"Becoming Bold": Alcohol use and sexual exploration among Black and Latino young men who have sex with men (YMSM)

Abstract

Alcohol use is correlated with unprotected sex, which may place YMSM who use alcohol with sex at increased risk for contracting HIV. However, little is known about how this link develops. This study used qualitative interviews to explore how alcohol became associated with sex and sexual risk among YMSM. We purposively sampled 20 Black and 20 Latino YMSM (N=40), ages 21–24, who used substances (alcohol, marijuana, and crystal methamphetamine) with sex. Interviews focused on participants’ personal histories to trace how these associations developed for each individual. Drawing on sexual script, emotion regulation, and alcohol expectancy theories, analyses followed a modified grounded theory approach. Participants stated that alcohol enabled them to engage in sexual behaviors with men that they wanted to try, allowing them to be more “bold,” overcome stigma about homosexuality, and feel increased comfort with their sexual desires and identities. The use of alcohol during sex was helpful to some of the participants, but could also lead to sexual risk behaviors. Intervention programs seeking to reduce alcohol misuse and sexual risk should take into account how YMSM conceptualize associations between alcohol and sex. These programs may be more effective if they provide support for sexual identity exploration.

Introduction

Alcohol use is common among young men who have sex with men (YMSM) across different ethnic groups and regions in the U.S (Thiede et al., 2003) and can lead to drinking problems (Boehmer, Miao, Linkletter, & Clark, 2012; Hughes & Eliason, 2002; White & Jackson, 2004–2005; Wong, Kipke, & Weiss, 2008). YMSM report more alcohol and drug related problems compared to heterosexual young adults (Reed, Prado, Matsumoto, & Amaro, 2010), in addition to initiating alcohol use at a younger age (Corliss, Rosario, Wypij, Fisher, & Austin, 2008). Heavy/frequent alcohol use is correlated with having more sexual partners and more sex among YMSM (Greenwood et al., 2001; Rotheram-Borus et al., 1994). Further, alcohol use is well known as a contributor to sexual risk behavior among young adults in general (Bellis & Hughes, 2004; Colemon & Cater, 2005) and among YMSM specifically (Celentano et al., 2006; Ruiz, Facer, & Sun, 1998; Celentano et al., 2006; Seage et al., 1998).

Unprotected sex between YMSM is particularly concerning because they are at disproportionately greater risk of HIV infection, accounting for half of all HIV infections among adolescents and emerging adults (Centers for Disease Control and Prevention [CDC], 2009). A study of 3,492 15–22 year old MSM found higher rates of HIV infection among Blacks (14.1%) and Latinos (6.9%) compared to White (3.3%) YMSM (Valleroy et al., 2000), and more recent research has found that these HIV infection disparities continue among these populations (CDC, 2012a,b; Hall et al., 2007). Alcohol is the most commonly used substance among YMSM (Celentano et al., 2006), in addition to being the substance that Black and Latino YMSM themselves associate with sex most often (Mutchler et al., 2011). Despite calls for more research using theoretically-driven and contextual approaches to the topic (Eisenberg & Wechsler, 2003; Woolf & Maisto, 2009), no research that we are aware of has examined the actual processes through which Black and Latino YMSM begin to associate alcohol with sex or sexual risk.

The relationship between alcohol use and non-condom use is particularly complex and nuanced for YMSM (Mustanski, 2008; Seage et al., 1998; Woolf & Maisto, 2009). Recent quantitative research with YMSM found that the relationship between alcohol use and sexual risk was mediated by age and was stronger for older MSM compared to YMSM (Mustanki, 2008), and that sensation seeking moderates the relationship between alcohol use and sexual risk among YMSM (Newcomb, Clerkin, & Mustankski, 2011). One study of 508 YMSM, mostly White (77.6%), found that alcohol use is associated with unprotected sex with casual (but not primary) sexual partners (Seage et al., 1998). Very little is known about the processes through which alcohol and sex become linked among Black and Latino YMSM. Therefore, qualitative research is warranted to shed new light on the roles that alcohol actually plays in their sexual lives.

It is crucial to understand the social contexts in which substance use occurs (Zinberg, 1984) and particularly for Black and Latino YMSM. For example, alcohol use enables sexual minorities to transcend the constrictions of gender norms (Caceres & Cortinas, 1996; Parsons et al., 2004; Peralta, 2008). Some Latino patrons of gay bars report using alcohol to enable themselves to more freely transgress norms and expectations for male sexualities (Caceres & Cortinas, 1996). Similarly, some adult MSM draw on sexual scripts in which alcohol enables them to more comfortably engage in stigmatized behaviors, such as receptive anal sex (Parsons et al., 2004). Peralta (2008) found that both gay and heterosexual young adults use alcohol to engage in “inappropriate” displays of gender, but also found that the “alcohol excuse” can reaffirm normative gender roles. Findings such as these underscore the importance of analyzing social contexts and identities in relation to alcohol use and sex. Family, culture, media, and peer influences on alcohol use among young adults are also common (Andrews, Tildesly, Hops, & Li., 2002; Maxwell, 2002; Smith & Goldman, 1994; White & Jackson, 2004–2005).

Like other young adults, Black and Latino YMSM are by definition in a period of their lives known as emerging adulthood (Arnett, 2004). This period spanning the ages of 18–26 is characterized by a focus on self-discovery, experimentation, and an increasing reliance on friendships with peers. For many young adults, this period may involve experimenting with substances, sex, and social identities (Arnett, 2004) involving heterogeneous trajectories of alcohol use (Hatzenbuehler, Corbin, & Fromme, 2008; Maggs & Schulenberg, 2004–2005; White & Jackson, 2004–2005; Coleman & Cater, 2005), a pattern that has also been observed among YMSM (Wong et al., 2008). Black or Latino YMSM in particular may experience additional stress related to experiences of racial/ethnic discrimination or stigma (Diaz, Peterson, & Choi, 2008) further increasing their chances of misusing alcohol especially if they come from a lower socio-economic background (Zemore, Karriker-Jeffe, Keithly, & Mulia, 2011). Black and Latino YMSM may also be exposed to contradictory scripts for substance use, sex, and safer sex within gay and bisexual communities and also between racial/ethnic and sexual communities in which they live (Mutchler, 2000a; Diaz et al., 2008).

