Homosexuality as a cause of alcoholism: a historical review

Constructing a 'target population': A critical analysis of public health discourse on substance use among gay and bisexual men, 2000-2020

BACKGROUND

Gay and bisexual men (GBM) have higher substance use prevalences than general population samples - often attributed to stigmatisation of sexual minority identities. We examined how influential public health research on substance use among GBM interprets this behaviour and what GBM-specific identities emerge through the discourses employed.

METHODS

We searched Web of Science for publications on substance use among GBM, selecting 60 of the most cited papers published during 2000-2020. We studied the language used to describe and interpret drug-using behaviour using critical discourse analysis, focusing on interpretive repertoires and subject positions.

RESULTS

Three distinct discursive tendencies were identified. First, in constructing a target population, GBM who use illicit drugs are positioned as deficient, socially irresponsible, and maladapted to dealing with stigmatisation and HIV risks. Second, in shifting the focus beyond the individual, the gay community is conceptualised as offering a safe space for socialisation. Nonetheless, gay community spaces are problematised as promoting substance use among vulnerable GBM through aggravating loneliness and normalising drug use as a form of maladaptive (avoidance) coping. Third, counterdiscursive movements add nuance, context, and comparisons that relativise rather than generalise substance use and focus on pleasure and self-determination. Such discourses centre the need for interventions that disrupt homophobic socio-structures instead of individualising approaches to limit non-conformity.

CONCLUSION

'Expert' assessments of substance use among GBM perpetuate pathologising understandings of this behaviour and promote abject subject positions, contributing to perpetuations of intergroup stigma and social exclusion based on drug and sexual practices. Our findings highlight the need for deliberate and critical engagement with prior research and a conscious effort to disrupt dominant discourses on GBM's substance use.

The Etiologic, Theory-Based, Ontogenetic Hierarchical Framework of Alcohol Use Disorder: A Translational Systematic Review of Reviews

Modern nosologies (e.g., ICD-11, DSM-5) for alcohol use disorder (AUD) and dependence prioritize reliability and clinical presentation over etiology, resulting in a diagnosis that is not always strongly grounded in basic theory and research. Within these nosologies, DSM-5 AUD is treated as a discrete, largely categorical, but graded, phenomenon, which results in additional challenges (e.g., significant phenotypic heterogeneity). Efforts to increase the compatibility between AUD diagnosis and modern conceptualizations of alcohol dependence, which describe it as dimensional and partially overlapping with other psychopathology (e.g., other substance use disorders) will inspire a stronger scientific framework and strengthen AUD's validity. We conducted a systematic review of 144 reviews to integrate addiction constructs and theories into a comprehensive framework with the aim of identifying fundamental mechanisms implicated in AUD. The product of this effort was the Etiologic, Theory-Based, Ontogenetic Hierarchical Framework (ETOH Framework) of AUD mechanisms, which outlines superdomains of cognitive control, reward, as well as negative valence and emotionality, each of which subsume narrower, hierarchically-organized components. We also outline opponent processes and self-awareness as key moderators of AUD mechanisms. In contrast with other frameworks, we recommend an increased conceptual role for negative valence and compulsion in AUD. The ETOH framework serves as a critical step towards conceptualizations of AUD as dimensional and heterogeneous. It has the potential to improve AUD assessment and aid in the development of evidence-based diagnostic measures that focus on key mechanisms in AUD, consequently facilitating treatment matching.

Addressing gaps on risk and resilience factors for alcohol use outcomes in sexual and gender minority populations

ISSUES

In 2011, the Institute of Medicine released a report that constituted the first comprehensive effort by a federal body to understand the current state of science pertinent to the health needs of sexual and gender minority populations. This mini-review summarises recent empirical, methodological and theoretical advances in alcohol-related research among to lesbian, gay, bisexual and transgender (LGBT) populations and highlights progress towards addressing gaps, with a particular interest in those identified by the Institute of Medicine report.

