on Sexual Aggression, Sexual Misperception, and Coercive Condom Use Resistance: A Scoping Review

Abstract

Several robust predictors of men’s sexual aggression perpetration include components of the confluence model, specifically alcohol consumption and constellations of attitudes referred to as hostile masculinity and impersonal sex. These constructs have also been found to predict sexual misperception, a frequent intermediary for sexual aggression, and coercive condom use resistance. Whether alcohol and hostile masculinity and impersonal sex operate independently or in concert to increase the likelihood of male sexual aggression perpetration and these related behaviors is unclear, and prior studies produced mixed findings. To address these knowledge gaps, we reviewed empirical studies that examine the impact of associations between alcohol and hostile masculinity and alcohol and impersonal sex on sexual aggression perpetration, sexual misperception, and coercive condom use resistance by men. We identified 19 studies of undergraduate and community men. There was support for a shared pathway from alcohol use and impersonal sex to sexual aggression and misperception, although potential causal mechanisms remain untested. There was limited evidence that alcohol intoxication interacts with hostile masculinity to predict sexual aggression perpetration, but further studies are needed to replicate and extend these findings. Critical gaps include limited studies of sexual misperception and condom use resistance and limited testing of competing hypotheses.

Introduction

Approximately 29% – 43% of men self-report sexual aggression perpetration (Abbey et al., 2011; Anderson et al., 2021; Pegram et al., 2018), which refers to any sexual activity with a nonconsenting partner including behaviors ranging from unwanted sexual contact to forced penetration (Basile et al., 2014). Sexual victimization is associated with elevated risk for psychopathology, substance misuse, and difficulties with academic, occupational, and interpersonal functioning (Kilpatrick, 2000; Nickerson et al., 2013; Molstad et al., 2023; Schalk et al., 2023), making sexual aggression (SA) perpetration a significant public health concern. Despite a proliferation of SA prevention programming, rates of SA victimization and perpetration remain largely unchanged (Koss et al., 2022), indicating the presence of critical gaps in our understanding of SA perpetration.

Sexual aggression is a multi-determined phenomenon and has been shown to result from several person- and situation-level factors including acute alcohol intoxication (Abbey & Helmers, 2020; Abbey et al., 2014) and attitudes (Tharp et al., 2013; Thompson et al., 2013), specifically those represented in Malamuth’s confluence model (Bruera et al., 2022; Malamuth, 1986; Malamuth et al., 1996; Ray & Parkhill, 2023). Sexual misperception has also been identified as a key intermediary factor in a subset of SA events (Abbey et al., 1998; Abbeyet al., 2001; Farris et al., 2008). Sexual misperception is the inaccurate judgment of a potential partner’s sexual interest or consent (Treat & Viken, 2018) and can occur at the initial stages of an interaction (e.g. mistaking friendliness for sexual interest) as well as during intimate interactions (e.g. incorrectly decoding or contextualizing non-consent cues; Farris et al., 2008). Although sexual misperception does not inevitably result in SA, it can function as a key precursor for perpetration (Abbey et al., 1998; Abbey et al., 2001; Farris et al., 2008). Frequency of sexual misperception is associated with SA perpetration, and men with SA histories experience greater difficulties correctly interpreting women’s sexual interest and/or consent in vignettes (Treat & Viken, 2018) and photographs (Farris et al., 2006). Moreover, both alcohol consumption and confluence model constructs have been linked to sexual misperception (Abbey et al., 2000; Davis & Logan-Greene, 2012; Farris et al., 2010; Treat & Viken, 2018; Tuliao et al., 2019). Thus, understanding the associations among intoxication, confluence model constructs, and sexual misperception can inform etiological models of SA perpetration.

While anyone can perpetrate or experience SA, the majority of SA is perpetrated by men against women (Black et al., 2014), and SA is not the only threat women experience to their sexual autonomy. Coercive condom use resistance (CUR) has been defined as the use of coercive tactics (e.g. verbal manipulation, deception, physical force) to obtain unprotected sex with a partner who wants to use a condom (Davis et al., 2014). Coercive CUR and SA involve many of the same tactics which are deployed to limit a potential sexual partner’s ability to exercise their sexual agency (Testa & Dermen, 1999; Davis, Gulati et al., 2018). SA perpetration and coercive CUR are empirically linked, with higher rates of coercive CUR intentions and behaviors reported among men with a history of SA perpetration (Abbey et al., 2009; Davis, Gulati et al., 2018). Like sexual misperception, associations have also been found between coercive CUR and established predictors of SA perpetration like alcohol consumption and confluence model constructs (Abbey et al., 2009; Davis & Logan-Greene, 2012). Understanding how acute intoxication and confluence model constructs facilitate other nonconsensual sexual behaviors like coercive CUR can also inform our conceptualization of SA perpetration.

The Confluence Model

One of the most robust predictors of SA perpetration is Malamuth’s confluence model (Malamuth, 1986; Malamuth et al., 1995,1996, 2021). The foundational pillar of the model asserts that SA perpetration results from the independent and synergistic effects of two distinct constellations of attitudes: hostile masculinity and impersonal sex (Malamuth et al., 2021).

Hostile masculinity (HM) reflects a personality profile with two interrelated components: (1) an orientation toward women that is hostile, defensive and distrustful, and (2) sexual dominance motives (Malamuth et al., 1991, 2021). Men high in HM view heterosexual relationships as inherently adversarial and regard women with hostility and suspicion (Malamuth et al., 1991). They view women as inferior and experience sexual gratification by exerting control and dominance over them (Malamuth et al., 1991). Acceptance of interpersonal violence and negative attitudes towards survivors of sexual assault are often considered a component of HM as well (Malamuth et al., 1991,1995; Ray & Parkhill, 2023). HM is typically conceptualized as a latent construct composed of several attitudinal constructs measured as adversarial heterosexual beliefs, hostility towards women, sexual dominance, acceptance of rape myths, and acceptance of interpersonal violence (Malamuth et al., 1995; Malamuth & Hald, 2017;. Ray & Parkhill, 2023). Studies have found that undergraduate and community men high in these constructs engage in greater SA perpetration (Abbey et al., 2007; Degue & DiLillo, 2004; Lyndon et al., 2007; Widman & Olson, 2013), and that these constructs predict subsequent perpetration (Loh et al., 2005; Thompson et al., 2015). Men who endorse these beliefs also report greater sexual misperception (Abbey et al., 2011; Farris et al., 2008; Tuliao et al., 2019) and coercive CUR (Davis et al., 2020; Wegner et al., 2017).

