Sexual orientation disparities in psychiatric and drug use disorders among a nationally representative sample of women with alcohol use disorders

doi:10.1016/j.addbeh.2015.03.023

Addictive Behaviors

Volume 47, August 2015, Pages 80-85

https://doi.org/10.1016/j.addbeh.2015.03.023 Get rights and content

Highlights

•
Women with alcohol use disorders from the NESARC were studied.
•
Sexual orientation disparities were found in co-occurring psychiatric disorders.
•
Sexual orientation disparities were found in co-occurring drug use disorders.

Abstract

Background and aims

Sexual minority women (SMW) are at greater risk for alcohol use disorders (AUDs) compared to heterosexual women. However, there is a dearth of research on sexual orientation disparities in co-occurring disorders among women with AUDs. We examined disparities in lifetime co-occurring psychiatric and drug use disorders among a nationally representative sample of women with lifetime AUDs.

Methods

Data were analyzed from the 2004–2005 (Wave 2) of the National Epidemiological Survey on Alcohol and Related Conditions (NESARC), which was collected in structured diagnostic face-to-face interviews. Adult women with AUDs (N = 4342) were included in the analyses and approximately 191 of those women self-identified as SMW. Lifetime alcohol and drug use disorders and psychiatric disorders were assessed using DSM-IV criteria. We conducted multivariate logistic regression analyses to compare SMW and heterosexual women with lifetime AUDs on lifetime psychiatric disorders and drug use disorders, while adjusting for sociodemographic variables.

Findings

While accounting for several covariates, SMW with lifetime AUDs were more likely than heterosexual women with lifetime AUDs to have lifetime psychiatric disorders (e.g., mood, anxiety, panic disorders) and drug use disorders (e.g., prescription drugs, cannabis use disorders).

Conclusions

Sexual minority women with lifetime alcohol use disorders are at heightened risk for co-occurring psychiatric and drug use disorders than heterosexual women with lifetime alcohol use disorders. The findings warrant the need for more research and empirically based interventions for the comprehensive treatment and prevention of alcohol use disorders among sexual minority women.

Section snippets

Sample

We analyzed data from Wave 2 of the National Epidemiological Survey on Alcohol and Related Conditions (NESARC). The NESARC is a nationally representative survey, sponsored by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Wave 1 was conducted in 2001 and 2002, and Wave 2 was conducted in 2004 and 2005. The NESARC surveyed non-institutionalized adults age 18 years and older of the United States, including the District of Columbia, Alaska, and Hawaii, and oversampled African

Sociodemographic characteristics

Of the 4342 participants, 4151 (95.6%) self-identified as heterosexual, and 191 (4.4%) self-identified as sexual minority (see Table 1). Among women who have a lifetime alcohol use disorder, SMW are more likely to be never married and less educated, and less likely to have any health insurance at any time in the past year.

Lifetime psychiatric disorders and drug use disorders

Compared to heterosexual women with lifetime AUDs, SMW with AUDs had a higher prevalence of any mood disorder, dysthymic disorder, and panic disorder with/without agoraphobia (

Discussion

In this nationally representative sample, we found sexual orientation disparities in lifetime psychiatric and drug use disorders among adult women with lifetime AUDs. These findings build on the extant literature of sexual orientation disparities in AUDs to document disparities in co-occurring disorders among women with AUDs. These results also respond to multiple federal public health calls for research on sexual orientation health disparities and have implications for research and treatment

Role of funding sources

Funding was provided by the National Institute of Alcohol Abuse and Alcoholism (grants U24 AA022000 and P01 AA019072), the National Institute of Drug Abuse (T32DA016184), and the National Institute of Mental Health (T32MH078788). The NIAAA conducted the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) survey. However, NIAAA had no role in the analysis or interpretation of the data for this manuscript, writing of the manuscript, or the decision to submit the paper for

Contributors

Authors Mereish, Gamarel, Zaller, and Operario conceptualized the study. Author Lee conducted the statistical analysis. Author Mereish wrote the first draft of the manuscript. All authors contributed to and have approved the final manuscript.