APPROACH

Articles published since 2011 were identified from PsycINFO and PubMed database searches, using various combinations of keyword identifiers (alcohol, alcohol abuse, substance abuse, LGBT, lesbian, gay, bisexual, transgender). Reference sections of included articles were also examined for additional citations.

KEY FINDINGS

Recent empirical work has contributed to a greater understanding of sub-group differences within this diverse population. Evidence has supported theorised influences that can account for alcohol-related disparities, yet important gaps remain. Studies that examine the role of gender identity and its intersection with sexual identity within transgender and gender non-conforming sub-populations are lacking. Methodological advances in this literature have begun to allow for examinations of how minority-specific and general risk factors of alcohol misuse may contribute to patterns of alcohol involvement over time and within social-relational contexts

CONCLUSIONS

The recommendations made in the current mini-review are meant to facilitate future collaborative efforts, scale development, thoughtful methodological design and analysis and theoretically driven nuanced hypotheses to better understand, and ultimately address, alcohol-related disparities among sexual and gender minority populations. [Talley AE, Gilbert PA, Mitchell J, Goldbach J, Marshall BDL, Kaysen D. Addressing gaps on risk and resilience factors for alcohol use outcomes in sexual and gender minority populations. Drug Alcohol Rev 2016;35:484-493].

Does comparing alcohol use along a single dimension obscure within-group differences? Investigating men's hazardous drinking by sexual orientation and race/ethnicity

BACKGROUND

Some studies have found that gay, bisexual, and other men who have sex with men (MSM) have higher odds of alcohol abuse and dependence than heterosexual men, but others have found no differences. We investigated whether the association between sexual orientation and hazardous drinking varied by race/ethnicity.

METHODS

We estimated the odds of past-year heavy daily, heavy weekly, and binge drinking by sexual orientation and race/ethnicity among non-Latino White, non-Latino Black, and Latino (any race) men (n = 9689) who reported current alcohol use in the 2004-2005 National Epidemiological Survey of Alcohol and Related Conditions (NESARC). Interaction terms were included in multivariable logistic regression models to evaluate possible effect modification.

RESULTS

In most comparisons, sexual minority men reported equivalent or lower levels of hazardous drinking than heterosexual peers. There was no association between sexual orientation and heavy daily drinking. Sexual minority Black men had lower odds of heavy weekly drinking and binge drinking than both heterosexual White men and heterosexual Black men. Among Latinos, the odds of heavy weekly drinking were higher for sexual minority men than heterosexuals; there was no difference by sexual orientation for binge drinking among Latinos.

CONCLUSIONS

With one exception, sexual minority men were at equivalent or lower risk of hazardous drinking than heterosexual men. The Black-White advantage observed in other alcohol studies was observed in our study and was heightened among sexual minority men, suggesting the presence of protective factors that curb hazardous drinking. Additional research is necessary to identify the mechanisms responsible for these patterns.

Alcohol and tobacco use patterns among heterosexually and homosexually experienced California women

BACKGROUND

Mounting evidence suggests that lesbians and bisexual women may be at especially elevated risk for the harmful health effects of alcohol and tobacco use.

METHODS

We report findings from the California Women's Health Survey (1998-2000), a large, annual statewide health surveillance survey of California women that in 1998 began to include questions assessing same-gender sexual behavior.

RESULTS

Overall, homosexually experienced women are more likely than exclusively heterosexually experienced women to currently smoke and to evidence higher levels of alcohol consumption, both in frequency and quantity. Focusing on age cohorts, the greatest sexual orientation disparity in alcohol use patterns appears clustered among women in the 26-35-year-old group. We also find that recently bisexually active women report higher and riskier alcohol use than women who are exclusively heterosexually active. By contrast, among homosexually experienced women, those who are recently exclusively homosexually active do not show consistent evidence of at-risk patterns of alcohol consumption.

DISCUSSION

Findings underscore the importance of considering within-group differences among homosexually experienced women in risk for tobacco and dysfunctional alcohol use.

