Sexual minorities more likely to suffer severe substance use disorders

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Icon illustration of commonly abused substances. Illustration credit: Kaitlyn Bukema

ANN ARBOR—Researchers know that lesbian, gay and bisexual individuals are more likely than heterosexuals to use alcohol, tobacco or other drugs, but until now they didn’t know to what degree.

New research out of the University of Michigan provides that context by examining the severity of alcohol, tobacco and other drug abuse reported by lesbian, gay and bisexual individuals, and people who aren’t sure how they identify.

The study confirms that substance use disorders are more prevalent—and more severe—among sexual minorities in the United States, said lead researcher Carol Boyd, U-M professor of nursing.

“Our findings provide strong evidence that a higher proportion of sexual minority individuals, particularly bisexual individuals and those who are not sure of their sexual identities, have severe alcohol and tobacco use disorders, and those who are ‘not sure’ also have a higher proportion of severe drug use disorders,” said Boyd, who’s also the director of the Center for Drugs, Alcohol, Smoking and Health.

In the past, researchers often focused on any use or misuse of alcohol and drugs, and failed to document the severity of substance use disorders experienced by sexual minorities. Boyd said it’s important to assess the severity of a substance use disorder to better understand the degree of impairment experienced and the treatment needs.

Researchers used 2012-13 data from the National Epidemiological Survey on Alcohol and Related Conditions-III. Of 36,309 adults, roughly 6 percent fell into the sexual minority category. Within these groups, researchers looked at three related but distinct domains of sexual orientation and how these domains impacted substance abuse: sexual identity, sexual attraction and sexual behavior.

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The study found that people who identified as bisexual or were unsure about their sexual identity were at greatest risk for a substance use disorder. Individuals who were unsure of their sexual identity were five times as likely to have a severe alcohol abuse disorder and roughly four times as likely to report a severe tobacco or drug problem, when compared to heterosexuals.

Bisexual individuals were roughly three times as likely to have a severe alcohol use disorder, and two-and-a-half times more likely to have a severe tobacco use disorder.

People who identified as lesbian or gay were over twice as likely to have a severe alcohol or tobacco use disorder, when compared to heterosexuals.

The study didn’t examine the reasons behind the alcohol and drug use, and more research is necessary to understand what it means to be “not sure,” Boyd said.

One surprising finding in terms of sexual behavior is that people who reported having no sex during the past year were significantly less likely to have any substance use disorder, Boyd said. Again, researchers didn’t examine why.

“The severity is what leads to health and social consequences such as poor health, impaired driving and loss of work,” Boyd said. “We already know that disproportionately, gay men and women go to bars and drink more, so that has been known for decades. But these findings tell us something else––it’s about severity of their alcohol and other drug use disorders.”

The study appears online in the journal LGBT Health. Co-authors include: Philip Veliz, Rob Stephenson and Sean Esteban McCabe, all of the U-M School of Nursing; and Tonda Hughes of Columbia University’s School of Nursing.

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