Conflict of interest

The authors have no conflicts of interest.

References (44)

B.N. Cochran et al.
Characteristics of lesbian, gay, bisexual, and transgender individuals entering substance abuse treatment
Journal of Substance Abuse Treatment
(2006)
P.M. Flynn et al.
Co-occurring disorders in substance abuse treatment: Issues and prospects
Journal of Substance Abuse Treatment
(2008)
B.F. Grant et al.
The 12-month prevalence and trends in DSM-IV alcohol abuse and dependence: United States, 1991–1992 and 2001–2002
Drug and Alcohol Dependence
(2004)
D. Hasin et al.
The alcohol use disorder and associated disabilities interview schedule (AUDADIS): Reliability of alcohol and drug modules in a clinical sample
Drug and Alcohol Dependence
(1997)
T.L. Hughes et al.
Sexual victimization and hazardous drinking among heterosexual and sexual minority women
Addictive Behaviors
(2010)
S.E. McCabe et al.
Sexual orientation and substance abuse treatment utilization in the United States: Results from a national survey
Journal of Substance Abuse Treatment
(2013)
P. Najt et al.
Co-occurring mental and substance abuse disorders: A review on the potential predictors and clinical outcomes
Psychiatry Research
(2011)
S. Nolen-Hoeksema
Gender differences in risk factors and consequences for alcohol use and problems
Clinical Psychology Review
(2004)
J.E. Pachankis et al.
The influence of structural stigma and rejection sensitivity on young sexual minority men's daily tobacco and alcohol use
Social Science & Medicine
(2014)
W.J. Ruan et al.
The alcohol use disorder and associated disabilities interview schedule-IV (AUDADIS-IV): Reliability of new psychiatric diagnostic modules and risk factors in a general population sample
Drug and Alcohol Dependence
(2008)

J.D. Swendsen et al.

The comorbidity of depression and substance use disorders

Clinical Psychology Review

(2000)

V.R. Brooks

Minority stress and lesbian women

(1981)

S.D. Cochran et al.

Mental health and substance use disorders among Latino and Asian American lesbian, gay, and bisexual adults

Journal of Consulting and Clinical Psychology

(2007)

B.N. Cochran et al.

Do specialized services exist for LGBT individuals seeking treatment for substance misuse? A study of available treatment programs

Substance Use & Misuse

(2007)

M.S. Friedman et al.

A meta-analysis of disparities in childhood sexual abuse, parental physical abuse, and peer victimization among sexual minority and sexual nonminority individuals

American Journal of Public Health

(2011)

B.F. Grant et al.

Introduction to the National Epidemiologic Survey on Alcohol and Related Conditions

Alcohol Research & Health

(2006)

B.F. Grant et al.

Nicotine dependence and psychiatric disorders in the United States: Results from the National Epidemiologic Survey on Alcohol and Related Conditions

Archives of General Psychiatry

(2004)

B.F. Grant et al.

Source and accuracy statement for the Wave 2 national epidemiologic survey on alcohol and related conditions (NESARC)

(2005)

B.F. Grant et al.

Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: Results from the national epidemiologic survey on alcohol and related conditions

Archives of General Psychiatry

(2004)

K.E. Green et al.

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

Psychology of Addictive Behaviors

(2012)

C.E. Grella et al.

Effects of sexual orientation and gender on perceived need for treatment by persons with and without mental disorders

Psychiatric Services

(2011)

C.E. Grella et al.

