Substance use in lesbian, gay, and bisexual populations: An update on empirical research and implications for treatment.

Abstract

Historically, substance use problems were thought to be more prevalent in lesbian, gay, and bisexual (LGB) populations, and correcting skewed perceptions about substance abuse among LGB individuals is critically important. This review provides an update on empirical evidence on LGB substance use patterns and treatment outcome, with specific focus on clinical implications of findings. Compared to earlier studies, the recent research included in this review has used more sophisticated methodologies, more representative samples, and also has investigated multiple dimensions of sexual orientation in relation to substance use patterns. Findings from recent research suggest that lesbians and bisexual women are at greater risk for alcohol and drug use disorders and related problems, and that gay and bisexual men are at greater risk for illicit drug use and related problems. Several sociocultural factors have emerged as correlates of substance use patterns in LGB populations (e.g., affiliation with gay culture, HIV-status), and several demographic characteristics (e.g., female, older age) do not appear to be as robust of protective factors against substance abuse for LGB individuals compared to heterosexual populations. Bisexual identity and/or behavior in particular seem to be related to increased risk for substance abuse. In terms of treatment outcome, limitations of extant research prevent conclusions about the relative impact of LGB-specific interventions, and further research that includes women and uses more equivalent comparison interventions is needed. Clinical implications of research findings are discussed for case identification, selection of treatment goals (e.g., moderation versus abstinence), targets for intervention, and specific treatment modalities.

Do Substance Use Norms and Perceived Drug Availability Mediate Sexual Orientation Differences in Patterns of Substance Use? Results from the California Quality of Life Survey II

“…For example, there is a positive relationship between neighborhood alcohol outlet density and social norms regarding alcohol use, as well as rates of alcohol consumption (Scribner et al, 2000). In this regard, the social organization of a visible gay and lesbian community, traditionally centered on "gay bars" and social outlets, may encourage the use of alcohol and illicit drugs (Green and Feinstein, 2011;Simon Rosser et al, 2008). The effect may be to create a climate of tolerant injunctive social norms surrounding substance use in which illicit drugs are, in turn, more readily available.…”

“…However, the same study also found contradictory evidence with regard to men. Specifi cally, rates of heavy drinking among men did not vary by sexual orientation across settings, even though gay men spent more time in bars than bisexual and heterosexual men did.Some researchers (Cochran, 2001;Green and Feinstein, 2011;McKirnan and Peterson, 1989) have speculated that tolerant norms regarding drug use are endemic among sexual orientation minorities, particularly among those living in areas of higher gay density. In one study of more than 700 gay men living in New York City, men with more "gay-centric" networks had higher rates of substance use (Carpiano et al, 2011).…”

Testing Cross-Sectional and Prospective Mediators of Internalized Heterosexism on Heavy Drinking, Alcohol Problems, and Psychological Distress Among Heavy Drinking Men Who Have Sex With Men

“…In addition, studies that test alternative theories that explain substance use among LGB individuals simultaneously to understand their interconnection and/or independent contributions are sorely needed. For example, understanding the interplay of minority stress with potentially learned or reinforced social behaviors will be crucial for initiating the most effective interventions, whether at a macro or a micro level (Green & Feinstein, 2012).…”

“…Empirical evidence mostly supports the negative effects of internalized heterosexism on poorer mental health outcomes, such as alcohol use and psychiatric disorders (Green & Feinstein, 2012;Hatzenbuehler, 2009). Meta-analyses show that internalized heterosexism is associated with internalizing mental health problems, such as depression, and risky sexual behaviors among sexual minority men (Newcomb & Mustanski, 2010.…”

“…Together these provide evidence of a syndemic of co-occurring behavioral health problems among this population (Parsons et al, 2012). Thus, there is a need for understanding the underlying factors associated with problematic alcohol use and other poorer health outcomes to improve treatments for sexual minorities (Green & Feinstein, 2012;Mustanski et al, 2011).…”