The nature and predictors of substance use among lesbians

doi:10.1016/S0306-4603(98)00003-3

Addictive Behaviors

Volume 23, Issue 4, July–August 1998, Pages 517-528

https://doi.org/10.1016/S0306-4603(98)00003-3 Get rights and content

Abstract

It has been suggested that lesbians lack mainstream coping resources and are thus at risk for maladaptive coping efforts, which include substance abuse. However, data for this population are sparse. Levels of stress, coping styles, rates of problematic substance use, and relationships among these variables were examined. Two hundred sixty-three lesbians completed a self-report questionnaire as part of a larger study. Neither high rates of heavy drinking nor drug use were found in this sample. Among those who did drink excessively, it was associated with avoidant coping. Perceived stress and social resources did not differ significantly from the general female population. Levels of stress, social support, and coping style were not predictive of problematic substance use. The most significant predictor of alcohol use was reliance on bars as a primary social setting. Implications of these findings are discussed.

Section snippets

Risk factors

If there is increased risk for alcohol problems among lesbians, what might be the specific risk factors involved? The early reports of Fifield (1975) and others gave rise to a range of hypotheses including the stresses of stigmatization, lack of self-acceptance, the importance of bars as a safe place for lesbian and gay socializing, use of psychoactive substances to facilitate sexual behavior deemed forbidden, and the risk for denial of alcohol problems created by the development in lesbians

Coping styles

Coping may be broadly defined as the efforts made by an individual to manage external or internal demands that strain his or her resources, in a manner that serves to modify the effects of such stressors. It may be conceptualized, therefore, as a mediator of the relation between stress and resulting distress or disorder. Research has shown that active coping styles are associated with less depression and better adjustment, while passive or avoidant styles are associated with greater depression,

Substance use, stress, and coping

There is a considerable literature suggesting that deficits in coping processes are related to increased likelihood of substance abuse. Specifically, reliance on avoidant or escapist coping has been associated with the consumption of alcohol to cope with stressors, and with alcohol abuse (e.g., Blechman, Wills, & Adler 1992, Cooper et al. 1988, CRI: Moos 1992, Moos et al. 1990). It has also been proposed that tendencies toward escapist coping may be strengthened by cultural or subcultural norms

Subjects

Two hundred and sixty-three lesbians participated in the study (response rate: 39%). They were recruited from a variety of sources, which included campus lesbian and gay organizations, lesbian/gay community centers, a variety of groups meeting for recreational, political, support, or other purposes, and a recently established countrywide collaborative network for the distribution of surveys by researchers studying lesbian and gay issues in which participants distribute one another’s

Stress and resources

The mean level of perceived stress was 25.67 (SD 8.01), which is slightly elevated compared to the norm for women in the general population (20.20, SD 7.8),3 but within 1 standard deviation. While some participants had experienced up to 9 episodes of discrimination within the past month, there was generally a low frequency of such experiences in this sample (M = 0.87, SD 1.36). The majority of participants (91.6%) were completely or mostly out, and only one (0.4%)

Discussion

Twenty-eight percent of the lesbians surveyed in this study reported abstinence from alcohol, in contrast to McKirnan and Peterson’s (1989a) finding of 15%. Similarly, in contrast to 9% of McKirnan and Peterson’s (1989a) sample, none of the participants in the present study were heavy drinkers. McKirnan and Peterson (1989a) do not break down the percentage of moderate drinkers by gender, but given that they found no significant differences between lesbians and gay men in the categories of

Acknowledgements

This article is based on data collected as part of the author’s doctoral dissertation. I gratefully acknowledge the support of G. Terence Wilson in the conceptualization and completion of this research. I would like to express my appreciation to Erich Labouvie and Katharine Loeb for their helpful input, and also thank the many individuals who assisted in data collection.

References (36)

H. Cookson
Personality variables associated with alcohol use in young offenders
Personality and Individual Differences
(1994)
D.J. McKirnan et al.
Alcohol and drug use among homosexual men and womenEpidemiology and population characteristics
Addictive Behaviors
(1989)
D.J. McKirnan et al.
Psychosocial and cultural factors in alcohol and drug abuseAn analysis of a homosexual community
Addictive Behaviors
(1989)
T.L. Rosenthal et al.
Substance abuse patterns reveal contrasting personal traits
Journal of Substance Abuse
(1990)
G.T. Wilson
Alcohol and anxiety
Behavior Research and Therapy
(1988)
G. Bernstein
Assessment and goal selection with lesbian and gay clients
The Behavior Therapist
(1993)
Blechman, E. A., Wills, T. A., & Adler, V. (1992). Process measures in interventions for drug-abusing women: From...
J. Bradford et al.
National Lesbian Health Care SurveyImplications for mental health care
Journal of Consulting and Clinical Psychology
(1994)
Bux, D. A. (in press). The epidemiology of problem drinking in gay men and lesbians: A critical review. Clinical...
Cohen, S., & Williamson, G. M. (1987). Perceived stress in a probability sample of the United States. In S. Spacapan &...

