Estimates of alcohol use and clinical treatment needs among homosexually active men and women in the U.S. population.

Abstract

Concerns about dysfunctional alcohol use among lesbians and gay men are longstanding. The authors examined alcohol use patterns and treatment utilization among adults interviewed in the 1996 National Household Survey on Drug Abuse. Sexually active respondents were classified into 2 groups: those with at least 1 same-gender sexual partner (n = 194) in the year prior to interview and those with only opposite-gender sexual partners (n = 9,714). The authors compared these 2 groups separately by gender. For men, normative alcohol use patterns or morbidity did not differ significantly between the 2 groups. However, homosexually active women reported using alcohol more frequently and in greater amounts and experienced greater alcohol-related morbidity than exclusively heterosexually active women. Findings suggest higher risk for alcohol-related problems among lesbians as compared with other women, perhaps because of a more common pattern of moderate alcohol consumption.Alcohol abuse and related morbidity are continuing health concerns in the United States (Harwood, Fountain, & Fountain, 1998). Although moderate drinking may confer some protective health benefits, there is no doubt that heavier or dysfunctional patterns of alcohol consumption have adverse health effects (Poikolainen, 1996). Among those individuals thought to be at higher risk for problematic alcohol use are lesbians and gay men (Bux, 1996;Hughes & Wilsnack, 1994;Paul, Stall, & Bloomfield, 1991). This concern emanates from beliefs that social stigma encourages higher rates of problematic alcohol use, that the traditionally safe environment of gay bars fosters excessive drinking in the population, and that there are fewer normative pressures against alcohol consumption in the gay community that act as inhibitors of alcohol abuse (Bux, 1996;Hughes & Wilsnack, 1997;McKirnan & Peterson, 1989;Paul et al., 1991).In support of these perspectives, early convenience-based surveys of the gay and lesbian population found high-prevalence rates of alcoholism (up to 30%;Fiefield, 1975;Lohrenz, Connely, Coyne, & Spare, 1978). However, samples were commonly small and participants were often recruited from bars frequented by the lesbian and gay community. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript alcohol-related studies, recruitment of lesbians and gay men relied on more sophisticated strategies, drawing large convenience-based samples from multiple sources not exclusively dependent on bar-related proximity but, nonetheless, relying heavily on visible gaycommunity involvement. These researchers, as might be expected, found lower prevalence of alcoholism but also, especially for women, indications of rates exceeding population estimates (Bradford, Ryan, & Rothblum, 1994;Cochran, Bybee, Gage, & Mays, 1996;Knowlton, McCusker, Stoddard, Zapka, & Mayer, 1994;Martin, 1990;McKirnan & Peterson, 1989;Seage et al., 1998).Across studies, a picture emerged that lesbians and gay men may be more likely than other Americans to consume alcohol r...

Gender and Sexual Orientation Differences in Cognition Across Adulthood: Age Is Kinder to Women than to Men Regardless of Sexual Orientation

“…The data on health-linked behaviors are largely consistent with previous literature on consumption of alcohol, nicotine, and drugs in showing greater intakes of all three substances in men than in women, and greater intakes of nicotine and drugs in non-heterosexuals than in heterosexuals (e.g., Ryan, Wortley, Easton, Pederson, & Greenwood, 2001), although we did not find higher alcohol intake in non-heterosexual women compared with heterosexual women, contrary to some studies (Cochran, Keenan, Schober, & Mays, 2000;Drabble, Midanik, & Trocki, 2005). Interestingly, if rate of cognitive decline is associated with such health-linked behaviors, then one might expect homosexual and bisexual members of both genders to show male-typical rates of cognitive decline.…”

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

“…Lesbians and gay men commonly report positive histories of victimization and discrimination (Herek, Gillis, & Cogan, 1999;Hershberger & D'Augelli, 1995;Krieger & Sidney, 1997), particularly in adolescence or young adulthood (D'Augelli, Hershberger, & Pilkington, 1998;Lock & Steiner, 1999). As a consequence, homosexuality may be a risk indicator for higher rates of psychological distress and some mental disorders.Much of the recent population-based research in this area (Bloomfield, 1993;Cochran, Keenan, Schober, & Mays, 2000;Cochran & Mays, 2000a, 2000bFaulkner & Cranston, 1998;Fergusson, Horwood, & Beautrais, 1999;Garofalo, Wolf, Wissow, Woods, & Goodman, 1999;Gilman et al, 2001;Herrell et al, 1999;Lock & Steiner, 1999;Remafedi, French, Story, Resnick, & Blum, 1998;Saewyc, Bearinger, Heinz, Blum, & Resnick, 1998;Sandfort, de Graaf, Bijl, & Schnabel, 2001;Stall & Wiley, 1988) was made possible by the serendipitous inclusion of questions concerning genders of sexual partners in large healthrelated studies of the general population. This attention to the occurrence of homosexual sexual behavior arose out of public health surveillance needs to track risk factors for HIV transmission in the general population.…”

“…Some, but not all, studies have observed higher rates of major depression (Cochran & Mays, 2000a, 2000bSandfort et al, 2001), suicide attempts (Herrell et al, 1999), and anxiety disorders (Cochran & Mays, 2000b;Sandfort et al, 2001) in homosexually active men when compared with heterosexually active men. Similarly, some, but not all, studies found higher rates of major depression (Gilman et al, 2001;Sandfort et al, 2001), suicide attempts (Gilman et al, 2001), some anxiety disorders (Gilman et al, 2001), and alcohol-and drug dependency disorders (Cochran & Mays, 2000b) in homosexually active women when compared with heterosexually active women.Because sexual orientation is a broader construct than same-gender sexual activity (Sell, 1997), the use of sexual behavior alone to determine identity has led to some concern about mis-classification bias in these studies (Bailey, 1999;Cochran et al, 2000;Cochran & Mays, 2000b), Indeed, Bailey (1999 suggested that this approach indexes not only sexual orientation but also, to some degree, impulsivity among those who are heterosexual but may engage in same-gender sexual behavior at times. The effect of this might be to overestimate rates of mental health morbidity.…”

Coping Styles as Mediator of Sexual Orientation-Related Health Differences

“…Several studies in large probability samples have shown that homosexuality is a risk factor for mental health problems (Cochran, Keenan, Schober, & Mays, 2000;Cochran, Sullivan, & Mays, 2003;Fergusson, Horwood, & Beautrais, 1999;Gilman et al, 2001;Jorm, Korten, Rodgers, Jacomb, & Christensen, 2002;King et al, 2003;McDaniel, Purcell, & D'Augelli, 2001;Meyer, 2003;Sandfort, de Graaf, & Bijl, 2003;Sandfort, de Graaf, Bijl, & Schnabel, 2001;Skegg, Nada-Raja, Dickson, Paul, & Williams, 2003). Sandfort et al (2001), for instance, found in a large population sample of 7,076 heterosexually and homosexually active adults (aged 18-64 years) that homosexual men had a higher 12-month prevalence of mood disorders and anxiety disorders than did heterosexual men, while homosexual women had a higher 12-month prevalence of substance use disorders than did heterosexual women.…”