The use of alcohol for coping with emotions, such as overcoming fear of rejection from a potential sexual partner is also common among young adults (Abrahamson, 2004; Lewis et al., 2008). YMSM may face additional sources of anxiety; for example, heterosexism in mainstream institutions often precludes them from learning about the “nuts and bolts” of sex with men, particularly anal sex, before they begin having sex (Mutchler, 2000a; Kubicek, Beyer, Weiss, Iverson, & Kipke, 2009). Although research suggests that young lesbian, gay, bisexual, and transgender (LGBT) individuals may experience less stigma and report less alcohol use compared to previous LGBT generations (Crosby, Stall, Paul & Barrett, 1998; Savin-Williams, 2005), homosexuality remains stigmatized, and some LGBT young adults still resort to isolating (McDermott et al., 2008) or self-destructive methods to cope with shame induced by homophobia, including sexual risk and substance misuse (Wright & Perry, 2006). In a study of a random representative sample of university students (N=998), gay, lesbian, and bisexual students were more likely to report more frequent negative consequences of their alcohol and drug use compared to their heterosexual peers (Reed et al., 2010). Although it is likely that Black and Latino YMSM use alcohol in similar ways compared to other young adults with respect to easing social and sexual interactions and transgressing social norms, we expect to find that they also may use it to overcome stigmatized sexual identities as they seek to explore sex with other men during emerging adulthood (Hatzenbuehler et al., 2008).

Our data provide unique opportunities to explore how sexual identification and exploration processes may influence sexual activities, sexual risk and alcohol use among Black and Latino YMSM. Our approach to the design of this study was guided by sexual script theory – the view that sexuality is guided by internalized narratives containing the expectations, assumptions and behavioral patterns associated with sexual behaviors. Sexual scripts function at three levels: cultural, interpersonal, and intrapsychic (Simon & Gagnon, 1986). Cultural scripts include instructions that guide sexual behaviors in general; such scripts may also operate at the sub-cultural level for members of sub-populations, such as Black and Latino YMSM (Plante, 2006). Interpersonal scripts account for the actual patterns of interaction in which individuals engage in everyday sexual activities. At the intrapsychic level, alcohol-based sexual scripts may embody individual desires and fantasies for sexual conduct as well as individual reflections on actual or imagined sexual behaviors. Sexual scripts may also operate at all three levels simultaneously. However, there may be contradictions between different scripts for alcohol and sex that must be negotiated by sexual actors (Mutchler, 2000a).

As suggested by the literature on alcohol use and sexual disinhibition among gay men, individuals may use alcohol as a tool to help them engage in sexual activities they want to do but might otherwise feel uncomfortable doing (Stall, McKusick, Wiley, Coates, & Ostrow, 1986). Alcohol expectancy theory suggests that individuals know that alcohol will lower their inhibitions and that they may purposefully use it to engage in sexual activities they desire (Booth & Hasking, 2009; MacAndrew & Edgerton, 1969; George & Stoner, 2000); this process can also allow for unintentional or intentional behaviors such as sex without condoms to occur (Aguinaldo & Meyers, 2008). Research conducted with 907 adolescents and young adults who had consumed alcohol (Dermen et al., 1998) found that respondents who expected alcohol to increase their sexual risk were more likely to report risk taking behaviors.

Consistent with the assumptions in alcohol expectancy theory, emotion regulation theory accounts for the diverse strategies by which individuals down-regulate emotions they dislike or up-regulate emotions they want to feel (Gross & Thompson, 2006). For example, one might forestall a negative emotion by avoiding situations that trigger it; conversely, one could attempt to modify an emotion after it has already been triggered by using substances (Gross, 1998; Sher & Grekin, 2007). Like research on alcohol expectancies, emotion regulation theory has primarily been developed based on studies with the general (mainly heterosexual) population. We expect that many aspects of this research would be consistent with the experiences of Black and Latino YMSM; however, we also anticipate that YMSM would have additional motives for regulating emotions through alcohol use related to the prevalence of heterosexist stigma in American culture (Herek, 2009). For example, some research suggests that YMSM often regulate emotions related to internalized homophobia through the use of substances or other counterproductive behaviors (Rosario et al., 2006; Wright and Perry, 2006). No research that we are aware of has attempted to apply emotion regulation theory to an understanding of alcohol-based sexual scripts and YMSM.

The present study used qualitative interviews to explore how such alcohol-based sexual scripts may contribute to an understanding of connections between alcohol and sex among Black and Latino YMSM. The purpose is to better understand how these young men develop such associations in order to inform HIV prevention and alcohol misuse programs working with Black and Latino YMSM. Therefore, the guiding research questions were: how does sex become associated with alcohol use among Black and Latino YMSM, under what conditions does alcohol use lead to sexual risk, and how do these young men themselves understand these connections?

Methods

We conducted a primarily qualitative study between 2009 and 2010 to examine how substances become associated with sex and sexual risk among Latino and Black YMSM. Forty YMSM participated in in-depth individual interviews approximately 90–120 minutes in length (see Table 1), administered with a brief 6-page complementary quantitative survey including basic items on socio-demographics, sexual risk behaviors, and substance use during sex. The authors conducted all study interviews. We purposively sampled 20 Black and 20 Latino young men, ages 21–24, at gay-identified commercial venues and youth programs in Los Angeles County. Thirty five of the forty participants (87.5%) were recruited from gay identified clubs serving alcohol; three (7.5%) of the participants were recruited from a crystal methamphetamine prevention and recovery program for gay youth, and two (5%) of the participants were recruited at a gay pride event that happened during the study period.

Table 1.

Interview Guideline Sample Items

EARLY SCRIPTS
Substance Use Scripts
How did you first learn about drug and alcohol use?
Probes:
Description of the first experience they remember of using substance(s): ○When did it happen ○Where they were ○Who they were with ○Were there any sexual activities involved ○If so, did they use a condom
Sexual Scripts
How did you learn about having sex with men?
Probes:
Description of their first sexual experience with a man: ○Where they were ○Who they were with ○What sexual activities did they engage in ○Did they use condoms ○Were there any substances used How would that situation have been different with/without substance(s)?

The sample was stratified so that equal portions of each ethnic group met one of four criteria for self-reported lifetime experiences of sex under the influence of substances: (a) alcohol with sex 1–4 times (limited users), (b) alcohol with sex 5 or more times, (c) marijuana with sex 5 or more times, (d) crystal methamphetamine with sex 5 or more times. These categories represent the substances most commonly associated with sex among our study participants in previous research (citation blinded). We selected lifetime experiences with substance use and sex as our eligibility criteria (rather than most recent experiences) in order to address our primary research objective of exploring how substances initially became connected with sex. Participants only needed to meet the criteria for one of these groups to be eligible. Although not all of these categories required participants to have had sex under the influence of alcohol, we found that all of the participants who were enrolled in fact had at least one experience of sex with alcohol in their lives. It is important to consider the findings in the context of the sample we recruited, (i.e., primarily Black and Latino YMSM who attend gay identified venues that serve alcohol) because there may be some variation among Black and Latino YMSM who do not attend such venues.

The qualitative interviews utilized a semi-structured discussion guide that focused on participants’ personal histories to trace how associations between sex and alcohol had developed for each individual. We sought to understand how participants’ views of alcohol and sex evolved over time, as well as how, if at all, alcohol and sex came to be related to each other. In addition, interviews examined the social and cultural contexts of sexual experiences, and elicited detailed descriptions of experiences of sex with and without alcohol and other substances. Interviews were transcribed by a professional transcription service, and then reviewed by staff for accuracy. All names were replaced with pseudonyms.

