# Alcohol and "Heat of the Moment" Sexual Decision Making among MSM: Identifying Mechanisms of Sexual Risk and Promoting Behavior Change Through Brief Intervention

> **NIH NIH R01** · BOSTON UNIVERSITY (CHARLES RIVER CAMPUS) · 2024 · $691,154

## Abstract

PROJECT SUMMARY/ABSTRACT
This application is in response to two objectives of RFA-AA-21-016: HIV Prevention and Alcohol to translate
basic behavioral science findings about alcohol’s effects on sexual decision-making to 1). Test an intervention
designed to address sexual decision-making in the “heat-of-the-moment” (i.e., when intoxicated and sexually
aroused), and 2). Extend laboratory research to test cognitive and motivational within-person mechanisms
underlying alcohol and arousal effects on sexual decision-making in the natural environment. The application is
informed by our previous alcohol challenge laboratory research on factors contributing to CAI among MSM.
This research showed that intoxication was associated with heightened sexual arousal and increased CAI
intentions. Consistent with dual process theories, intoxication and arousal were associated with a shift in
decision-making process characterized by an increased role of sexual reward motivation relative to condom
use motivation and a corresponding decrease in the role of executive functioning. This pattern suggests that
prevention interventions may be effective in reducing CAI by targeting strategies that enhance condom use
motivation and reduce the reliance on effortful / controlled processing in the “heat-of-the-moment.” We piloted
an intervention that integrates motivational interviewing, personalized cognitive counseling, and text messaging
that decreased alcohol consumption and CAI in MSM. The intervention is designed, in part, to foster increased
condom-related planning and increase the use of implementation scripts to foster use of condoms in the “heat-
of-the-moment.” In AIM 1, we extend the pilot work on the intervention to a larger sample and an intensive
longitudinal design comprised of 3-weeks of experience sampling method (ESM) pre- and post- intervention to
test the intervention’s mechanisms of action. Specifically, we hypothesize that A. the intervention will be
associated with reduced alcohol intoxication and CAI, B. the intervention will reduce within-person associations
of intoxication and arousal with CAI, and C. intoxication and condom-related planning will mediate associations
between intervention condition and CAI at 4-month follow-up. Of particular importance is hypothesis B, which
tests whether the intervention affects sexual decision-making in the “heat-of-the-moment” when compelling
cues are prominent. Aim 2 extends to the natural environment our laboratory research to test dual-process
theory derived mechanisms linking intoxication, arousal, and CAI. Here, we test if sexual delay discounting and
working memory mediate, within-person, associations of intoxication and arousal with CAI and if changes in
these effects underlie the intervention effects during the 3-week post-intervention period. The proposed study
will advance understanding of within-person processes affecting sexual decision-making in the “heat-of-the-
moment” when drive for immediate gratific...

## Key facts

- **NIH application ID:** 10837102
- **Project number:** 5R01AA030461-03
- **Recipient organization:** BOSTON UNIVERSITY (CHARLES RIVER CAMPUS)
- **Principal Investigator:** STEPHEN A MAISTO
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $691,154
- **Award type:** 5
- **Project period:** 2022-08-15 → 2027-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10837102

## Citation

> US National Institutes of Health, RePORTER application 10837102, Alcohol and "Heat of the Moment" Sexual Decision Making among MSM: Identifying Mechanisms of Sexual Risk and Promoting Behavior Change Through Brief Intervention (5R01AA030461-03). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10837102. Licensed CC0.

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