M.L. Cooper et al.

Coping expectancies and alcohol abuseA test of social learning formulations

Journal of Abnormal Psychology

(1988)

D.L. Diamond et al.

Alcohol abuse among lesbiansA descriptive study

Journal of Homosexuality

(1978)

S.B. Eysenck et al.

Impulsiveness and venturesomenessTheir position in a dimensional system of personality description

Psychological Reports

(1978)

L.F. Fifield

On my way to nowhereAlienated, isolated, and drunk

(1975)

K.O. Glaus

Alcoholism, chemical dependency and the lesbian client

Women and Therapy

(1988)

P.R. Holleran et al.

Support choices and abstinence in gay/lesbian and heterosexual alcoholics

Alcoholism Treatment Quarterly

(1989)

J.G. Hull

A self-awareness model of the causes and effects of alcohol consumption

Journal of Abnormal Psychology

(1981)

S. Israelstam

Alcohol and drug problems of gay males and lesbiansTherapy, counseling, and prevention issues

Journal of Drug Issues

(1986)

Cited by (63)

Stress and substance use among sexual and gender minority individuals across the lifespan
2019, Neurobiology of Stress
Citation Excerpt :
However, this community characteristic has also contributed to longstanding norms regarding the use of substances as a form of socialization in the SGM communities, which still prevail today. This is evidenced in findings of heightened substance use among sexual minority men (Greenwood et al., 2001; Halkitis and Palamar, 2008; Kipke et al., 2007) and lesbian women (Heffernan, 1998) who frequent gay bars and parties. These norms have seemingly extended beyond nightlife settings, as it has also been found that living in predominately SGM-populated neighborhoods and being actively involved in SGM community activities may contribute to higher odds of drug use among gay and bisexual men (Carpiano et al., 2011) and cigarette use, drinking, and drug use in sexual minority women (Feinstein et al., 2017; Johns et al., 2013).
Sexual and gender minority (SGM) individuals face marked disparities in substance use. The present narrative review explores research on substance use in SGM communities using a minority stress theory lens. We define the SGM population and minority stress, and explore stresses and substance use disparities in adolescence, adulthood, and older age. Though research on this topic is beginning to highlight the relationship between stress and substance use for SGM individuals, more work is needed on older SGM populations and in translating research findings to effective interventions.
Sexual orientation, treatment utilization, and barriers for alcohol related problems: Findings from a nationally representative sample
2016, Drug and Alcohol Dependence
Citation Excerpt :
For example, bisexual individuals reported higher prevalence of alcohol use disorders when compared to individuals who identify as gay, lesbian, or heterosexual (Hughes and Eliason, 2002; McCabe et al., 2013; Ziyadeh et al., 2007), with bisexual women having a higher rate of binge drinking when compared to heterosexual women (Eisenberg and Wechsler, 2003; Nawyn et al., 2000). Lastly, research findings indicated that lesbian women reported higher levels of alcohol consumption compared to gay men (Heffernan, 1998; Lea et al., 2013), had more negative consequences associated with increased alcohol consumption (Heffernan, 1998; Nawyn et al., 2000), and had a higher likelihood of any substance use disorder when compared to heterosexual women (McCabe et al., 2013). Given these observations of increased alcohol use severity among GLB individuals, previous research using the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) demonstrated that GLB individuals utilized treatment for alcohol related problems at higher rates (McCabe et al., 2013).
Gay, lesbian, and bisexual (GLB) individuals appear to have an increased likelihood of alcohol use disorders and treatment utilization for alcohol related problems compared to heterosexual individuals. Despite this increase, treatment utilization rates among GLB individuals remain low. In an effort to address this, our paper examined whether or not GLB individuals encounter unique barriers when pursuing treatment for alcohol related problems.
Using data from the National Epidemiologic Survey on Alcohol Related Conditions (NESARC), we examined service sector specific factors, some of which included (a) utilization rates, (b) self-reported treatment barriers, and (c) whether or not there were emergent differences among GLB individuals, after controlling for socio-demographic and clinical characteristics.
Findings indicated that GLB individuals reported higher severity rates for alcohol use disorders when compared to heterosexual individuals, and were significantly more likely to utilize treatment services for alcohol related problems, however, not across all treatment sectors. While similar patterns were observed when examining barriers to treatment, bisexual individuals reported significantly more barriers than heterosexual and gay/lesbian individuals.
