Substance use, including alcohol, has been repeatedly identified as a risk factor for sexual behavior among young people. Young people who consume alcohol are seven times more likely to engage in risky sexual behaviors than those who do not. Alcohol use is also often associated with sexual experiences that lead to risky behaviors (e.g., lack of or inconsistent use of condoms). Compared with non-drinkers, alcohol users may differ significantly in their plans to adopt safer sex practices. In addition, risk perception, which contributes to motivation to engage in preventive behaviors, is lower among heavy drinkers, and individuals who perceive less risk are consequently less motivated to avoid it (Harkabus, Harman & Puntenney, 2012). 

Sexual intercourse that occurs when one or both partners are under the influence of substances is more likely to be unplanned and therefore less likely to involve condom use. This indicator, focused on the respondent, does not reflect the number of sexual encounters while under the influence of substances, but rather the number of people who have had sexual encounters while under the influence of substances, since the same study may include people who have had sexual intercourse with each other.

Substance use is associated with early sexual initiation. Similarly, sexual activity while under the influence of alcohol or other drugs is associated with a lower likelihood of condom use and a higher likelihood of sexual violence (Shneyderman & Schwartz, 2012).

Alcohol use is common among university students. Although most are light to moderate drinkers, many students engage in problematic or heavy drinking occasionally or frequently. However, both light to moderate and heavy drinking are thought to decrease the likelihood of condom use and increase the likelihood of having multiple or casual partners (Kaly, Heesacker & Frost, 2002; Grello, Welsh & Harper, 2006). 

Data from other studies suggest curious facts about a relationship between alcohol use and university students' adherence to preventive practices, as well as the influence of alcohol intervention programs on condom use or non-use, or on having or not having sex with multiple partners. For example, Dermen & Thomas, acknowledging that their results differ from those of other studies, found in their study of university students in the Buffalo metropolitan area (New York State) that interventions focused on alcohol use had no effect on risky sexual behaviors, suggesting that alcohol use is irrelevant to decisions about whether or not to use condoms and whether or not to have sex with multiple partners (Dermen & Thomas, 2011).

For their part, Abbey et al. found in a study of university students that "the strongest predictor of condom use when intoxicated is condom use when sober" (Abbey, Parkhill, Buck & Saenz, 2007). Consistent with this finding, Leigh et al (2008), in a study also of university students, found that drinking before sex did not reduce the likelihood of condom use. On the contrary, individuals were consistent in their condom use or non-use, regardless of alcohol consumption and quantity.

For Cooper, the evidence suggests that alcohol use among young university students is more related to having multiple or casual partners than to reducing the likelihood of condom use (Cooper, 2012). Neal & Fromme (2007) suggest that alcohol use may have an acute effect on risky sexual behavior among light drinkers, but not among heavier drinkers.

Pombo & Sampaio point out that, although gender differences in alcohol use are usually recognized, with men having higher levels of consumption than women, recent European epidemiological data, with special attention to Portugal, indicate a convergence in consumption between the two sexes. Regarding the type of drink most commonly consumed by young university students, the authors report 20% wine, 38% beer, 63.6% spirits (shots), and 50.4% alcoholic juices. Regarding patterns of consumption, the authors mention that 85.6% of respondents reported drinking only at night, 60.3% only at parties, 66.7% usually drink in groups, 32.5% only on weekends, 15.9% associate alcohol consumption with other psychoactive substances, and 69.7% of respondents reported a history of binge drinking.

This pattern of alcohol use among young university students, which the authors consider "common and normative in adolescence," is known to be associated with the occurrence of risky sexual behavior (Pombo & Sampaio, 2010).

- Avaliar os níveis de risco relativos ao consumo de álcool e outras substâncias psicoativas (policonsumos), em diferentes contextos e ao longo do ciclo vital.

- Perceber a influência do consumo de substâncias sobre os comportamentos sexuais de risco (não uso do preservativo; parceiros múltiplos e ocasionais).

- Implementar as intervenções breves em função das necessidades identificadas e adaptados aos diferentes contextos.

- Avaliar o efeito das intervenções breves na redução do consumo nocivo de álcool e outras substâncias psicoativas.

- Perceber a influência do consumo de substâncias sobre os comportamentos sexuais de proteção.

Escola Superior de Enfermagem de Coimbra

Centro de Saúde de Celas – Centro de Atendimento de Jovens (CAJ)

UCC Celas

Abbey, A., Parkhill, M. R., Buck, P. O. & Saenz, C. (2007). Condom use with a casual partner: What distinguishes college students’ use when intoxicated? Psychology of Addictive Behaviors; 21: 76-83.

Cooper, M. L. (2002). Alcohol use and risky sexual behavior among college students and youth: Evaluating the evidence. Jounal of Studies on Alcohol. Supplement nº 14: 101-117.

Dermen, K. H. & Thomas, S. N. (2011). Randomized controlled trial of brief interventions to reduce college students' drinking and risky sex. Psychol Addict Behav; 25 (4): 583-94. doi: 10.1037/a0025472.

Grello, C. M., Welsh, D. P. & Harper, M. S. (2006). No string attached: The nature of casual sex in college students. The Journal of Sex Research; 43:255-267

Harkabus, L. C., Harman, J. J. & Puntenney, J. M. (2012). Condom accessibility: The moderating effects of alcohol use and erotophobia in the information-motivation-behavioral skills model. Health Promotion Practice. Publicação online. doi: 10.1177/1524839912465420.

Kaly, P. W., Heesacker, M. & Frost, H. M. (2002). Collegiate alcohol use and high-risk sexual behavior: A literature review. Journal of College Student Development; 43: 838-850.

Leigh, B. C., Vanslyke, J. G., Hoppe, M. J., Rainey, D. T. Morrison, D. M. & Gillmore, M.R. (2008). Drinking and condom use: Results from an event-based daily diary. AIDS and Behavior; 12: 104-112 [Publimed: 17333311].

Neal, D. J. & Fromme, K. (2007). Event-level covariation of alcohol intoxication and behavioral risks during the first year of college. Journal of Consulting and Clinical Psychology; 75: 294-306. [PubMed: 20147689].

Pombo, S. & Sampaio, D. (2010). Depois da embriaguez vem a ressaca: Uma perspectiva sobre o consumo de álcool nos jovens. Acta Med. Port; 23: 973-982. 

Shneyderman, Y. & Schwartz, S. J. (2012). Contextual and intrapersonal predictors of adolescent risky sexual behavior and outcomes. Health Educ. Behav. doi: 10.1177/1090198112447800.

WHO - World Health Organization (2004). National AIDS programmes – A guide to indicators for monitoring and evaluating national HIV/AIDS prevention programs for young people. Geneva