Sexual orientation, substance use behaviors and substance dependence in the United States

Abstract

Aims To assess past-year prevalence rates of substance use behaviors and substance dependence across three major dimensions of sexual orientation (identity, attraction, and behavior) in a large national sample of adult women and men in the United States. Design Data were collected from structured diagnostic face-to-face interviews using the Alcohol Use Disorder and Associated Disabilities Interview Schedule DSM-IV Version (AUDADIS-IV). Setting Prevalence estimates were based on data collected from the 2004–2005 (Wave 2) National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Participants A large national sample of 34,653 adults aged 20 years and older: 52% female, 71% White, 12% Hispanic, 11% African American, 4% Asian, and 2% Native American or other racial/ethnic categories. Findings Approximately 2% of the sample self-identified as lesbian, gay or bisexual; 4% reported at least one lifetime same-sex sexual partner, and 6% reported same-sex sexual attraction. Although non-heterosexual orientation was generally associated with a higher risk of substance use and substance dependence, the majority of sexual minority respondents did not report substance use or meet criteria for DSM-IV substance dependence. There was considerable variation in substance use outcomes across sexual orientation dimensions; these variations were more pronounced among women than among men. Conclusions Results support previous research findings of heightened risk of substance use and substance dependence among some sexual minority groups and point to the need for research that examines reasons for such differences. Results also highlight important gender differences and question previous findings indicating uniformly higher risk for substance dependence among sexual minorities. Risks appear to vary based on gender and how sexual orientation is defined. Findings have implications for prevention and intervention efforts that more effectively target subgroups at greatest risk.

Effects of Sexual Orientation and Gender on Perceived Need for Treatment by Persons With and Without Mental Disorders

“…This finding is similar to a recent study using national survey data showing that the effects of sexual minority status on substance use and dependence were larger for women than men (44). However, in our study, the effect of sexual minority status was most apparent among women without a mental health or substance use disorder.…”

Patterns of Alcohol Use and Consequences Among Empirically Derived Sexual Minority Subgroups

“…This approach allowed for a greater understanding of heterogeneity in sexual orientation development during emerging adulthood and suggested that patterns of sexual orientation development are dynamic and have complex relations with alcohol-related outcomes (Cicchetti and Rogosch, 2002). Contrasting previous fi ndings (Marshal et al, 2008;McCabe et al, 2005McCabe et al, , 2009, bisexual/lesbian women in the current report did not endorse elevated levels of alcohol use and consequences. We speculate that more normative patterns of alcohol use during the college years (Hatzenbuehler et al, 2008;McCabe et al, 2003) and previous lumping of mostly straight individuals under bisexual self-identifi cation categories (see McCabe et al, 2011) are plausible explanations for these fi ndings.…”

“…Importantly, variations in sexual orientation development processes may alter the relative likelihood of each explanation. Consequently, examinations of the patterns of alcohol use among diverse subgroups of sexual minority individuals may be helpful in understanding potentially distinct etiologic pathways of alcohol-related outcomes.The majority of research examining sexual minority alcohol use has been cross-sectional (Amadio, 2006;Drabble et al, 2005;McCabe et al, 2009;Ridner et al, 2006;Rosario et al, 2004Rosario et al, , 2008Stall et al, 2001;Wong et al, 2008). Recently, longitudinal studies (Corliss et al, 2008;DeBord et al, 1998;Hatzenbuehler et al, 2008;Marshal et al, 2009;Rostosky et al, 2007Rostosky et al, , 2008Skinner and Otis, 1996;Talley et al, 2010;Tucker et al, 2008) have examined temporal patterns of alcohol use among nonclinical samples of sexual minority individuals and compared those with patterns among sexual majority individuals.…”

Hazardous Drinking, Depression, and Anxiety Among Sexual-Minority Women: Self-Medication or Impaired Functioning?

“…This historic report emphasizes the unique health needs of sexual minorities and the limited understanding of these needs. Indeed, research over the past decade has produced compelling evidence of mental health disparities among sexual-minority women, including a heightened risk of hazardous drinking (Drabble et al, 2005;McCabe et al, 2009), depression, and anxiety Cochran and Mays, 2009;King et al, 2008). However, little attention has been paid to the social and psychological processes underlying these disparities.…”