These findings underscored the importance of identifying and developing interventions that addresses treatment barriers associated with alcohol use service utilization among GLB populations, and creating improved outreach and education programs to better address stigmas associated with substance use and sexuality.
Sexual assault, drinking norms, and drinking behavior among a national sample of lesbian and bisexual women
2014, Addictive Behaviors
Citation Excerpt :
Although a somewhat cyclical explanation, individuals with higher drinking norm perceptions are often part of peer groups that socialize in heavy drinking social settings, such as at bars or parties (Ullman, Karabatsos, & Koss, 1999a; 1999b). Because of the social importance of the bar culture for the lesbian and bisexual community (Condit, Kitaji, Drabble, & Trocki, 2011; Parks, 1999; Trocki, Drabble, & Midanik, 2005), and frequency of going to bars is associated with heavier or more frequent drinking (Heffernan, 1998; Trocki et al., 2005), perceptions of drinking norms would be higher for this population. Moreover, because lesbian and bisexual women have a higher likelihood of CSA history, while spending time with others in their community, there may be increased likelihood to drink to cope with this history, which is supported by our data since CSA was related to drinking behavior.
Childhood sexual abuse (CSA) and adolescent/adult sexual assault (ASA) are strongly associated with women's alcohol use and the rates of both alcohol use and sexual assault history are higher among lesbian and bisexual women than heterosexual women. Although descriptive drinking norms are one of the highest predictors of alcohol use in emerging adults, this is the first study to examine the relationship between sexual assault history, drinking norms, and alcohol use in lesbian and bisexual women. We found that CSA severity was associated with a higher likelihood of experiencing more severe alcohol-involved ASA, more severe physically forced ASA, and was indirectly associated with more drinking behavior and higher drinking norms. Additionally, more severe alcohol-involved ASA was associated with higher drinking norms and more drinking behavior, but physically forced ASA was not. These findings help explain previous contradictory findings and provide information for interventions.
Alcohol and illicit drug use among gay, lesbian and bisexual: A literature review
2013, Evolution Psychiatrique
Cet état exhaustif de la littérature s’intéresse à la consommation de substances psychoactives (SPA) (alcool et drogues illicites) chez les personnes gaies, lesbiennes ou bisexuelles (LGB). Il fournit également l’état de la situation au niveau des liens entre la consommation de SPA, le coming-out et l’importance des lieux de socialisation. La sélection des articles scientifiques s’est effectuée à partir des grandes banques de données anglophones et francophones. Parmi les 468 articles répertoriés, 112 ont été traités manuellement, avec une analyse finale basée sur 45 articles. Les résultats montrent une consommation d’alcool et de drogues plus importante chez les hommes gais que chez les hommes hétérosexuels, sans que cette consommation soit décrite comme problématique. Il y a également une différence significative chez les lesbiennes par rapport aux femmes hétérosexuelles, cette fois avec une consommation problématique significativement plus fréquente. Au niveau du coming-out, cette étude présente trois hypothèses appuyées empiriquement pour expliquer la présence d’une consommation problématique d’alcool. Enfin, l’influence des lieux de consommation apparaît comme un facteur de risque à prendre en considération. Dans une perspective de santé publique, tous ces éléments amènent à apprécier les personnes LGB comme un sous-groupe à risque et nécessitant des aménagements dans une prise en charge addictologique.
This exhaustive literature review focuses on substance use and abuse (alcohol and illicit drugs) among gays, lesbians and bisexuals (LGB). It also describes the association between drinking patterns, coming-out and bars or social environment. Articles were selected from major English and French medical and humanities databases. On the 468 selected articles across databases, 112 were manually examined and 45 were selected for the review. Results show a more frequent alcohol and illicit drug use among homosexual than heterosexual men, but this difference is not significant at a problematic level of use. There is also a significant difference between lesbian and heterosexual women at a regular and problematic level of use. Considering the coming-out process, three empirical hypotheses are presented to explain a problematic psychoactive substance use. The influences of social environment are presented and seem to play their part as a risk factor. In a public health perspective, all these data show the importance to consider LGB population as a group risk, with a need for accommodation in treatment settings.
Romantic attraction and adolescent smoking trajectories
2011, Addictive Behaviors
Citation Excerpt :
