Associations Among Childhood Household Dysfunction, Sexual Orientation, and DSM-5 Alcohol, Tobacco and Other Substance Use Disorders in Adulthood: Evidence From a National U.S. Survey

Abstract

Objectives: This study examined the associations between childhood household dysfunction and adulthood past-year DSM-5 alcohol, tobacco, and other substance use disorders across sexual orientation subgroups (eg, lesbian/gay, bisexual, and heterosexual). Methods: Prevalence estimates were based on National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III) data collected from structured diagnostic face-to-face interviews in a nationally representative sample of 36,309 U.S. adults. Multivariable regression was used to examine associations between childhood household dysfunction and past-year substance use disorders in adulthood. Results: Sexual minorities, particularly sexual minority women, reported higher rates of childhood household dysfunction (eg, parental/household history of substance-related problems) and adulthood DSM-5 alcohol, tobacco, and substance use disorders. Results of multivariable analyses indicated that childhood histories of parental/household substance-related problems were associated with greater odds of past-year substance use disorders among sexual minorities than heterosexuals, and that such histories may moderate differences among sexual orientation subgroups. The risk of substance use disorders among sexual minority women relative to exclusively heterosexual women (ie, heterosexual-identified women without same-sex attraction or behavior) remained high, even when accounting for household dysfunction. In contrast, there were no such differences between sexual minority men and exclusively heterosexual men. Conclusions: Sexual minorities are more likely to have childhood household dysfunction which in turn is associated with a higher risk of developing DSM-5 alcohol, tobacco, and substance use disorders in adulthood, especially among sexual minority women. Healthcare providers who care for individuals raised in dysfunctional households should carefully assess risk for substance use disorders and intervene as needed.

Health Outcomes of Sexual Minority Women Who Have Experienced Adverse Childhood Experiences: A Scoping Review

“…L. Hughes et al, 2014; T. Hughes et al, 2010a; T. L. Hughes et al, 2010b; Katz-Wise et al, 2014; Lehavot & Simpson, 2014; McCabe et al, 2020a; Persson et al, 2015; Sigurvinsdottir & Ullman, 2016; Wilsnack et al, 2008; Wright, 2018), and four studies used Self-Medication Hypothesis (Gilmore et al, 2014; Johnson et al, 2013; Lehavot et al, 2014; Talley et al, 2016). The following theories or frameworks were each used in one study: Emotional Processing Theory (Gold et al, 2011), the Traumagenic Dynamics Model (Crump & Byers, 2017), traumatic sexualization (Robohm et al, 2003), which is part of the Traumagenic Dynamics model, the Social Norms Approach to Drinking (Gilmore et al, 2014), Intersectionality Theory (Greene et al, 2019), common cause explanations (Zietsch et al, 2012), protective measures theory (Smith et al, 2010), life course (Reisner et al, 2013), and socialization and human capital formulations of financial earnings (Hyman, 2000).…”

“…Fifteen studies examined the relationship between ACEs and substance use-related problems (Drabble et al, 2013; Gilmore et al, 2014; Hughes et al, 2007, 2010a, 2010b; Lehavot et al, 2014; McCabe et al, 2020a; Reisner et al, 2013; Roberts et al, 2005; Wilsnack et al, 2008; Yuan et al, 2014). Of these, 11 focused exclusively on alcohol-related outcomes and four examined both alcohol and other drug use outcomes.…”

“…However, far fewer studies have examined the relationship between ACEs and negative health outcomes among SMW. This gap is important because SMW appear to be more likely than heterosexual women to report several ACEs, including CPA, CSA, neglect, household dysfunction, and bullying (Alvy et al, 2013;Austin et al, 2008a;Friedman et al, 2011;Giano et al, 2020;McCabe et al, 2020aMcCabe et al, , 2020bMerrick et al, 2018;Wilsnack et al, 2008;Zou & Andersen, 2015). For example, in a national sample of U.S. adults, reports of CPA were highest among lesbian (45.5%) and bisexual (47.5%) women, and women unsure of their sexual identity (51.6%), compared to 32.9% of heterosexual women (McCabe et al, 2020b).…”

Psychiatric Disorders Mediates the Association between Sexual Orientation Discrimination and Substance Use Disorders among Sexual Minority Adults

“…Sample design, response rates, and weighting procedures have been described elsewhere. 33,34 The NESARC-III includes reliable and validated measures that align with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM -5) criteria for SUD and mental health 35 and the Alcohol Use Disorder and Associated Disabilities Interview Schedule-5 (AUDADIS-5), a fully structured diagnostic interview. 36 All NESARC-III procedures received institutional review board (IRB) approval before data collection, and the present secondary analysis using de-identified data was determined exempt by the IRB at the first author's institute.…”

“…13,33,34 Compounding the impact of SOdiscrimination are additional distal stressors experienced by SM, including family rejection, adverse childhood experiences, and social isolation. 35,36 Studies have found that cumulative effects of abuse and victimization in childhood and adolescence have a stigmatizing effect that may increase risk for later mental health disorders and SUD. 26,[37][38][39] However, less is understood about the combined effect of SM-related stressors and the specific relationships between SO-discrimination, mental health, and SUD severity.…”