Lesbians’ Drinking Patterns: Beyond the Data#

Early studies report very high rates of “alcohol abuse” and alcoholism among lesbians. However, serious methodological problems, including nonrepresentative samples that were often recruited in lesbian or gay lesbian bars, limit the validity of findings from these studies. In this article, I briefly review the literature on lesbians’ use of alcohol and present findings from a recent study conducted in Chicago (USA). This study recruited a race- and age-diverse sample of lesbians and a demographically matched group of heterosexual women. Rates of “heavy” alcohol use and alcohol-use-related problems among lesbians were much lower in this study than in early studies. However, lesbians were more likely than their heterosexual counterparts to be in recovery and to have been in treatment for alcohol-use-related problems. Further, high rates of childhood sexual abuse, depression, and suicidal ideation reported by lesbians suggest that at least some groups may be at heightened risk for “heavy” drinking and drinking-related problems. Nevertheless, results of this and other studies suggest that reports of heavy drinking and drinking-related problems among lesbians may have been inflated in earlier studies, or that heavy drinking and drinking-related problems may have declined among lesbians.     

Lesbians' drinking patterns: beyond the data

Early studies report very high rates of "alcohol abuse" and alcoholism among lesbians. However, serious methodological problems, including nonrepresentative samples that were often recruited in lesbian or gay lesbian bars, limit the validity of findings from these studies. In this article, I briefly review the literature on lesbians' use of alcohol and present findings from a recent study conducted in Chicago (USA). This study recruited a race- and age-diverse sample of lesbians and a demographically matched group of heterosexual women. Rates of "heavy" alcohol use and alcohol-use-related problems among lesbians were much lower in this study than in early studies. However, lesbians were more likely than their heterosexual counterparts to be in recovery and to have been in treatment for alcohol-use-related problems. Further, high rates of childhood sexual abuse, depression, and suicidal ideation reported by lesbians suggest that at least some groups may be at heightened risk for "heavy" drinking and drinking-related problems. Nevertheless, results of this and other studies suggest that reports of heavy drinking and drinking-related problems among lesbians may have been inflated in earlier studies, or that heavy drinking and drinking-related problems may have declined among lesbians.     

Waterpipe tobacco smoking among sexual minorities in the United States: Evidence from the National Adult Tobacco Survey (2012-2014)

ObjectiveThe current study examined differences in waterpipe smoking (both lifetime and current) comparing sexual minority populations - those identifying with lesbian, gay, or bisexual identity - to their heterosexual counterparts using a nationally representative dataset.MethodsThe current study used pooled data from the 2012–2013 & 2013–2014 National Adult Tobacco Survey (NATS). Log-Poisson multivariable regression models were deployed to determine the prevalence of waterpipe smoking behavior among sexual minority individuals controlling for sociodemographic characteristics and stratified by current gender status.ResultsIn fully-adjusted models assessing lifetime WTS, lesbian/gay and bisexual respondents reported higher prevalence of WTS compared to their heterosexual counterparts. This trend held true in gender-stratified models among gay men [gay men: PR 1.25, 95%CI [1.06, 1.47] and women ([lesbians: PR 1.38, 95%CI [1.12, 1.69] and bisexual women: 1.69, 95%CI [1.45, 1.97]). In fully-adjusted models assessing current WTS, lesbian/gay and bisexual respondents reported higher risk of WTS compared to their heterosexual counterparts. This trend held true in gender-stratified models, only for among gay men [gay men: PR 1.56, 95%CI [1.18, 2.05] and bisexual women: 2.38, 95%CI [1.84, 3.09]).ConclusionsAmong the US general adult population, sexual minorities exhibited increased prevalence of current waterpipe smoking compared to their heterosexual counterparts. This pattern is also shaped by gender and variation of sexual orientation identification (e.g., lesbian/gay vs. bisexual). This warrants development of tailored interventions aimed at decreasing waterpipe smoking among sexual minority populations.     

