The Double-Edged Sword: LGBTQ+ Belongingness, Discrimination, and Substance Use in Kentucky

Background and Purpose: LGBTQ+ individuals often face significant discrimination, contributing to adverse health outcomes, including higher rates of substance use. Concurrently, a sense of belonging within the LGBTQ+ community is typically viewed as a protective factor buffering against minority stress. However, the relationship between community belongingness and specific substance use behaviors (e.g., alcohol consumption or hard drug use) remains complex, especially among those experiencing frequent discrimination within politically challenging environments like Kentucky, which has seen recent anti-LGBTQ+ legislation. This study aimed to examine the association between LGBTQ+ community belongingness and (1) hard drug use and (2) frequency of alcohol consumption among LGBTQ+ adults in Kentucky. We hypothesized that higher belongingness would be negatively associated with both forms of substance use.

Methods: Data were derived from the Queer KY Survey, a cross-sectional online survey conducted April 13 through July 15, 2024. Participants (N=3370) included LGBTQ+ adults living in Kentucky, recruited through convenience and snowball sampling primarily at large community events; participants were also asked to share the survey link within their social networks. Participation was incentivized by a random drawing for $100 gift cards. The analytic sample for this study (n=692) included individuals who reported experiencing discrimination once a month or more, assessed via the Every Day Discrimination Scale. Key measures included: (1) the LGBTQ Belongingness Attainment Scale (α=.89); (2) self-reported frequency of daily alcohol consumption; and (3) self-reported hard drug use (binary: yes/no). Analytic strategy involved: (1) a binary logistic regression predicting hard drug use from belongingness scores, and (2) a linear regression predicting frequency of alcohol consumption from belongingness scores. Covariates included income, education level, and gender identity.

Results: The binary logistic regression revealed that greater LGBTQ+ belongingness was significantly associated with higher odds of reporting hard drug use (OR=2.76, 95% CI=(2.02, 3.79), p<.001), controlling for covariates. The linear regression analysis indicated that greater LGBTQ+ belongingness was significantly associated with a lower frequency of alcohol consumption (β=-.24, p=.004), controlling for covariates. Income emerged as a significant covariate in the logistic (p=.045) and linear (p=.039) regression models.

Conclusions and Implications: Findings reveal a nuanced, potentially paradoxical role of LGBTQ+ community belongingness among Kentuckians facing frequent discrimination. While higher belongingness appears protective against more frequent alcohol consumption, it was unexpectedly associated with increased odds of hard drug use in this specific sample and context. This suggests community belonging, while vital, is not universally protective against all forms of substance misuse; specific social dynamics, coping mechanisms within community spaces, or norms may be linked to certain use patterns, particularly under conditions of high external stress (e.g., discrimination, hostile political climate). The consistent significance of income highlights intersecting socioeconomic vulnerabilities. Implications point towards the need for integrated, culturally-responsive substance use prevention, harm reduction, and treatment strategies situated within LGBTQ+ community settings, acknowledging the complex realities beyond simple assumptions of belonging as solely beneficial. Further research, including qualitative methods, is essential to understand the mechanisms driving the observed association between higher belongingness and hard drug use among frequently discriminated LGBTQ+ individuals in this region.