Discrimination and drinking: A systematic review of the evidence

Abstract

Although it is widely accepted that discrimination is associated with heavy and hazardous drinking, particularly within stress and coping frameworks, there has been no comprehensive review of the evidence. In response, we conducted a systematic review of the English language peer-reviewed literature to summarize studies of discrimination and alcohol-related outcomes, broadly defined. Searching six online data bases, we identified 937 non-duplicative titles published between 1980 and 2015, of which 97 met all inclusion criteria for our review and reported quantitative tests of associations between discrimination and alcohol use. We extracted key study characteristics and assessed quality based on reported methodological details. Papers generally supported a positive association; however, the quantity and quality of evidence varied considerably. The largest number of studies was of racial/ethnic discrimination among African Americans in the United States, followed by sexual orientation and gender discrimination. Studies of racial/ethnic discrimination were notable for their frequent use of complex modeling (i.e., mediation, moderation) but focused nearly exclusively on interpersonal discrimination. In contrast, studies of sexual orientation discrimination (i.e., heterosexism, homophobia) examined both internalized and interpersonal aspects; however, the literature largely relied on global tests of association using cross-sectional data. Some populations (e.g., Native Americans, Asian and Pacific Islanders) and types of discrimination (e.g., systemic/structural racism; ageism) received scant attention. This review extends our knowledge of a key social determinant of health through alcohol use. We identified gaps in the evidence base and suggest directions for future research related to discrimination and alcohol misuse.

Drinking, Alcohol Use Disorder, and Treatment Access and Utilization Among U.S. Racial/Ethnic Groups

“…Others suggest that some immigrant groups possess protective characteristics such as family cohesion that may be lost in future generations of the U.S.-born (Marsiglia et al, 2009b; Rivera et al, 2008; Canino et al, 2008; Estrada-Martinez, et al, 2011). Some have suggested that the poorer health indices of subsequent U.S.-born members of immigrant groups are due to the frustration associated with difficulty in fulfilling ambitions of socioeconomic betterment due to segregation and discrimination, all factors of risk for increased involvement with substance use (Smedley et al, 2003; Mason et al, 2011; Cooper et al, 2007; Williams and Collins, 2001; Landrine and Klonoff, 2000; Gilbert and Zemore, 2016; Brondolo et al, 2009; Tran et al, 2010). …”

“…Research findings have generally demonstrated a positive association between experiences of racial/ethnic discrimination, drinking and alcohol-related consequences among minorities (Martin et al, 2003, Gee et al, 2007; Mulia et al, 2008, Chae et al, 2008, Mulia et al, 2009; Tran et al, 2010; Borrell et al, 2010; Zemore el al., 2011; Mulia and Zemore, 2012; Borrell et al, 2013; Otiniano Verissimo et al, 2014; Zemore et al, 2016; Gilbert and Zemore, 2016). For example, Martin et al (2003) found that among a national sample of Blacks, reports of discrimination more than doubled the odds of problem drinking.…”

“…Among Asian Americans with low levels of ethnic identification, racial/ethnic discrimination was associated with an increased likelihood of past-year AUD (Chae et al, 2008). In a recent literature review of 97 scientific articles on the association between discrimination and alcohol outcomes, 71 of which specifically focused on racial/ethnic discrimination, Gilbert and Zemore (2016) concluded that the research generally affirms that experiences of discrimination are positively linked to alcohol misuse and related consequences. However, they note that the quality of research in this area varies widely and that the literature primarily focuses on Blacks with an under-representation of research on other U.S. racial/ethnic minority groups.…”

Interaction Between Race and Gender and Effect on Implicit Racial Bias Against Blacks

“…5,22 Perceived discrimination increases risk of depression, 23 anxiety, 24 suicide, 25 and substance use. [26][27][28] Implicit bias also influences Blacks' opportunity for employment, education, and health care. [29][30][31][32] There is growing evidence suggesting that exposure and vulnerability to racial bias is a function of the intersection of race and gender, with Black men having higher exposure and vulnerability to discrimination than Black women.…”

Gender discrimination, educational attainment, and illicit drug use among U.S. women

“…However, while substance use is a well-established dysfunctional coping behavior for acute and chronic stressors [19–23], little is known about the relationship between gender discrimination and illicit substance use or substance use disorders among U.S. women. A recent review of the literature on discrimination and alcohol use found that of the 97 studies reviewed from the previous 35 years, only 3% focused on gender discrimination (compared 70% on racial/ethnic discrimination and 16% on sexual orientation discrimination) [24]. Studies in local or convenience samples of women show that gender discrimination is associated with substance use or abuse in college students [13], young adults [25], and those seeking family planning services [26].…”