Content warning: This article discusses sexual assault and trauma.

If you do a cursory Google search of “sexual assault and drinking,” you’ll find countless articles stating the fact that drinking puts you at higher risk for sexual assault. This is not one of those articles. As one study succinctly states: “[The survivor] is in no way responsible for the assault. The perpetrators are legally and morally responsible for their behavior.”

The relationship between drinking and sexual assault is nuanced and insidious. Studies show that at least one-half of all violent crimes involve alcohol consumption by the perpetrator, the victim, or both. In order to analyze this relationship, context is crucial; more than half of female victims of rape reported being raped by an intimate partner. In common speak, this means that men are raping their wives and girlfriends.

So, what’s the true force behind these crimes? In a phrase: The perpetuation of misogyny, said Molly Boeder Harris, founder and executive director of the Breathe Network.

“One more time for the people in the back: Drinking does not cause sexual assault. Male entitlement causes sexual assault.”

“People who are not susceptible to sexually assaulting another person are not going to suddenly become a rapist when they are drunk. This is not how it works,” Boeder Harris says. “There are beliefs that have been well ingrained about entitlement, power, control, and dominance in the psyche of someone who rapes another human.”

One more time for the people in the back: Drinking does not cause sexual assault. Male entitlement causes sexual assault.

“It is critical that we reinforce the message that sexual assaults are crimes, regardless of the involvement of alcohol,” says Dr. George F. Koob, Director of the National Institute on Alcohol Abuse and Alcoholism.

What becomes interesting, however, is the relationship between sexual assault and drinking after the incident. Thirteen percent of American women have been raped, and 31 percent of rape victims will develop post-traumatic stress disorder (PTSD). Therefore, approximately 3.8 million female survivors of rape have PTSD stemming from the traumatic event.

PTSD forces the body into a perpetual state of fight, flight, or freeze; in a sense, it’s living in a body that’s constantly under attack. Symptoms may include nightmares, flashbacks, depression, anxiety, and heightened reactions. When someone is navigating PTSD’s neverending funhouse of horrors, they’re reliving their trauma every day. For countless people, the easiest way to quiet those symptoms is by reaching for the bottle. In fact, approximately 50 percent of people seeking treatment for substance use disorder have a co-occurring diagnosis of PTSD.

“If you are a person whose traumatic experiences have left your brain in a constant state of hyperarousal, then it makes sense that you might rely on a substance that calms the central nervous system,” says Houser.

“If you are a person whose traumatic experiences have left your brain in a constant state of hyperarousal, then it makes sense that you might rely on a substance that calms the central nervous system,” says Kristen Houser, spokesperson of the National Sexual Violence Resource Center.

Another common symptom of PTSD is disassociation, which is characterized by a person disconnecting from their thoughts or feelings. If a person is constantly battling against traumatic memories, sometimes the only way they can cope is to periodically check out. Those who struggle with disassociation may gravitate towards a stimulant, such as cocaine or methamphetamine.

This can make sobriety particularly trying for those dealing with PTSD. When first getting sober, victims with co-occurring PTSD may experience increased symptoms, such as memories of the trauma, hyperarousal, anxiety, or depressed mood.

Heightened reactions and general emotional misery (also known as ‘hyperkatifeia’) is common in early sobriety from alcohol,” Koob says. “For those with PTSD, the combination of alcohol cessation-related hyperkatifeia and the underlying neurological changes in PTSD can exacerbate the emotional pain and make it harder to avoid relapse.”

“A survivor of sexual assault doesn’t need to walk into a church basement and hear that they’re powerless (especially by a circle of men); they’ve felt powerless since the moment their perpetrator changed the course of their life.”

This begs the question: What are some of the most effective treatments for those with alcohol use disorder who have suffered sexual assault?

“Traditional substance abuse treatment programs have only focused on the substance use behavior, and not on the underlying trauma,” Houser says. “It’s just not optimal for long-term sobriety.”

In a way, using and recovery is the inverse of Leo Tolstoy’s famous quote: “Happy families are all alike; every unhappy family is unhappy in its own way.” Every person with an addiction has experienced the deep shame, pain, and guilt that fuels substance use; what varies is the road to recovery. If you’ve been sexually assaulted, finding a recovery community that is trauma-informed is crucial.

“Trauma is a body living in a stuck survival state, and the substances help to diffuse the pain associated with states and memories and feelings and sensations we are trying to overcome,” Boeder Harris says. “Healing comes from learning to slowly and gently feel those states, those changes in our body, the sensations and emotions and memories, and successfully being able to work with and through and beyond them.”

A survivor of sexual assault doesn’t need to walk into a church basement and hear that they’re powerless (especially by a circle of men); they’ve felt powerless since the moment their perpetrator changed the course of their life. Instead, a survivor of sexual assault must feel worthy of treatment and must regain a sense of control in a life that has been dominated by the grip of trauma.

On the surface, the prevalence of alcohol in sexual assault and the use of alcohol to cope with the aftermath of sexual assault may seem unrelated. However, these two epidemics are both rooted in society’s lack of respect for women.

“Nevertheless, a woman is more likely to be raped than diagnosed with breast cancer in her lifetime.”

When a woman is raped while intoxicated, she is blamed for the incident — why did she drink so much? Why did she dress like that? Meanwhile, a man groping a woman can be casually waved off, because “boys will be boys.” Therefore, women not only deal with the trauma of sexual assault but the trauma of people repeatedly questioning the nature of the incident. When a woman is diagnosed with breast cancer, nobody claims that she asked for it. Nevertheless, a woman is more likely to be raped than diagnosed with breast cancer in her lifetime.

In the aftermath of sexual assault, a woman is left with shame — one of the most common emotions experienced by someone with alcohol use disorder. So she drinks. She drinks to forget the incident that literally altered her brain. She drinks to calm her perpetually alarming nervous system. She drinks to grieve the person she used to be. And then she drinks to deal with the shame of drinking to deal with the shame.

Until the entangled triangle of alcohol, sexual assault, and misogyny can be untangled, women are left to drink away their fears  — or at least try. If you’ve ever tried to outdrink your demons, you know it can’t be done. And until recovery circles embrace the fact that so many women drink to cope with the incessant terror of PTSD, countless survivors of sexual assault will continue to unsuccessfully chase down sobriety.

If you’ve experienced sexual violence and are in need of support, call the RAINN Sexual Assault Hotline at 1-800-656-HOPE (4673).