Differential Effects of State Policy Environments on Substance Use by Sexual Identity: Findings From the 2000-2015 National Alcohol Surveys.

INTRODUCTION: This study explored whether structural stigma, defined by U.S. state policies related to sexual minority rights, moderated the relationship between sexual identity identity and heavy drinking, alcohol problems, and marijuana use among men and women. METHODS: Using combined data from the National Alcohol Survey (NAS) series (2000, 2005, 2010, and 2015), the sample included 11,115 men (421 sexual minority and 10,694 heterosexual) and 14,395 women (413 sexual minority and 13,982 heterosexual). State policy environment was assessed using a time-varying dichotomous indicator of comprehensive protections for sexual minorities (4-6 protections vs. limited or no protections). Gender-stratified logistic regression analyses examined the differential effect of the policy environment by sexual identity on three past-year substance use outcomes: high-intensity drinking (8+ drinks/day), any DSM-5 alcohol use disorder, and marijuana use. RESULTS: Among women, sexual minority status was associated with increased odds of all alcohol and marijuana use outcomes. Among men, sexual minority status was associated with decreased odds of high-intensity drinking but increased use of marijuana. Comprehensive policy protections were associated significantly decreased odds of high-intensity drinking among sexual minority men and marginally significant decreases among women. CONCLUSIONS: Comprehensive policy protections appear to be protective for high-intensity drinking among sexual minority men and women. Findings underscore the importance of supportive policies in reducing risk of alcohol-related problems among sexual minorities.

Investigating differential protective effects of marriage on substance use by sexual identity status.

BACKGROUND: Research suggests that marriage is protective against substance use. However, few studies have examined whether this protective effect differs for sexual minorities, a population at increased risk for substance use. Using data from four waves of the cross-sectional U.S. National Alcohol Survey (NAS; 2000, 2005, 2010, and 2015), we investigated whether the protective effects of marriage varied by sexual identity. METHODS: Sex-stratified logistic regression models were used to examine independent and interactive effects of current marital status (being married vs. not) and sexual minority status (lesbian/gay/bisexual vs. heterosexual) on high-intensity drinking, alcohol use disorder, and marijuana use in the past year. RESULTS: Among both women and men, sexual minority status was generally associated with higher odds of these outcomes and marriage was consistently associated with lower odds. Differential effects of marriage by sexual identity with respect to marijuana use were found only among men; marriage was significantly associated with decreased odds of marijuana use among heterosexual men but increased odds among sexual minority men. CONCLUSIONS: Marriage may be less consistently protective against hazardous drinking and marijuana use among sexual minorities than heterosexuals. Findings underscore the importance of both quantitative and qualitative studies designed to better understand disparities in substance use across both sexual identity and relationship statuses.

Effects of Distance to Treatment on Subsequent Alcohol Consumption.

BACKGROUND: Distance and travel time are barriers to attending and completing drug and alcohol treatment. Few studies have examined proximity to treatment in relation to long-term outcomes. OBJECTIVES: Aims were to examine effects of distance to treatment on alcohol consumption in the year after treatment intake; assess moderation of distance effects by treatment type; and test mediators of effects of distance to treatment on later alcohol use. METHODS: Data from clients in inpatient and outpatient alcohol treatment programs in California (n=560) were used in linear regression models. RESULTS: There was a significant interaction between treatment type and distance on later drinking, with a significant positive association of distance to treatment with alcohol use after treatment for inpatient clients only. Among inpatient clients, none of the mediators significantly explained the relationship between a longer distance to treatment and greater subsequent alcohol use. CONCLUSION: Inpatient clients may benefit from customized post-treatment recommendations to identify recovery resources near home.

Comparing substance use and mental health outcomes among sexual minority and heterosexual women in probability and non-probability samples.