Age and racial/ethnic differences in drinking and drinking-related problems in a community sample of lesbians

OBJECTIVE: Although research on alcohol use among women has increased dramatically during the past several decades, relatively few studies have focused on lesbians, and almost none have included sufficient numbers of older lesbians or lesbians of color to permit comparative analyses. Using data from the Chicago Health and Life Experiences of Women Study (CHLEW), we examined drinking patterns and problems in a large and diverse sample of lesbians. METHOD: Structured interviews were conducted with 447 community-residing adult women (ages 18-83) who self-identified as lesbians (48% non-Hispanic white, 28% non-Hispanic black, and 20% Hispanic/Latina; the remainder were in the "other" category). We used multivariate logistic regressions to examine and compare the prevalence of lifetime and 12-month problem-drinking indicators across four age and three racial/ethnic groups. RESULTS: Unlike findings from general population surveys, in which women's rates of drinking tend to decrease with age, we found relatively few differences across the four age groups of CHLEW respondents. We also found no significant differences between Hispanic and white lesbians on any of the lifetime or 12-month problem-drinking indicators and only a few significant differences between white and black lesbians. CONCLUSIONS: As with heterosexual women, patterns of drinking and drinking-related problems among lesbians vary by age and race/ ethnicity. However, given our findings of substantially smaller variations among lesbians than among women in the general population, research is needed that examines in greater depth the intersections between age, race/ethnicity, sexual orientation, and drinking. Understanding how these sociocultural factors interact with each other and with other known risk factors is important for identifying population groups at greatest risk for developing alcohol-related problems.     

Sexual orientation, gender, and alcohol use in a cohort study of U.S. adolescent girls and boys

BACKGROUND: Sexual minority youth may be at elevated risk for alcohol use relative to heterosexual youth, but the reasons underlying higher rates and whether there may be gender differences in risk are not known. METHODS: Cross-sectional survey data from 9731 early and middle adolescent girls and boys in the Growing Up Today Study in 1999 were examined to assess sexual orientation and gender patterns in alcohol use. Multivariable regression models estimated associations between sexual orientation and alcohol-related behaviors, such as binge drinking and drinking before age 12 years. Models controlled for sociodemographic and psychosocial factors, with heterosexuals as the reference. RESULTS: Girls who described themselves as "mostly heterosexual" and lesbian/bisexual girls were at elevated risk compared to heterosexual girls on almost all alcohol-related behaviors and exposures. "Mostly heterosexual" boys were also at elevated risk. No significant differences in alcohol-related behaviors were observed between gay/bisexual and heterosexual boys. Gender-by-sexual orientation interactions were statistically significant for LGB but not other orientations, indicating that lesbian/bisexual girls experienced elevated risk above and beyond that of gay/bisexual boys relative to same-gender heterosexual peers. CONCLUSIONS: In early and middle adolescence, sexual minority girls and "mostly heterosexual" boys experienced consistent patterns of elevated risk for alcohol use.     

Drinking in the Swedish gay and lesbian community.

Drinking patterns among Swedish gay men and lesbians (n = 1720) are compared to two nationally representative survey groups. Findings point at elevated levels of drinking among lesbians, but not among gay men. Gay men and lesbians do not, as in the general population, reduce their drinking with increasing age and there are very few gay and lesbian abstainers. Experiences of consequences of drinking are more frequent, particularly among lesbians. The study reveals that alcohol plays a more substantial role at the core of the gay and lesbian community, at least, than in many other subgroups of the Swedish society.     

The Need for Understanding the Role of Spirituality in Twelve-Step Programs

Abstract

The Boston Lesbian Health Project II, a national survey of 1139 self-identified lesbian women, found higher rates of drinking alcohol, heavy alcohol intake and self reported alcoholism than in national studies of women in general. Several known risk factors for alcoholism were higher in lesbians who self defined as alcoholic in this sample: family history of alcoholism and drug abuse, rape and childhood sexual abuse and report of having made a suicide attempt. These findings are consistent with other studies that found a high rate of drinking alcohol, alcohol abuse and problem drinking among lesbians. The reasons for these findings are not clear and further research is needed to continue to explore the reasons.     

Sexual identity and prevalence of alcohol and other drug use among Australians in the general population