Impersonal sex (IS) comprises an approach to sex that prioritizes non-committal sexual encounters and conceptualizes sex as a conquest, or a game to be won (Malamuth, 1986; Malamuth et al., 1991). Men high in IS have a detached orientation toward sex, characterized by a desire for a high volume of sexual encounters that do not involve emotional intimacy (Malamuth, 1986; Malamuth et al., 1991). In addition, men who engage in greater number of encounters are also likely to have increased opportunities for SA (Abbey et al., 2006; Logan-Greene & Davis, 2011). IS has been captured through both individuals’ attitudes about sexual relationships and actual sexual behaviors, such as number of sexual partners (Malamuth et al., 1996, 2021). Men with histories of SA perpetration typically report elevated IS behaviors such as greater numbers of sexual partners (Abbey & McAuslan, 2004; Abbey et al., 2012; Bouffard, 2010; Davis et al., 2018; Degue & DiLillo, 2004; Peterson et al., 2010) and one-night stands (Davis et al., 2018; Peterson et al., 2010; Zawacki et al., 2003). Number of sexual partners has also been significantly associated with coercive CUR (Davis & Logan-Greene, 2012) and sexual misperception (Wegner & Abbey, 2016). Although few studies have examined the relationship between IS attitudes alone and SA perpetration, favorable attitudes towards casual sex have been associated directly with cross-sectional SA perpetration (Abbey et al., 2006) and sexual misperception (Treat & Viken, 2018) and indirectly with subsequent SA perpetration (Cleveland et al., 2019).

Although one of the key tenets of the confluence model is the interactive effect of hostile masculinity and impersonal sex, such that men high on both constructs experience the greatest increase in risk for sexual violence (Malamuth, 1986; Malamuth et al., 1995, 1996, 2021), much of the sexual aggression literature has examined these constructs independently (for examples, see Treat & Viken, 2018; Pegram et al., 2018; Testa et al., 2019; Davis et al., 2020) or even in isolation (for examples, see Davis & Logan-Greene, 2012; Kingree & Thompson, 2015; Cleveland et al., 2019).

Alcohol

Alcohol is estimated to be involved in about half of SA events (Abbey et al., 2001). There is substantial evidence in support of an association between alcohol and SA perpetration (Abbey et al., 2014; Crane et al., 2016); and, emerging evidence also supports a relationship between alcohol and both sexual misperception (Farris et al., 2010; Tuliao et al., 2019) and coercive CUR (Davis, Gulati et al., 2018; Wegner et al., 2017). Alcohol’s effects on these behaviors can be conceptualized as operating at three levels: event, situational and global (Cooper, 2002; Parkhill & Abbey, 2008; Testa, 2002). Event-level studies provide information about the role of acute intoxication in a specific instance of SA, sexual misperception, or CUR. This is typically examined through experimental paradigms but can also be evaluated in real-world contexts through daily diary or ecological momentary assessment studies. Situational alcohol use refers to patterns of alcohol consumption in situations that confer high-risk for these behaviors, such as dates, sexual encounters, and venues like bars, clubs, and parties (Armstrong et al., 2006; Parkhill & Abbey, 2008; Testa, 2002). Global alcohol use captures general consumption patterns such as frequency and quantity of typical drinking, heavy episodic drinking, and alcohol problems and involves the most distal relationship between alcohol and SA (Cooper, 2002; Parkhill & Abbey, 2008; Testa, 2002), Broadly speaking, studies examining the effects of global and situational alcohol use can be conceptualized as providing information about sexually aggressive behaviors among individuals who typically engage in certain kinds of drinking behaviors.

Event-Level Alcohol Consumption (Acute Intoxication)

Experimental evidence indicates acute intoxication can play a causal role in SA, sexual misperception, and coercive CUR (Abbey & Helmers, 2020; Abbey et al., 2000; Crane et al., 2016; Davis, Gulati et al., 2018; Farris et al., 2010; George et al., 2024). A meta-analysis of experimental studies found that alcohol consumption had a small but significant effect (d = .32) on sexual aggression in laboratory paradigms (Crane et al., 2016). Similarly, intoxicated participants experienced greater sexual misperception, as indicated by reduced sensitivity to distinctions between women’s friendliness and sexual interest (Farris et al., 2010) and decreased reliance on women’s behavioral cues in ratings of their sexual interest (Abbey et al., 2000). Intentions to engage in coercive CUR were also higher among intoxicated participants (Wegner et al., 2017). At least for SA perpetration, it appears that alcohol’s causal impact extends beyond laboratory paradigms, suggesting that alcohol consumption increases the likelihood of SA perpetration during a specific sexual encounter (Abbey et al., 2001; Testa et al., 2015, 2019). For instance, alcohol consumption during the event distinguished bad dates from SA events (Abbey, McAuslan, et al., 2001) and predicted SA across sexual encounters in a daily diary study (Testa et al., 2015, 2019).

Global and Situational Alcohol Consumption

Situational alcohol consumption has been found to predict SA perpetration (Abbey, Zawacki, et al., 2001; Cleveland et al., 2019; Kirwan et al. 2019) and specifically alcohol-involved SA perpetration (Parkhill & Abbey, 2008). In a longitudinal study of undergraduate men, individuals who reported new SA perpetration at follow-up drank more in dating and sexual situations than non-perpetrators and participants with past but not current perpetration (Abbey & McAuslan, 2004). In support of a global association between alcohol and SA and related behaviors, studies have found direct and indirect effects of general indicators of alcohol use on SA perpetration (Abbey et al., 2006, 2014; Davis et al., 2012; Parkhill & Abbey, 2008; for exceptions, see Abbey & McAuslan, 2004; Loh et al., 2005), sexual misperception (Farris et al., 2008; Jacques-Tiura et al., 2007; Tuliao et al., 2019), and coercive CUR (Kirwan et al., 2022).

Alcohol use at the global, situational, and event levels are unlikely to be wholly independent, with men higher on indices of global alcohol use more likely to drink more heavily/frequently in high-risk settings, which in turn likely increases the likelihood of intoxication during any given SA perpetration event (Jacques-Tiura et al., 2007; Parkhill & Abbey, 2008; Testa, 2002; Zawacki et al., 2003). Overall, available evidence from multiple paradigms indicates that alcohol is linked with SA perpetration and related behaviors across multiple levels.