Analyses followed a modified grounded theory approach, in which emergent themes were first identified, and then compared with existing research literature (Glaser & Strauss, 1967; Timmermans & Tavory, 2007). Once an initial set of interviews was transcribed, the investigators reviewed them to develop preliminary codes. NVivo software was utilized to facilitate the coding process, which initially consisted of “open coding,” (Strauss & Corbin, 1990), including basic codes such as “Sex-Drug Associations” and “Contexts of Use.” This was followed by the “axial coding” phase in which sub-themes such as “Initial Associations with Alcohol and Sex” and “How Alcohol Facilitated Exploration of Same-Sex Sexual Behavior” were identified.

Guided by grounded theory (Straus & Corbin, 1990), we followed an iterative process of analysis, reaching theoretical saturation once we found the same themes emerging repeatedly within the data. Grounded theory requires the researcher to approach the findings with an open mind, allowing themes to emerge from the data. Once themes have been identified, grounded theory allows the researcher to review the literature to identify existing theories that may help explain the findings. We found that different aspects of the sexual scripts we observed could be accounted for by several existing psychological constructs and theories. These include alcohol expectancy, alcohol myopia, and operant conditioning. Thus we have adopted an interdisciplinary approach, integrating the guiding sociological theoretical framework (sexual script theory) with psychological theories that provide explanations of the findings and suggest lines for further study. In this article we focus on the theories that most broadly account for the data presented (Sexual Script Theory and Emotion Regulation Theory).

The data analysis process was rigorous and systematic. Emerging categories were subjected to a process of member validation in which community stakeholders offered feedback to assess and establish credibility. Finally, we engaged in ‘selective’ or ‘targeted’ coding (in which two coders were used) to focus on the data relevant to our analysis. The authors discussed any discrepancies between coders, reconciling differences by consensus. We established inter-rater reliability for coding of key themes by using rates of agreement, with 80% as a baseline criterion for reliability. Consistent with qualitative research principles, we report the frequency of themes in categories such as “a few” or “many’ in order to roughly characterize the relevance of the theme to the overall sample (Mutchler & McDavitt, 2011; Strauss & Corbin, 1990; Parsons et al., 2004). Our analytic goal was to identify sexual scripts and learn how these scripts were developed, modified, reinforced and maintained. Thus we focused on participants’ expectations of sexual scenarios involving alcohol use and how those expectations had evolved during their adolescence and early adulthood.

Results

Forty individuals participated in the study, with a mean age of 22.4 (SD=1.24; range=21–24 years). Half of these participants identified as Latino and half identified as Black. Half also reported current enrollment in school (either part-time or full-time). Ninety-percent of the participants reported having stable housing. Most participants (85%) identified as gay or homosexual and 15% identified as bisexual. Despite the fact that two of the categories (marijuana use and crystal use) did not include sex under the influence of alcohol as an eligibility criterion, all participants had sex while under the influence of alcohol at least once in their lives. Of those having anal sex while feeling the effects of alcohol in the past 30 days, 42.1% reported unprotected anal sex. Additional sociodemographic and sexual history data are reported in Table 2.

Table 2.

Description of the Study Sample (n = 40)

Variables	Categories	n	mean /range/sd
Age		40	22.4/21–24, sd=1.24
Age at first sex with male		40	15.6/6–24, sd=3.64
		n	%
Race/ethnicity	Black	20	50
	Latino	20	50
Sexual identity*	Gay	34	85
	Bisexual	6	15
	Heterosexual	0	0
	Other	1	3
School status	In school	20	50
	Not in school	20	50
Education	Some High School	2	5
	High School Diploma	11	27.5
	GED	3	7.5
	Trade/Vocational Degree	2	5
	Some College	18	45
	College Degree	4	10
Current housing Status	Stable housing	36	90
	Homeless/shelter	4	10
Income (In the last 30 days, how much money did you get altogether? Please include money YOU got from all sources1. Please do not include money that your parents make, except for money they give you.)	Less than $500	14	35
	$500–999	11	27.5
	$1,000–1,499	4	10
	$1,500–1,999	4	10
	$2,000–2,999	4	10
	$3,000 or more	3	7.5
Sexual History	Ever had a male primary partner	37	87.5
	In the last 30 days, had anal sex with primary partner	19	45
	Ever had a casual male partner	39	95
	In the last 30 days, had anal sex with casual partner	20	50
Alcohol and Sexual behavior (past 30 days)	Anal intercourse	29	75
	Unprotected anal intercourse	18	45
	Used alcohol at least once	37	87.5
	**Anal sex while feeling the effects of alcohol	21	57
	***Of those having anal sex while feeling alcohol:	8	42.1
	Unprotected anal sex while feeling the effects of alcohol

¹Sources may include from work, gifts, tips, financial aid.

^*Total percentage sums to more than 100 because participants could select multiple sexual identities.

^**Total number does not equal 40 due to missing data from 3 participants

^***Total number does not equal 21 due to missing data from 2 participants

Nearly all participants reported that they viewed alcohol as being linked with sex (“like peanut butter and jelly, they just go hand in hand,” as one participant characterized the connection). They described a variety of ways in which this association developed, many of which involved exploring sex with men. Although for most the link initially developed through the influence of media, friends, and family, it was strengthened during later adolescence as young men began to experiment with sexual activity. Many reported that drinking prior to having sex with men diminished self-critical thoughts about being gay or bisexual. They stated that alcohol enabled them to engage in behaviors that they wanted to try, but that they would not otherwise have felt “bold” enough to carry out when sober. These activities included not only having sex with men, but also approaching men for dating, kissing men, and in some cases attending gay-identified venues such as bars and clubs. Additionally, alcohol was reported to diminish physical pain associated with receptive anal intercourse and increase sexual pleasure.

From the perspective of emotion regulation theory (Gross & Thompson, 2006), many participants also described sexual scripts and experiences that involved the use of alcohol to down-regulate uncomfortable affects. Specifically, they learned about and employed alcohol-based sexual scripts based on the assumption that alcohol can reduce feelings of anxiety or shame while also allowing them to be more confident or “bold” in seeking a sexual connection with another man.

Most participants viewed early sexual experiences with alcohol as valuable and satisfying opportunities to explore and affirm their sexuality. Some reported that as they became increasingly comfortable with approaching and relating to other men socially and sexually, both their discomfort and reliance on alcohol during sex decreased. However, many also felt concerned that alcohol could impair their ability to make safe choices regarding partners or risk behaviors. In contrast to the overall trend, a subset of the sample (limited users) reported less frequent overall use of alcohol with sex than the others, as well as feeling little or no discomfort initiating or exploring sex with men. The common themes below were found to be similar across both Black and Latino YMSM in this sample, with some nuanced differences in the initial alcohol scripts. Additional common themes included “How Alcohol Facilitated Exploration of Same-Sex Sexualities”, “Alcohol and Sexual Risk Behaviors”, and “Limiting Alcohol with Sex.”

