Global Epidemiology and Social-Ecological Determinants of Substance Use Disparities, Consequences of Use, and Treatment Options Among Sexual and Gender Minority Populations

Abstract

Across the globe, sexual and gender minority populations experience stressors (e.g., stigma, discrimination, violence) at the individual, interpersonal, and environmental levels that may increase their risk of substance use and substance use disorders compared to their heterosexual and cisgender peers. This chapter describes the scope of disparities in substance use and related deleterious health outcomes for sexual and gender minority individuals from a global perspective. We give a brief overview of substances and their common classifications to provide context for how each may affect sexual and gender minority populations. Next, we review epidemiology of substance use and addiction across regions, with attention to cultural context. We emphasize disproportionate burden of substance use and resultant disease in sexual and gender minority individuals compared to both sexual majority groups and the general population in each of these geographic areas. In addition, we examine substance use and misuse specific to categories of sexual and gender minorities (e.g., gay men, transgender women) as well as racial/ethnic disparities within sexual and gender minority groups. We then discuss both risk and protective factors that may contribute to disparities in substance use and misuse for sexual and gender minority groups from a social-ecological perspective. Next, we describe consequences of substance use, specific to sexual and gender minority populations, including physical health outcomes (i.e., infectious and chronic diseases), social isolation, and incarceration. Lastly, we conclude this chapter with a review of substance use interventions specific to sexual and gender minorities.