7. Project Summary/Abstract
Consistent with NIAAA’s expressed goal to understand sex differences in risk of problem alcohol use and
target mechanisms that contribute to known disparities within high-risk communities, the current proposal
seeks to examine the role of internal sources of minority stress (i.e., stress unique to those from marginalized
communities) in potentiating heavy alcohol use, particularly among female and male bisexual/bi+ individuals.
Prior work has focused almost exclusively on sources of minority stress among those who already identify as
lesbian, gay, or bisexual. The proposed project seeks to examine physiological and psychological mechanisms
that account for consumption among adults who report uncertainty about their sexual orientation, or sexual
identity uncertainty (SIU). Uncertainty-identity theory suggests that when someone feels uncertain about a core
aspect of their identity, they are motivated to reduce resulting psychological distress, which can account for
increased alcohol consumption. No study, to date, has used an experimental design to examine physiological
stress responses to ethanol consumption following exposure to internal sources of minority stress. The
proposed work will test for differences in consumption and alleviation of distress based, in part, on participants’
physiological stress responses and the pharmacological effects of ethanol. This application proposes to recruit
200 cisgender participants with varying levels of SIU and uses a 3 x 2 x 5 mixed-factorial design. Participants
will be randomly assigned to give one of three speeches, as part of an adapted Trier Social Stressor Test
(TSST): (a) Relevant Proximal Stressor-TSST: development of their sexuality, including any feelings of
uncertainty; (b) Irrelevant Proximal Stressor-TSST: development of their gender identity, including any feelings
of uncertainty; or (c) Control-TSST: a recent book, movie, or TV show. Participants will then engage in a 35-
minute ad libitum taste-test (ethanol, placebo). Project design includes: (a) a baseline survey and (b)
experimental lab session that measures (i) alcohol consumption and 5 assessments of: (ii) breath alcohol
concentration, (iii) salivary stress hormones, (iv) heart rate, (v) blood pressure, (vi) psychological distress, and
(vii) perceived intoxication. Participants’ SIU and biological sex will alter the effect of condition on consumption.
Indirect effects are expected, such that exposure to relevant internal sources of minority stress is expected to
increase stress responses, which will account for drinking amount among those with higher SIU. We will also
determine the extent to which physiological stress-dampening effects and perceived intoxication account for
reductions in distress following drinking, depending on participant sex, whether beverages contain ethanol (or
not), and positive beliefs about alcohol’s effects. Results will inform interventions that target physiological and
psychological processes, especially those reinforcing use following exposure to internalized minority stressors.