Initial Associations with Alcohol and Sex

“It’s like Drinking Water.” Initially scripts for alcohol use (not necessarily with sex) developed through the influence of family, the media, and friends. Alcohol was frequently observed as being used during social gatherings, to increase pleasure and to regulate emotions, such as diminishing discomfort in social settings. In this quote, Lonnie describes a cultural script of viewing family members drinking alcohol at family gatherings. He states that these influences caused him to view the use of alcohol as “second nature” and compares it to “drinking water.”

Nine times out of ten, somebody in your family drinks and so you see it at family gatherings. You see it at home… I just thought it was the comfortable thing to do because its-- I don’t know, to me, it’s like second nature, I guess you would say kind of like drinking water. You see it done so you kind of fall into doing it.

~Lonnie, Latino, 23

Nearly all participants reported that they viewed alcohol as being linked with sex, such that a cultural script in which alcohol use during sex was seen as common and perhaps even necessary for sexual activities. This link was formed in some cases long before adolescence. Movies and television also laid the foundation for impressions that the receptive partner (typically a female character in films and television) would be easier to sexually engage when drunk.

It’s in the movies. It’s everywhere. Get her drunk and you will be fine, stuff like that. So, that’s how [alcohol] automatically links to sex.

~Leo, Black, 22

In addition to media sources, participants cited friends and family as important influences on the early association of alcohol with sex – even before participants ever had sex in most cases.

“Drunk sex is really good.” Participants described how they learned about alcohol-based sexual scripts from conversations suggesting that sex under the influence could be more relaxed, passionate, and better overall than sober sex. These conversations had a clear influence on the expectations of most of the young men we interviewed, although a few reported that they were initially skeptical as to whether alcohol would enhance sexual pleasure as much as they had heard. This was the case for Daniel, for whom direct experience later confirmed what he had heard through word-of-mouth, a cultural script that “drunk sex is really good.”

I knew it [sex under the influence of alcohol] was going to be good because I don’t know, it was either friends or family or somebody had told me about it. I just remember hearing people saying, “Drunk sex is good. Drunk sex is awesome.” …Then [after trying it] I was like, “No, drunk sex is really good. No wonder people have a glass of wine before bed.”

~Daniel, Latino, 22

Initial associations between alcohol and sex were, thus, most often formed early from multiple socializing sources and reinforced at the intrapsychic level through reflecting on direct experiences of interpersonal scripts for alcohol and sex. These early experiences led to the internalization of cultural scripts for sex and alcohol use in which the participants learned that the use of alcohol for sex was almost expected, and that “drunk sex is awesome.”

“Differences Between Black and Latino YMSM Alcohol Scripts”. There were a few differences in how Black participants described their initial exposure to alcohol when compared with Latinos, indicating the presence of nuanced variations in cultural scripts for alcohol use within different racial/ethnic communities. First, although both groups saw alcohol at family gatherings, several Latinos spoke about it as being a part of Mexican culture whereas none of the Blacks mentioned it as linked with being Black. As Paco, a 23 year-old Latino participant explained,

I am Mexican. [laugh] No… its not actually being generalistic…. I am not saying it’s just Mexican but a lot of it is. Every weekend they work their asses off all week and Friday comes and it’s like that in my family, and that’s been a common thing from everybody else that I talk to…

Another difference was that Black participants mentioned observing specific family members drinking alcohol (rather than the family as a whole) or having heavy drinkers and alcoholics in their family more often than Latinos would. Notably, we did not find differences in alcohol-based sexual scripts. In fact, we found that the characteristics and relative frequency of the scripts for use of alcohol with sex were remarkably similar between the two groups.

“Drunk Sex is More Passionate.” Participants also described how early influences of family, media, and friends, along with their own experiences, contributed to feeling that sex when drunk or buzzed was more “passionate” than sex without alcohol. For example, Lalo, a 24 year-old Latino participant, described feeling more “passionate” as one of the qualities he most liked about an experience when he and his first boyfriend rented a hotel room so that they could spend time together, drink, and have sex:

We were alone and had no one to bother us. And drinking, because when you have sex, it makes you feel better… I guess because you do it more passionately… you don’t care what’s going on, you are just doing it.

Lalo’s experience reflects the dominant cultural script that alcohol makes sex feel better, and depicts a process of conditioning in which scripts that link alcohol with sex are reinforced. As with many other participants, his positive experiences of enacting this script effectively reinforced a script that he had previously learned from other sources, such as family, friends and the media. Simultaneously, he points out that alcohol may facilitate “not caring” about what is going on, allowing individuals to do just “do it,” a view that corresponds to additional interrelated theories about the use of alcohol. First, the idea that individuals prioritize salient aspects of an experience while neglecting less salient aspects is consistent with alcohol myopia theory. In Lalo’s case this involved a focus on immediate gratification while implicitly disregarding the possible consequences of those activities. This quote also begins to illustrate a common theme that is consistent with emotion regulation theory, since he makes the link between using alcohol to purposefully regulate his feelings (to feel better and more passionate and not “care about what is going on”), while also being able to more fully enjoy a passionate sexual encounter with his partner.

How Alcohol Facilitated Exploration of Same-Sex Sexualities: “Becoming Bold”

An overall theme that emerged throughout the stories told by the young men in which they linked alcohol use and sex relates to the process of becoming more confident or “bold” in their abilities to explore sex and intimacy with other men. Several sub-themes were linked to this over-arching theme, including lowering inhibitions, reducing self-critical thoughts about their sexuality, increasing sexual exploration and social risk taking (approaching men for romantic interests), lowering fears of rejection, breaking gender expectations and overcoming stigma about homosexuality, using alcohol as an excuse to have sex with men, and diminishing the physical discomfort that may be associated with initial anal penetration. The link between alcohol and sex became more complex and nuanced as YMSM began to explore sex with men. This overall theme was consistent and similar in quality between Latino and Black participants.

“Becoming Bold: Let it Go and Let it Flow.” Many participants reported that drinking prior to having sex with men diminished self-critical thoughts about being gay or bisexual, especially when they were in the process of coming to terms with having same-sex desires. For example, certain religious influences that were internalized could lead to harsh feelings of homophobic self-condemnation during or after sexual activity with a man. These involved beliefs that one was “bad” for being gay, or “going to hell” for having sex with men along with attendant feelings of guilt or shame. Several young men reported that alcohol during sex diminished such concerns about judgment, or fears of adverse consequences for sexual exploration. It thus enabled them to embody aspects of themselves that they might otherwise feel needed to be hidden or eliminated. As Curtis explained, alcohol freed him from such negative culturally-based scripts for sex between men and enabled him to “let it go and let it flow:”

It was always taught… growing up… that being gay was a bad thing and going to church, you are going to hell… Maybe if I am drunk it will help me to cope with the right and wrong and stop giving a care about what people say and what people do. I was thinking about, “Oh, my god. Church. God.” All that go out the window when you are a little buzzed. You just let it go and let it flow.

