From the Experts: Linda Ledray

This month, Dr. Linda Ledray, RN, SANE-A, PhD, FAAN--Director of SANE-SART Resource Services and contributor to G.W. titles such as Intimate Partner Violence: A Resource for Professionals Working with Children and Families and the forthcoming Medical Response to Adult Sexual Assault--was generous enough to provide an article about the impact of alcohol on sexual assault. Please enjoy.


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Addressing the Impact of Alcohol on Sexual Assault
Linda E. Ledray, RN, SANE-A, PhD, LP,FAAN


Estimates of the percentage of sexual assault victims intoxicated at the time of the sexual assault vary greatly from as low as 20% to more than 50%[1], and in Indian country experts estimate nearly 100% of the women who report sexual assault are intoxicated. When not involved in the assault, alcohol abuse has also long been recognized as a result of the trauma.[2]

Sexual Assault Nurse Examiners (SANEs) and advocates working with this population have long been aware that alcohol use or abuse is a significant vulnerability factor in sexual assaults. SANEs are also well acquainted with the concept that many tend to blame intoxicated victims for the assault, which may have resulted from poor choices they made while intoxicated. Many SANEs are overly concerned about appearing as though they, too, are blaming the victim, which results in the issue’s not being properly addressed. Many choose to look the other way; therefore, effective treatment models have been neither developed nor adapted to work with other populations.

While there is certainly still significant bias against intoxicated sexual assault victims in those who respond—including law enforcement officers, medical personnel, and the jurors who judge them—avoiding the issue has not helped. Alcohol abuse has become the elephant in the room that no one will talk about. Protecting the victim from blame and addressing the alcohol abuse do not need to be mutually exclusive goals. It is possible to develop treatment models that do not blame the victim. One promising model effective with other Emergency Department (ED) populations is screening combined with brief intervention. Studies have found this feasible and effective in limiting unhealthy alcohol abuse.[3] The National Institute on Alcohol Abuse and Alcoholism (NIAAA) recognizes the ED as a opportunity to screen and, when appropriate, initiate brief alcohol intervention as well.[4] Brief interventions involve short, 5-60 minute counseling sessions performed by non-addiction specialists. This model has been shown to be effective with other victims of trauma.[5-8]

We cannot continue to ignore the problem. Effective screening for and intervention of alcohol abuse is clearly necessary to better meet the needs of this very vulnerable population.

References

1. Ledray, LE. 2 SART Model Final Report. US Department of Justice, Office of Justice Programs; 2007

2. Kilpatrick D, Acierno R, Resnick H, et al. A 2-year longitudinal analysis of the relationship between violent assault and substance use in women. J Conslt Clin Psychol. 1997;65(5):834-847.

3. D’Onofrio G, Nadel E, Degutis L. Improving emergency medicine residents’ approach to patients with alcohol problems: A controlled educational trial. Annals Emerg Med. 2002;40:50-62.

4. D’Onofrio G, Degutis L. Screening and Brief Intervention in the Emergency Department. National Institute on Alcohol Abuse and Alcoholism. http://pubs.niaaa.nih.gov/publications/arh28-2/63-72.htm.Published March 19, 2009. Accessed August 14, 2009.

5. Gentilello L, Rivara F, Donovan D, et al. Alcohol interventions in a trauma center as a means of reducing the risk of injury recurrence. Annals Surg. 1999;230(4):473-80.

6. Longabaugh R, Woolard R, Nirenberg T, et al. Evaluating the effects of a brief motivational intervention for injured drinkers in the emergency department. J Stud Alcoho. 2001; 62(6).

7. Monti PM, Barnett NP, Colby SM, et al. Motivational interviewing versus feedback only in emergency care for young adult problem drinking. Addiction. 2007;102:1234-1243.

8. Spirito A, Monti P, Barnett N, et al. A randomized clinical trial of a brief motivational intervention for alcohol-positive adolescents treated in an emergency department. J Pediatr. 2004;145(3):396-402.