Alcohol x Confluence Model Construct Interactions

Across levels, alcohol typically works in conjunction with other individual differences to increase the likelihood of SA, sexual misperception, and coercive CUR. Evidence suggests that alcohol’s effects on these behaviors may be dependent on or exacerbated by dispositional predictors of these behaviors (Abbey et al., 2014; Benbouriche et al., 2019; Testa, 2002; Wegner et al., 2017). Accordingly, there has been significant interest in integrating alcohol into Malamuth’s (1986) confluence model and delineating alcohol’s potential role in pathways from HM and IS to SA. Theoretical and empirical work both suggest that global, situational, and event-level effects of alcohol on SA perpetration and related behaviors may be tied to how it interacts with HM and IS. Specifically, compared to men low in HM and IS, men high in HM and IS may have heavier and higher-risk consumption patterns (global and situational levels; Abbey et al., 2011; Flowe et al., 2011; Parkhill & Abbey, 2008) and, when drinking, may be differentially impacted by acute intoxication (event-level; Benbouriche et al., 2019; Moss & Albery, 2009; Testa, 2002).

There are two distinct causal pathways that could account for greater global alcohol consumption, situational alcohol consumption, and perpetration of SA and related behaviors among men high in HM and IS (see Figure 1): 1) an indirect path from global and situational alcohol consumption to SA related behaviors via IS and 2) an indirect path from HM and IS to SA related behaviors via situational alcohol use. Heavier global and situational alcohol use appears to facilitate sexual behaviors consistent with IS such as one-night stands and sexual encounters with greater numbers of partners (Buddie & Parks, 2003; Hittner et al., 2016) suggesting IS may mediate the effects of global and situational alcohol consumption on SA and related behaviors through IS.; That is, men who engage in heavier and higher-risk alcohol use are more often in situations that confer a greater likelihood of IS behaviors (e.g. sexual encounters with new partners), which in turn increases their likelihood of SA and related behaviors. Alternatively, it has been hypothesized that men at elevated risk for SA perpetration, such as those high in HM and IS, may engage in greater alcohol consumption in high-risk settings (e.g. drinking venues, dates, and sexual encounters) as a means to inhibit internal barriers to aggressive or non-aggressive sexual interactions (Abbey et al., 2014; Seto & Barbaree, 1995). This would suggest a mediational pathway from HM and/or IS to SA perpetration via situational alcohol use. Models of global- and situation-level interactions between alcohol and individual risk factors like HM and IS have generally focused on mediation pathways (Seto & Barbaree, 1995; Testa, 2002), and when moderation effects have been proposed, they have generally been conceptualized as reflections of event-level interactions (Lisco et al., 2012).

Figure 1.

Hypothesized pathways from alcohol consumption and confluence model constructs to nonconsensual sexual behaviors.

At the event level, HM and IS have been theorized to moderate the link between alcohol and SA. Specifically, HM and IS may exacerbate alcohol’s adverse effects on information processing through a process referred to as alcohol myopia. Briefly, alcohol myopia posits that intoxicated individuals devote disproportionate attention to more salient impelling, or “go,” cues at the expense of less salient inhibiting, or “no go,” cues, giving impelling cues an undue influence over behavior (Steele & Josephs, 1990). The salience of cues appears to be influenced by individual schema and beliefs (Moss & Albery, 2009) like those encapsulated by HM and IS. Thus, alcohol’s myopic effects may be especially pronounced for men high in these constructs, such that impelling cues aligned with their desires for sexual conquest and dominance being especially salient during intoxication and inhibiting cues inconsistent with these views being particularly inconspicuous during intoxication.

Current Study

Prior work has examined a variety of mediational and moderating pathways linking alcohol, HM, and IS to sexually aggressive behavior with mixed results (Davis et al., 2020; Jacques-Tiura et al., 2007; Parkhill & Abbey, 2008; Tuliao et al., 2019; Wegner et al., 2017). Although several reviews have offered compelling support for independent links between alcohol and sexually aggressive behavior (Abbey & Helmers, 2020; Abbey et al., 2014, 2023), HM and sexually aggressive behavior (Ray & Parkhill, 2023), and IS and sexually aggressive behavior (Davis et al., 2018), a comprehensive review is needed to consolidate and evaluate the evidence for intersecting effects of HM and/or IS with alcohol at the event, situation, and global levels. Distinguishing between event, situation, and global alcohol use is critical because interactions among alcohol and confluence model constructs at each level are associated with distinct hypotheses and interpretations. Experimental event-level studies provide information about whether acute intoxication and confluence model constructs can interact to increase the likelihood of SA perpetration, whereas studies examining alcohol use at the situation and global levels provide information about whether these interactions do, in fact, present increased risk for SA perpetration. Furthermore, given the conceptual and empirical overlap among SA, sexual misperception, and coercive CUR (Davis, Gulati, et al., 2018 citing Testa & Dermen, 1999; Farris et al., 2008), examining how overlapping effects of alcohol, HM, and IS impact sexual misperception and coercive CUR can expand our etiological understanding of unwanted sexual behavior. The purpose of this scoping review is to 1) summarize and synthesize the literature regarding the impact of relationships between alcohol and HM and alcohol and IS on SA perpetration, sexual misperception, and coercive CUR and 2) identify critical gaps in order to guide future etiological research and inform targeted risk assessment and intervention development pursuits for sexual misperception and sexually coercive behaviors. Because much of the literature examining interactions between alcohol and HM and alcohol and IS 1) has not directly examined the synergistic effects of HM and IS and 2) varies considerably in both the inclusion/exclusion of other, more distal primary predictors from the confluence model (e.g. adolescent delinquency, childhood sexual abuse) and the inclusion/exclusion of non-confluence model variables, this review examines the constellations of HM and IS and their interactions with alcohol consumption separately.

Method

Relevant studies were obtained by searching the PubMed, Web of Science, and PsycInfo databases for combinations of key words or measures associated with alcohol and HM or IS. Given the vast number of studies conducted on relationships among IS behavioral measures (e.g. number of partners, one night stands) and alcohol, search terms related to sexual debut, number of lifetime partners, and casual sex behaviors were constrained to include terms related to SA perpetration (for full search strings, see Appendix I). An initial search yielded 357 results which included a total of 225 non-duplicate publications. Initial review inclusion criteria were: (1) was published in a peer-reviewed journal; (2) was written in English; (3) tested a relationship between alcohol and at least one construct related to HM or IS; and (4) examined that relationship in the context of SA perpetration.

During abstract review, authors identified several papers that fit criteria 1–3 but examined alcohol x confluence model construct associations in the context of coercive CUR and sexual misperception, behaviors that are conceptually and empirically linked to SA perpetration (Abbey et al., 2009; Davis, Gulati, et al., 2018; Farris et al., 2008; Testa & Dermen, 1999). Thus, authors decided to expand the inclusion criteria to include sexual misperception and coercive CUR, and conducted a second search to reflect the changes (see Appendix I). This second search yielded 15 new, unique results, bringing the total number of articles to 240. The first author reviewed all titles and abstracts and obtained 78 articles that appeared to meet criteria. Ten additional articles that fit review criteria were identified from reference sections of retained articles (total = 88). After full article review, the final sample included 19 studies (see Figure 2).

