Recovery among sexual minorities in the united states population: Prevalence, characteristics, quality of life and functioning compared with heterosexual majority

https://doi.org/10.1016/j.drugalcdep.2022.109290Get rights and content

Highlights

  • Prevalence of sexual minorities in the US recovery population was 11.7%.

  • Sexual minorities are less likely to be employed in recovery.

  • Sexual minorities are more likely to have a co-occurring psychiatric disorder.

  • Sexual minorities are more likely to have an arrest history.

  • Sexual minorities had significantly worse levels of well-being in recovery.

Abstract

Background

Lesbian, gay, and bisexual individuals (“sexual minorities” [SMs]) are overrepresented among individuals suffering from alcohol and other drug (AOD) problems. However, little is known regarding differences, particularly in functioning and well-being, between SMs and heterosexuals in recovery from AOD problems.

Method

Cross-sectional, nationally representative sample of US adults who resolved an AOD problem (N = 2002; National Recovery Study [Kelly et al., 2017]). Univariate analyses tested for differences between SMs and heterosexuals on socio-demographic, AOD use/treatment and clinical/legal factors. Unadjusted regressions tested for group differences on indices of current functioning and well-being. Multivariable regressions investigated factors that differentiated groups to understand which might explain any observed group disparities in functioning and well-being. LOWESS analyses explored differences across time in recovery on functioning/well-being.

Results

Prevalence of SMs in the US recovery population was 11.7% (n = 220). Compared with heterosexuals (88.3%, n = 1666), SMs had shorter time in recovery (OR=0.97; 95% CI: 0.96, 0.99); were less likely to be employed (OR=0.64; 95% CI: 0.43, 0.96); and more likely to have a co-occurring psychiatric disorder (OR=2.24; 95% CI: 1.49, 3.37), an arrest history (OR=1.61; 95% CI: 1.08, 2.39), and report opioids as primary substance (OR=2.50; 95% CI: 1.18, 5.28). Unadjusted models showed, compared to heterosexuals, SMs had significantly worse levels on all functioning and well-being outcomes. Adjusted models explained most differences, except for psychological distress.

Conclusion

SMs evince more problematic clinical/legal histories and face greater psychosocial challenges in recovery. Research is needed to understand the unique experiences of recovering SMs in order to better address observed functioning and well-being disparities.

Introduction

Alcohol and other drug (AOD) disorders are a major public health concern in most middle- and high-income countries globally, conferring a prodigious burden of disease, injury, premature mortality, and economic costs (NIDA, 2020, SAMHSA, 2019, WHO, 2018). Sexual minorities [SMs], including adults who identify as lesbian, gay, or bisexual, are overrepresented among the AOD disorder population and suffer higher rates of mental health morbidity and comorbidity (Cochran et al., 2003, Lee et al., 2015). Compared to heterosexuals, SMs are between 50% and 250% more likely to report a psychiatric disorder (Kerridge et al., 2017).

Compared to the majority heterosexual population, SMs report hazardous drinking (Hughes, 2011, Hughes et al., 2014) and experience AOD disorders at significantly higher rates (Boyd et al., 2019, Chaudhry and Reisner, 2019, Cochran et al., 2003, Duncan et al., 2019, Grella et al., 2011, Hughes et al., 2010, Kecojevic et al., 2017, Kecojevic et al., 2012, Kerridge et al., 2017, McCabe et al., 2010, McCabe et al., 2009, McCabe et al., 2019, Mereish and Bradford, 2014, Rosario et al., 2014, Schuler et al., 2018, Valentino, 2020), and are approximately two times more likely to report any past year alcohol use disorder (AUD) or drug use disorder (DUD) (SM AUD, 21.5% and heterosexual AUD, 12.8%; SM DUD, 7.7% and heterosexual DUD, 3.8%; (Boyd et al., 2019)). Also, in terms of severity of disorder, 7.2% of SMs report severe AUD in the past-year, compared to only 2.9% of heterosexuals (Boyd et al., 2019). This increased prevalence of AOD disorders appears to be the case regardless of age—SMs show an approximate doubling of risk compared to heterosexuals in every age group (Han et al., 2020, Peralta et al., 2019).

Conceptually, the increased risk for AOD disorders and other psychiatric disorders encountered by SMs might be explained by epigenetic stress and coping theories (e.g., (Folkman and Moskowitz, 2000; Gottlieb, 2007; Lazarus, 2000)). Minority stress, for example, which refers to the unique, chronic interpersonal stressors that SMs face, including stigma, discrimination, and prejudice (Meyer, 2003), may serve as an epigenetic factor triggering onset of other substance use and mental health conditions. At the same time, SM may also have access to fewer social-psychological resources which could help to buffer against these increased stressors (e.g., social support; (Bryan et al., 2017; Gilbert and Zemore, 2016; Lee et al., 2016; Lehavot and Simoni, 2011; McCabe et al., 2010; McCabe et al., 2019; Slater et al., 2017; Vu et al., 2019)). Research has also documented greater rates of unemployment and homelessness among SM individuals stemming from discriminatory practices (Mallory and Sears, 2015).