~Curtis, Black, 24

Thus, for many participants, a key way in which alcohol became linked with sex was through its role in liberating them from judgmental beliefs that would interfere with intimacy, sexual fulfillment, or self-discovery through sexual exploration. This quote by Curtis demonstrates how he consciously drew upon the alcohol-based script that being drunk during sex would help him defend against internalized homophobia. Down-regulating feelings of shame and anxiety about being gay allowed Curtis to “let it flow” and enact his desires to have sex with men. For him, as for many others, alcohol served as an emotion regulating tool to facilitate sexual exploration. As Leo put it, alcohol “brings another side of you. It brings this person that you want to be, that you [otherwise] don’t put out.” Consistent with alcohol expectancy theory, participants often spoke about experiences in which alcohol enabled them to engage in behaviors that they wanted to try, but that they would otherwise have had difficulty carrying out. Many young men said of an early sexual event that although they wanted to be able to have the experience, “it wouldn’t have happened without drinking.” Alcohol also became linked with sex by diminishing other forms of discomfort that might have thwarted opportunities for sexual exploration, such as offering relief from fears of rejection. Respondents felt that, especially during initial efforts to reach out to other gay or bisexual men, drinking enabled them to more readily approach men for dating, sex, or talking; it also facilitated attending gay-identified venues such as clubs, bars, and gay pride events. In addition, alcohol allowed young men to initiate sex or kissing when they felt anxious about the response of the person with whom they were involved. The following quote illustrates an aspect of this common cluster of themes:

I would get nervous. I wouldn’t [kiss men] because they are going to get mad at me or something – like push me away if I would try. Yeah, I wouldn’t have done that sober… making the first move.

~Fabian, Black, 21

“I Was Drunk at the Time, so I’m Not Gay.” Alcohol also facilitated sexual exploration by providing an “alibi” to individuals, so that sex with men could be attributed to alcohol rather than to same-sex sexual or romantic attraction. This too was emphasized most often in early experiences of sexual exploration, prior to participants becoming more comfortable with their sexual and romantic desires. In these cases, sex with men could be explored without it carrying the implication that the individual engaging in sex might actually be gay or bisexual. Most of the participants who spoke about these types of experiences had since progressed toward greater self-acceptance, so that they could reflect retrospectively on their previous intrapsychic scripts for their use of alcohol as an “excuse” for having sex with men. This was the case for Marcus:

A lot of my earlier sexual experiences happened under the influence simply for the fact that I wasn’t comfortable with my sexuality… I was drunk and, “I don’t remember what happened the night before, so it’s okay. I am not gay!” That type of shit.

~Marcus, Black, 23

“It’s What You Really Wanted to Do Anyway.” Similarly, citing his own experiences and those of his partners, Gordon explained how using drinking as an “excuse” for having sex with men often obscured the initial motivations for drinking in the first place. Many participants emphasized that for young men who want to have sex with men but feel uncomfortable, alcohol can serve a useful role, insofar as it makes people “bold:”

People use liquor as an excuse all the time. So, they’re using – “It was the liquor, blame it on the liquor.” But I know that’s what you really wanted to do sober, but you’re just not bold enough to do it. So when you drink, you become somebody else. You want to be Mr. Bold!

~Gordon, Black, 23

Because Gordon held this view of sex with alcohol, he felt that providing alcohol to himself and his partner was a useful way to help them “loosen up,” transforming an intrapsychic script for sex into an interpersonal script about being “bold” during sex with other men. Gordon’s quote also exemplifies the common theme that these young men know about the script that “alcohol is an excuse for having sex”, but more importantly, that many of them have utilized alcohol with the conscious intention of facilitating sexual exploration. As Gordon states, many young men do not feel “bold” enough to explore their sexuality with another man, but they know they can drink and have an excuse to be somebody else, i.e., they can be a man who seeks sex with another man by relying on a defense against internalized stigma. Drinking also can serve the purpose of reinforcing who one really is by allowing one to inhabit particular roles and to experience a positive outcome, such as being “Mr. Bold.”

In addition, some of the other participants had been offered alcohol prior to sex, in order to decrease their anxiety, or render sex “more comfortable.” Several participants said that they appreciated the ways that this improved the experience of sex during initial explorations, providing satisfying opportunities to affirm their sexuality:

[Alcohol] made it easier to have sex with a guy because that was the first guy I ever had sex with too. So, I was still kind of ‘weirded out’ with the whole gay thing, the whole gay sex. So I am happy he brought [alcohol] over because it opened me up.

~Melvyn, Black, 21

“Sex Doesn’t Hurt as Much, and the Pleasure Comes Faster.” Participants also described how alcohol could diminish physical pain associated with receptive anal intercourse, especially the first times they tried it. Many reported that prior to trying receptive intercourse they had developed an expectation that it would be painful, based on what they heard from friends or partners. Few if any had received education about how to engage in anal sex in ways that could make it fully comfortable without the use of alcohol. The majority of them had learned that alcohol could limit both the sensation of pain that they anticipated, as well as the anxiety that might cause them to be physically “tense” while being penetrated during anal sex. This meant that one could more quickly reach the point of having a pleasurable and fulfilling experience. This positive outcome appeared to reinforce the association between alcohol and sex for some participants:

Daniel: The part that hurts, it doesn’t hurt so much when I am drinking. I don’t think about the pain and I am more able to take in-- I take the pain and the pleasure comes faster. Like when [your partner] barely enters, that hurts a lot because the ass is trying to push it out…

Interviewer: So, that part doesn’t hurt as much with alcohol?

Daniel: Yeah, that part doesn’t hurt as much or even if it does you are kind of just, “Go for it.” You are like, “Fuck it.” You don’t really care.

~Daniel, Latino, 22

Alcohol and Sexual Risk Behavior

“You Just Go for it.” Participants held a diverse range of views about the relationship between alcohol and sexual risk. Some felt that they could use condoms consistently while under the influence of alcohol; however the majority of participants expressed some degree of concern about the effects of alcohol on sexual risk, and many felt that it could impair their ability to make safe choices regarding sex partners or condom use. One of the main reasons participants reported that they had difficulty limiting sexual risk behavior when drinking was that alcohol made them feel less aware of what they were doing. This was a factor insofar as alcohol was seen as leading to greater impulsivity (“you just go for it”) and less concern about risks overall when drinking. For example, Lalo, a Latino 24 year-old, stated that sometimes when he is under the influence of alcohol he does not use condoms and engages in sexual activities he would not normally do if he were sober:

Lalo: I think that when you drink or you are under any influence—you just go for it. Probably do things you wouldn’t do if you are drinking or anything like that. But at least in my experience I think that’s what happens with me. I would do things that I wouldn’t do maybe if I was sober.