Figure 2.

PRISMA Flow Diagram

Results

There were 14 studies identified that included SA perpetration as an outcome measure, with 10 studies examining the impact of IS and alcohol, 8 examining the impact of HM and alcohol consumption, and four examining the impact of both HM and alcohol and IS and alcohol. Five studies reviewed included measures of sexual misperception, with four studies evaluating intersecting effects IS and alcohol, two studies evaluating intersecting effects of HM and alcohol, and one study evaluating intersecting effects of HM and alcohol and IS and alcohol. Two studies examined coercive CUR, both of which assessed joint effects of HM and acute intoxication on the outcome. Table 1 summarizes the studies reviewed, constructs examined, and relevant findings.

Table 1.

Studies Included in Review

	Alcohol	Confluence Model		Outcome Measure	Findings
		HM	IS
Survey
Abbey et al., 2006	Global: alcohol problems	Sexual dominance	Attitudes: attitudes about casual sex	SA perpetration	Direct Paths (S): IS, alcohol (NS): HM Indirect Paths: HM via IS NS: alcohol to IS
Abbey et al., 2011	Global: composite frequency HED, drinking in consensual sexual situations, drinking on dates	Sexual dominance, RMA (composite)	Attitudes: attitudes about casual sex Behaviors: # sexual partners (consensual, female), # one-night stands (women)	SA perpetration	Direct Paths (S): HM, IS, sexual misperception Indirect Paths: alcohol via IS; alcohol, IS, and HM via sexual misperception
				Sexual misperception (strangers, acquaintances, friends, partners)	Direct Paths (S): HM, IS, alcohol Indirect Paths: alcohol via IS
Cleveland et al., 2019	Global: frequency HED Situational: drinking venue attendance		Attitudes: SOI, desired # sexual partners Behaviors: # sexual partners (female), # hookups	SA perpetration	Direct Paths (S): situational alcohol, global alcohol (−) Indirect Paths (S): global alcohol via situational alcohol, IS attitudes and behaviors via situational alcohol Correlations: global alcohol and IS attitudes and behaviors
Hall et al., 2000	Situational: drinking in sexual situations	HTW, RMA	Behaviors: # sexual partners (consensual)	SA perpetration Asian-American men	Interactions (S): HTW x situational alcohol, IS x situational alcohol
				SA perpetration European-American men	Direct Paths (S): HTW Interactions (NS): HTW x situational alcohol Poor model fit
Jacques-Tiura et al., 2007	Global: frequency, quantity Situational: drinking in sexual situations, drinking during dates	Sexual dominance, Adversarial heterosexual beliefs, RMA, AIV	Attitudes: attitudes about casual sex Behaviors: # sexual partners (consensual), # one-night stands (women)	Sexual misperception	Direct Paths (S): HM, IS, situational alcohol Indirect Paths: global alcohol via situational alcohol Interaction Effects (S): IS x situational alcohol (NS): HM x situational alcohol
Lisco et al., 2012	Global: typical # drinks	Hostile Sexism		Intimate partner SA perpetration	Main Effects (S): HM (NS): global alcohol Interactions (S): HM x global alcohol
Malamuth et al., 2021 1	Situational: attendance and knowledge of alcohol and sex parties	Hostile Masculinity Scale	Attitudes: attitudes about monogamy, attitudes about casual sex, need for emotional connection in sex Behaviors: # sexual partners	SA perpetration	Direct Paths (S): HM, IS, HM x IS Indirect Paths (S): situational alcohol via IS Interaction Effects (S): HM and situational alcohol (NS): IS and situational alcohol
Parkhill & Abbey, 2008	Global: typical # drinks, # drinking days Situational: drinking in sexual situations, drinking on dates	Adversarial heterosexual beliefs, HTW, sexual dominance	Attitudes: attitudes about casual sex, expected # dates before sex Behavior: # sexual partners	SA perpetration, sober	Direct Paths (S): HM, IS Indirect Paths (S): global alcohol via HM and IS
				SA perpetration, intoxicated	Direct Paths (S): IS, HM, situational alcohol Indirect Paths: global alcohol via HM, IS, and situational alcohol Correlations: IS and situational alcohol
Pegram et al., 2018	Global: frequency HED, max # drinks	Sexual dominance, HTW	Attitudes: attitudes about casual sex Behavior: # sexual partners, # one-night stands	SA perpetration, casual partner	Direct Paths (S): HM, IS Indirect Paths (S): global alcohol via IS (NS): global alcohol via HM
				SA perpetration, steady partner	Direct Paths (S): HM, IS, global alcohol Indirect Paths (NS): global alcohol via HM
Testa et al., 2015	Event: perceived intoxication time of each sexual encounter	HTW	Attitudes: attitudes about casual sex Behavior: # sexual partners, # one-night stands, desired # sexual partners	SA perpetration (verbal persuasion, physical pressure, encouraged intoxication)	Event-Level (S): event alcohol and verbal persuasion, event alcohol and encouraged intoxication (NS): event alcohol and physical pressure Person-Level (S): HM and verbal persuasion, HM and physical pressure, IS and less verbal persuasion Person x Event (NS): event alcohol x HM, event alcohol x IS
Testa et al., 2019	Global: # drinking days Event: number of drinks in 4 hours before sex	HTW		SA perpetration	Event-Level (S): event alcohol Person-Level (S): event alcohol, global alcohol, HM Person x Event (NS): event alcohol x HM
Tuliao et al., 2019	Global: frequency, typical # drinks, frequency HED	HTW	Attitudes: attitudes about casual sex	SA perpetration	Direct Paths (S): sexual misperception (NS): HM, IS Indirect Paths: HM, IS, global alcohol via sexual misperception
				Sexual misperception	Direct Paths (S): HM, IS, global alcohol Indirect Paths: global alcohol via IS
Wegner & Abbey, 2016	Situational: drinking in consensual sexual situations	HTW	Behaviors: # sexual partners (consensual, female), # one-night stands (women)	Sexual misperception	Direct Effects (S): HM, IS (NS): situational alcohol Correlations (S): IS and situational alcohol
Experimental
Benbouriche et al., 2019	Target BrAC = .08%	Rape Supportive Attitudes		Sexual misperception (latency in indicating woman is no longer interested)	Main Effects (S): HM, alcohol Interaction Effects (S): HM x alcohol
Davis et al., 2020	Target BrAC = .08%	Adversarial heterosexual beliefs		Coercive CUR intentions	Direct Effects (S): HM (NS): alcohol Interaction Effects (NS): HM x alcohol
Noel et al., 2009	Target BrAC = .04% or .08%, collapsed	Sexual dominance, AIV		SA perpetration intentions	Main Effects (S): alcohol Interaction Effects (S): alcohol x sexual dominance (NS): alcohol x AIV
Norris & Kerr, 1993	Target BrAC = .04%	Hyper-masculinity		SA perpetration intentions	Main Effects (S): HM (NS): alcohol Interaction Effects (NS): alcohol x HM
Norris et al., 1999	Target BrAC = .04%	Hyper-masculinity		SA perpetration intentions	Main Effects (S): HM (NS): alcohol Interaction Effects (NS): alcohol x HM
Wegner et al., 2017	Peak BrAC = .08%	HTW		Coercive CUR intentions	Main Effects (S): HM, alcohol Interaction Effects (S): alcohol x condom request style x HM (NS): HM x alcohol

¹Malamuth et al., 2021 tested effects via structural equation modeling and regression analyses. Interaction effect of HM and situational alcohol use was not retained for testing in the structural equation model.

