Sexual consent is a foundational aspect of sexual encounters as it distinguishes sexual assault from consensual sex. Despite alcohol-involved sexual assault being a serious public health issue, many college students report engaging in "consensual drunk sex." Thus, understanding how college students determine consent to alcohol-involved sex is essential. We explored college students' perceptions of consensual alcohol-involved sexual encounters, focusing on how they determine and communicate consent to sex after having consumed alcohol. We conducted 30 qualitative interviews with college students about their alcohol-involved sexual experiences, assessing how they communicated consent and determined alcohol-involved sex was consensual. Interviews were transcribed and analyzed using reflective thematic analysis. We found five sequential, process-oriented themes: (1) presence in alcohol-intensive environments suggests "pre-consent," (2) alcohol-oriented socializing is an "initial consent" cue, (3) leaving alcohol-intensive environments suggest consent, (4) communicating consent immediately prior to sexual behavior is necessary, and (5) reflecting on and evaluating the encounter when sober helps determine consent, and an additional sixth theme reflecting participants' perceptions of risk associated with alcohol-involved sex. Our findings suggest college students rely on a range of cues to determine consent to alcohol-involved sex stemming from when they first meet in alcohol-intensive environments to when they are sober and engage in reflection. These cues underscore the complexities in consent communication in general, specifically highlighting further nuance when considering consent to alcohol-involved sexual behavior. Health promotion and sexual assault prevention educators should continue to incorporate consent into their initiatives, remaining attentive to the complexities and nuances inherent in consent.
