Risk factors associated with alcohol and drug use among bisexual women: A literature review.

Abstract

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.

Impulsivity, sex‐related alcohol expectancies, alcohol use, and sexual risk‐taking among bisexual women

“…Thus, interventions could assess binegativity to identify bisexual women at greatest risk for negative health outcomes. 6…”

“…15,16 Extant literature suggests that among bisexual women, specifically, impulsive tendencies may associate with heightened drinking motivations and greater risk for alcohol-related problems. 6 For example, one cross-sectional study found that impulsivity moderated the relationship between drinking-to-cope motivations and alcohol-related problems among a sample of bisexual women. 8 That is, although drinking-to-cope motivations were found to positively associate with alcohol-related problems, the relationship was stronger for individuals who demonstrated greater dispositional impulsivity.…”

“…Bisexual women's increased engagement in alcohol use and sexual behavior could be supported by minority stress theory 5 . Specifically, bisexual women may experience greater minority stressors about their sexual identity (e.g., discrimination, stigmatization) from heterosexual and sexual minority individuals, 6 also known as binegativity. Binegativity has been linked to psychological distress, 7 alcohol use, 7,8 and sexual behavior 9 .…”

Examining the differential protective effects of women’s spirituality and religiosity on alcohol and marijuana use by sexual identity

“…Another study found that religiosity was protective against hazardous drinking and drug use among both SMW and heterosexual women ( Drabble et al, 2016 ). Associations between religiosity and alcohol use may also differ between bisexual and lesbian women ( Schulz et al, 2021 ). One study found that religiosity was protective against heavy episodic drinking among heterosexual women; however, it was not protective for lesbian women and it was associated with increased drinking among bisexual women ( Rostosky et al, 2014 ).…”

Dimensions of binegativity differentially predict drinking to cope motivations and alcohol use severity among bisexual women.

“…When compared to lesbian and heterosexual women, bisexual women have been found to report greater odds of alcohol use, binge drinking, and alcohol-related problems (Schuler & Collins, 2020; Schulz et al, 2021). For example, data from the 2015 to 2017 National Survey on Drug Use and Health revealed that 38.7% of bisexual women reported past month binge drinking and 12.5% were diagnosed with an alcohol use disorder in the past year, which were significantly higher rates as compared to lesbian (binge: 30.1%; alcohol use disorder: 7.7%) and heterosexual (binge: 21.2%; alcohol use disorder: 3.9%) women (Schuler & Collins, 2020).…”