Implementing an evidence-based alcohol use and sexual risk intervention in young adult homeless service settings - each year, about one in 10 U.S. Young adults aged 18-25 experience homelessness or…

The National Institute on Alcohol Abuse and Alcoholism awarded The Rand Corporation $731,345 on September 1, 2026, under the Alcohol Research Programs (CFDA 93.273) to implement and evaluate AWARE, a brief group counseling intervention addressing hazardous alcohol use and sexual risk behaviors among young adults experiencing homelessness.

The project will conduct a hybrid type 1 effectiveness-implementation study in partnership with three drop-in centers in Pittsburgh, Pennsylvania. The work includes a group-randomized trial comparing AWARE's effectiveness and cost-effectiveness against services as usual on primary outcomes of alcohol use and consequences, guided by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. This represents the first delivery of AWARE entirely by drop-in center staff rather than trained research personnel, generating real-world effectiveness and implementation data to enhance sustainability. The intervention uses motivational interviewing, social learning, and psychoeducation delivered over four sessions.

The period of performance extends through August 31, 2031. The Alcohol Research Programs support development of improved treatment methods and prevention strategies for alcoholism and alcohol-related problems through research in biomedical, psychological, environmental, health services, and prevention domains.

Implementing an evidence-based alcohol use and sexual risk intervention in young adult homeless service settings - each year, about one in 10 U.S. Young adults aged 18-25 experience homelessness or unstable housing. Compared to their stably housed counterparts, young adults experiencing homelessness are at greater risk of hazardous alcohol and other drug (AOD) use and engaging in sexual risk behaviors. There remains an urgent need to expand access to evidence-based interventions (EBIS) that use strength-based approaches to address these health risks. Drop-in centers are one of the most popular service settings where young adults experiencing homelessness go to meet their basic needs for food, clothing, and connection to services. Given that drop-in centers are preferable and engaging to young adults experiencing homelessness, they present a potentially valuable access point to provide EBIS for this population. One promising EBI to address hazardous AOD use and sexual risk behaviors is aware: a brief (FOUR-SESSION) group counseling intervention that uses motivational interviewing, social learning, and psychoeducation. Aware has demonstrated efficacy in reducing alcohol-related problems and sexual risk behaviors among young adults receiving services at drop-in centers. However, like other EBIS for this population, aware has been delivered by trained research staff, yielding limited understanding of its effectiveness and implementation under real-world conditions. In partnership with three drop-in centers, this project will use a hybrid type 1 effectiveness-implementation study guided by the exploration, preparation, implementation, sustainment (EPIS) framework to evaluate effectiveness and enhance sustainability of aware-delivered for the first time entirely by drop-in center staff. This study will (1) conduct a group-randomized trial to compare the effectiveness and cost-effectiveness of aware versus services as usual on primary (alcohol use and consequences) and secondary outcomes (other substance use, sexual risk behaviors, mental health, social functioning, housing stability); (2) evaluate aware implementation across sites, including reach to young adults experiencing homelessness, acceptability, aware fidelity, and sustainability; and (3) explore gaps and opportunities in funding to sustain aware by engaging drop-in centers in a unique fiscal mapping process and conducting qualitative interviews with policy actors. Findings will improve understanding of how to successfully implement and sustain EBIS such as aware at young adult homeless service organizations.