Sexual minorities are substantially more likely than heterosexuals to have substance use disorders, but a new study suggests that the drivers of this trend differ among various subgroups.
The study, based on National Epidemiologic Survey on Alcohol and Related Conditions data and published this month in the American Journal of Preventive Medicine, found that gay and lesbian individuals are more likely to develop a substance use disorder because of minority-specific discrimination. Bisexual individuals, on the other hand, are more likely to develop a substance use disorder because of everyday stressors common to all individuals.
“Future research should assess how specific stressors and alternate mechanisms contribute to sexual orientation disparities in substance use,” concluded the study, authored by researchers at the University of Maryland School of Public Health.
Specifics of study
The study examined epidemiologic survey data from 2012-2013, with an analytic sample of more than 34,500. It looked at past-year alcohol, cannabis and tobacco use disorders, and analyzed responses to stressful life event and sexual discrimination scales.
The stressful life event scale asked individuals whether they had experienced any of 16 common stressors in the past 12 months (such as losing a job, declaring bankruptcy or experiencing the death of a family member or close friend). Individuals identifying as a sexual minority were also asked if they had experienced any of six discrimination stressors, such as experiencing discrimination in health care coverage or services or being made fun of or threatened because of one's sexual orientation.
The results showed a higher proportion of substance use disorders among sexual minorities. For example, the prevalence of alcohol use disorder among gay, bisexual and heterosexual men was 26.6%, 31.4% and 17.6%, respectively. Lesbian and bisexual women had a higher prevalence of all three of the studied substance use disorders than heterosexual women.
The study found that while both stressful life events and minority-specific discrimination mediate the differences seen in substance use disorder prevalence, indirect effects of discrimination are stronger for gay men and lesbians, while indirect effects of general stressors are stronger for bisexual individuals.