Predicting, understanding and changing: three research paradigms regarding alcohol use among lesbians

The author presents a paradigmatic categorization and review of the literature that is available regarding lesbians and alcohol. She illuminates the characteristics, shortcomings, and strengths of Empirical Post Positivist, Interpretive, and Critical Social research paradigms. Results of the various studies are presented while research and funding directions are proposed.

Sexual identity and alcohol-related outcomes: contributions of workplace harassment

PURPOSE

While workplace sexual harassment has received a great deal of attention in both the popular media and scientific literature, less attention has been directed to the differential occurrence of sexual harassment among lesbians, gay men, and heterosexual men and women, and the relationships between these experiences and alcohol-related outcomes. Additionally, the distribution of alcohol-related outcomes of non-sexual forms of workplace harassment among these groups have not been adequately explored.

METHOD

Using data from a university-based study of workplace harassment and alcohol use (N = 2492), we focus on exposure to workplace harassment and alcohol-related outcomes for lesbians, gay men, and bisexuals compared to heterosexual men and women.

RESULTS

Lesbian/bisexual women did not differ significantly from heterosexual women in their experiences of workplace harassment. However, stronger linkages between harassment and increased alcohol consumption and problems were found for lesbian and bisexual women than for heterosexual women. Gay/bisexual men, on the other hand, experienced significantly more sexual harassment than heterosexual men, but did not report a corresponding increase in alcohol use and abuse.

IMPLICATIONS

Implications for future research on sexual identity, alcohol use, and workplace harassment are discussed.

The use of alcohol by lesbians: a review and research agenda

This article reviews the literature on alcohol use by lesbians. Comparisons of data on lesbians and women from the general population show that lesbians tend to drink more than other women; that rates of drinking do not decline with age as is true for general population women; and that even when levels of drinking are equivalent between lesbians and general population women, lesbians report greater difficulties related to alcohol consumption. Differences in sampling techniques and differences in definitions of drinking among the papers made comparisons of results difficult. These issues are discussed and recommendations are made concerning standardization of data collection.

Survey of drug and alcohol use by lesbian women in New Zealand

The objective of this study is to describe the prevalence of alcohol and drug use and attitudes towards alcohol use in a group of New Zealand lesbian women. The method used is 1,222 copies of a postal questionnaire (the Lesbian Mental Health Survey [LMHS]) were distributed via lesbian newsletters over a 4-month period. Responses were received from 561 women, an estimated response rate of 50.8%. The respondents were predominantly New Zealand European, highly educated, urban women in the 25- to 50-year age bracket; 30.1% smoked cigarettes, and 90.2% had drunk alcohol at some time in the past year, over half once per week or less. The median number of drinks per week was 1.5 drinks, equivalent to 22.5 ml alcohol per week. Despite a comparatively low reported use of alcohol, 48.1% of respondents expressed the view that alcohol is used excessively in the lesbian community; 75.8% had used cannabis at least once, 32.6% in the past year; 30.8% had used recreational drugs other than cannabis and alcohol at some time, 4.5% in the past year.

Sex under the influence of alcohol among Norwegian adolescents

The purpose of this paper is to study alcohol consumption among Norwegian adolescents at their most recent experience of sexual intercourse. The material comprises a stratified sample of 920 adolescents aged 16-20 years in a Norwegian county (52.3% of the girls and 41.4% of the boys had coital experience). Data were collected by means of questionnaires; 21.0% of the adolescents reported sex under influence of alcohol. A logistic regression analysis showed that the best predictors of sex under influence of alcohol were intercourse location, sexual enjoyment and sexual intercourse motivated by "Don't know, it just turned out that way". Adolescents who had their most recent experience of intercourse away from home, who had problems enjoying sex and/or who said it just turned out that way, were more likely than others to have had sex under influence of alcohol. A multivariate logistic regression analysis showed that among adolescents who reported that the intercourse took place away from their homes, the odds ratio (OR) for sex under influence of alcohol increased by 8.7. Those who had consumed alcohol before sex, more often than non-drinkers, tended to enter into sexual intercourse motivated by factors external to their own person. This tendency was more pronounced among boys than girls.

