Full length articleCo-occurring psychiatric and drug use disorders among sexual minority men with lifetime alcohol use disorders
Introduction
Alcohol use disorders (AUDs) are prevalent in the United States population, with estimates of lifetime AUD prevalence ranging from 8.3% to 30.3% (Hasin et al., 2007). Over the past decade, a growing body of epidemiological evidence has documented disproportionately higher rates of AUD among sexual minority men in the United States (Gruskin and Gordan, 2006 Coffin et al. 2014 Drabble et al., 2005, McCabe et al., 2009). For example, one nationally representative sample found that sexual minority men had more than three times the odds of reporting alcohol dependence compared to heterosexual men (McCabe et al., 2009).
A high prevalence of diagnostic co-occurring substance use disorders and mental health problems, such as depressive symptoms, have previously been reported in studies of people with AUD (Hesselbrock et al., 1985; Swendsen and Merikangas, 2000, Grant et al., 2004, Conway et al., 2006, Natj et al., 2011). The co-occurrence of substance use disorders and mental health problems is alarming as AUD has been associated with mortality, liver cirrhosis, certain cancers, and unintentional injuries (Compton et al., 2007, Gonzales et al., 2014, Hasin et al., 2007). A number of studies suggest that sexual minority adults have a greater risk of both psychiatric and substance use disorders compared with heterosexual populations (Bostwick et al., 2010, Cochran et al., 2003, Institute of Medicine, 2011). However, there is limited population-level research that examines whether sexual minorities with AUD experience greater diagnostic co-occurring psychiatric and substance use problems compared with heterosexuals.
There is reason to expect a heightened risk for diagnostic co-occurring psychiatric problems among sexual minority populations with AUD. Studies have found that cumulative exposure to stress related to societal discrimination can have deleterious effects on mental and behavioral health of sexual minority populations (Bloomfield et al., 2011, Meyer, 2003). For example, using data from a national representative survey, one study found that lesbian, gay, and bisexual adults who reported greater exposure to discrimination also had significantly higher risk for past-year substance use disorder (McCabe et al., 2010). Other recent studies have found that sexual minority individuals residing in states that lacked protective policies against bias (i.e., laws against hate crimes, employment discrimination) have higher prevalence of alcohol, drug, and mental health disorders than those who live in states with protective policies (Pachankis et al., 2014, Hatzenbuehler et al., 2009. Thus, AUD may be especially likely to emerge in sexual minority individuals in the context of multiple psychiatric disorders as a result of discrimination.
The present study seeks to extend existing evidence by examining the potential disparities in diagnostic co-occurring health conditions between adult heterosexual and sexual minority men with AUD. The study uses data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a population-based survey conducted by the National Institute of Alcohol Abuse and Alcoholism (NIAAA). Our aims were to utilize the NESARC to: (i) compare heterosexual and sexual minority men on the prevalence of diagnostic co-occurring psychiatric and drug use disorders among men with AUD; and (ii) examine whether disparities in the prevalence of co-occurring disorders persist between sexual minority and heterosexual men after adjustment for potential sociodemographic confounders.
Section snippets
Sample
The 2004–2005 NESARC (Wave 2) collected data from a nationally representative sample of 34,653 civilian, non-institutionalized U.S. adults, ages 18 and older. Data were collected via face-to-face interviews. Sample weights were calculated to ensure that the weighted sample represented the U.S. adult non-institutionalized population based on the 2000 census. Detailed information of the NESARC survey methods and procedures is described elsewhere (Grant and Dawson, 2006, Grant and Kaplan, 2005).
Sociodemographic characteristics
Of the 6899 adult male participants with AUD who were included in this analysis, 176 (2.6% weighted) identified as a sexual minority and 6723 (97.4%) identified as heterosexual. Table 1 shows that sexual minority men with AUD were significantly less likely than heterosexual men with AUD to be married or living with partner, less likely to be employed full time, more likely to have completed college or higher degree, and more likely to have a past year family income <$20,000.
Prevalence of diagnostic co-occurring psychiatric and drug use disorders
Table 2 presents
Discussion
In this nationally representative survey, we found a significantly higher prevalence of lifetime co-occurring psychiatric and drug use disorders among sexual minority men with AUD compared with their heterosexual male counterparts. Sexual minority men with AUD had between a two- to three-fold greater odds of major depressive episodes, panic disorder without agoraphobia, specific phobia, posttraumatic stress disorder and general anxiety disorder, as well as a nearly two-fold greater odds of any
Role of funding source
Funding was provided by the National Institute of Alcohol Abuse and Alcoholism (grants U24-AA022000 and P01-AA019072), National Institute of Allergy and Infectious Diseases (grant P30-AI042853) and National Institute for Mental Health (grant T32-MH07878).
Contributors
All authors made significant contributions to the study's design and conduct. Study topic and analysis plan were conceived by JL, NZ, and DO. JL led the statistical analysis, with significant input from NZ, KG, and DO. JL, KG, and DO wrote the first full draft. CK, BM, JV, NZ and KB contributed to the interpretation of data and writing. All authors have approved of submission of this version of the manuscript to Drug and Alcohol Dependence.
Conflict of interest statement
No conflict of interest declared.
References (35)
- et al.
The alcohol use disorder and associated disabilities interview schedule (AUDADIS): Reliability of alcohol and drug modules in a clinical sample
Drug and Alcohol Dependence
(1997) - et al.
Social patterning of stress and coping: does disadvantaged social statuses confer more stress and fewer coping resources?
Soc. Sci. Med.
(2008) - et al.
The influence of structural stigma and rejection sensitivity on young sexual minority men's daily tobacco and alcohol use
Soc. Sci. Med.
(2014) - et al.
The alcohol use disorder and associated disabilities interview schedule-IV (AUDADIS-IV): Reliability of new psychiatric diagnostic modules and risk facts in a general population sample
Drug and Alcohol Dependence
(2008) - et al.
The comorbidity of depression and substance use disorders
Clin. Psychol. Rev.
(2000) - et al.
International difference in alcohol use according to sexual orientation
Subst. Abuse
(2011) - et al.
Dimensions of sexual orientation and the prevalence of mood and anxiety disorders in the United States
Am. J. Public Health
(2010) - et al.
Prevalence of mental disorders, psychological distress, and mental service use among lesbian, gay, and bisexual adults in the United States
J. Consult. Clin. Psychol.
(2003) - et al.
Adapted personalized cognitive counseling for episodic substance-using men who have sex with men: a randomized controlled trial
AIDS Behav.
(2014) - et al.
Prevalence, correlates, disability, and comorbidity of DSM-IV drug abuse and dependence in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions
Arch. Gen. Psychiatry
(2007)