Making and Communicating Decisions About Sexual Consent During Drug-Involved Sex: A Thematic Synthesis

Abstract

Sexual consent is a central component in the primary prevention of sexual violence. There is growing evidence of the impact that alcohol consumption has on sexual consent. However, there has been no review examining sexual consent in the context of other drug-taking. Published literature was sought using searches of: PsycINFO, PsycARTICLES, Scopus, Web of Science, CINAHL, MEDLINE and Open Dissertations. Unpublished literature, such as unpublished government or charity reports, were identified through Google search engine. All 21 eligible studies employed qualitative or mixed methods; therefore, a thematic synthesis was deemed an appropriate method of analysis. Three themes were constructed: "Drug-taking changes sexual norms", "Drug-taking diminishes the capacity to make sexual decisions" and "Drug-taking reduces verbal and non-verbal ability to communicate consent". The findings demonstrated that prevailing models of sexual consent may not account for circumstances relevant to drug-involved sex, such as how drug-taking impacts freedom and capacity to consent to sex. We propose the use of the medical model of capacity to consent as a broader framework through which capacity to consent to sex in drug-taking contexts can be assessed. The importance of both the social and situational context for sexual decision-making following drug-taking is discussed.

Internal and external sexual consent during events that involved alcohol, cannabis, or both

“…A recent review of the literature examined associations between sexual consent and substances other than alcohol. 26 Those findings suggested that people hold positive sex-related expectancies for cannabis use, including that it enhances intimacy, connectedness, and trust; the authors argued that this "heightened emotional connection" may increase people's willingness to engage in sexual activity. 26 In about 20% of the articles reviewed, drug use was described as improving clarity and decision-making abilities, which contrasts effects of alcohol consumption.…”

“…26 Those findings suggested that people hold positive sex-related expectancies for cannabis use, including that it enhances intimacy, connectedness, and trust; the authors argued that this "heightened emotional connection" may increase people's willingness to engage in sexual activity. 26 In about 20% of the articles reviewed, drug use was described as improving clarity and decision-making abilities, which contrasts effects of alcohol consumption. Such increases in perceived clarity may empower people to believe they are capable of consenting to sex while using cannabis.…”

Profiles of HIV Risk, Sexual Power, and Decision-Making among Sexual Minority Men of Color Who Engage in Transactional Sex: A Latent Profile Analysis

“…Substance use, especially of injection drugs, during sex increases the risk of HIV transmission [36,41,42]. Substance use during sex can affect an individual's ability to consent and assert their sexual preferences, resulting in low sexual relationship power [22]. This, in turn, is associated with an increase in high-risk sexual behaviors, such as condom-less sex [43].…”

“…Consequently, SMM who have endured forms of abuse were more likely to engage in risky sexual behaviors such as substance use [20], condom-less sex [21], and transactional sex [6]. Substance use can exacerbate low sexual relationship power since substance use can affect an individual's decision-making ability and also limit one's agency for sexual negotiation [22]. If substance dependency develops, the financial burden of sustaining dependency may increase financial need to engage in transactional sex [23].…”

Comparing Transgender and Cisgender Experiences of Being Taken Advantage of Sexually While Under the Influence of Alcohol and/or Other Drugs

“…Accordingly, researchers have investigated associations between alcohol and/or other drug use and sexual violence, with some finding alcohol and/ or other drug consumption to be a risk factor for sexual assault (Anderson et al, 2017;Beynon et al, 2008;Slaughter, 2000). A common explanation for this is that alcohol and/or other drug use can impair an individual's cognitive and/or physical capabilities, thus leading to an increased vulnerability to sexual violence (Beynon et al, 2008;Smith et al, 2020).…”