BackgroundInternational research assessing differences in the prevalence of alcohol and other drug (AOD) use among Lesbian Gay Bisexual and Transgender (LGBTI) and heterosexual populations shows elevated prevalence rates of substance use among LGBTI people. To date no research has been published investigating these differences at a population level among both men and women in Australia.MethodsThe 2013 National Drug Strategy Household Survey, a multistage stratified population sample collecting data on AOD use in the Australian population over 14 years of age, was analysed for differences between gay and bisexual (GB) men and lesbian/gay and bisexual (LGB) women and their heterosexual counterparts in: (1) the prevalence of lifetime and past year tobacco and AOD use; (2) age of initiation of tobacco and AOD use; and (3) frequency of alcohol and cannabis use, and history of AOD treatment.ResultsThere were elevated rates of past year cannabis (22.4%), ecstasy (11.8%) and methamphetamine (9.7%) use among GB men compared to heterosexual men (12.4%, 2.9% and 2.5%). LGB women also reported elevated rates of past year use (tobacco – 23.7%; cannabis – 24.6%) compared to heterosexual women (10.6% and 7.1%). LGB women initiated tobacco (15.2 years) and alcohol (15.5 years) at an earlier age than heterosexual women (16.6 and 17.7 years), and were significantly more likely to report daily alcohol consumption (OR 3.2, 95% CI: 2.1, 5.1), and weekly or more frequent cannabis use (OR 1.7, 95%CI: 1.1, 3.1).ConclusionsThese findings are indicative of the need for more responsive and targeted AOD harm reduction and treatment services for LGBTI communities in Australia. Of concern is the elevated risk among LGB women for earlier initiation of substance use, and the development of problematic consumption patterns. Further research, investigating the risk and protective factors for AOD use among LGB women is warranted.     

Elevated alcohol and sexual risk behaviors among young Thai lesbian/bisexual women

BackgroundLittle empirical data have been published about drinking or sexual behaviors among Thai lesbians. We examine the association of sexual identity with established indicators of alcohol- and sexual-related health behaviors among female bar patrons.MethodsWe conducted a cross-sectional study among women (N = 121) aged 18–24 who frequented popular drinking establishments in Chiang Mai, Thailand. We used general linear modeling techniques to estimate associations between sexual identity and positive alcohol expectancy, harmful drinking, age at sexual debut, and number of lifetime sexual partners.ResultsNearly one-third of women aged 18–24 recruited from Chiang Mai drinking venues identified as lesbian/bisexual. As compared to their heterosexual counterparts, lesbian/bisexuals reported higher positive alcohol expectancy scores, more harmful drinking, earlier age at sexual debut, and higher number of lifetime sexual partners. In adjusted models, lesbian/bisexual identity was associated with higher positive alcohol expectancy (β = 1.94 points; 95% CI: 0.75, 3.13), earlier age at sexual debut (β = ?0.85 years; 95% CI: ?1.46, ?0.23), and higher number of lifetime sexual partners (rate ratio = 1.70; 95% CI: 1.22, 2.37).ConclusionLesbian/bisexual women in this study engaged in multiple behaviors that are potentially harmful to health, which may in turn place this group at heightened risk for alcohol abuse and sexually transmitted infections in Thailand. The clustering of alcohol- and sexual-related risk behaviors, and its consequences for health outcomes in this population, should be explored in future research and may be an important point of intervention.     

Syndemic factors associated with drinking patterns among Latino men and Latina transgender women who have sex with men in New York City

Alcohol consumption is a significant public health concern among Latino men and Latina transgender women who have sex with men. However, characteristics and behaviors associated with alcohol consumption in this population, particularly in regard to the complex influence of syndemic factors, remain understudied. The purpose of this study was to examine predictors of high-risk alcohol consumption (i.e. binge or heavy drinking). Between January and March of 2014, 176 Latino men and Latina transgender women in New York City completed an interviewer-administered questionnaire. We developed a syndemics scale to reflect the total number of syndemic factors – clinically significant depression, childhood sexual abuse, intimate partner violence, and discrimination – reported by each participant. We also carried out a multinomial logistic regression model predicting binge and heavy drinking. Forty-seven percent of participants reported high-risk alcohol consumption in the past 30 days (21% binge and 26% heavy). Approximately 16% of participants reported no syndemic factors, 27% reported one factor, 39% reported two factors, and 18% reported three or four. In the multinomial logistic regression model, our syndemic factors scale was not significantly associated with binge drinking. However, participants who reported three or four factors were significantly more likely to report heavy drinking. In addition, having multiple sexual partners was associated with an increased risk of binge and heavy drinking; involvement in a same-sex relationship was associated with binge drinking. Further work is needed to develop effective prevention intervention approaches for high-risk alcohol consumption within this population.     