A comparison of alcohol consumption between lesbians and heterosexual women in an urban population

An elevated rate of alcohol problems is believed to exist in the gay and lesbian community. However, prevalence estimates suggesting this have generally been based on convenience samples which have over-represented bar patrons and clinical sources. Recent epidemiological studies examining risk factors for AIDS have gathered information on alcohol consumption as well as sexual orientation. Data based on improved sampling methods are now available for estimating drinking rates of lesbians and gay men. This study compares the drinking patterns of heterosexual women and lesbian/bisexual women who were recruited through a random sampling design in San Francisco, CA. Contrary to previous research, no statistically significant differences in alcohol consumption and drinking patterns between these two groups were found.

Lesbians and alcohol: patterns and paradoxes in medical notions and lesbians' beliefs

There is growing awareness in the lesbian community about the prevalence of alcohol problems, and the meanings and values attached to alcohol use are currently undergoing change. Little research has focused on lesbians' life experiences and alcohol use practices, although in earlier decades a number of medical theories linked lesbianism with alcohol problems as copathologies. More recent theories from the social sciences also linked lesbianism with alcohol problems, but on the basis of sociocultural dynamics and consequent negative self-images. This article compares and contrasts medical theories about lesbians and alcohol with lesbians' own ideas about alcohol use and alcohol problems. Mutually reinforcing themes in medical views and lesbians' experiences are identified. The analysis clarifies what is at stake in the current debates about alcohol, alcohol problems and recovery experiences in the lesbian community, and offers suggestions for research, theory, and practice regarding this significant health issue.

HIV, substance use and related behaviour of gay and bisexual men: an examination of the talking sex project cohort

This paper reports on the substance use of 612 gay and bisexual men who participated in an HIV risk reduction project. Use/non-use, level of substance use, and reported frequency of use prior to sexual activity were examined in relation to number of sexual partners, sexual activities, HIV antibody test seeking behaviour and known HIV status. The use of substances among the study cohort appear to be higher than in a comparable heterosexual male group. An association was found between substance use, and both number of sexual partners and sexual activities. However, no significant difference was found in substance use between men participating in protected versus unprotected anal sex. Similarly, no significant difference was found in the reported frequency of substance use prior to sex by those participating in protected and unprotected anal intercourse. Greater drug use was reported among those who were known to be HIV antibody positive. These findings raise issues for further research. The high use of alcohol and drugs by gay and bisexual men may pose significant health risks for this group of men.

Gay men's perceptions and responses to AIDS

Gay men continue to be the largest group in Canada developing AIDS. They have responded to this threat on a personal and community level. The purpose of this study was to explore the perceptions of gay men about AIDS, and how they responded to these perceptions. Data were gathered through unstructured interviews with 34 healthy gay men, from participant observations chosen from logs that described nursing interactions with gay men who had AIDS, and fieldnotes collected during AIDS education programmes with health care workers and gay men. Using constant comparative analysis, a substantive conceptual framework was developed. Trusting was identified as the basic social psychological process that determined how gay men responded to AIDS. AIDS was perceived by all gay men in this study to threaten their own health and their acceptance by society. Variables identified behaviour, ranging from denial of personal risk to taking leadership roles in organizations to fight AIDS related to the trusting theory. This theoretical explanation of gay men's responses provides direction for programmes to educate gay men about HIV-related diseases, as well as to support those who acquire the HIV.

