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Bisexual women report elevated alcohol and drug use compared to other sexual minority women. This review summarized extant research on mechanisms (i.e., coping processes with minority stress and victimization, disclosure of sexual identity, connectedness to lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ+) community, religiosity, and normative perceptions) that may influence alcohol and other drug use among bisexual women. Specifically, bisexual women experience unique sexual discrimination (i.e., binegativity) and are at heightened risk for other forms of victimization and other stressful life events. Given this heightened experience with stress, bisexual women may use alcohol as a maladaptive coping mechanism. Further, disclosure of one's sexual identity may produce opportunities for connecting with the LGBTQ+ community, but such openness may increase exposure to discrimination and stigmatization among bisexual women. Findings on religiosity have been mixed, but there is some support that bisexual women may use substances in response to internal conflict between their religious beliefs and sexual identity. Lastly, we found that normative perceptions of other bisexual women's drinking behaviors are strongly tied to their own levels of alcohol use. From a therapeutic perspective, we suggest that practitioners recognize the unique experience of minority stress and teach strategies that lessen internalized stigma and promote healthy psychosocial adjustment among their bisexual clients. Clinicians may also help their clients find sources of support, which may protect them against the use of alcohol and drugs to manage minority-induced stress. Public Significance StatementBisexual women are a vulnerable population at increased risk for substance use-related harms. This review discusses underlying mechanisms (i.e., coping processes with minority stress and victimization, disclosure of sexual identity, connectedness to LGBTQ+ community, religiosity, and normative perceptions) that may be unique or contribute to substance use among bisexual women.

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Research indicates that bisexual women experience greater stigmatization and discrimination compared to lesbian women. Such oppression is described as binegativity and is associated with alcohol use among bisexual women. Specifically, previous research has suggested that bisexual women may drink to cope in an effort to self-medicate from experiences of binegativity. Although substantial research has been conducted with regard to drinking behaviors among at-risk groups, research has yet to identify which specific types of binegativity may be most predictive of drinking outcomes among bisexual women. Consequently, the present study sought to examine the predictive utility of three dimensions of binegativity: (a) sexual orientation instability (e.g., the perception of bisexuality as an illegitimate sexual orientation), (b) sexual irresponsibility (e.g., the stereotype that bisexual persons are oversexualized or sexually promiscuous), and (c) interpersonal hostility (e.g., the alienation and uncomfortability with bisexual identification), on drinking to cope motivations and alcohol use severity. Participants were 225 self-identified bisexual women between the ages of 18 and 30 years (Mean = 22.77, SD = 3.45) who participated in a larger study about health behaviors among bisexual women. Multiple regressions revealed that, compared to other binegativity dimensions, sexual irresponsibility was the strongest predictor of typical alcohol use, drinking to cope motivations, and alcohol use severity. Thus, bisexual women who are stereotyped to be sexually promiscuous are at particular risk for problematic alcohol use. Prevention and intervention efforts should target stress associated with experiences of oversexualized stigmatizations, in an effort to reduce alcohol-related risk among bisexual women. Public Health SignificanceThe present study investigated the relationship between specific facets of binegativity and various drinking behaviors among a sample of bisexual women. Findings from this study suggested that sexual irresponsibility or the oversexualized stereotype of bisexual individuals, was the most predictive of drinking behaviors. Study findings highlight oversexualized stigmatizations as an independent risk factor for problematic drinking behavior and should be targeted by efforts aimed at reducing alcoholrelated risk among bisexual women.