Interviewer: What kind of things?

Lalo: Maybe more sexual things or maybe for example, not using a condom because I guess when you are—when you haven’t been drinking you kind of think about it more and you use a condom. When you are drinking I guess, I care less.

“I Would Have Made a Bad Choice if I Were Drunk.” For nearly all participants, scripts for alcohol use with sex existed simultaneously with strong intentions to use condoms. In fact, many participants expressed concerns that alcohol use with sex would make them forget to use condoms in “the heat of the moment.” Lalo’s story also conforms to aspects of alcohol myopia theory, insofar as he is primarily attentive to immediate needs rather than thinking about health risks or long term consequences when he drinks. Significantly, none of the young men in this study expressed conscious desires to escape from the constraints of using condoms – a motive for sexual risk cited in prior research with gay and bisexual men (McKirnan et al., 2006). In fact, many cited the possibility of increased sexual risk behavior as a reason to limit their use of alcohol with sex. When asked how they had learned to be cautious about alcohol with sex, several reported times when they did not recall whether they had used a condom or not, and a few described experiences of waking up naked next to somebody and not remembering having had sex at all. Such experiences often had a strong impact on the young men, causing them to feel seriously concerned about the influence of alcohol on their health and well-being. Oscar, a Latino 24 year-old who had only limited experiences of sex on alcohol, reported an experience of this sort – one that caused him to become more cautious about drinking with sex later on. One of his biggest concerns afterward was his realization that he would have engaged in unprotected sex, if his partner had not brought out a condom:

Luckily for me he wasn’t as drunk as I was, and he still had some consciousness, because he is like, “Oh, yeah wait up, let me get a condom.” …Had it not been for that I think I would made a really bad choice because not even knowing who this guy is or whatever….I would have had unprotected sex.

Limiting Alcohol with Sex

“Cautionary Tales.” Many participants had taken steps to limit how much or how often they drank alcohol with sex, and a few had entirely stopped combining alcohol with sex. Often they did this out of a concern that alcohol could impair their ability to make safe choices regarding partners or risk behavior. This was particularly common among individuals who had more limited histories with use of substances other than alcohol. Many of them cited personal experiences or stories they had heard in which someone had sex they regretted as a result of drinking or using substances. Others became concerned after hearing about individuals who had been “taken advantage of” while under the influence of alcohol (or seeing it occur in movies). This larger cultural sexual script connecting alcohol use with risk provided a powerful motive for some young men to limit drinking with sex, illustrating how some participants were able to internalize alternative cultural alcohol-based scripts for sex while having relatively few interpersonal experiences with alcohol and sex. Participants often referred to such stories when explaining why they avoided drinking more than a specified amount prior to sex.

Ernest: I need to be sober so, for example, if the condom breaks I am going to be very protected.

Interviewer: How do you think you learned that?

Ernest: You hear stories or watch movies and you see people getting taken advantage of while they are drunk and “out of it.” …I’ve got my guard up very tight, and lately I haven’t been drinking as much.

~Ernest, Black, 21

“Alcohol is a Sexual Enhancement.” In contrast to the overall trend, a subset of the sample said they did not need to use alcohol in order to explore sex. Rather, these individuals reported using alcohol simply as an overall enhancement of the sexual experience, or that instances when alcohol and sex were combined resulted from happenstance rather than due to a desire to regulate emotional or physical discomfort. For example, some described situations in which they happened to be out at a club with their boyfriend, drinking alcohol together and later in the night having sex at home. These individuals tended to report less frequent overall use of alcohol with sex than the others.

“The Best Sex is Sober Sex” Some participants had decided that sex is better without any alcohol, since drinking impairs memory, and if a person is intoxicated, “how are you going to know if [the sex] is good or not?” Interestingly, participants who reported using alcohol with sex but did not use alcohol for sexual identity exploration also reported feeling little or no discomfort initiating or exploring sex with men. Some of these individuals felt that alcohol use was “for partying with friends,” but not for sex with romantic partners. Some reported that as they became increasingly comfortable with approaching and relating to other men socially and sexually, their reliance on alcohol during sex decreased. Thus, the presence or absence of alcohol became one marker that differentiated scripts for socializing in casual settings (partying, dancing, etc.) from scripts for more intimate connections with primary romantic partners, in which alcohol was viewed as unnecessary or even as an unwanted intrusion. For instance, those who preferred sober sex often cited the enhanced sense of closeness they felt without alcohol. This was explained well by Michael, who drew a distinction between casual sex and “making love,” which in his view should not be accompanied by drinking:

I felt in a way that we were making love and not just fucking because in a sense, if you are drinking, I don’t think you can really be making love.

~Michael, Black, 23

Discussion

This study is the first to explore the processes through which sex becomes associated with alcohol among Black and Latino YMSM. We found that alcohol-based sexual scripts were quotidian, and frequently reinforced in the many social and cultural contexts inhabited by our study participants. Such scripts as “It’s like Drinking Water”, “Drunk Sex is Really Good”, and “Drunk Sex is More Passionate” exemplify this pattern. However, young sexual minorities are also exposed to norms about alcohol use and sex within gay communities, since clubs and bars serving alcohol are often the main venues where they socialize with friends and where they can meet other gay men in person. Like other young adults, Black and Latino YMSM learn some lessons early and often, i.e., that alcohol and sex go together and also that alcohol seems to make sex better.

Our analyses also revealed a general theme with particular relevance for YMSM, namely that alcohol may allow them to become more “bold” as they seek to explore their sexualities as sexual minorities (e.g., “Let it Go and Let it Flow”). Although this theme is similar to scripts described by other young adults (Abrahamson, 2004), our participants frequently emphasized the particular ways in which becoming “bold” played a significant role in their process of self-discovery as gay or bisexual young men. In these scripts, alcohol played the part of assisting them to more easily approach men for intimacy, reduce emotional discomfort or anxiety about having sex with men (to enact a stigmatized sexual orientation), diminish physical pain that may be associated with having anal sex, and become more comfortable with their sexual identities over time. Heterosexuals, on the other hand, do not drink alcohol in order to “become” straight. The findings thus demonstrate that rather than simply causing sex to occur by lowering inhibitions, alcohol affords some sexual minority young men opportunities to have sexual experiences that they already yearn for but feel uncomfortable seeking without alcohol. In this manner, alcohol appears to help facilitate the process of sexual exploration for some YMSM.

As suggested by previous research with gay men (Aguinaldo & Myers, 2008), alcohol can also lead to unprotected sex and sexual risk behaviors (“You Just Go for it”). Many of the participants regretted instances in which they had not used condoms, and reported worrying a great deal afterward about the possible risk of HIV infection. Still, some in the limited user category, who had only used alcohol with sex a few times, reported that they were able to avoid such situations by implementing lessons learned about the possible downside of drinking alcohol (“Cautionary Tales”). Some felt that alcohol was not needed for sex but could be used to enhance the experience (“Alcohol as a Sexual Enhancement”). Some even felt that sex was better without alcohol (“The Best Sex is Sober Sex.”), and that alcohol-free sexual experiences could involve greater romantic intimacy than those that involved alcohol. Some of these individuals were able to explore their sexualities and feel “bold” by learning from their own or their peers’ experiences (rather than using alcohol to facilitate boldness).

