Substance Misuse among Sexual and Gender Minorities: The Role of Everyday Discrimination and Identity

Abstract

Background

Sexual and gender minorities (SGMs) often deal with discrimination which can result in maladaptive coping like substance misuse, yet few studies have examined the association between everyday discrimination and various types of substance misuse among SGMs or whether there is heterogeneity in substance misuse or this relationship by SGM identity.

Methods

Data from 1316 adult SGMs in the United States were recruited from Reddit between February and March 2022. SGM identities (sexual minorities assigned male at birth (AMAB), sexual minorities assigned female at birth (AFAB), gender minorities AMAB, gender minorities AFAB), everyday discrimination, depressive symptoms, marijuana and alcohol misuse, over-the-counter drug misuse, prescription drug misuse, and heroin use were measured, along with demographics. Multivariable logistic regressions examined relationships between everyday discrimination and each substance misuse outcome, adjusting for SGM identity, race/ethnicity, age, income, and depressive symptoms. Interaction terms between everyday discrimination and SGM identities were added to each model to test for moderation.

Results

In fully adjusted models, with each additional unit of everyday discrimination score, there were significantly increased odds of substance misuse for all outcomes. SGM by everyday discrimination interactions was significant for alcohol misuse, over-the-counter drug misuse, and heroin use, with the association between everyday discrimination and substance misuse stronger among gender minorities.

Conclusions

Substance misuse varied by SGM identity. Everyday discrimination was associated with substance misuse, but there was heterogeneity in this relationship between SGM identity and substance. Substance use disorder treatment and prevention among SGMs should consider heterogeneity by SGM identity and substance.

Keywords:

• Substance use
• sexual orientation
• gender identity
• sexual and gender minorities
• discrimination

Acknowledgements

This study was supported by an internal Johnson & Wales University Provost Innovation Fund Award. We would like to thank Samantha Philippe, Carla Ibarra, Deanna Biddy, and Brian Harrington, without whom this study could not have been accomplished.

Declaration of interest

The authors have no conflicts of interest to report. This study was approved by the local Institutional Review Board. Electronic informed consent was obtained by all study participants.

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Definition of terms

Sexual & Gender Minority (SGM): Individuals whose sexual orientation and/or gender identity do not align with the majority culture of cisgender and/or heterosexual individuals.

Assigned Male at Birth (AMAB): Individuals who were assigned the sex of “male” by their doctor upon birth, typically based on external genitalia.

Assigned Female at Birth (AFAB): Individuals who were assigned the sex of “female” by their doctor upon birth, typically based on external genitalia.

Sexual Minority (SM): Individuals whose sex assigned at birth aligned with their gender identity and reported a sexual orientation other than heterosexual/straight.

Gender Minority (GM): Individuals whose sex assigned at birth differed from their gender identity regardless of sexual orientation or reported transgender status. Individuals may identify within or outside of the gender binary.

Additional information

Funding

This work was supported by Johnson & Wales University Provost Innovation Fund Award