Minority Stressors and Substance Use Severity Among Gay Emerging Adult Men: A Person-Centered Analysis

Background and Purpose: Minority stress is a documented risk factor for substance use problems among sexual minority young adults. Yet, our current understanding about potential heterogeneity in these relations among gay emerging adult men, a population at high risk for multiple health risk behaviors and negative health outcomes, is rudimentary. This gap in available research reflects weaknesses in available health care and substance use treatment services for young gay men. The aim of this cross-sectional study was to describe between-group differences among homogenous subgroups of an Internet-recruited sample of gay emerging adult men, grouped by their experiences of recent minority stress for (a) past-year alcohol risk behaviors, (b) drug use problems, and (c) negative consequences of substance use.

Methods: 205 gay emerging adult men (age_M = 24.33, 42.0% non-White, 25.1% Latine) were recruited via the Internet using CloudResearch. Participants answered a 20-minute survey measuring substance use, lifetime traumas, romantic relationships, sexual-minority related stressors, and structural influences on violence exposure. Recent substance use involvement was assessed using validated brief screeners of alcohol risk behaviors (AUDIT), substance use problems (DAST-10) and negative consequences of substance use (SIP-R). Five measures of sexual minority stressors included: degree of disclosure of sexual minority status to others, degree of concealment of sexual minority status to others, ratings of felt stigma, ratings of internalized sexual stigma, and self-reported experiences of everyday discrimination.

Results: Iterative agglomerative cluster analysis (average linkage) was used to partition the sample into four non-overlapping, homogenous groups (of 80, 10, 49 and 66 participants) on the basis of their self-reported sexual minority stressor scores. The four groups that emerged demonstrated substantial variability in each of the five component variables. The four groups were labeled: High identity Disclosers; High Identity Concealers; Socially Isolated-High Experiences of Stigma/Discrimination; Socially Connected-High Experiences of Stigma/Discrimination. One MANOVA model was conducted to evaluate significant multivariate patterns of between-group differences in substance use involvement by cluster membership. Cluster membership was associated with significant mean differences in AUDIT (p<.01), DAST-10 (p<.005), and SIP-R (p<.001) scores. The Socially Isolated-High Stigma/Discrimination cluster of participants consistently reported the most maladaptive scores for measures of substance use involvement. In contrast, the High Identity Concealers reported the lowest scores for substance use involvement.

Conclusions and Implications: Our findings have implications for efforts to provide health care or counseling services to gay emerging adult men who have experienced multiple sexual minority stressors and substance use problems. Our findings emphasize the importance of addressing both social isolation and minority stressors in tailored intervention and treatment services to address co-occurring experiences of stigma and discrimination and harmful substance use patterns, as well as specialized training for social work and other professionals who provide services to this vulnerable population.