The young men’s experiences invoked particular scripts for sex, such as the larger cultural scripts that “Alcohol Allows you to Have Sex,” “Alcohol and Sex go Hand in Hand,” and “Drunk Sex Equals Awesome Sex.” Black and Latino YMSM engage in sexual communities in unique ways and within particular social and cultural contexts that become exemplified in their experiences. For example, within the sub-cultural contexts in which Black and Latino YMSM grow up, the scripts are more specific, i.e., “Alcohol Makes you Bolder to Explore (Stigmatized) Sexualities.” These data also contain scripts that are relevant to their unique experiences, such as the use of alcohol to overcome internalized stigma about having sex with men and reducing anxiety and physical pain that some of them associated with having anal sex. The present study thus indicates that exploration of a marginalized sexual identity represents a distinct path through which the link between alcohol and sex is forged and strengthened among some Black and Latino YMSM.

In some respects, the participants in our study are no different from many others who use alcohol as a tool to facilitate romantic and sexual encounters (Bellis & Hughes, 2004; Kuntsche, Knibbe, Gmel, & Engels, 2006; Sumnall, Beynon, Conchie, Riley, & Cole, 2007; Abrahamson, 2004). YMSM share with other adolescents and young adults the learned association of sex and alcohol that develops through influences from many interconnected socializing agents, including family, friends, communities, and the media. Consistent with Peralta’s (2008) finding that alcohol enabled young adults to break gender norms and engage in behaviors that would normally be considered unacceptable for someone of their sex, we found alcohol could be used as an “excuse” for same-sex sexual activities, while also nullifying feelings of shame about being gay or bisexual. However, we also found that alcohol allows Black and Latino YMSM to become more bold and to explore their sexualities in order to become more comfortable with accepting their marginalized sexual identities.

The findings revealed important similarities and differences with sexual scripts described among other populations. Specifically, the “becoming bold” script bears similarities to scripts reported by some young heterosexual males, who rely on alcohol to regulate anxiety about approaching women for sex, but also to those of young women who sometimes use alcohol to regulate anxiety about dating and flirting with men (Abrahamson, 2004). Also like other young adults, Black and Latino YMSM learn about alcohol and sex during a period of emerging adulthood (Arnett, 2004), in which they are exploring their social identities and different social experiences (such as alcohol use), although our participants also must grapple with racism and heterosexism in their daily lives which may factor in to how they use alcohol with sex. However, we did not replicate findings with our sample from a qualitative study exploring how lesbians use alcohol during sex, i.e., that some avoided excessive drinking because it might prevent them from reflecting on and “processing” the events afterwards with their sexual partners (Parks, 1999). Consistent with other studies of gay and bisexual men, the participants in our study used alcohol to explore new possibilities for sex between men (Parsons et al., 2004). Like other sociological research on becoming a substance user (Becker, 1953), we found that “becoming bold” is a social process through which our participants explored their sexualities, connecting alcohol use to a deeper process of identification. Depth psychological and social psychological research into the process of individuation suggests how compelling the impulse toward self-discovery can and must be, especially for a marginalized group (Jung, 1954; Shibutani, 1986). The experiences of the young men profiled in this study reveal their determination to discover their identities and explore their sexualities in spite of strongly inhibitory internal and external forces of bias. Thus, although Peralta’s (2008) research on emerging adults indicates ways in which “alcohol allows you not to be yourself” at least temporarily, Peralta also found that some of young gay men in his study were less likely to use alcohol as a way to do gender differently as their gay identity progressed. Our data suggest that Black and Latino YMSM perceive alcohol as allowing them to explore and become more fully themselves by revealing aspects of their selves that had been hidden or disavowed due to stigma or rigid cultural scripts for sex.

Consistent with the principles of alcohol expectancy theory and disinhibition theory (Aguinaldo & Myers, 2008; George & Stoner, 2000; Smith, 1994), participants often spoke about using alcohol in ways consistent with their expectations that it would support disinhibition, thereby increasing comfort and making the experience more “passionate.” Many participants talked about using alcohol as a means of engaging in sexual experiences and intimacy (e.g., kissing) with men that they felt would have been impossible to enact without the “emboldening” effects of alcohol. For many of them, alcohol was used as a tool used to overcome physical as well as emotional forms of discomfort since many reported that alcohol helped to ease the pain involved with receptive anal sex. This was particularly true for early experiences of anal sex since young gay men often have limited access to the knowledge and skills that would enable them to more comfortably engage in these activities (Kubicek et al., 2009). Operant conditioning theory helps explain one way the link between alcohol and sex gets forged. Participants said that combining alcohol with sex felt good in several ways: it was more passionate, less physically painful, in addition to helping them feel more “bold” (less anxious), and greater freedom to “be myself” (less ashamed). This applies to both initial experiences where the link may be first forged, as well as later experiences, where reinforcement may serve to maintain the link. These sorts of positive reinforcement appeared to strengthen the connection between sex and alcohol in participants’ scripts.

This study reveals how stigma plays an important role in the development of perceived associations between alcohol and sex in this population. Stigma, the discrediting of a person based on a particular characteristic (Goffman, 1963), in this case takes the form of an internalized bias against same-sex sexuality. For many young men, the desire for intimacy with other men may require a great deal of “boldness,” especially in the wider social context of a culture pervaded by heterosexism (Herek, 2009). Participants spoke evocatively about how internalized negative feelings about homosexuality made sex with men difficult for them to initiate and explore without the aid of alcohol, and how reliance on alcohol enabled them to momentarily free themselves from such feelings. This in turn allowed sex-positive intrapsychic scripts (involving wishes and desires to have sex with men) to become enacted in interpersonal contexts. The stories told by these Black and Latino YMSM illustrate how scripts for alcohol use intermingle with sexual scripts at differing levels, while simultaneously revealing how individuals exercise individual agency by developing their own scripts, such as “becoming bold.” However, these data suggest that such scripts may be particularly influential if they are linked to processes of self-identification with a marginalized sexual identity.

