ParTy ’n’ Play: Associations Between Sex-Related Substance Use and the Disinhibited Externalizing Spectrum Among Gay and Bisexual Men

Abstract

Research suggests sex-related substance use can be conceptualized within the disinhibited externalizing spectrum of psychopathology. However, this research has generally excluded sexual-minority samples. In the current study, we examined the associations between the disinhibited externalizing spectrum and several sex-related substance use domains (i.e., heavy drinking and poppers [alkyl nitrite], cannabis, cocaine, and methamphetamine use) in a clinical sample ( N = 254) of sexual-minority men. Disinhibited externalizing was significantly associated with reporting sex-related cannabis and methamphetamine use versus not and with frequency of sex-related alcohol and cocaine use. These results suggest few and generally weak associations—except for methamphetamine use—between the disinhibited externalizing spectrum and sex-related substance use. Implications for the applicability of dimensional models of psychopathology for sexual-minority populations, future directions for research on sexual behavior and substance use grounded in the specific sociocultural context in which sexual-minority men exist, and transdiagnostic interventions for sex-related substance use are discussed.

State of the Science: The Hierarchical Taxonomy of Psychopathology (HiTOP)

“…For instance, harmful substance use (e.g., Cochran et al, 2004) and externalizing behavior more broadly (Rodriguez-Seijas et al, 2019) are higher among sexual and gender minority populations when compared with cisgender heterosexuals. However, engagement in sex-related substance use shows little association with the externalizing domain among sexual minority men (Rodriguez-Seijas, Rogers, et al, 2023), in contrast to findings in heterosexual cisgender men (Rodriguez-Seijas et al, 2017). Thus, it is possible that the associations between overt behaviors and HiTOP dimensions are not consistent across all populations.…”