Impersonal Sex

Impersonal Sex and Event-Level Alcohol Consumption

The link between IS and alcohol use in SA and sexual misperception was exclusively examined through survey-based research. None of the experimental studies reviewed included IS as an independent variable; thus potential joint, causal effects of IS and acute intoxication on sexual aggression and misperception remain unknown. Evidence from the sole event-level study that examined joint effects of IS and alcohol at the event-level did not support any interaction effects (Testa et al., 2019). In a daily diary study of undergraduate men, Testa et al. (2019) found no significant interaction effect of perceived intoxication during a sexual encounter and IS on the use of sexually aggressive tactics. While greater perceived intoxication was significantly associated with the use of certain SA tactics (verbal coercion and encouraged intoxication), men high in IS were actually significantly less likely to engage in one specific tactic, encouraged intoxication (Testa et al., 2019).

Impersonal Sex and Situational Alcohol Consumption

Associations among alcohol, IS, and SA and sexual misperception primarily assessed alcohol use at the global (6 out of 10 studies; Abbey et al., 2006, 2011; Jacques-Tiura et al., 2007; Parkhill & Abbey, 2008; Pegram et al., 2018; Tuliao et al., 2019) and/or situational (5 out of 10 studies; Cleveland et al., 2019; Jacques-Tiura et al., 2007; Malamuth et al., 2021; Hall et al., 2000; Parkhill & Abbey, 2008) levels. Four studies (Cleveland et al., 2019; Hall et al., 2000; Malamuth et al., 2021; Parkhill & Abbey, 2008) tested independent and intersecting effects of situational alcohol use and IS on SA perpetration, with one study testing indirect pathways (Cleveland et al., 2019), two testing interaction effects (Hall et al., 2000; Parkhill & Abbey, 2008), and one testing both (Malamuth et al., 2021).

Two distinct indirect paths were found from alcohol and IS to SA perpetration (Cleveland et al., 2019; Malamuth et al., 2021). Malamuth et al. (2021) found a significant indirect effect (ß = .04) of attendance at alcohol parties on SA perpetration via IS while a longitudinal study by Cleveland et al., 2019 found significant indirect effects (ß = .04) of IS attitudes and behaviors on subsequent SA perpetration through drinking venue attendance. Moreover, this IS to situational drinking to SA perpetration path had superior fit to a path from situational drinking to IS to SA perpetration (Cleveland et al., 2019).

Thus far, there appears to be limited evidence for the role of a situational alcohol use x IS interaction (Malamuth et al., 2021; Hall et al., 2000; Parkhill & Abbey, 2008). Although one study did find that the relationship between number of consensual sexual partners and number of SA victims was moderated by drinking before or during sex, this relationship was only supported in Asian-American men (Hall et al., 2000). Two other studies failed to find significant effects of IS x situational alcohol use on SA perpetration (Malamuth et al., 2021; Parkhill & Abbey, 2008), although one hypothesized, and found, a significant correlation (r = .14) between IS and situational drinking (Parkhill & Abbey, 2008).

Conflicting evidence emerged for the nature of the relationships among situational alcohol use, IS, and sexual misperception (Jacques-Tiura et al., 2007; Wegner & Abbey, 2016). There were consistent significant effects of IS but not situational drinking on sexual misperception (Jacques-Tiura et al., 2007; Wegner & Abbey, 2016). Jacques-Tiura et al. (2007) found that situational alcohol use moderated the relationship between IS and sexual misperception, such that IS was only related to sexual misperception in men with high levels of alcohol consumption in sexual situations. There was also support for a model of sexual misperception that included a significant correlation (r = .44) between drinking in sexual situations and IS (Wegner & Abbey, 2016).

Impersonal Sex and Global Alcohol Consumption

Studies reviewed found some support for intersecting effects of global alcohol use and IS on SA perpetration, with three out of five studies finding significant associations among global alcohol use, IS, and perpetration (Abbey et al., 2011; Parkhill & Abbey, 2008; Pegram et al., 2018). All three studies found an indirect path from global alcohol use to SA perpetration via IS (Abbey et al., 2011; Parkhill & Abbey, 2008; Pegram et al., 2018). Typical alcohol use (Parkhill & Abbey, 2008) and heavy drinking (Abbey et al., 2011; Pegram et al., 2018) were associated with IS which in turn was associated with SA perpetration. Indirect effects were small, ranging from ß = .03 (Parkhill & Abbey, 2008) to ß =.06 (Abbey et al., 2011), although conclusions regarding mediation effects are difficult to draw given limited reporting of significance testing for indirect effects. The one study that did report significance testing did find statistically significant indirect effects of heavy drinking on SA perpetration via IS (Pegram et al., 2018). This indirect path from global alcohol use to perpetration via IS appears to be specific to perpetration against casual partners (Pegram et al., 2018), which is unsurprising given that IS is not conceptually relevant to sexual encounters within steady partnerships.

Indirect effects of global alcohol use via IS were also found for sexual misperception (Abbey et al., 2011; Tuliao et al., 2019). Of the three studies that included sexual misperception, two (Abbey et al., 2011; Tuliao et al., 2019) found significant direct effects of general alcohol consumption on sexual misperception and small indirect effects (.04 - .06, significance testing not reported) via IS in American (Abbey et al., 2011; Tuliao et al., 2019) and Filipino men (Tuliao et al., 2019). Both studies also found significant direct effects of sexual misperception on SA perpetration (Abbey et al., 2011; Tuliao et al., 2019), which presents the possibility that the global alcohol-IS pathway to SA perpetration operates, at least in part, through its impact on sexual misperception. The extent to which sexual misperception could account for the effects of alcohol and IS on SA perpetration is unclear. Tuliao et al. (2019) found only indirect effects of IS via misperception on SA perpetration, suggesting that there may be full mediation, although Abbey et al. (2011) found additional direct effects of IS on SA perpetration.