Influence of gender, sexual orientation, and need on treatment utilization for substance use and mental disorders: Findings from the California Quality of Life Survey

BMC Psychiatry

(2009)

Cited by (21)

Mental Health Disparities in Sexual Minority and Transgender Women: Implications and Considerations for Treatment
2023, Psychiatric Clinics of North America
Self-compassion buffers the internalized alcohol stigma and depression link in women sexual assault survivors who drink to cope
2023, Addictive Behaviors
Depression is strongly implicated in drinking to cope and the development of alcohol use disorders (AUD) in women, particularly among women with a history of sexual assault victimization (SAV). Alcohol use in women is heavily stigmatized, and substance use stigma is associated with depression. This study examined the link between internalized alcohol stigma (AS) and depression and tested whether self-compassion buffered (i.e., moderated) this association in a sample of women with a history of SAV and unhealthy drinking to cope.
Women sexual assault survivors (N = 288; 82 % White, 91.2 % Non-Hispanic, 20.2 % sexual minority) reporting unhealthy drinking (Alcohol Use Disorders Inventory Test-C ≥ 4) and drinking to cope (Drinking Coping Motives Questionnaire-Revised ≥ 2) completed online self-report surveys. Hierarchical regression analyses tested associations between internalized-AS and self-compassion with depression after controlling for covariates (age, income, education, AUD symptoms, and posttraumatic stress disorder) and then, whether self-compassion moderated the Internalized-AS and depression link.
Internalized-AS accounted for 1.4 % of variance in depression (p < .01); self-compassion accounted for added variance when subsequently modeled (8.2 %, p < .001). Moderation analyses revealed self-compassion to buffer the internalized-AS and depression link. Among participants reporting high levels of self-compassion, there was no association between internalized-AS and depression (p = .894).
While findings are modest, they align with the previously observed link between internalized-AS and depression and extend these findings to women with a history of SAV endorsing elevated coping motives and unhealthy drinking. Self-compassion may protect against this link, pending further research sampling greater diversity of participants and longitudinal and controlled designs.
A scoping review of alcohol, tobacco, and other drug use treatment interventions for sexual and gender minority populations
2022, Journal of Substance Abuse Treatment
Citation Excerpt :
Research on interventions for SMW are needed, particularly those that address concurrent risk factors. For example, among SMW, hazardous drinking often occurs in the context of depression and anxiety (Drabble et al., 2018; Mereish et al., 2015). Further, hazardous drinking, depression, and anxiety are strongly associated with trauma exposure among SMW (Hughes et al., 2014; Hughes, McCabe, et al., 2010; Hughes, Szalacha, et al., 2010; Szalacha et al., 2017).
Alcohol, tobacco, and other drug use are among the most prevalent and important health disparities affecting sexual and gender minority (SGM; e.g., lesbian, gay, bisexual, transgender) populations. Although numerous government agencies and health experts have called for substance use intervention studies to address these disparities, such studies continue to be relatively rare.
We conducted a scoping review of prevention and drug treatment intervention studies for alcohol, tobacco, and other drug use that were conducted with SGM adults. We searched three databases to identify pertinent English-language, peer-reviewed articles published between 1985 and 2019.
Our search yielded 71 articles. The majority focused on sexual minority men and studied individual or group psychotherapies for alcohol, tobacco, or methamphetamine use.
Our findings highlight the need for intervention research focused on sexual minority women and gender minority individuals and on cannabis and opioid use. There is also a need for more research that evaluates dyadic, population-level, and medication interventions.
Examining the association between sexism, self-objectification, empowerment, and alcohol-related problems: Pathways through drinking to cope
2021, Addictive Behaviors
Citation Excerpt :
Our correlational results suggest that women of color experience less alcohol use and fewer alcohol-related problems than white women, though because race was not significantly directly associated with alcohol-related problems, there may be other specifically racialized processes (e.g., racialized discrimination, cultural values from ethnic heritage cultures) that are worth investigating in future research. Future studies should also take into account women with different marginalized forms of identity, such as sexual and gender minority women’s unique experiences related to sexism and alcohol-related problems (Mereish, Lee, Gamarel, Zaller, & Operario, 2015), given that our sample was predominantly heterosexual. Moreover, those who conduct these future studies should aim to use culturally-sensitive and non-stigmatizing language.
While research suggests that sexism is associated with college women’s hazardous alcohol use, few studies have investigated the psychological factors that underlie the association between sexism and alcohol-related problems. Thus, the purpose of the present study was to examine the direct and indirect effect of gender-relevant sociocultural factors, including sexism, self-objectification, and empowerment, on college women’s alcohol-related problems through drinking to cope. 450 women attending a large public university completed a cross-sectional survey that assessed these gender-relevant sociocultural factors and alcohol-related outcomes. Controlling for Greek membership, perceived drinking norms, and alcohol use, sexism and empowerment were both directly associated with alcohol-related problems, while sexism, self-objectification, and empowerment were indirectly associated with alcohol-related problems through the mechanism of drinking to cope. The results of this study highlight the importance of taking into account gender-relevant risk factors for women’s alcohol-related problems, as well as the role of psychological processes such as drinking to cope. Pathways for intervention on both individual and systemic levels are discussed.
