Objective <p>Although Black Americans have less alcohol use than non-Hispanic/Latine White Americans, they have comparable rates of binge drinking and alcohol use disorder. Moreover, Black Americans that smoke cigarettes appear at especially high risk for alcohol-related problems, highlighting a need to identify factors related to alcohol outcomes among Black Americans that smoke to better tailor treatments. Anxiety sensitivity (AS) and distress intolerance (DI) are associated with greater drinking and related problems. However, little research has tested the interactive effects of these risk factors on drinking behaviors. Further, AS and DI have differential relationships with drinking behaviors for men and women, so it may be that the synergistic effect of AS and DI on alcohol use behaviors vary by sex.</p> Method <p>This sample consisted of 419 community-recruited Black adults (51.1% women) with a history of cigarette use and past-month drinking for an online cross-sectional study.</p> Results <p>Although DI and AS were significantly correlated with alcohol quantity, binge drinking frequency, and problems, after controlling for shared variance, AS was no longer significantly related to quantity or problems. The DI X AS X sex interaction was statistically significantly related to binge drinking frequency, such that DI was related to greater binge drinking frequency for men with lower AS and women with higher levels of AS.</p> Conclusions <p>This study furthers our understanding of sex differences in transdiagnostic risk factors related to alcohol misuse among Black adults who smoke, highlighting the clinical relevance of AS and DI for intervention and efforts among this high-risk group.</p>