Due to SMs being a uniquely high-risk population for AOD and related mental health problems, SMs have been shown to utilize more treatment services to resolve an AOD problem compared to heterosexuals (Grella et al., 2011, Grella et al., 2009, Hughes, 2011, McCabe et al., 2013; US Department of Health and Human Services, 2018). Allen and Mowbray (2016) found about 24% of gay and lesbian individuals with an AUD and 29% of bisexual individuals with an AUD sought treatment compared to about 14% of heterosexual individuals with an AUD (Allen and Mowbray, 2016).

In spite of higher treatment utilization, SMs also report more barriers to treatment compared to heterosexuals. Bisexual individuals, for example, have been shown to be substantially more likely to endorse barriers, such as, “Did not think anyone could help,” when compared to heterosexual individuals (about 50% and 13%; respectively, (Allen and Mowbray, 2016)). Furthermore, SMs struggle finding treatment services that cater to their unique needs (Hughes, 2011), as very few SM-specific treatment programs exist (Mericle et al., 2018). Additional barriers are fears of discrimination (Jeong et al., 2016), stigma (Jeong et al., 2016), harassment (Brown et al., 2016), and being misunderstood (Brown et al., 2016). Therefore, even though SMs utilize treatment services at higher rates, a significant portion of SMs may delay seeking needed treatment (Allen and Mowbray, 2016, Corliss et al., 2006).

There is emerging literature on AOD disorder treatment amongst SMs, yet little is known about characteristics of recovering SMs. Also, while SMs are known to experience more treatment barriers, greater knowledge regarding SMs’ well-being and functioning across the recovery continuum would help inform SM-tailored services and policies. Such knowledge includes how SMs compare with the heterosexual majority in terms of AOD use and mental health histories, services used, recovery pathways followed, comfort in disclosing a history of an AOD problem, and quality of life (QOL) and psychological functioning. Research on such trajectories among those with significant AOD histories is emerging (Earnshaw et al., 2019, Kelly et al., 2017, Kelly et al., 2018), but little is known regarding the SM population, in particular, and how SMs compare to heterosexuals in terms of their characteristics, clinical histories, and well-being in recovery.

The current study uses a nationally representative sample of US adults who have successfully resolved a significant AOD problem (National Recovery Study; Kelly et al., 2017) to address these knowledge gaps for SMs, in part, by comparing their characteristics and experiences to those of their heterosexual counterparts. Specifically, the current study attempts to answer three main research questions: 1. What is the prevalence of SMs among those in the US population who have resolved a significant AOD problem; 2. How are SM and heterosexual individuals similar or different in terms of their demographics, clinical histories, and problem resolution pathways; and 3. To what extent do SM and heterosexual individuals differ in terms of QOL and psychological functioning and well-being outcomes following AOD problem resolution, and what factors in particular might explain any observed disparities. Greater knowledge regarding how SMs experience the recovery process compared to the majority heterosexual population could inform and enhance more targeted strategies and services to better meet the AOD recovery needs of this high-risk population.

Section snippets

Sample and procedure

Data for the current study comes from the National Recovery Study (NRS), described in more detail elsewhere (Earnshaw et al., 2019, Kelly et al., 2017, Kelly et al., 2018). In short, the NRS is a nationally representative sample of US adults (18 + years) who have resolved a significant AOD problem. Participants answered “yes” to the screener question “Did you used to have a problem with drugs or alcohol, but no longer do?” Data was collected using the survey company GfK via their KnowledgePanel

Prevalence of SM individuals among those in the US population who have resolved a significant AOD problem

The proportion of the sample that identified as SM (lesbian, gay, or bisexual) was 11.7% (Table 1). The SM group included n = 17 individuals who self-identified as “Something else” other than heterosexual or lesbian, gay, or bisexual.

