Perceived social support, problematic drug use behaviors, and depression among prescription drugs-misusing young men who have sex with men

High-risk polysubstance use among LGBTQ+ people who use drugs in the United States: An application of syndemic theory

BACKGROUND

Compared to heterosexual and cisgender people, lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) people are more likely to develop problems with high-risk polysubstance use. According to syndemic theory, this disparity in high-risk polysubstance use is produced by the LGBTQ+ community's increased vulnerability to experiencing psychosocial (e.g., discrimination, unwanted sex) and structural (e.g., food insecurity, homelessness) conditions, greater likelihood of coping with concurrent health problems (e.g., human immunodeficiency virus [HIV]), and decreased opportunities to develop protective factors (e.g., social support, resilience).

METHODS

Data from 306 LGBTQ+ participants living in the United States (U.S.) with a lifetime history of alcohol and drug use were analyzed; 21.2% reported lifetime problems with 10 different drugs. Bootstrapped hierarchical multiple regression was used to test demographic correlates and syndemic predictors of high-risk polysubstance use. One-way ANOVA and post-hoc comparison tests were used to test subgroup differences by gender.

RESULTS

Results indicated that income, food insecurity, sexual orientation-based discrimination, and social support were associated with high-risk polysubstance use, explaining 43.9% of the variance of high-risk polysubstance use. Age, race, unwanted sex, gender identity-based discrimination, and resilience were not significant. Group comparison tests revealed that, compared to nonbinary people and cisgender sexual minority men and women, transgender individuals experienced significantly higher levels of high-risk polysubstance use and sexual orientation-based discrimination but significantly lower levels of homelessness and social support.

CONCLUSION

This study provided further evidence for conceptualizing polysubstance use as an adverse outcome of syndemic conditions. Harm reduction strategies, anti-discrimination laws, and gender-affirming residential treatment options should be considered in U.S. drug policy. Clinical implications include targeting syndemic conditions to reduce high-risk polysubstance use among LGBTQ+ people who use drugs.

Associations among internalized and perceived stigma, state mindfulness, self-efficacy, and depression symptoms among men who have sex with men in China: A serial mediation model

Previous research has demonstrated that stigma is strongly related to depressive symptoms among men who have sex with men (MSM). However, data are limited regarding the associations between stigma, state mindfulness, self-efficacy, and depression symptoms. The current study aimed to analyze state mindfulness and self-efficacy as possible mediators between internalized and perceived stigma and depression symptoms. A sample of 2610 Chinese MSM (Mage = 23.99, SD = 6.09, age range: 18-68 years) was recruited from an online survey platform and completed the HIV and Homosexuality Related Stigma Scale, Patient Health Questionnaire-9, the short version of Five Facet Mindfulness Questionnaire, and the Chinese General Self-Efficacy Scale. Results indicated that state mindfulness significantly mediated the linkage between internalized and perceived stigma and depressive symptoms, and self-efficacy significantly mediated the relation between state mindfulness and depression symptoms. Furthermore, internalized and perceived stigma were associated with depression symptoms through a serial mediation of state mindfulness and self-efficacy. This study highlights that state mindfulness and self-efficacy might play important roles in the psychological response of MSM to stigmatization and psychopathology symptoms.

Temporal association of pre-pandemic perceived social support with psychological resilience and mental well-being during the COVID-19 pandemic among people with a history of injection drug use

BACKGROUND

There are limited data on whether modifiable social factors foster psychological resilience and mental well-being among people who use drugs following Big Events. We examined the temporal association of pre-pandemic perceived social support with psychological resilience and negative mental health symptoms during the COVID-19 pandemic among people with a history of injection drug use.

METHODS

Between June and September 2020, we conducted a telephone survey among 545 participants in the AIDS Linked to the IntraVenous Experience (ALIVE) study: a community-based cohort of adults with a history of injection drug use. Leveraging data from study visits in 2018-early 2020, associations of pre-pandemic perceived social support with psychological resilience scores (range=1-5) and the probability of negative mental health symptoms during the pandemic were assessed using multivariable linear and modified Poisson regression models, respectively.

RESULTS

Participants' median age was 58 years, 38.2% were female, 83.3% identified as Black, and 30.3% were living with HIV. During the pandemic, 14.5% had low (<3) resilience scores, 36.1% experienced anxiety, and 35.8% reported increased loneliness. Compared to participants in the lowest tertile of pre-pandemic social support, participants in the highest tertile had higher mean resilience scores (β = 0.27 [95% CI = 0.12, 0.43]), a lower probability of anxiety (prevalence ratio [PR] = 0.71 [95% CI = 0.52, 0.96]), and a lower probability of increased loneliness (PR = 0.62 [95% CI = 0.45, 0.84]).

CONCLUSIONS

Pre-pandemic perceived social support was associated with greater psychological resilience and generally better mental well-being during the pandemic. Interventions that improve social support may foster psychological resilience and protect the mental well-being of people who use drugs, especially during periods of social disruption.

