The primary aim of this proposal is to develop and test the efficacy of a cognitive behavioral treatment (CBT) for the co-occurrence of alcohol use disorders (AUD) and sexual-risk taking behaviors among men-who-have-sex-with men (MSM). This proposal will build on empirical research demonstrating the effectiveness of current CBT for AUD and HIV prevention, and recommended strategies to improve CBT by providing more individualized and broad focused interventions. Cognitive Behavioral Risk Reduction Treatment (CBRRT) will address motivational factors, teach skills to cope with proximal risk antecedents, and teach skills to cope with underlying problems that serve to maintain AUD and sexual-risk taking behaviors. Three types of underlying problems will be addressed: sensation seeking, gay identity issues, and psychological distress. A secondary aim of this proposal is to examine moderators and mediators of CBRRT. Specifically, the proposal will test whether MSM with higher levels of underlying problems or higher levels of baseline risky behaviors will differentially benefit from CBRRT. In addition, the proposal will test whether changes in CBT mediators (e.g., self-efficacy) or underlying problems mediate the effects of CBRRT on outcomes. In order to accomplish these aims, a randomized clinical trial will be conducted. Two hundred and forty seronegative MSM seeking treatment for AUD and sexual risk-taking behaviors will be recruited into the study and assessed. Subjects will be randomly assigned to two intervention conditions: CBRRT or a control treatment consisting of alcohol skills treatment. Each treatment will consist of 12 weekly individual psychotherapy sessions. Observation and ratings of treatment sessions (via videotape) and weekly supervision will be used to monitor and document treatment delivery. Subjects will be assessed at baseline, end of treatment, and at three, six and 12 months following treatment. Biological and collateral verification of self-reported alcohol and drug use will be conducted. The primary outcomes measured will be: the number of unprotected anal intercourse acts with a partner of positive or unknown HIV status and the number of drinks per possible drinking day.