Hostile Masculinity

Hostile Masculinity and Event-Level Alcohol Consumption

Alcohol and HM’s joint impact on SA perpetration was typically evaluated at the event-level (5 out of 11; Noel et al., 2009; Norris et al., 1999; Norris & Kerr, 1993; Testa et al., 2019; Testa et al., 2015), and event-level studies almost exclusively involved alcohol administration studies (3 out of 5; Noel et al., 2009; Norris et al., 1999; Norris & Kerr, 1993). Overall, the studies reviewed did not support the hypothesis that acute intoxication and HM operate in concert to increase SA perpetration, although there are considerable limitations to consider. Only one event-level study found evidence for an interactive effect of acute intoxication and HM on SA (Noel et al., 2009). In this alcohol administration experiment, men high in need for sexual dominance reported greater SA perpetration intentions when they were intoxicated but not sober, although there was no significant interaction effect for alcohol and acceptance of interpersonal violence, another component of HM (Noel et al., 2009). Interestingly, while the presence of inhibiting cues (anti-rape messaging) reduced SA intentions in intoxicated men low in need for sexual dominance, they had no impact on intoxicated men high in need for sexual dominance (Noel et al., 2009).

HM was a significant predictor of SA for all but one study (Noel et al., 2009), but the effects of acute intoxication were less consistent (Noel et al., 2009; Norris et al., 1999; Norris & Kerr, 1993; Testa et al., 2019; Testa et al., 2015). Two alcohol administration studies found that hypermasculinity, a precursor to HM (Malamuth, 1986), but not alcohol condition or alcohol condition x hypermasculinity predicted SA intentions (Norris et al., 1999; Norris & Kerr, 1993). It is possible that the alcohol doses in these studies (.04% and .06%) were insufficient to impact responding, especially since the measure of SA perpetration intentions was limited, assessing only the participants’ likelihood of behaving like the male rapist in the vignette (Norris et al., 1999; Norris & Kerr, 1993). However, higher alcohol doses do not appear to impact the strength of alcohol-aggression associations (Crane et al., 2016); and, another study was able to detect significant alcohol and alcohol x HM effects with a similar SA measure (Noel et al., 2009). Taken together, the event-level studies generally did not find support for interactive effects of acute intoxication and HM on SA, with only one study finding an event-level alcohol x HM interaction effect (Noel et al., 2009).

A similar pattern emerged for coercive CUR intentions, with both studies failing to find any significant acute intoxication x HM interactions, although one study did observe a three-way interaction between alcohol condition, condom request style, and hostility towards women (Davis et al., 2020; Wegner et al., 2017). Intoxicated men high in hostility towards women had the highest coercive CUR intentions across all condom request styles, and these were the greatest in response to indirect and direct condom requests (Wegner et al., 2017). Men low in hostility towards women, however, reported low coercive CUR intentions regardless of alcohol condition or condom request style (Wegner et al., 2017). This suggests that HM and acute intoxication may interact to exacerbate risk for coercive CUR, and perhaps SA more broadly, under certain conditions. Whether certain condom request styles themselves introduce conditions conducive to coercive behaviors for intoxicated men high in HM is less clear, particularly given the absence of any interactions among condom use request, acute intoxication, and HM in the other alcohol administration study (Davis et al., 2020).

The sole study on sexual misperception found that HM predicted sexual misperception in intoxicated but not sober men (Benbouriche et al., 2019). The study tasked sober and intoxicated men with listening to a fictional heterosexual sexual encounter in which the woman expresses increasing disinterest in engaging in intercourse and asked them to indicate when the woman is no longer interested in sex (Benbouriche et al., 2019). For every 1-unit increase in rape-supportive attitudes, the probability of indicating the female protagonist in a date rape analogue was no longer interested in sex decreased by 80% in the alcohol vs. control condition (Benbouriche et al., 2019). In other words, men who were high in HM took significantly longer than sober men high in HM and intoxicated men low in HM to recognize that a fictional woman expressing disinterest in sex was, in fact, not interested in engaging in sexual intercourse (Benbouriche et al., 2019).

Hostile Masculinity and Situational Alcohol Consumption

There was limited evidence for interactive effects of situational alcohol use and HM on SA perpetration in the three studies that tested these effects (Hall et al., 2000; Malamuth et al., 2021; Parkhill & Abbey 2008). While hostility towards women predicted SA perpetration in both Asian-American and European-American men, this effect was only moderated by drinking before/during sex in the former (Hall et al., 2000). Preliminary regression analyses in a study of SA perpetration by undergraduate men found a significant situational alcohol x HM interaction effect, with men who reported greater personal or peer exposure to parties with alcohol and sexual activity and relatively high levels of HM more likely to engage in SA perpetration (Malamuth et al., 2021). However, the interaction was not retained for the final structural equation model, so conclusions about the relative impact of this interaction in the context of other predictors is unclear. Furthermore, the inclusion of an interaction between drinking in dating and sexual situations and HM reduced the fit of a model of intoxicated SA perpetration, although both independently predicted alcohol-involved perpetration (Parkhill & Abbey, 2008). In line with these findings, HM and situational alcohol use had independent but not interactive effects on frequency of sexual misperception (Jacques-Tiura et al., 2007).

Hostile Masculinity and Global Alcohol Consumption

Studies of global alcohol use and HM focused exclusively on SA perpetration. Findings for intersecting effects of global alcohol use and HM on SA perpetration were mixed, with two out of four studies finding evidence for significant associations among the constructs (Abbey et al., 2006; Lisco et al., 2012; Parkhill & Abbey., 2008; Pegram et al., 2018). Two studies hypothesized indirect effects of alcohol problems (Abbey et al., 2006) and heavy drinking (Pegram et al., 2018) on SA perpetration via HM constructs but failed to find either an association between the alcohol and HM constructs (Pegram et al., 2018) or between the HM construct and SA perpetration (Abbey et al., 2006), precluding any indirect paths. In one study, general alcohol consumption was associated with HM, which in turn was associated with sober and intoxicated SA perpetration (indirect effects = .04 and .05 respectively, no significance testing reported), although the addition of this pathway was data rather than theory driven (Parkhill & Abbey., 2008). The sole non-directional study examining the joint effects global alcohol consumption and HM on SA perpetration found that typical drinking was associated with intimate partner SA perpetration for men high in hostile sexism (Lisco et al., 2012).