OBJECTIVE: To examine similarities and differences in demographics and key substance use and mental health outcomes in a probability sample of heterosexual women and two samples of sexual minority women (SMW), one recruited using probability and the other using non-probability methods. METHODS: Using data from four waves of the National Alcohol Survey (NAS; n = 315 SMW; 10,523 heterosexual women) and Wave 3 of the Chicago Health and Life Experiences of Women (CHLEW; n = 688 SMW) study, we examined hazardous drinking, drug use, tobacco use, depression, and help-seeking for alcohol or other drug problems. RESULTS: Compared to SMW in the probability sample, SMW in the non-probability sample were older, more likely to be college educated, and more likely to be in a partnered relationship. Compared to heterosexuals, SMW in both the probability and non-probability samples had greater odds of past-year hazardous drinking, marijuana use, and other drug use. We found similar results for lifetime help-seeking for alcohol or drug problems, past week depression, and co-occurring hazardous drinking and depression. In comparisons with heterosexual women, the magnitude of difference for drug use was greater for the SMW non-probability sample; for tobacco use, the difference was greater for the SMW probability sample. CONCLUSION: Given the difficulties recruiting probability samples of SMW, researchers will continue to use non-probability samples in the foreseeable future. Thus, understanding how findings may differ between probability and non-probability samples is critically important in advancing research on sexual-orientation-related health disparities.

Effects of Treatment Type on Alcohol Consumption Partially Mediated by Alcoholics Anonymous Attendance.

BACKGROUND: As insurance coverage, funding sources and venues for drug and alcohol treatment evolve in the United States, it is important to assess how the type of treatment received may impact long-term outcomes. The current study aims were to examine effects of treatment type on alcohol consumption in the year after treatment intake and to test mediators of effects of treatment type on later alcohol use. METHODS: Longitudinal data from clients in inpatient and outpatient alcohol treatment programs in California (n = 560) were used in ordinary least squares path analysis adjusting for respondent characteristics typically associated with both treatment completion and alcohol use. The primary outcome was amount of alcohol consumed in the 12 months after treatment entry; hypothesized mediators were treatment duration and participation in Alcoholics Anonymous (AA). RESULTS: Despite higher baseline problem severity and a shorter treatment duration, inpatient clients consumed less alcohol after treatment than outpatient clients (B [95% CI] = -0.95 [-1.67, -0.23]). AA involvement was a significant mediator of the relationship between treatment type and alcohol consumption, with inpatient clients being more involved in AA and also drinking less after treatment than outpatient clients; the bias-corrected bootstrap 95% confidence interval for the indirect effect (B = -0.20) was entirely below zero (-0.43 to -0.05). CONCLUSIONS: Outpatient clients may benefit from customized posttreatment recommendations to identify additional resources to assist in the recovery process during the first year after treatment.

Religiosity as a protective factor for hazardous drinking and drug use among sexual minority and heterosexual women: Findings from the National Alcohol Survey.

OBJECTIVE: Despite research documenting disparities in risk for alcohol-related problems among sexual minority women, few studies explore potential protective factors within this population. This study examines how religiosity may function as a protective or risk factor for alcohol-problems or other substance use among sexual minorities compared to heterosexuals. METHOD: Data from 11,169 women who responded to sexual identity and sexual behavior questions from three population-based National Alcohol Survey waves (2000, 2005, 2010) were utilized for analyses of religiosity in relation to lifetime drinking, past year hazardous drinking, and past year drug use. RESULTS: Religiosity was significantly greater among exclusively heterosexual women compared to all sexual minority groups (lesbian, bisexual and heterosexual women who report same sex partners). Lesbians reported the lowest rates of affiliation with religions/denominations discouraging alcohol use. Past year hazardous drinking and use of any illicit drugs were significantly lower among exclusively heterosexual women compared to all sexual minority groups. High religiosity was associated with lifetime alcohol abstention and was found to be protective against hazardous drinking and drug use among both sexual minority and heterosexual women. Reporting religious norms unfavorable to drinking was protective against hazardous drinking among exclusively heterosexual women but not sexual minority women. CONCLUSIONS: Findings reveal the importance of considering sexual minority status in evaluation of religion or spirituality as protective among women. Future studies should explore religiosity in the context of other individual and environmental factors, such as positive identity development and community-level acceptance, which may be salient to resiliency among sexual minorities.