Our findings extend the theory of sexual scripts by drawing on psychological constructs to explain how certain scripts are maintained while others are not. Integration with operant conditioning enhances the sexual scripts framework, since it accounts for the fact that individuals do not simply repeat or maintain scripts because they are exposed to them (in the media or elsewhere), but also because they gain benefits from enacting certain scripts and not others. Many participants described sexual scripts and experiences that involved the use of alcohol to down-regulate uncomfortable feelings, such as anxiety or shame about homosexuality. Using alcohol in this way enabled them to engage in and enjoy sex with men without the interference of emotions that many said would otherwise have prevented the sex from occurring. Consistent with the model developed by Rosario and colleagues (2006), our participants reported that regulating emotions such as internalized homophobia or shame through alcohol use was accompanied by multiple down-sides, including increased sexual risk due to alcohol myopia. Notably, most participants described efforts to down-regulate the emotional response itself initially rather than addressing the cause of the emotional response – the negative beliefs about sex with men. From the perspective of emotion regulation theory, attempting to down-regulate an emotional response, such as by using alcohol or other substances, is considered less adaptive than strategies to change the situation itself or one’s thoughts about it (Gross, 1998; Sher & Grekin, 2007). In addition, though alcohol appears to help participants regulate discomfort in the short term, it became associated with sex over the long term for many of them through a conditioning process that occurred due to the positive experiences alcohol facilitated.

Ideally, a greater portion of YMSM would have access to information and support to facilitate positive views of same-sex sexuality, thereby obviating the need to down-regulate shame and anxiety due to internalized homophobia and social stigma. Notably, many of the participants who engaged in more limited use of alcohol with sex already held positive views of their sexuality, while others who had reduced their consumption of alcohol with sex had also managed to develop more positive views over time. More research is needed to explore factors related to emotion regulation strategies and alcohol use in addition to the processes involved with sexual minorities becoming more comfortable exploring their sexuality without the use of alcohol.

Certain limitations of the present study should also be noted. These include the non-probabilistic sampling methods and exclusion of YMSM who do not use substances with sex or attend gay venues, as well as other YMSM populations. Since previous research shows that alcohol use trajectories are different for gay and lesbian young adults compared to their heterosexual peers (Hatzenbuehler et al., 2008; Maggs & Schulenberg, 2004–2005; Tucker, Orlando, & Ellickson, 2003), more research is needed to explore how alcohol use trajectories may be linked to processes of identity formation as well. Research is also warranted to explicate the conditions under which alcohol may lead to risk for various sub-populations of YMSM and to further develop theoretical frameworks for analyzing the topic (Mustanski, 2008). We found subtle differences in how initial alcohol scripts are observed among family and community members between Black and Latino respondents, suggesting the need for further research and tailored responses to addressing alcohol misuse in their respective communities.

Further research could elucidate some of the connections the participants described between differing sexual scripts about alcohol and different attitudes toward sexual risk. It is noteworthy that those participants who described relatively low levels of discomfort regarding sex with men also expressed less reliance on alcohol for sexual exploration, in some cases feeling that sex without alcohol was more satisfying. Given this pattern, future research should examine whether greater comfort with exploring sexual identities and behaviors is protective against alcohol use or misuse with sex among YMSM. In a related vein, those who had developed scripts that strongly linked alcohol with “passionate sex” or greater excitement also tended to report multiple experiences of sexual risk in the context of alcohol use as well as crystal use. In light of this, further research should explore the role of sensation-seeking in alcohol misuse and sexual risk (Newcomb et al., 2011). Since Black and Latino YMSM are at disproportionately higher risk of HIV infection (CDC, 2012a,b; Valleroy et al., 2000) and since YMSM in general are at higher risk of negative consequences from alcohol and substance use (Reed et al., 2010), it is essential to further address how alcohol may or may not be helpful in their lives as they explore their sexual identities. Although a recent study of 558 YMSM in New York City found that White YMSM were more likely to drink alcohol than non-white YMSM (Pollock et al., 2012); these findings still have important implications for the development of interventions to reduce alcohol misuse and unprotected sex that may occur under the influence of alcohol among Black and Latino YMSM in particular. We can speculate that our paper’s main themes, such as using alcohol to “become bold,” are likely to apply to other sub-populations of YMSM, with some nuances regarding alcohol scripts for how and what they drink since we found these minor nuances when comparing Black YMSM to Latino YMSM. Further qualitative research is needed to examine possible differences in these processes of alcohol use and sexual exploration among varying populations.

Since scripts for alcohol use during sex were learned early on before and during emerging adulthood, and from various sources, it is critical to address the topic of alcohol use early and often. Certain types of sexual scripts may be particularly challenging to alter through intervention, such as the notion that “Alcohol and Sex go Hand in Hand,” which is broadly reinforced throughout popular culture as well as in bars and clubs. However, some participants reported being able to become “bold” without the aid of alcohol, and to explore their sexuality freely. Thus, programs that seek to work with Black and Latino YMSM to build on their own sense of agency for reflecting on alcohol-based sexual scripts may be effective in supporting health and wellness, helping them to boldly “Let it Go and Let it Flow” without the aid of alcohol. Since previous research has shown that the number of rejecting reactions to disclosure of one’s sexual identity is associated with increased alcohol use among young sexual minorities, working with socializing agents such as peers and family members to be more accepting of sexual minorities and support health-oriented scripts may be useful, especially before YMSM go to gay venues where they may be more likely to use alcohol (Rosario et al., 2004; Rosario et al., 2009). This research also indicates the value of working in communities to provide alternative spaces for YMSM to explore their sexualities by increasing the availability of alcohol-free spaces in which there are community norms for gay pride and safer sex (Mutchler, 2000b).

Our study suggests that interventions could help Black and Latino YMSM question their alcohol expectancies that “Drunk Sex Equals Awesome Sex” by providing models for having “awesome sex” without alcohol. Our data also indicate that patterns of alcohol use with sex among YMSM may be difficult to modify in part because they are closely connected to important impulses toward self-discovery and self-determination among sexual minorities. The most effective ways of reducing alcohol misuse with sex will therefore be those that take into account the validity of such processes of exploration. Programs that facilitate greater comfort with marginalized sexual identities and with overcoming rejection from sexual partners may help reduce reliance on alcohol to facilitate sexual exploration. Specifically, such programs may benefit Black and Latino YMSM by incorporating safe alcohol-free spaces in which they can practice building self-efficacy and self-monitoring for dating and intimacy with potential sexual partners. Such programs may assist them in building stronger default scripts for safer sex, as well as countering and circumventing alcohol-based scripts that include alcohol use as a necessary element of successful intimacy and sex with other men (Kus, 1988).

Health education programs could adopt a strengths-based approach by reinforcing existing safety-oriented scripts, such as “The Best Sex is Sober Sex.” Similarly, interventions might engage YMSM in discussions of the types of “Cautionary Tales” that motivated some of our participants to limit alcohol use with sex. Still, it is important to note that for some of the young men, alcohol was used successfully as one tool to facilitate the process of exploring sex, love, and intimacy; for them, use of alcohol may not require intervention. Black and Latino YMSM who use alcohol in moderation or not at all, while successfully exploring their sexualities can be seen as role models for their peers helping to build stronger communities. Building on these young men’s desires for self-discovery, safer sex and alcohol intervention programs may assist Black and Latino YMSM in their quests for “boldness” and personal fulfillment.