Alcohol Intoxication, Sex to Cope, and Sexual Outcomes: The Role of Loneliness
Year: 2026
Type: preprint
Abstract: Growing research suggests loneliness, defined as the discrepancy in the quality or quantity of actual and desired levels of social connection (Fried et al., 2020; Perlman & Peplau, 1982), is associated with sexual risk behaviors (Fisher, 2015). Theoretical and empirical research primarily draw from a self-medication model, where individuals may engage in sex behavior, including risky sexual behavior such as condomless sex, as a means of coping with, or temporarily reducing, the negative internal experience of loneliness (Torres & Gore-Felton, 2007). Further research suggests alcohol intoxication may be an important component of this association; loneliness is associated with alcohol use (Wakabayasi et al., 2022), and alcohol use is a robust predictor of sexual behavior, including condomless sex (George et al., 2024). The vast majority of past research has examined the association between loneliness, sexual risk, and alcohol among sexual minority men (Skakoon‐Sparling et al., 2023; Torres & Gore-Felton, 2007). However cisgender women who have sex with men also report high rates of sexual risk behaviors, including condomless sex (Hayaki et al., 2018). Moreover, young adult cisgender women report the highest rates of loneliness of any group in the United States (Pew Research Center, 2025). Seeking to address the gap in the literature, the current study recruited cisgender, female social drinkers to complete 31-days of daily diaries to examine two primarily aims: 1) to what extent do loneliness and alcohol predict sexual activity (vaginal sex); and 2) on days when sex occurs, how do loneliness, alcohol, and sex to cope predict sexual outcomes (condom use, consent). Participants were ages 21 to 30, interested in sex with men, and reported at least one instance of consensual, condomless sex with a male partner in the past year and a second sexual risk indicator (Jaffe et al., 2023). While there has been tremendous focus on condomless sex as a sexual health outcome, the current also examines the extent to which participants consented to sexual activity. The current analyses is a secondary data analysis from a larger alcohol administration study. We hypothesize that daily feelings of loneliness to be associated with same-day alcohol consumption and sexual activity. On days participants had sex, we anticipate loneliness to be associated with alcohol consumption and condomless sex. We hypothesize the association between loneliness and condomless sex will be strongest for those who reported having sex to cope. The extent to which participants consented to sexual activity is included as an exploratory aim, and we have no hypotheses about this outcome. As part of the study protocol, participants provided a report of their same-day loneliness and past-day sexual behaviors, including whether they engaged in vaginal sex with a male partner, whether they used a condom, if they consented to sex, and the extent to which they had sex to cope with negative emotions. Two multi-level models will be conducted, the first of which examines how within-person and between-person loneliness and alcohol use predict whether a participant engages in sexual activity. The second model is an event-level analysis and examines sex to cope as a motivational state that influences the association between loneliness, alcohol, and sexual outcomes. Same-day loneliness will be lagged to compute associations between loneliness, alcohol consumption, sexual activity, and sexual outcomes.
Language: English
Topic: HIV, Drug Use, Sexual Risk
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7168092307