AIDS and chemical dependency: special issues and treatment barriers for gay and bisexual men

Because gay and bisexual men continue to be the largest at-risk group for human immunodeficiency virus (HIV) related conditions, the special role of substance abuse, and not just intravenous drug abuse, must be understood in order to provide adequate services and prevention. Gay men and women appear to have a higher incidence of substance abuse than the general population. Genetic, biochemical, societal, and cultural factors may all contribute to this increase, especially the overwhelming impact of societal homophobia. To address the treatment barriers to gay and bisexual men seeking or needing treatment for HIV-related conditions, chemical dependence or both, the gay community should be seen like any other minority community. The social and cultural norms of this widely varied community should be studied: the socialization of being gay in mainstream society, including the awareness of being different; the coming-out process; and dealing with internalized homophobia need to be understood. In addition, the resistance or anxiety health care providers may feel in working with gay or bisexual men or with HIV-related conditions should be addressed.

Alcohol and masculinity

Alcohol use--and abuse--has always been more prevalent among males than among females. The sex role prescription for men to affirm their masculinity by drinking is a major determinant of this sex difference. This paper reviews the intricate interrelationship between masculinity and both social and alcoholic drinking. A large body of evidence indicates that social drinking is a primary cultural symbol of manliness; portrayals in the media strengthen this association. Less evidence exists to connect masculinity issues with alcoholic dependence, but there has been much speculation: Three psychodynamic theories of alcoholism--the repressed homosexuality, dependency, and power theories--hypothesized that men who drink addictively have the most fragile masculine identities. The 1980s have witnessed a widespread recognition of the dangers of equating drinking and manliness, and societal changes suggest that drinking may be gradually losing its masculine aura.

A comparison of alcohol and drug use patterns of homosexual and heterosexual men: the San Francisco Men's Health Study

Very high prevalence rates for problem drinking and/or alcoholism have been estimated for homosexual male populations. Populations characterized by high prevalence rates for problematic drug or alcohol use are of special interest since study of such groups may help to provide insights regarding the processes associated with problematic substance use. However, prevalence estimates for problematic substance use within gay male populations have most typically relied on convenience samples and generally contain an over-representation of bar patrons. This study reports data from a large scale random household sample of homosexual and heterosexual men who live in an urban district of San Francisco, California. Few differences were noted in the drinking patterns of these men, although important differences were found in the prevalence of drug use over a 6-month period. Differences in the prevalence of at least weekly drug use were comparatively minor, however. Health policy implications of these findings are discussed.

MMPI-derived prevalence estimates of homosexuality among drug-dependent patients

Prevalence estimates of homosexuality among 225 drug-abusing clients in treatment were placed at 11%. The rate among Black cocaine free-basers was 17%, and among Black opiate users the rate was 10%. These rates are two to three times the rate of homosexuality among the general population. They may be an underestimation because of our inability to detect hidden homosexuality among those persons wishing to remain undetected in gender orientation.

Psychosocial and other factors in excessive drinking of homosexuals and the general population: opinions of alcohol intervention workers in Ontario, Canada

85 intervention workers indicated agreement with 18 statements about factors in excessive drinking of homosexuals and 18 parallel statements concerning the general population. Some respondents also listed other factors. t tests for means showed that respondents rated statements differently for homosexuals and the general population. When respondents were classified by demographic variables, F ratios yielded the same outcomes.

Alcohol and Drug Problems of Gay Males and Lesbians: Therapy, Counselling and Prevention Issues

Therapists, counsellors and researchers looking into the alcohol and drug problems of homosexuals report that there have been inappropriate treatment and lack of facilities. This is slowly changing. The specific needs of gays were first recognized by Alcoholics Anonymous (A.A.), which by forming the splinter group of Gay A.A., provides the most support for gay alcoholics. The specific needs of gays with alcohol problems are discussed, as are intervention procedures and lack of knowledge—especially in the area of drugs other than alcohol.

Homosexuality and alcohol: observations and research after the psychoanalytic era

There is very little literature in the area of homosexuals and alcohol but since the 1960s some work on the alcohol use of homosexuals has begun to surface. Most studies focus on the male but there are some studies of lesbians. The gay bar seems to be the best starting point for such studies as it is so central to gay society. How sex, drugs, and acquired immune deficiency relate to alcohol use are discussed. Ideas relating to intervention into the alcohol problems of gays are put forward.