Discussion

The goal of this scoping review was to summarize and synthesize the literature regarding the impact of the distinct relationships between alcohol and HM and alcohol and IS on SA perpetration, sexual misperception, and coercive CUR and identify critical gaps. The review was successful in summarizing existing findings regarding the joint influence of alcohol and confluence model constructs on SA, sexual misperception, and coercive CUR at the global, situational, and event levels and identifying gaps in the literature. Several patterns were identified, including evidence for a shared pathway from alcohol and impersonal sex to nonconsensual sexual behaviors and limited evidence for a shared pathway from hostile masculinity and alcohol to nonconsensual sexual behaviors. However, the kinds of conclusions that could be drawn were more limited than anticipated due to a small number of studies across levels of analysis of alcohol use and methodological factors, such as heterogeneous measures of relevant constructs and emphasis on analyzing holistic, idiosyncratic models rather than specific relationships among the constructs included in those models.

Impersonal Sex

Existing research supports associations of some form among (global and situational) alcohol use, IS, and sexual aggression and misperception. Although additional replication is needed, the studies reviewed suggest the effects of both IS and global and situational alcohol consumption on SA perpetration are driven, at least in part, by a common pathway (Abbey et al., 2011; Cleveland et al., 2019; Malamuth et al., 2021; Parkhill & Abbey, 2008; Pegram et al., 2018; Tuliao et al., 2019). Taken together, findings suggest that IS and alcohol consumption in general and in high-risk contexts are linked in some way, and that men with these attitudes and behaviors are at increased risk for SA perpetration and sexual misperception. However, the limited number of studies, mixed findings, and heterogeneity in the forms of relationships examined among situational drinking, IS, and sexual aggression and misperception preclude any firm conclusions about the nature of these relationships. It is also important to note that all but one of the studies (Cleveland et al., 2019) examining indirect effects of global and situational alcohol use and IS relied on cross-sectional data rendering interpretations of observed pathways largely speculative, and further research is required to clarify these relationships. Due to the absence of experimental studies, any joint, causal effects of IS and acute intoxication on sexual aggression and misperception remain unknown, and future studies should explore the presence and impact of acute intoxication x IS interactions on SA and sexual misperception experimentally.

Hostile Masculinity

Across global, situational, and event levels of alcohol use, studies reviewed did not support joint effects of HM and alcohol consumption on SA perpetration, sexual misperception, and coercive CUR. At the event-level, studies generally did not find that acute intoxication interacted with HM to increase SA perpetration intentions or coercive CUR intentions (Davis et al., 2020; Norris & Kerr, 1993; Norris et al., 1999; Wegner et al., 2017). However, conclusions regarding synergistic, causal effects of acute intoxication and HM on SA and related behaviors are limited by the dearth of relevant studies and potential dependence on situational factors. There was also limited evidence for interactive or shared indirect effects of HM and drinking generally or in high-risk contexts on SA perpetration or sexual misperception.

Impersonal Sex, Hostile Masculinity, and Sexual Misperception

It is possible that joint effects of alcohol consumption and confluence model constructs on SA perpetration may occur primarily through their impact on sexual misperception (Abbey et al., 2011; Tuliao et al., 2019). Direct effects of alcohol (Abbey et al., 2011; Benbouriche et al., 2019; Jacques-Tiura et al., 2007; Tuliao et al., 2019;), IS (Abbey et al., 2011; Jacques-Tiura et al., 2007; Tuliao et al., 2019;), and HM (Abbey et al., 2011; Benbouriche et al., 2019; Jacques-Tiura et al., 2007; Tuliao et al., 2019) on sexual misperception were supported across the (limited) studies that tested these associations. Moreover, sexual misperception partially or fully mediated the impacts of global alcohol consumption, HM, and IS on SA perpetration (Abbey et al., 2011; Tuliao et al., 2019).

One descriptive and perhaps explanatory possibility is that acute intoxication interacts with IS and HM at the event-level to increase the likelihood of sexual misperception. When intoxicated, men high in IS and/or HM may devote disproportionate attention towards sexual interest cues and away from disinterest cues when inferring women’s sexual interest and consent (Moss & Albery, 2009; Steele & Josephs, 1990). Consistent with this hypothesis, intoxicated men are more likely to judge women’s positive affect as sexual interest (Farris et al., 2010) and less likely to incorporate women’s expressions of disinterest into their judgments of her sexual interest (Abbey et al., 2000). This pattern may be especially relevant for men high in rape myth acceptance, whose sober sexual interest judgments are generally less influenced by women’s affect (Treat & Viken, 2018), and for men high in IS, who perceive continued advances following an initial positive response as more justified (Treat & Viken, 2018). This could also account for the absence of differential effects of acute intoxication on SA intentions for men high in HM in most of the event-level studies – interest cues may have been too limited or disinterest and non-consent cues too salient to observe any interaction effects.

Critical gaps and future directions

Conclusions regarding the intersecting effects of alcohol consumption and confluence model constructs on SA and related behaviors are substantially limited by the paucity of empirical studies and the heterogeneity of existing studies. Although more studies are needed across levels of alcohol consumption and behaviors, these deficits are especially pronounced for experimental studies of IS and acute intoxication and for studies of sexual misperception and coercive CUR. There was not a single experimental study identified that evaluated the impact of IS on SA or related behaviors independently or in concert with acute intoxication. While it has been theorized that the role of IS as a risk factor for SA and sexual misperception is largely a function of the increased opportunity inherent in higher volumes of sexual partners/experiences (Abbey et al., 2006; Jacques-Tiura et al., 2007) at the global and situational level, experimental research is needed to rule out causal pathways, such as interactions with alcohol’s myopic effects (Steele & Josephs, 1990). In addition, the dearth of studies testing relationships among alcohol, IS, and coercive CUR at any level is surprising given that both IS behaviors and unprotected sex are often classified as risky sexual behaviors (Chawla & Sarkar, 2019). The limited research on potential intersecting effects of global, situational, and event-level alcohol consumption and confluence model constructs on coercive CUR reflects a critical gap, especially since non-forceful coercive CUR tactics (e.g. deception, stealthing) are largely considered normative by young heterosexual men (Davis, Schraufnagel, et al., 2014). Understanding if, and how, confluence model constructs and alcohol work in concert to increase the likelihood of coercive CUR can inform broader conceptualizations of coercive sexual behavior and inform targeted interventions relevant to both sexually transmitted infection transmission and sexual aggression.

Further alcohol administration studies are also needed to replicate and extend experimental findings on interactive effects of acute intoxication and HM on SA perpetration. The experiments reviewed were limited to evaluating interactive effects of alcohol and HM on participants’ likelihood of behaving like a male protagonist who used physical force to obtain sex (Noel et al., 2009; Norris et al., 1999; Norris and Kerr, 1993). SA encompasses a broad range of tactics, but the restriction of sexually aggressive behavior to the most severe and least common tactic (Anderson et al., 2021; DeGue & DeLillo, 2004) may have suppressed potential effects. In addition, these studies do not provide any information about whether acute intoxication and HM exert synergistic effects on intentions to use other, higher base rate sexually aggressive tactics like verbal coercion. Although the limited non-experimental research at the event-level suggests that even if interactions between intoxication and HM can increase lower severity SA intentions, they may not necessarily do so consistently (Testa et al., 2015, 2019), experimental evidence is needed to test causal pathways.