The relation of perceived social support to compulsive sexual behavior

We conducted two studies to investigate the links between perceived social support, problematic pornography use (PPU) and compulsive sexual behavior disorder (CSBD). In Study 1 (n=807, convenience sample recruited via social media) we collected preliminary data and in Study 2 (n=1526) we checked whether the results replicate in a sample representative of the Polish adult population. In both studies participants completed the Brief Pornography Screen, Compulsive Sexual Behavior Disorder Scale and Multidimensional Scale of Perceived Social Support. In Study 1 and 2, general social support was a weak protective factor against CSBD (β = -0.15 and β = -0.10) and PPU (β = -0.12 and β = -0.09 respectively, all p values ≤ .001) adjusting for gender, age, sexual orientation and relationship status. The results for three domains of social support (from friends, significant other and family), however, largely differed between the two studies. In Study 1, perceived friends' support weakly protected against PPU and CSBD symptoms. In Study 2 higher support from friends weakly predicted lower CSBD symptoms among men; and stronger family support predicted lower PPU. Support from a significant other was weakly related to lower CSBD for women in Study 1. The conducted studies provided evidence that perceived social support is a protective factor against problematic sexual behavior; however, its predictive power is limited and further studies are needed to assess the importance of various domains of social support in the development of CSBD and PPU symptoms.

Being Simultaneously Curious and Stressed, Precipitants to Methamphetamine Initiation Among Chinese Men Who Have Sex With Men: Findings From a Qualitative Study

ABSTRACT

The cultural context and precipitants for initiating methamphetamine (MA) using among Chinese men who have sex with men (MSM) are unclear. This qualitative descriptive study, which explores the specific precipitants of MA initiation within a cultural context among MSM in China, was conducted with data from semistructured, face-to-face interviews with 24 MA-using MSM (8 HIV positive). Two themes were identified, internal precipitants included the following: (a) curiosity, (b) desire for maximum sexual pleasure, (c) experience with other drugs, and (d) strong sense of self-control capacity. External precipitants included (a) Xiao (filial piety), (b) peer pressure, (c) negative life events, (d) parental emotional neglect, and (e) experiences of homophobia. Internal precipitants to MA initiation for Chinese MSM are consistent with past research. External precipitants were more culture specific. This exacerbates the vulnerability of MSM to MA initiation and keeps it hidden among this population. Future drug use prevention interventions for MSM should address external precipitants and integrate culture-specific strategies.

Antisocial Personality Disorder as a Risk Factor for Opioid Use: The Dual Mediating Roles of Antisocial Attitudes and Self-Control

Antisocial personality disorder is a risk factor for opioid use. There is a dearth of research which examines self-control and moral disengagement as potential mediators of this relationship. This study utilized data from the Pathways to Desistance study in analyses. Generalized structural equation modeling was utilized to test for mediation of the relationship between antisocial personality disorder and opioid use. Bootstrapped standard errors were computed so that a Clogg Z test could be estimated to determine if identified mediation effects significantly differed. Results indicated that a likely diagnosis of antisocial personality disorder increased risk for opioid use. Inclusion of moral disengagement and self-control into the model resulted in attenuation of this effect to non-significance and reduced the magnitude of the effect by around 45%. The contribution of both constructs to the total indirect effect did not significantly differ and only the total indirect effect was significant.

An inverse relationship between perceived social support and substance use frequency in socially stigmatized populations

INTRODUCTION

Social isolation and alcohol and substance use disorders (ASUD) have been identified as global health risks. Social support is protective against developing ASUD and is associated with beneficial addiction treatment outcomes. Socially stigmatized populations are at higher risk of both social isolation and ASUD, and the link between social support and substance use in these populations has been less researched than in general substance-using populations. We hypothesized that perceived social support, as measured by the Social Provisions Scale (SPS), would have an inverse relationship with frequency of substance use, from subsections of the Addiction Severity Index (ASI) that estimate use over the past 30 days and over an individual's lifetime.

METHODS

Using a cross-sectional design, we conducted secondary correlational analyses with pre-existing data to test our hypothesis in two separate samples made up of socially marginalized populations entering ASUD treatment programs. Sample 1: substance-using male prison inmates (n = 72, average age = 30.79) and Sample 2: primary methamphetamine-using men who have sex with men (n = 86, average age = 43.41).

RESULTS

Significant negative correlations were found between SPS and lifetime use of alcohol, tobacco, and cannabis (r s  - 0.27, -0.39, -0.26; p-values 0.04, 0.001, 0.04, respectively) in Sample 1 and 30-day use of methamphetamine (r s  - 0.28; p-value 0.008) in Sample 2.

DISCUSSION

Differences in results between the samples (lifetime vs 30-day use) may reflect psychosocial and contextual differences impacting perceived social support. Our findings provide support for an important link between perceived social support and frequency of substance use in socially stigmatized populations.