Study: Higher Substance Abuse Rates for Lesbian, Gay, Bisexual People Linked to Stress, Discrimination

Lesbian, gay and bisexual (LGB) people have a higher prevalence of substance use disorders than heterosexual people, the result of stressful life events and discrimination, according to a new study by a team that includes a School of Public Health researcher.

The paper published Friday in the American Journal of Preventive Medicine explores sexual-orientation disparities in alcohol, cannabis and tobacco use disorders, assessing differences both between sexual minorities and heterosexuals, and between different sexual minority groups.

It expands on a recent study on lesbian and gay women and their increased prevalence of high-intensity binge drinking published by one of the authors, Jessica Fish, an assistant professor of family science at the University of Maryland. 

Evan Kreuger from the University of Southern California was the lead author on the paper. He and the other researchers used a nationally representative survey conducted in 2012–13 that asked respondents about their substance use, sexual orientation and experiences with stigma. The latter questions are not always included in such wide-reaching surveys, making this data important in understanding LGB-related health disparities.

“Because it’s nationally representative, this data gives us really strong insights into what happens in the real world,” Fish said.

Using this data set, her research expanded on the minority stress model, a theory that helps explain how stigma and discrimination against LGB people create a higher risk of mental health and substance use disorders. 

Much of the research that uses this theory focuses on the stress generated from blatant or heavily impactful acts of discrimination. Fish and Kreuger found that everyday stressors—unemployment, interpersonal problems, property destruction, homelessness—also contribute to LGB peoples’ substance abuse.

“It’s not as simple as you experience discrimination and therefore, you are at risk of a substance use disorder because of your sexual orientation,” Fish said. “It’s also elevated rates of everyday stressors compared to heterosexual people. Those in combination contribute to elevated rates of substance use disorders.” 

For example, a queer woman wrestling with whether to come out at work might encounter a question that assumes heterosexuality, like “What does your husband do?” In a heteronormative society, a queer person may be asked questions like this several times a week, compounding stress, Fish said.

“Although we couldn’t test these instances, this example helps to illustrate how LGB people have to, in nanoseconds, decide whether to reveal or hide your identity,” she said. “The identity management process that occurs internally can be so incredibly stressful, and it requires a level of mental gymnastics that is stress-inducing.”

The study also found that stressors do not affect subgroup identically. Lesbian and gay individuals were more likely to develop substance use disorders due to discrimination, while bisexual people were more likely to experience substance abuse in conjunction with everyday stressors. 

“Our findings really emphasize the point that we can’t just assume that LGB people experience the same things in the same way,” Fish said.

Acknowledging the role everyday stressors play in substance abuse is important, Fish said, because while anti-discrimination laws have been shown to reduce rates of discrimination and victimization, it is much harder to police cultural factors that shape everyday interactions.

Addressing microaggressions and other everyday factors that induce stress for LGB people will demand new intervention and prevention strategies, Fish said, unique from those in place for overt discrimination.