Differences between SM and heterosexual groups in terms of their demographics, clinical histories, and problem resolution pathways

SM participants were less likely to be employed relative to heterosexual participants (OR=0.64; 95% CI: 0.43, 0.96). SM participants were more likely than heterosexual participants to have a co-occurring psychiatric disorder (OR=2.24; 95% CI: 1.49, 3.37) and arrest

Discussion

This investigation estimated the national prevalence of SMs in recovery and compared SM and heterosexual individuals on socio-demographic, clinical, and service use characteristics as well as indices of QOL, functioning, and well-being. The prevalence of SM individuals in recovery translates into approximately 2.6 million adults in the US general population. Compared to heterosexual individuals, SM individuals differed on several socio-demographic and clinical/legal factors. Notably, the SM

Role of Funding Source

This work was supported by Massachusetts General Hospital Recovery Research Institute (No: RRI081715N) and NIAAA (K24AA022136; K23AA025707).

Contributors

Amanda Haik and John Kelly conceptualized and wrote the first draft of the manuscript. Claire Greene conducted the data analyses. Brandon Bergman and Alexandra Abry helped with manuscript drafting and revisions. All authors have been personally and actively involved in substantive work leading to the report and will hold themselves jointly and individually responsible for its content. All authors have approved the final version of this manuscript version to be published.

Declarations of interests

None.

Conflict of Interest

No conflict declared.

References (64)

  • M.S. Schuler et al.

    Disparities in substance use behaviors and disorders among adult sexual minorities by age, gender, and sexual identity

    Drug Alcohol Depend.

    (2018)
  • C.L. Vilsaint et al.

    Perceived discrimination in addiction recovery: Assessing the prevalence, nature, and correlates using a novel measure in a U.S. National sample

    Drug Alcohol Depend.

    (2020)
  • C.L. Vilsaint et al.

    Development and validation of a Brief Assessment of Recovery Capital (BARC-10) for alcohol and drug use disorder

    Drug Alcohol Depend.

    (2017)
  • M.P. Battaglia et al.

    Practical considerations in raking survey data

    Surv. Pract.

    (2009)
  • C.J. Boyd et al.

    Severity of alcohol, tobacco, and drug use disorders among sexual minority individuals and their “not sure” counterparts

    LGBT Health

    (2019)
  • S. Brown et al.

    Psychometric evaluation of the customary drinking and drug use record (CDDR): a measure of adolescent alcohol and drug involvement

    J. Stud. Alcohol

    (1998)
  • A. Brown et al.

    Systematic review of barriers and facilitators to accessing and engaging with mental health care among at-risk young people

    Asia Pac. Psychiatry

    (2016)
  • A.E.B. Bryan et al.

    Factors associated with high-risk alcohol consumption among LGB older adults: The roles of gender, social support, perceived stress, discrimination, and stigma

    Gerontologist

    (2017)
  • Centers for Disease Control and Prevention, 2013, Unweighted Response Rates for the NHANES 2011–2012. Centers for...
  • A.B. Chaudhry et al.

    Disparities by sexual orientation persist for major depressive episode and substance abuse or dependence: findings from a national probability study of adults in the United States

    LGBT Health

    (2019)
  • S.D. Cochran et al.

    Prevalence of mental disorders, psychological distress, and mental health services use among lesbian, gay, and bisexual adults in the United States

    J. Consult Clin. Psychol.

    (2003)
  • Conron, K.J., & Goldberg, S.K., 2020, Adult LGBT Population in the United States. The Williams Institute, UCLA....
  • H.L. Corliss et al.

    Drug use, drug severity, and help-seeking behaviors of lesbian and bisexual women

    J. Women’s. Health (Larchmt. )

    (2006)
  • Dennis, M., T.J., White, M., Unsicker, J., Hodgkins, D., 2002, Global Appraisal of Individual Needs (GAIN):...
  • S. Folkman et al.

    Positive affect and the other side of coping

    Am. Psychol.

    (2000)
  • GfK, 2013, KnowledgePanel Design Summary. GfK....
  • G. Gottlieb

    Probabilistic epigenesis

    Dev. Sci.

    (2007)
  • B.F. Grant et al.

    Epidemiology of DSM-5 alcohol use disorder: results from the national epidemiologic survey on alcohol and related conditions III

    JAMA Psychiatry

    (2015)
  • C.E. Grella et al.

    Effects of sexual orientation and gender on perceived need for treatment by persons with and without mental disorders

    Psychiatr. Serv.

    (2011)
  • C.E. Grella et al.

    Influence of gender, sexual orientation, and need on treatment utilization for substance use and mental disorders: findings from the California Quality of Life Survey

    BMC Psychiatry

    (2009)
  • T. Groshkova et al.

    The Assessment of Recovery Capital: Properties and psychometrics of a measure of addiction recovery strengths

    Drug Alcohol Rev.

    (2013)
  • B.H. Han et al.

    Substance use among middle-aged and older lesbian, gay, and bisexual adults in the United States, 2015 to 2017

    J. Gen. Intern. Med.

    (2020)
  • Cited by (4)

    View full text