Sexual Orientation, Treatment Utilization and Barriers to Accessing Alcohol-Related Treatment Services

Background and Purpose: An estimated 8.5% of Americans experience an alcohol use disorder within the past-year. While effective treatment exists, only about 28% of individuals suffering from alcohol use disorders seek help for their problems. While gay, lesbian, and bisexual individuals are more likely to engage in alcohol use than their heterosexual counterparts, it is unclear whether gay, lesbian, and bisexual individuals are more likely to seek help for alcohol related problems, or whether they are more likely to experience barriers associated with seeking treatment. This study examined two research questions. 1) Controlling for social and clinical factors association with treatment utilization, is sexual orientation significantly associated with alcohol-related treatment utilization. 2) Is sexual orientation associated with any barriers to accessing alcohol-related treatment services, controlling for additional social and clinical factors  Methods:Wave 1 (2001-2002) and Wave 2 (2004-2005) data from the National Epidemiologic Survey on Alcohol Related Conditions (NESARC), a population-representative survey of United States adults aged 18 or older living in non-institutionalized settings. Our sample included respondents who had a lifetime DSM-IV alcohol use disorder diagnosis (n = 11,182). Participants reported on many sociodemographic and clinical factors, including self-reported sexual orientation. Participants also reported whether they had utilized 13 different types of treatment services for alcohol related problems, and whether they had experienced 27 different types of barriers associated with accessing alcohol-related treatment services. All analyses were completed using the survey weights provided in the NESARC sampling strategy. Logistic regression models, controlling for sociodemographic and clinical characteristics, examined whether sexual orientation was significantly associated with treatment utilization, and any barriers associated with accessing treatment services.  Results: Overall, gay, lesbian and bisexual individuals had a significantly higher prevalence alcohol use disorders, and an increased likelihood to utilize treatment services for alcohol related problems, compared to heterosexual individuals. Logistic regression analyses showed that gay or lesbian individuals experienced higher odds for treatment from a private medical professional (OR = 1.89), while bisexual individuals showed higher odds of receiving treatment from multiple sectors, including Alcoholics Anonymous (OR = 2.28), detoxification centers (OR = 3.20), and private medical professionals (OR = 2.83). Among barriers to treatment, gay or lesbian individuals reported higher odds of not wanting to go to treatment (OR = 3.08), whereas bisexual individuals reported significantly higher odds across a multitude of barriers, including they thought the problem would get better by itself (OR = 3.04), they thought they should be strong enough to handle it on their own (OR = 3.03), and they didn’t think anyone could help (OR = 5.39).  Conclusion and Implications: While there is some evidence that GLB individuals with alcohol dependence are more likely to utilize treatment services for alcohol-related problems, evidence also suggest that they still encounter barriers when accessing substance use treatment. It is important that service providers become cognizant of these barriers, and advocate for educational programs associated with the health and mental health of GLB individuals who have a substance use disorder and are attempting to access treatment.