Reports of alcohol consumption and alcohol-related problems among homosexual, bisexual and heterosexual respondents: results from the 2000 National Alcohol Survey

OBJECTIVE: Few population-based studies have explored differences in alcohol consumption by sexual orientation. This study examined the prevalence of abstinence, drinking, heavier drinking, alcohol-related problems, alcohol dependence and help-seeking among homosexual and bisexual women and men compared with heterosexuals. METHOD: Data are from the 2000 National Alcohol Survey, a national population-based survey of adults (N = 7,612), a Random Digit Dialing telephone survey of all 50 states of the United States and Washington, DC. Four categories of sexual orientation were created using questions on both sexual orientation self-identification and behavior: homosexual identified, bisexual identified, heterosexual identified with same sex partners and exclusively heterosexual. Five alcohol measures (past year) were used in the analyses: (1) mean number of drinks, (2) days consuming five or more drinks on a single occasion, (3) drunkenness, (4) negative social consequences (2 or more) and (5) Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, alcohol dependence. A lifetime measure of help-seeking for an alcohol problem was also analyzed. RESULTS: Few significant differences were found among men by sexual orientation. By contrast, both lesbians and bisexual women had lower abstention rates and significantly greater odds of reporting alcohol-related social consequences, alcohol dependence and past help-seeking for an alcohol problem. CONCLUSIONS: These findings suggest that alcohol dependence and alcohol-related consequences differ by sexual orientation, particularly among women. These findings also emphasize the need for the inclusion of sexual-orientation items in population-based surveys so that prevalence rates within these subgroups can be effectively monitored.     

Cigarette,smokeless tobacco,and alcohol use among transgender adults in the United States

BackgroundResearch suggests that sexual minority adults face disparate risks for poor health outcomes. However, prior research on transgender populations has been limited by small and nonprobability samples and has potentially masked important differences between transgender subgroups. We examined disparities in cigarette, smokeless tobacco, and alcohol consumption by transgender and cisgender adults.Methods2014–2017 Behavioral Risk Factor Surveillance System data were used. Multivariable logistic regressions examined differences in cigarette, smokeless tobacco, and alcohol use between cisgender adults and transgender sub-identities: male to female (MTF), female to male (FTM), and gender nonconforming.ResultsCigarette and smokeless tobacco use were higher among transgender adults. The gender nonconforming subgroup reported more binge and heavy drinking. In a multivariable logistic analysis, higher odds of smokeless tobacco use were found for all transgender sub-identities compared to cisgender females. The gender nonconforming group had higher odds of heavy drinking (AOR = 2.09, 95% CI 1.14–3.82) and binge drinking (AOR = 1.94, 95% CI 1.25–3.02) compared to cisgender females. The MTF subcategory was more likely to binge drink (AOR = 1.88, 95% CI 1.44–2.46) compared to cisgender females. The FTM subcategory had lower odds of binge drinking (AOR = 0.49, 95% CI 0.33-0.73) compared to cisgender males.ConclusionsSignificant heterogeneity in smokeless tobacco and alcohol use were found among transgender subgroups, particularly when compared to cisgender females. Our findings demonstrate that it is important to consider sub-identities in both the transgender population and in the reference cisgender population.     

Binge drinking,stimulant use and HIV risk in a sample of illicit drug using heterosexual Black men

BackgroundRelatively little research has examined the effects of binge drinking and HIV risk in heterosexual Black men. Even less research has explored this relationship in illicit drug using heterosexual Black men who are at an elevated risk of contracting and transmitting HIV through various vectors, including risky sexual behavior, in the Black community.PurposeThe purpose of the current study is to examine the associations between binge drinking, drug use and HIV status in a community-based sample of 127 self-identified heterosexual Black men.ResultsOverall, 17% reported binge drinking in the past month. Both stimulant use (AOR 7.29; 95%; CIs, 2.07, 25.70), and binge drinking (AOR = 5.28; 95% CIs, 1.34, 20.91) were associated with HIV status.ConclusionThese findings will inform prevention interventions to reduce the HIV risk among Black heterosexual men.     

Lesbian use and abuse of alcohol: results of The Boston Lesbian Health Project II.

The Boston Lesbian Health Project II, a national survey of 1139 self-identified lesbian women, found higher rates of drinking alcohol, heavy alcohol intake and self reported alcoholism than in national studies of women in general. Several known risk factors for alcoholism were higher in lesbians who self defined as alcoholic in this sample: family history of alcoholism and drug abuse, rape and childhood sexual abuse and report of having made a suicide attempt. These findings are consistent with other studies that found a high rate of drinking alcohol, alcohol abuse and problem drinking among lesbians. The reasons for these findings are not clear and further research is needed to continue to explore the reasons.     

