How Does Sexual Orientation Influence the Drug of Choice, Age of Onset, and Route of Drug Administration Among Adults Receiving Substance Use Treatment? an Evaluation at Mile High Behavioral Healthcare in Colorado

Background and Purpose: Substance use is a well-documented factor negatively affecting health outcomes across sexual minorities (Substance Abuse and Mental Health Services Administration, 2023). This evaluation examined the differential associations of sexual orientation and drug of choice, age of onset, and route of drug administration among adults receiving substance use treatment in Colorado.

Methods: This evaluation used admissions and discharge data from the Colorado Drug and Alcohol Coordinated Data System (DACODS). Data were obtained from adults receiving substance use treatment (N = 1,158) at Mile High Behavioral Healthcare in Colorado from October 2019 to September 2023. Analyses were conducted using descriptive statistics, multinomial logistic, and binary logistics regression.

Results: Fifty-six percent of clients were female. The mean age was 39 years old. Results indicated heterogeneous associations. Methamphetamine (31.4%), alcohol (30.2%), heroin (13.0%), and marijuana/ hashish (11.1%) were the predominant primary drugs of choice. Lower percentages of cocaine hydrochloride/ crack (5.4%), other opiates/ synthetic opiates (7.2%), and benzodiazepine tranquilizers (0.5%) suggest that while less prevalent, there is a diversity in drug of choice. Fifty-six percent of clients started using substances in their youth. Smoking (32%) and oral (25.3%) were the most common routes of administration, potentially reflecting the substances’ legal status (such as alcohol and tobacco). Compared to heterosexual clients, gay/lesbian clients were less likely to choose alcohol (RRR = 0.41, p < 0.05) and cocaine (RRR = 0.12, p < 0.05) as their primary drugs of choice. Gay/lesbian clients were less likely to abstain from drug use (RRR = 0.38, p < 0.05). Bisexuals were more likely to choose injection as a route of drug administration (RRR = 2.86, p < 0.05). Sexual orientation was not reliably different from zero with the age of onset of substance use.

Conclusions and Implications: Findings support differential associations of sexual orientation with the drug of choice, age of onset, and route of drug administration. Lower levels of RRR in gay/lesbian clients appear to be robust a predictor of not choosing alcohol or cocaine as the drugs of choice and less likely to refrain from drug use. Higher levels of RRR in bisexual clients appear to be a robust predictor of using injections. In contrast, sexual orientation’s association with the age of onset is inconclusive. Our findings confirm that aspects of sexual orientation may have robust associations with affective and behavioral indicators related to substance use. Unlike external factors, which involve interactions with others, sexual identity may exemplify individuals’ inner struggle to understand their preferences and behaviors in the context of societal norms and their substance use patterns. It should be noted that the DACODS data set limits response options for sexual orientation to Heterosexual, Gay/Lesbian, Bisexual, and Other and Declined; therefore, the data presented may not reflect all sexual identities. The complexity of sexual orientation requires a precise explication of the associations among different drugs of choice, age of onset, and route of administration and outcomes, which can inform the development of substance use reduction interventions targeting sexual identity experiences.