Project Summary: Gender minority individuals (GM; transgender and gender non-conforming), an NIH- designated disparity population (NOT-MD-19-001), experience numerous health disparities including high rates of hazardous drinking and alcohol use disorder (AUD). GMs also have culturally-distinct life experiences that can further increase alcohol risk. Standard alcohol treatment programs often neglect such GM-specific experiences. Cultural adaptation can improve treatment acceptability, retention, and effectiveness in minority populations by increasing treatment compatibility with patients’ cultural norms/values. Despite alcohol disparities and unique risk factors, there are no evidence-based alcohol interventions for this marginalized population. In this application, Dr. Jeremy Kidd proposes a comprehensive path toward becoming an independent physician-researcher of innovative treatments for alcohol and drug use disorders among GMs. Specifically, this proposal follows the Stage Model of Behavioral Therapies Research to develop and evaluate the feasibility of a culturally-adapted psychosocial intervention for AUD among GMs. Cultural adaptation will address the specific types of interpersonal disruptions (e.g., with family, friends, coworkers) that many GMs experience due to gender transition or anti-GM discrimination/stigma. These disruptions result in interpersonal distress that increases alcohol risk. In Stage 0 formative research, Dr. Kidd will use latent class analysis to examine the relationship between social support and trajectories of hazardous drinking in an established multi-site, longitudinal cohort of GMs (N = 330). Next, he will employ qualitative descriptive methodologies to conduct individual semi-structured interviews with cohort members (N = 48) to understand in-depth how interpersonal factors influence GM drinking. He will use these formative findings to develop a culturally-adapted AUD intervention for GMs. He will use interpersonal psychotherapy (IPT) as a platform for adaptation because it is evidence-based for alleviating interpersonally-mediated psychological distress. Finally, Dr. Kidd will evaluate this intervention’s feasibility by delivering it to 20 GM individuals with AUD in a Stage 1 single-arm, pre-post, mixed-methods feasibility trial. To further his long-term career goal of becoming an independent clinical researcher focused on GM addiction disparities, Dr. Kidd will pursue training in the following 5 areas: (1) advanced epidemiology and biostatistics with longitudinal and clinical trials data, (2) qualitative research, (3) psychosocial intervention adaptation, (4) psychotherapy clinical trials, and (5) grant writing. The results of this study will be the first application of the Stage Model of Behavioral Therapies Research in GM populations and the first evidence-based psychosocial alcohol treatment for GMs. This approach may also inform clinical treatment research for other GM health disparities. Overall, this award will ensure Dr. Kidd’s successful transition to an independent clinical investigator studying prevention and treatment of substance use disorders in GM populations.

Project Narrative: Gender minority (GM; transgender and gender non-conforming) individuals experience disproportionately high rates of hazardous drinking and alcohol use disorder (AUD) and are an NIH-designated disparity population (NOT-MD-19-001). Despite marked disparities and unique alcohol risk factors, there are no evidence-based alcohol interventions for this population. This study will conduct mixed-methods formative research with an established multi-site longitudinal GM cohort to develop and assess the feasibility of the first culturally-adapted psychosocial treatment intervention for GMs with AUD.