Understanding Mental Health Predictors of AA Involvement for Sexual Minorities

BACKGROUND/PURPOSE:

Sexual minorities (e.g., gay, lesbian, bisexual individuals) are more likely than heterosexuals to experience symptoms of alcohol use disorder. Among the general population, Alcoholics Anonymous (AA) is the most common source of support for alcohol-related problems in the United States. Small, qualitative studies of sexual minority samples suggest that sexual minorities may be less likely to become involved in AA due to concerns about homophobia and religion. However, past research has found that sexual minorities may be more likely than heterosexuals to become involved with AA, even after controlling for increased risk of alcohol use disorder. Past research has found that some individuals may become involved with AA to receive no-cost support for depression. Given sexual minorities’ higher rates of depression relative to heterosexual individuals, seeking support for depression may help to explain sexual minorities’ higher rates of AA involvement. No known research has tested this hypothesis. This study aims to determine if higher lifetime rates of depression may explain sexual minorities’ higher rates of AA involvement relative to heterosexuals.

METHODS:

A nationally representative sample of 18,159 adults (n=561 sexual minorities) were surveyed between 2005 and 2015 through three waves of the National Alcohol Survey. Sexual orientation, gender, race/ethnicity, income, lifetime alcohol use symptom severity, and lifetime depression were self-reported. Logistic regression was utilized to determine odds of AA involvement across sexual orientations and genders, controlling for demographic factors, including lifetime depression.

RESULTS:

Overall, 8.4% (n=47) of sexual minorities vs. 3.0% (n=514) of heterosexuals endorsed AA involvement. Overall, sexual minorities were nearly twice as likely as heterosexuals to be involved with AA (AOR: 1.7, p<0.05), even after controlling for demographic factors, including depression. This effect held for lesbian and bisexual women (AOR: 2.2, p<0.05), but not gay and bisexual men.

CONCLUSIONS/IMPLICATIONS:

This study fills an important gap by being the first national, quantitative study to examine mental health factors as predictors of AA involvement across sexual orientation. The finding that sexual minorities have higher rates of AA involvement, even after controlling for depression, suggest that AA is an important source of support for members of this community who are struggling with alcohol use, and that AA involvement is not, primarily, a strategy to receive no-cost support for depression among this community. Nonetheless, significant barriers to AA involvement have been identified for sexual minorities. Given the large percentage of sexual minorities who attend AA, future research should assess strategies for overcoming sexual minorities’ barriers to AA involvement and satisfaction/outcomes of AA involvement among sexual minorities. Limitations of this study include its use of cross-sectional data, the small number of sexual minority respondents endorsing AA involvement, and non-nuanced measures of sexual orientation, gender, and AA involvement, which limited potential for causal inference, statistical power, and nuance with which types of involvement could be understood across the spectrum of genders and sexual orientations. Future research should replicate this analysis using longitudinal data, a larger sample of sexual minorities endorsing AA involvement, and improved measures.