Sexual orientation and gender identity disparities in co-occurring depressive symptoms and probable substance use disorders in a national cohort of young adults
2021, Addictive Behaviors
Citation Excerpt :
Overall, we found large sexual orientation disparities in co-occurring depressive symptoms across SUDs. Our findings are consistent with anayses of NESARC, which found greater lifetime prevalence of co-occurring mood and drug use disorders among adult sexual minorities compared to heterosexuals (Lee et al., 2015; Mereish et al., 2015), and extend this work by examining more recent assessments of co-occurrence (co-occurring past-week depressive symptoms and past 12-month SUDs) among young adults. Our findings align with prior research finding heightened vulnerability for depression and SUDs among sexual minority young adult women (Goldberg et al., 2013; Jun et al., 2019; Krueger et al., 2018; Rosario et al., 2014).
This study examined sexual orientation and gender identity differences in co-occurring depressive symptoms and substance use disorders (SUDs) among young adults in the Growing Up Today Study national cohort (n = 12,347; ages 20–35; 93% non-Hispanic white). Self-administered questionnaires assessed recent co-occurring depressive symptoms and probable nicotine dependence, alcohol use disorder, and drug use disorder. Multinomial logistic regressions with generalized estimating equations quantified differences in prevalences of depressive symptoms only, SUDs only, and co-occurrence, among sexual minorities (mostly heterosexual; lesbian, gay, and bisexual [LGB]) compared to completely heterosexual participants, and gender minorities compared to cisgender participants. Analyses stratified by sex assigned at birth revealed sexual minorities evidenced greater odds of co-occurrence than their completely heterosexual counterparts (assigned female AORs: 3.11–9.80, ps < 0.0001; assigned male AORs: 2.90–4.87, ps < 0.001). Sexual orientation differences in co-occurrence were pronounced among LGB participants assigned female at birth who evidenced nearly 10 times the odds of co-occurring depressive symptoms with nicotine dependence and drug use disorders than did heterosexual participants assigned female at birth. Relationships between gender identity and co-occurrence were generally weaker, possibly due to low power. Gender minorities assigned male at birth, however, evidenced greater odds of co-occurring depressive symptoms and alcohol use disorders (AOR 2.75, p = 0.013) than their cisgender counterparts. This study adds to the limited research quantifying sexual orientation or gender identity differences in recent co-occurring depressive symptoms and SUDs among young adults and suggests sexual and gender minority young adults should be prioritized in prevention and treatment of co-occurring depression and SUDs.
Sexual orientation and gender identity disparities in substance use disorders during young adulthood in a United States longitudinal cohort
2019, Drug and Alcohol Dependence
Citation Excerpt :
Aligning with previous literature (Goldberg et al., 2013; Kerridge et al., 2017; McCabe et al., 2009b), we found that SM status was associated with greater odds of past 12-month SUDs among young adults assigned female, and to a lesser extent among those assigned male. Co-occurrence of 2 or more SUDs in the past 12-months was also more common among SMs compared CHs, aligning with previous studies of lifetime SUD co-occurrence (Lee et al., 2015; Medley et al., 2016; Mereish et al., 2015). Contrary to our hypothesis, age-related declines in SUD prevalence were largely similar across sexual orientation and gender identity groups.
This study examined associations of sexual orientation and gender identity with prevalence of substance use disorders (SUDs) and co-occurring multiple SUDs in the past 12-months during young adulthood in a United States longitudinal cohort.
Questionnaires self-administered in 2010 and 2015 assessed probable past 12-month nicotine dependence, alcohol abuse and dependence, and drug abuse and dependence among 12,428 participants of an ongoing cohort study when they were ages 20–35 years. Binary or multinomial logistic regressions using generalized estimating equations were used to estimate differences by sexual orientation and gender identity in the odds of SUDs and multiple SUDs, stratified by sex assigned at birth.
Compared with completely heterosexuals (CH), sexual minority (SM; i.e., mostly heterosexual, bisexual, lesbian/gay) participants were generally more likely to have a SUD, including multiple SUDs. Among participants assigned female at birth, adjusted odds ratios (AORs) for SUDs comparing SMs to CHs ranged from 1.61 to 6.97 (ps<.05); among participants assigned male at birth, AORs ranged from 1.30 to 3.08, and were statistically significant for 62% of the estimates. Apart from elevated alcohol dependence among gender minority participants assigned male at birth compared with cisgender males (AOR: 2.30; p < .05), gender identity was not associated with prevalence of SUDs.
Sexual and gender minority (SGM) young adults disproportionately evidence SUDs, as well as co-occurring multiple SUDs. Findings related to gender identity and bisexuals assigned male at birth should be interpreted with caution due to small sample sizes. SUD prevention and treatment efforts should focus on SGM young adults.