Binge drinking among gay,and lesbian youths: The role of internalized sexual stigma,self-disclosure,and individuals’ sense of connectedness to the gay community

We examined the prevalence of binge drinking among lesbian and gay (LG) youths, and evaluated whether experiences such as internalized sexual stigma, the experience of “coming out” to family and friends, and the individuals' sense of “connectedness” to the gay community could be associated with alcohol abuse. The research involved 119 gay (58.9%) and 83 lesbian (41.1%) Italian youths (18 to 24 years old). According to previous research, youths were categorized in non-drinkers, social, binge and heavy drinkers. Results showed that the estimated percentage of binge drinking among gay and lesbian youths is 43.6%. The survey revealed that social, binge, and heavy drinkers differ in terms of some drinking variables, internalized sexual stigma, family and peer self-disclosure, and connectedness gay community. Implications for the prevention of binge drinking in LG youths are currently under discussion even if further investigation is urgently needed.     

Recreational drug use and use of drugs associated with chemsex among HIV-negative and HIV-positive heterosexual men and women attending sexual health and HIV clinics in England

BackgroundThere is little information on the prevalence of recreational drug use among UK heterosexual men and women, in particular on use of drugs associated with ‘chemsex’ within gay communities. The aim of this study was to examine among HIV-negative and HIV-positive heterosexual men and women in England: (i) the prevalence of recreational drug use (including use of drugs associated with chemsex), (ii) socio-economic/lifestyle correlates of drug use, and (iii) the association of drug use with sexual behavior measures and mental health symptoms.MethodsData are from the AURAH study of HIV-negative individuals attending sexual health clinics across England (2013–2014) and the ASTRA study of HIV-positive individuals attending HIV outpatient clinics in England (2011–2012). Prevalence of recreational drug use (past three months) and associations are presented separately among the four sample groups: HIV-negative (N = 470) and HIV-positive (N = 373) heterosexual men and HIV-negative (N = 676) and HIV-positive (N = 637) women.ResultsThe age standardized prevalence of any drug use was 22.9%, 17.1%, 15.3%, and 7.1% in the four sample groups respectively. In all groups, cannabis was the drug most commonly used (range from 4.7% to 17.9%) followed by cocaine (1.6% to 8.5%). The prevalence of use of drugs associated with chemsex was very low among HIV-negative participants (1.0% heterosexual men, 0.2% women) and zero among HIV-positive men and women. In age-adjusted analysis, factors linked to drug use overall and/or to cannabis and cocaine use specifically in the four sample groups included Black/mixed Caribbean and white (vs. Black/mixed African) ethnicity, lower level of education , cigarette smoking, and higher risk alcohol consumption. Associations of recreational drug use with measures of condomless sex, depression, and anxiety were observed in the four groups, but were particularly strong/apparent among women.ConclusionProviders need to be aware of cannabis and cocaine use and its potential link with sexual risk behavior and symptoms of depression and anxiety among heterosexual men and women attending sexual health and HIV clinics.     

Age Differences in Lesbian1 Identity Development and Drinking

Women who “come out” as lesbian must learn to cope with a stigmatized identity. Stress associated with the sexual identity development process is a commonly posed explanation for the high rates of “heavy drinking” and drinking consumption-related problems within this population. However, relatively little is known about the sexual identity development process in lesbians and even less about lesbians' drinking patterns during this process. Growing societal tolerance and visibility of sexual minorities over the past 35 years has likely created substantially different environments and experiences of coming out for individuals of different age cohorts. Data from the Chicago Health and Life Experiences of Women study provided the opportunity to examine relationships between variables associated with lesbian identity development and alcohol use–related problems in three age cohorts of self-identified lesbians. The study's limitations are noted.     

Depression and heavy drinking occasions: a cross-sectional general population study

The purpose of this study was to assess the association between depression and heavy drinking occasions in the Finnish general population. A subsample (2086/4020, response rate 51.9%) of the National FINRISK 2007 Study was used. Depression was assessed with a modified Beck Depression Inventory (short form) and alcohol problems with the Alcohol Use Disorders Identification Test. Total alcohol intake and number of heavy drinking occasions (≥7 drinks for men, ≥5 drinks for women) were evaluated using the Timeline Followback. Of the sample, 13.0% (123/946) of men and 17.4% (198/1140) of women were classified as being depressed. Further, 7.5% (71/946) of men and 3.5% (40/1140) of women reported having at least four heavy drinking occasions in the previous 28days. In an adjusted logistic regression model, these men had a 2.6-fold risk (95% C.I. 1.2-5.3) of depression, as compared to men with less than four heavy drinking occasions. The association was found irrespective of total alcohol consumption and alcohol problems. This association was not found in women.