Sexual Orientation and Service Utilization: Findings from a National Representative Sample

Background and Purpose: When compared to heterosexuals, individuals who identify as gay, lesbian, and bisexual (GLB) have an increased risk for substance use of all types, including alcohol use disorders. Despite these disparities, research regarding social and clinical correlates of service utilization for alcohol use disorders often overlook GLB individuals. On one hand, public health campaigns that are targeting GLB individuals to change health behaviors have been successful in increasing health service utilization. However, treatments for alcohol use seldom address issues surrounding the intersection of sexuality and substance use, which may provide some benefit to GLB individuals, or reduce the likelihood for substance abuse and treatment utilization. In the current study, logistic regression analysis examine whether sexual orientation is a factor associated with the likelihood of service utilization for alcohol use among individuals with known alcohol use disorders.

Methods: This study examined Wave 2 data from the 2004-2005 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), which is a nationally representative sample of the non-institutionalized U.S. adult population. Individuals who met criteria for a DSM-IV past year alcohol use disorder were included in the analysis (n=11,182). Independent sociodemographic variables including sexual orientation, gender, age, ethnicity, marital status, household income, and employment status were examined in relation to past-year service utilization for alcohol use. The independent clinical variables past-year major depressive disorder, past year anxiety disorder, past year diagnosis of alcohol dependence and past year diagnosis of any drug use disorder were also examined in relation to past-year service utilization for alcohol use. All analyses used sample weights provided by the NESARC.

Results: Bivariate results showed that approximately 8% of GLB individuals with past year alcohol use disorder reported service utilization for alcohol use, compared to 3% of heterosexual individuals. The logistic regression model suggested that, when controlling for the sociodemographic variables of gender, age, ethnicity, household income, and employment status, GLB individuals were 2.4 times more likely than heterosexuals to utilize treatment for alcohol use. However, when clinical variables were introduced as predictors, GLB individuals were no more likely to utilize treatment for alcohol use than heterosexual individuals.

Conclusions: While a larger percentage of GLB individuals are utilizing treatment for alcohol use, sexual orientation alone is not a substantial predictor of utilization. These findings have implications for both social work practice and research. In terms of social work practice, with high risk for alcohol abuse, health interventions targeting service utilization behaviors among GLB individuals may be successful in increasing access to treatment services for alcohol use. In terms of social work research, examining barriers associated with access to treatment services for alcohol use, including a possible absence of how sexuality and substance abuse intersect may assist in further reducing the risk of alcohol abuse among GLB individuals.