Alcohol and Substance Use and Dependence Within the LGBTQ+ Adult Population: An Exploration of Psychological and Social Factors

Background: Alcohol and drug use and dependence rates are substantially more prevalent within the LGBTQ+ population when compared with the general heteronormative population. These contribute to numerous health disparities for the LGBTQ+ community. Several psychosocial variables are posited to influence substance use within this population, including current minority stress, and past difficulties including childhood bullying and ACEs, all of which likely contribute to mental health difficulties such as social anxiety. Current evidence indicates different sexual orientation and gender groups will have unique relationships with substance use and associated factors. However, there is a current lack of research splitting the LGBTQ+ population into distinct categories, particularly within the UK and in relation to pansexual, asexual and transgender communities.

Aims: The current study aimed to provide a snapshot of current alcohol, smoking, vaping and various drug use rates within the UK adult LGBTQ+ population, and ascertain which psychosocial variables (other substance use, ACEs, childhood bullying, mental health symptoms, social anxiety, and LGBTQ+ related minority stress) had a relationship with alcohol use and drug use. The current study also aimed to identify key differences between alcohol and substance-dependent individuals in the sample compared with non-dependent participants, as well as substance use differences between sexual orientation and gender groups. Finally, the study wished to gain insight into the main reasons and contexts for LGBTQ+ substance use.

Method: Data was collected via an online Qualtrics survey with LGBTQ+ adults living in the UK being eligible to participate. Respondents filled out a series of questionnaires relating to their substance use, mental health, as well as both childhood and current life experiences. 352 participants completed the study and were included in analysis, which involved a series of correlations, multiple regression, MANOVA, and content analysis.

Results: Correlational and regression analysis found that alcohol use had a positive relationship with drug use and was predicted by this, whilst drug use was positively correlated with both alcohol use and ACEs. MANOVA analyses identified that LGBTQ+ smokers showed significantly higher alcohol and drug use, as well as significantly higher total minority stress, social anxiety, victimization events and ACEs. Victimization events had the strongest relationship with drinking, drug use and smoking compared with other minority stress components. No significant differences in substance use were found between groups based on sexual orientation or gender identity, but there were several differences on psychosocial variables, particularly minority stress. The most commonly-reported reason for using substances was management of mental health symptoms.

Conclusions: This study has provided an up-to-date snapshot of substance use prevalence within the LGBTQ+ population, with this population showing higher rates on all substances compared with the general UK population. Results provide some support for the link between the psychosocial variables and substance use, but more so for smoking, followed by drug use. Limitations of the study are discussed, as well as providing suggestions for future research to gain larger subgroups to help establish which psychosocial variables are most prevalent in predicting LGBTQ+ substance use. Longitudinal research with ethnically diverse samples are also warranted.