Sexual Orientation, Discrimination, and Risk for Alcohol Abuse and Dependence: Results from a National Probability Sample of U.S. Adults

Background: Several studies have examined the relationship between sexual orientation (i.e., heterosexual, gay/lesbian, bisexual, and unsure) and DSM-IV alcohol abuse (AA) and Dependence (AD). Findings suggest that prevalence of AA and AD is higher among sexual minorities although many of these studies are limited by using small community- based samples and grouping all sexual minorities together. Few studies examine AA/AD risk specific to sexual minority status. Additionally, theorists have considered the contributory role of sexual minority discrimination (SMD) on higher rates of AA/AD among sexual minorities. One regional study found that such discrimination was related to alcohol problems in at-risk gay males. We aimed to: 1) investigate the relationship between sexual orientation and both AA and AD in a national probability sample of U.S. adults; and 2) test the hypothesis that SMD is associated with an increased likelihood of AA and AD among sexual minorities.

Methods: We analyzed secondary data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; Wave 2 only; 2004-2005; n=34,653). Respondents were queried about sexual orientation AA and AD (past year and lifetime) and SMD (past year and >past year). A 6-item scale assessed SMD (ICC; past year=0.80; >past year=0.78). Bivariate models tested associations among sexual orientation, alcohol disorders, SMD, and socio-demographics. Multinomial logistic regression models tested associations between sexual orientation and the likelihood of having AA and AD (past year and lifetime), while controlling for socio-demographics. Additional models tested the hypothesis of SMD on AA and AD (past year and lifetime) among the sexual minority subsample (n=747; 1.93%).

Results: Aim 1: Compared to heterosexuals, gays/lesbians (lifetime ORadj=2.45; p<.0001; past-year ORadj=2.71 p<.0001), and bisexuals (lifetime ORadj=2.56; p<.0001; past-year ORadj=3.11; p<.0001) each had nearly three times the odds of both past year and lifetime AD (but no increased risk for AA). No significant differences were found among those who were unsure of their sexual orientation. At least one-third of sexual minorities (past-year=32%; >past year=39%; both=29%) endorsed SMD. Bisexuals had increased odds of past-year AD (ORadj=3.76; p=.0113), but decreased odds of past year AA (ORadj=0.23; p=.0142) compared with the reference group (unsure). Increased age was associated with decreased likelihood of lifetime AD (ORadj=0.98; p=.0013). High school (ORadj=10.42; p=.0086) and college (ORadj=6.25; p=.0361) education was associated with increased odds of AA compared with the (<high school) reference group. Aim 2: Despite associations with sexual orientation, SMD did not significantly affect the likelihood of AA and AD (at either time period).

Conclusions/Implications:

Our findings add to evidence that sexual minorities have increased AA/AD risk. Since NESARC is a national probability sample, it is unlikely that results represent sample bias. Additionally, our analyses found evidence of particular risk among bisexuals and protection among those unsure of their sexual orientation, suggesting heterogeneity among sexual minority groups. Discrimination was not directly associated with AA and AD. Further research is needed to understand the complex relationships between sexual orientation, AA/AD, and SMD, such as contextual factors like marginalization of U.S. sexual minorities in mainstream society.