title: Sex-related substance use and the externalizing spectrum.
abstract: Substance use before and during sexual activity is associated with many negative health outcomes. Estimates suggest that at least 4.3 million American adults annually engage in regular sex-related alcohol consumption, indicating that the intersection of substance use and sexual behavior is of public health concern. However, it is likely that when considering broader sex-related substance use, estimates would be notably higher. While substance use disorders and antisocial personality disorder have been associated with sex-related alcohol consumption, no study has investigated how regular sex-related substance use is associated with the broader transdiagnostic externalizing spectrum. Further, no studies have assessed whether or not sexual risk-taking behaviors can be integrated into the externalizing spectrum.
  
  
  
  In a large internet sample (N=936), we used confirmatory factor analysis, item response theory, and logistic regression to link sex-related alcohol and drug use to an externalizing latent variable; identified psychometric characteristics of these behaviors; and determined the extent to which one's externalizing level was associated with changes in odds of regular sex-related substance use. We then replicated these findings in a nationally representative sample (N=34,653).
  
  
  
  Results highlighted the close association between sex-related substance use and externalizing, with externalizing increases being associated with significantly increased odds of regular sex-related substance use.
  
  
  
  These findings bear notable implications for conceptualization and treatment of sex-related substance use. Transdiagnostic intervention can be an efficient means of addressing this problematic behavior as well as other comorbid presentations. Results expand the current conceptualization of the externalizing spectrum.
authors.affiliation: Department of Psychology, Stony Brook University, NY, USA. Electronic address: craig.rodriguez-seijas@stonybrook.edu.
authors.forename: Craig
authors.initials: C
authors.lastname: Rodriguez-Seijas
authors.affiliation: UCLA Center for HIV Identification, Prevention, and Treatment Services, University of California, Los Angeles, CA, USA.
authors.forename: Kodi B
authors.initials: KB
authors.lastname: Arfer
authors.affiliation: Department of Psychiatry, College of Physicians and Surgeons, Columbia University, NY, USA.
authors.forename: Ronald G
authors.initials: RG
authors.lastname: Thompson
authors.affiliation: Department of Psychiatry, College of Physicians and Surgeons, Columbia University, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, NY, USA; New York State Psychiatric Institute, NY, USA.
authors.forename: Deborah S
authors.initials: DS
authors.lastname: Hasin
authors.affiliation: Department of Psychology, Stony Brook University, NY, USA.
authors.forename: Nicholas R
authors.initials: NR
authors.lastname: Eaton
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000453:epidemiology* / Q000523:psychology*; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D007389:Internal-External Control; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012725:Sexual Behavior / Q000523:psychology*; D047568:Unsafe Sex / Q000523:psychology*; D055815:Young Adult
keywords: Drug and alcohol use; Externalizing; Risky sexual behaviors; Substance use; Transdiagnostic factors