Introduction
Sexual minorities are disproportionately more likely than heterosexuals to suffer
from substance use disorders, but relatively little is known about differences in
substance use disorders across diverse sexual minority subgroups. There is also limited
understanding of how different social stressors account for sexual orientation disparities
in substance use disorders.
Methods
Using nationally representative data collected in 2012–2013 (n=34,597), differences in past-year DSM-5 alcohol, cannabis, and tobacco use disorders
were assessed across 4 sexual orientation groups (heterosexuals and 3 sexual minority
subgroups, lesbian/gay-, bisexual-, and heterosexual-identified sexual minorities).
This study assessed whether stressful life events mediated substance use disorder
disparities between heterosexuals and each sexual minority subgroup, and whether stressful
life events and lesbian, gay, and bisexual discrimination events mediated these substance
use disorder differences. Analyses were conducted in 2019.
Results
For both men and women, substance use disorders and stress experiences varied by sexual
identity. For example, compared with heterosexual men, larger proportions of gay and
bisexual men had a past-year alcohol use disorder. Among women, all sexual minority
subgroups had higher rates of each substance use disorder than heterosexuals. For
each substance use disorder, stressful life events mediated disparities between heterosexuals
and sexual minority subgroups, except for heterosexual-identified sexual minority
men. Both stressful life events and lesbian, gay, and bisexual discrimination mediated
substance use disorder differences between sexual minority subgroups, with stronger
indirect effects through lesbian, gay, and bisexual discrimination for lesbians/gay
men and stronger indirect effects through stressful life events for bisexual adults,
generally.
Conclusions
Sexual minority subgroups have a greater prevalence of substance use disorders, mediated
through both stressful life events and lesbian, gay, and bisexual discrimination.
More research is needed to comprehensively assess the processes underlying sexual
orientation substance use disparities.
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Article Info
Publication History
Published online: November 20, 2019
Identification
Copyright
© 2019 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