View all citing articles on Scopus

View full text

Short CommunicationSexual orientation disparities in psychiatric and drug use disorders among a nationally representative sample of women with alcohol use disorders

Highlights

Abstract

Background and aims

Methods

Findings

Conclusions

Section snippets

Sample

Sociodemographic characteristics

Lifetime psychiatric disorders and drug use disorders

Discussion

Role of funding sources

Contributors

Conflict of interest

Journal of Substance Abuse Treatment

Journal of Substance Abuse Treatment

Drug and Alcohol Dependence

Drug and Alcohol Dependence

Addictive Behaviors

Journal of Substance Abuse Treatment

Psychiatry Research

Clinical Psychology Review

Social Science & Medicine

Drug and Alcohol Dependence

Clinical Psychology Review

Minority stress and lesbian women

Mental health and substance use disorders among Latino and Asian American lesbian, gay, and bisexual adults

Journal of Consulting and Clinical Psychology

Do specialized services exist for LGBT individuals seeking treatment for substance misuse? A study of available treatment programs

Substance Use & Misuse

A meta-analysis of disparities in childhood sexual abuse, parental physical abuse, and peer victimization among sexual minority and sexual nonminority individuals

American Journal of Public Health

Introduction to the National Epidemiologic Survey on Alcohol and Related Conditions

Alcohol Research & Health

Nicotine dependence and psychiatric disorders in the United States: Results from the National Epidemiologic Survey on Alcohol and Related Conditions

Archives of General Psychiatry

Source and accuracy statement for the Wave 2 national epidemiologic survey on alcohol and related conditions (NESARC)

Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: Results from the national epidemiologic survey on alcohol and related conditions

Archives of General Psychiatry

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

Psychology of Addictive Behaviors

Effects of sexual orientation and gender on perceived need for treatment by persons with and without mental disorders

Psychiatric Services

Influence of gender, sexual orientation, and need on treatment utilization for substance use and mental disorders: Findings from the California Quality of Life Survey

BMC Psychiatry

Short Communication
Sexual orientation disparities in psychiatric and drug use disorders among a nationally representative sample of women with alcohol use disorders