Minority stress theory and the overload model are neither mutually exclusive nor exhaustive, but both predict higher substance use among LGB youth as a coping mechanism. Higher use among LGB youth is also predicted by socialization-based explanations that posit greater use as a consequence of more frequent socializing in contexts supporting substance use (e.g., clubs, parties), and accompanying stronger use norms in LGB communities, rather than as a result of coping with stress (Heffernan, 1998; McKirnan & Peterson, 1989; Remafedi, 2007). Only five longitudinal studies have been published that consider developmental smoking patterns among LGB adolescents.
Research on sexual orientation and substance use has established that lesbian, gay, and bisexual (LGB) individuals are more likely to smoke than heterosexuals. This analysis furthers the examination of smoking behaviors across sexual orientation groups by describing how same- and opposite-sex romantic attraction, and changes in romantic attraction, are associated with distinct six-year developmental trajectories of smoking. The National Longitudinal Study of Adolescent Health dataset is used to test our hypotheses. Multinomial logistic regressions predicting smoking trajectory membership as a function of romantic attraction were separately estimated for men and women. Romantic attraction effects were found only for women. The change from self-reported heterosexual attraction to lesbian or bisexual attraction was more predictive of higher smoking trajectories than was a consistent lesbian or bisexual attraction, with potentially important differences between the smoking patterns of these two groups.
Age and gender as moderators of the relationship between physical activity and alcohol use
2011, Addictive Behaviors
Citation Excerpt :
One alcohol use measure was used to approximate participants' level of alcohol consumption. Following Heffernan's (1998) approach, the past 12 months alcohol composite variable was created using the product of two items, “During the last 12 months, about how often did you drink any kind of alcoholic beverage?”, and “How many drinks did you USUALLY have on days when you drank during the last 12 months?”
Understanding moderators of the relationship between physical activity (PA) and alcohol use is important for clarifying the mechanisms underlying these behaviors and informing health promotion interventions. This study examined age and gender as two candidate moderators of the PA-alcohol use link.
As part of a correlational, cross-sectional population-based study of US 34,653 adults, participants were administered surveys assessing demographics, alcohol use, moderate and vigorous PA, and other characteristics. Composite indices of the frequency and quantity of alcohol use and PA were utilized in analyses.
Age moderated the association between past-year vigorous PA and alcohol use (ps ≤ .01). Vigorous PA was positively associated with alcohol use in individuals under 50 years of age (ps ≤ .05), but not in individuals over 50 years of age (ps ≥ 0.05). Gender moderated the association between past-year moderate PA and alcohol use (ps < .001). The relation was stronger in males (β = .72) than in females (β = .41). Each of the findings remained significant even when controlling for demographics, psychiatric variables, and other potential confounds.
Among the American population of adults, age appears to moderate the relationship between vigorous PA and alcohol use, whereas gender appears to moderate the relationship between moderate PA and alcohol use. These findings shed light on the underlying mechanisms that may account for increased alcohol use in exercisers and may have clinical implications for alcohol screening and interventions in adults who lead active lifestyles.

View all citing articles on Scopus

View full text

The nature and predictors of substance use among lesbians

Abstract

Section snippets

Risk factors

Coping styles

Substance use, stress, and coping

Subjects

Stress and resources

Discussion

Acknowledgements

Personality and Individual Differences

Addictive Behaviors

Addictive Behaviors

Journal of Substance Abuse

Behavior Research and Therapy

Assessment and goal selection with lesbian and gay clients

The Behavior Therapist

National Lesbian Health Care SurveyImplications for mental health care

Journal of Consulting and Clinical Psychology

Coping expectancies and alcohol abuseA test of social learning formulations

Journal of Abnormal Psychology

Alcohol abuse among lesbiansA descriptive study

Journal of Homosexuality

Impulsiveness and venturesomenessTheir position in a dimensional system of personality description

Psychological Reports

On my way to nowhereAlienated, isolated, and drunk

Alcoholism, chemical dependency and the lesbian client

Women and Therapy

Support choices and abstinence in gay/lesbian and heterosexual alcoholics

Alcoholism Treatment Quarterly

A self-awareness model of the causes and effects of alcohol consumption

Journal of Abnormal Psychology

Alcohol and drug problems of gay males and lesbiansTherapy, counseling, and prevention issues

Journal of Drug Issues