Quantity and Quality of Research on Alcohol and Drug Behaviors Among Sexual Minority Women Lags Behind Research in Other Groups

A comprehensive scoping review conducted by Columbia University School of Nursing found scientific data on drinking and drug use behaviors among sexual minority women lagging behind other populations and an overall need for more and higher-quality research. Among important gaps in the research are a lack of long-term studies; over-representation of white, well-educated and younger sexual minority women; a lack of studies looking at the reasons for the disproportionate risk of alcohol and drug use in these women; and interventional studies looking at ways to improve their outcomes.

“Even though we need more research, there is enough to signal troubling patterns,” says lead author Tonda L. Hughes, PhD, associate dean of global health at Columbia Nursing. “Across most studies, sexual minority women report higher rates of alcohol consumption and hazardous drinking than their heterosexual counterparts and, while there are fewer studies looking at drug use, the same patterns appear to be true.”

Most of the research has been among U.S. women. However, the limited research completed outside the U.S.— just 25 of the 181 studies in this review – confirms the same sexual orientation-related patterns in Australia, the UK and some European countries. Hughes says it is clear something, likely a group of factors, puts sexual minority women at higher risk of alcohol and drug problems compared not only to heterosexual women but also to sexual minority men. The answers lie in more and higher-quality research.

Hughes and her colleagues also looked at evidence on racial, ethnic and age-related differences; factors that could increase or decrease the risk of misuse/abuse; and the effect of alcohol and drug use on health outcomes. The lack of conclusive research was a recurring theme.

Frequency and Factors that Affect the Risk of Alcohol and Drug Use

“We must acknowledge the increased risk of alcohol and drug use among sexual minority women compared to other groups, but we also need to also be clear that this does not mean all or even most of these women are misusing alcohol or drugs,” says co-author, Sharon Wilsnack, PhD, a professor of psychiatry and behavioral science at the University of North Dakota who has been studying drinking patterns in women for 40 years.

She recalls that the few studies available when professional research on sexual minorities began reported that up to one-third of sexual minority women (and sexual minority men) were alcoholic. But the studies had an inherent bias. Researchers recruited participants at gay and “gay friendly” bars. Research in the decades since has moderated these findings.

All of this makes it even more important to understand which sexual minority women are at increased risk and why. The available research provides some answers. Drug and alcohol use, including hazardous drinking, is more common in younger than older sexual minority women. The impact of race and ethnicity is less clear, but there is some evidence indicating an elevated risk among sexual minority women of color compared to their heterosexual counterparts.

Research consistently reports that sexual minority women are more likely than heterosexual women to report nearly every form of childhood and adult victimization, such as childhood physical or sexual abuse and neglect, as well as adult rape. Victimization, in turn, is associated with increases in negative alcohol and drug use outcomes. Reported rates of victimization are high in exclusively heterosexual women at 42%, but even higher in sexual minority women: 59% among lesbians, 64% among heterosexually identified women who report having same-sex partners and 76% among bisexual women.

Despite improvements in social acceptance of sexual minority women in many parts of the world, they remain a stigmatized and marginalized group, according to Hughes. But their analysis found little research and mixed findings on the impact of stigma, minority stress, and disclosure of women’s sexual status on their alcohol and drug use. Minority stress is a major driver of sexual-orientation-related health disparities, but research to date has not elucidated its impact on alcohol and drug behavior.

More Research is Needed to Inform and Drive Change

Valid, scientifically sound data is the first step toward identifying strategies that can reduce alcohol and drug-related health disparities. High-quality research drives policy discussions that can lead to legislation, regulations and medical practice standards that improve the lives of sexual minority women.

“Ideally, our work will shine a light on what’s in the health literature to provide guidance and baseline data for other researchers in the U.S. and across the world to build on,” says Hughes. “Research with sexual minority woman has improved in recent years, so we have a reasonable foundation to build on, but there is still a lot of work to be done.”

Read the full Research on alcohol and other drug (AOD) use among sexual minority women: A global scoping review study.