LGBT Alcohol Resource Guide

Alcoholism affects the LGBT community more than the heterosexual population (Hughes, Wilsnack & Kantor, 2016). Data from the 2015 National Survey on Drug Use and Health (NSDUH) reveal the following on alcohol use among sexual minority adults:

• Approximately 63.6% of sexual minority adults reported current alcohol use within the past month, compared to 56.2% of heterosexual adults
• An estimated 36.1% of LGBT individuals reported binge drinking within the past month, compared to 26.7% of the sexual majority
• About 8.2% of sexual minorities were heavy alcohol drinkers, compared to 7.1% of heterosexual adults

The National Alliance on Mental Illness (NAMI) estimates that 20-30% of LGBT individuals resort to substance abuse, compared to 9% of the sexual majority population. As for alcohol abuse, 25% of sexual minorities misuse alcohol compared to 5-10% of the heterosexual population.

The alcohol use disparities among sexual minorities may be attributed to social stigma and discrimination. Prior to the Stonewall Riots of 1969, LGBT individuals were forced to hide their sexual identity and sexual orientation so that they could maintain a public heterosexual identity (Orel, 2014). For many years, gay bars have served as a haven for individuals, particularly gay men, to openly disclose their sexual orientation without being judged, and consequently alcohol has become the central hub of social activities among sexual minorities.

Alcohol Use, Gender Identity and Sexual Orientation: The Meaning of Alcohol in LGBT Culture

We construct our identities by telling stories that define us (McAdams, Josselson & Lieblich, 2006). These stories consist of experiences, values, knowledge, emotions, practices and connections that shape how we express our identity to others and how we define ourselves. Alcohol identity refers to the extent that alcohol is used to define or express a person’s identity (Gray, Laplante, Bannon, Ambady & Shaffer, 2011).

Numerous studies and data have pointed to higher rates of alcoholism and drug use within the LGBT community, but research literature on the meaning of alcohol use among sexual minorities is very limited. The available research on the role of alcohol in identity formation for LGBT individuals can be found in a study that was conducted in Scotland, which examined the social context of LGBT alcohol use. Researchers have examined the relationship between alcohol and individuals who identify as lesbian, gay, bisexual and transgender (LGBT), and they found that the choice of drink and drinking vessel were either an expression of identity or a way to challenge traditional views about gender (Emslie, Lennox & Ireland, 2017). Stereotypes about different kinds of drinks influenced drinking behaviors; for example, the combination of one’s appearance and choice of drink would produce a certain effect in displaying a gender identity. Women and transgender individuals would “go straight” to mainstream parties in heels and a dress with a vodka in hand, but they would change their appearance and dress as a “dyke” as they chug pints of beer.

Understanding Alcohol Use Patterns among LGBT Individuals

• Lesbians are three times more likely to have lifetime alcohol use disorders and any lifetime substance use disorder than heterosexual women (McCabe et al., 2009).
• Rates of lifetime alcohol use disorders among men who have only had male sex partners are much lower than those of heterosexual men (McCabe et al., 2009).
• Compared to heterosexual women, bisexual women and lesbians are six to seven times more likely to develop alcohol dependence (Drabble, Midanik & Trocki, 2005).

The Minority Stress Perspective Explains Disparities in Alcohol Use
Sexual minority men and women are at greater risk for developing alcoholism and alcohol-related problems because they feel alienated and have a hard time opening up to others about their sexual identity (Lewis, Winstead, Mason & Lau-Barraco, 2017). From the minority stress perspective, LGBT individuals experience various forms social stressors (e.g., harassment, victimization, and discrimination) based on their gender identity and sexual orientation. Those who are unable to openly share and process their negative feelings about internalized heterosexism, the negative view about one’s own sexual minority as a result of living in a heterosexual society, are more vulnerable to developing mental disorders, substance use disorders and alcohol use disorder. The minority stress theory describes how sexual prejudice affects the daily lived experiences of LGBT individuals.

Sexual prejudice embodies negative attitudes toward anyone based on sexual orientation and can be directed at individuals who self-identify as heterosexual, homosexual, or bisexual. In today’s social context, sexual prejudice is most frequently directed at lesbian, gay, bisexual, transgender or queer/questioning individuals. Sexual prejudice events based on hostile attitudes toward same-sex behaviors occur every day for LGBT members, ranging from public stares to denial of adoption and marriage rights. Because of the widespread sexual prejudice, sexual minority men and women live in expectation of rejection, which is just as damaging as the experience of rejection itself. A study published in Transgender Health shows that the fear of rejection alone is enough to produce high levels of anxiety, alienation, fear, substance use and suicidal ideation, which are effects comparable to those of actual experiences of sexual prejudice (Rood et al., 2016).

To protect themselves from antigay hostility and various forms of discrimination, many LGBT members feel the need to hide and conceal their sexual identity, and their willingness to come out largely depends on the type of relationship they have with that person. Sexual identity mobility, referred to as a process of changing sexual orientation identity over time, is considered a stressful factor contributing to higher levels of depression and cognitive dissonance for LGBT individuals (Everett, 2015). Although “coming out” may reduce cognitive dissonance so that individuals no longer have to hide inside the closet, disclosing one’s sexual orientation and identity to loved ones could mean losing one’s social identity, resources and networks that are essential to one’s mental health functioning, exposing LGBT individuals to more stigma and discrimination, which are linked to social stress and alcohol use disorders. According to a new study, those who were not able to exclusively identify as heterosexual or homosexual reported higher rates of alcohol use than other LGBT groups who have defined their sexual orientation (Talley, Sher, Steinley, Wood & Littlefield, 2012).

Two organizations, Pride in London and Populus and Quadrangle , conducted research in 2016 for their #nofilter campaign to assess how comfortable sexual minorities felt about coming out to their friends, family, neighbors, colleagues, and others. About 96% of the respondents felt most comfortable about coming out to friends, and that percentage dropped to 68 69% for neighbors, roommates, and employers. Over half of the respondents reported being victims of internalized homophobia, with experiences such as public stares, verbal and physical abuse, threats and bullying. Despite laws that protected LGBT individuals such as equal employment, adoption, and marriage rights, the findings revealed huge gaps between the actual lived experiences of sexual minorities and the protective laws for LGBT rights.