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Research Review

Stress and Discrimination Linked to Higher Substance Use Disorders in Lesbian, Gay, and Bisexual Persons

Lesbian, gay, and bisexual (LGB) persons have a higher prevalence of substance use disorders caused by stressful life events and discrimination according to a new paper published in the American Journal of Preventive Medicine.

The paper, “Sexual Orientation Disparities in Alcohol, Cannabis, and Tobacco Use Disorders: Investigating Social Stress Mechanisms in a U.S. National Sample,” was authored by Evan Krueger, PhD, MPH, MSW; Jessica Fish, PhD; and Dawn M. Upchurch, PhD, LAc.

This new paper explores sexual-orientation disparities in alcohol, cannabis, and tobacco use disorders. It expands on a recent study on lesbian and gay women and their increased prevalence of high-intensity binge drinking published by Fish, an assistant professor of family science at the University of Maryland School of Public Health.

Krueger, from the University of Southern California, was the lead author on the paper.

“Evan and I have been talking for a long time about trying to model the complexity that is inherent in the experiences of lesbian, gay, bisexual people and their stress and how that contributes to their substance use,” Fish says.

The authors used a nationally representative survey that asked respondents questions relating to their substance use and their 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 says.

Using this data set, Fish’s 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. Still, Fish and Kreueger found that everyday stressors—such as unemployment, interpersonal problems, property destruction, homelessness—also contribute to an LGB person’s formation of 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 says. “It’s also elevated rates of everyday stressors compared to heterosexual people. Those in combination contribute to elevated rates of substance use disorders.”

For LGB individuals, these everyday experiences may look like a queer woman wrestling with whether to come out at work after a benign 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.

“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,” Fish says. “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, however, that different levels of stressors do not affect each subgroup of LGB in the same way. Lesbian and gay individuals, for example, were more likely to develop substance use disorders due to discrimination. In contrast, 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 says.

Acknowledging the role everyday stressors play in substance abuse is important, Fish believes, because while antidiscrimination 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 that are unique from those in place for overt discrimination, Fish says.

Fish’s work primarily centers on identifying factors that contribute to sexual and gender minority health disparities to inform policies, programs, and strategies that promote the health of sexual and gender minority people.

She will continue her work on sexual orientation and identity disparities as a core research faculty at the School of Public Health’s new Prevention Research Center. Funded by the Center for Disease and Control and Prevention, the center will be the first in the nation to study elevated rates of mental illness in the LGBT+ community.

Source: University of Maryland School of Public Health