Future research would also benefit from consideration of situational characteristics, such as distinguishing between SA perpetration, sexual misperception, and coercive CUR that involves alcohol (vs. no alcohol) or casual (vs. steady) partners. Situational alcohol use is not conceptually linked to sober SA perpetration or sexual misperception, and the use of variables that collapse alcohol-involved and uninvolved events may mask potential indirect or interactive effects (Parkhill & Abbey, 2008). Similarly, IS would not be expected to predict SA and related behaviors that occur with a steady partner (Pegram et al., 2018), and aggregating these behaviors across partner types may also obscure or attenuate potential effects. This is particularly important given the relatively small magnitude of indirect pathways among alcohol and confluence model constructs. While these characteristics are, by default, included in experimental studies, they should be incorporated more frequently in the design and analyses of survey-based research.

Broad conclusions regarding the intersecting effects of alcohol consumption and confluence model constructs on SA and related behaviors are limited by the heterogeneity of the existing literature. Studies that examined alcohol at global and situational levels typically considered shared alcohol and confluence model construct effects as part of a holistic model and did not necessarily propose, test, or compare specific hypotheses for paths among these variables. Different studies found support for different pathways among drinking, confluence model constructs, and sexual aggression and misperception, all of which suggest distinct etiological pathways. The heterogeneity of these pathways and their associated statistical models substantially limited the trends that could be observed in the current literature review and pose a clear impediment to future efforts to aggregate and meta-analyze findings. The field would benefit from the development and implementation of consensus models to be evaluated in several diverse samples by independent research teams. Furthermore, there was considerable variability in the measures employed to capture global and situational alcohol use, IS, and HM, indicating a potential benefit of future measurement studies and the adoption of field-wide consensus batteries. This is particularly relevant for HM, which represents a constellation of beliefs about and attitudes towards women; most of the studies examined one or two components of the broader constellation, making it especially difficult to draw broader conclusions (for a review of measures used to capture HM in confluence model studies, see Bruera and Bobbio, 2022). The literature would benefit from standardization of relevant HM constructs, especially given recent work has identified a similar but distinct construct, known as hostile sexism, may capture more variance in SA outcomes than HM (Yucel et al., 2023). Additionally, few studies provided significance testing for indirect effects, and none provided effect sizes for indirect or interaction effects, limiting the potential translational utility of the findings discussed.

Moreover, additional studies that directly evaluate hypotheses are needed to elucidate underlying mechanisms, especially psychological mechanisms (George et al., 2024). Future research should test alternative models and existing directional hypotheses, such as the hypothesis that men high in HM consume more alcohol in high-risk settings to reduce typical inhibitors to perpetration (Abbey et al., 2014; Seto & Barbaree, 1995). At the event-level, experimental work is needed to evaluate if or how HM and IS interact with alcohol’s myopic effects to increase SA intentions, sexual misperception, and coercive CUR intentions.

Conclusions

The current review advances the literature by synthesizing studies that directly examined intersecting effects of alcohol consumption and confluence model constructs on SA perpetration, sexual misperception, and coercive CUR across event-level, situational, and global alcohol consumption. This review focused on joint effects of alcohol consumption and HM or IS on SA perpetration and related behaviors given their robust associations with and proximity to these behaviors. Overall, there is evidence suggesting shared pathways from alcohol use patterns and IS to sexual aggression and misperception history, although causal mechanisms remain unexamined. There was limited support for the hypothesis that alcohol consumption can or does interact with HM to predict severe SA perpetration, but further studies are needed to replicate these findings across different SA tactics. It is important to acknowledge that effects identified were relatively small and exist as part of a broader constellation of risk factors; comprehensive models (such as the full confluence model) that include interactions between HM and alcohol use and/or IS and alcohol use can account for considerable variance in sexual violence (Malamuth et al., 2021). Additionally, more work is needed to evaluate synergistic effects of alcohol and HM or IS on sexual misperception and coercive CUR. Further research examining intersecting effects of alcohol and confluence model constructs on SA, sexual misperception, and coercive CUR could inform targeted interventions aimed at reducing threats to sexual autonomy.

Funding

This work was supported by a grant from the National Institute on Alcohol Abuse and Alcoholism (NIAAA F31AA030457; Smith, PI). Funding supported the first author’s time dedicated to this manuscript. This work was also supported by a Small Grants Program Award from the Addictions, Drug & Alcohol Institute at the University of Washington. Funders did not play any role in the design of the study, data collection, analysis, interpretation, or writing the manuscript.

Impact Statement.

This paper summarizes knowledge of the synergistic effects of two risk factors for sexual aggression perpetration, alcohol and confluence model constructs, and highlights critical gaps in our understanding. This information can assist researchers developing etiological models and evidence-based interventions by providing information about potential mechanisms of alcohol and confluence model effects on sexual aggression perpetration.

Appendix I. Search Strings for Review

Initial Search String

(alcohol OR drinking) AND (“hostile masculinity” OR “sexual dominance” OR “sexually dominant” OR “sex roles and beliefs” OR “hostility toward women” OR “hostility towards women” OR “adversarial sexual beliefs” OR “adversarial heterosexual beliefs” OR “rape myth” OR “acceptance of interpersonal violence” OR “impersonal sex” OR ((“first intercourse” OR “sexual debut”) AND (“sexual aggression” OR “sexual violence”) AND perpetr*) OR “sociosexual inventory” OR “sociosexual orientation” OR “confluence model” OR (number* AND (“sex partner*” OR “sexual partner*”) AND (“sexual aggression” OR “sexual violence”) AND perpetr*))

Final Search String

(alcohol OR drinking) AND (“hostile masculinity” OR “sexual dominance” OR “sexually dominant” OR “sex roles and beliefs” OR “hostility toward women” OR “hostility towards women” OR “adversarial sexual beliefs” OR “adversarial heterosexual beliefs” OR “rape myth” OR “acceptance of interpersonal violence” OR “impersonal sex” OR ((“first intercourse” OR “sexual debut”) AND (“sexual aggression” OR “sexual violence”) AND perpetr*) OR “sociosexual inventory” OR “sociosexual orientation” OR “confluence model” OR (number* AND (“sex partner*” OR “sexual partner*”) AND (“sexual aggression perpetr*” OR “sexual violence perpetr*”) OR “sexual misperception” OR “condom use resistance”))