Sexual Orientation, Social Determinants of Health, and Unmet Substance Use Treatment Need: Findings from a National Survey

Background and Purpose

Unmet substance use treatment need is a critical public health and a symptom of substance use treatment disparities that exist for minority populations. Although unmet treatment need for sexual minorities has received some attention in the literature, the associations between sexual orientation and specific reasons for unmet treatment need have not been investigated. Using data from a national study and a social determinants of health framework, this study examines perceived reasons for unmet substance use treatment need among sexual minorities. The main objective of this study was to identify factors related to reasons for perceived unmet substance use treatment among gay, lesbian, and bisexual individuals while accounting for the effects of various social determinants of health.

Method

Data Source

Pooled data from the public-release National Survey of Drug Use and Health datasets from 2015 through 2018 (unweighted n = 226,632) were used to examine reasons for unmet substance use treatment need in individuals who identified as gay, lesbian, or bisexual compared to their heterosexual counterparts. The sample was restricted to respondents who (1) identified their sexual orientation, (2) self-reported as needing treatment for alcohol or drug use, and (3) indicated they did not receive treatment (unweighted n = 988).

Analysis

Bivariate analyses were used to examine the relationship between the main independent variable (sexual orientation) and each dependent variable (reason for unmet treatment need). Benjamini-Hochberg false discovery rates were calculated for the 14 dependent variables to reduce Type I errors due to multiple outcomes. The relationships between the independent variables and each reason for unmet treatment need were analyzed using multivariate logistic regressions. Cohen’s d was also calculated to assess effect size for statistically significant results.

Results

Gay, lesbian, and bisexual respondents had significantly higher odds with moderate effect sizes (OR = 2.20), 95% CI [1.26, 3.84], d = 0.44) of not knowing where to go for treatment and significantly higher odds of not being able to get the type of treatment they wanted (OR = 2.27, 95% CI [1.07, 4.82], d = 0.45), compared to their heterosexual counterparts. Other significant relationships with moderate to strong effect sizes were found for Black non-Hispanic respondents, individuals who reported having a serious mental illness, and individuals with arrest histories.

Conclusions and Implications

The results support findings from previous research that have identified unmet treatment need related to sociodemographic characteristics in the general population. The findings also suggest that gay, lesbian, and bisexual individuals may not access treatment because they do not know where to go for treatment or are not able to find the type of treatment they desire. Overall, the findings underscore the need for more specialized services and efficient pathways for sexual minorities to access services. There is also a need for national studies to collect more extensive data concerning sexual identity, orientation, and gender. These data could be used to conduct research to inform new policies and practices that support better access to care and identify ways to remediate treatment disparities affecting sexual minority populations.