Department of Counseling and Educational Psychology, New Mexico State University, Las Cruces, NM, USA; Department of Psychology, Syracuse University, Syracuse, NY, USA.
Department of Counseling and Educational Psychology, New Mexico State University, Las Cruces, NM, USA.
Int J Drug Policy. 2023 Aug;118:104103. doi: 10.1016/j.drugpo.2023.104103. Epub 2023 Jul 4.
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).
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 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.
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.
与异性恋和顺性别者相比，女同性恋者、男同性恋者、双性恋者、跨性别者、酷儿和其他性与性别少数群体（LGBTQ+）更有可能出现高危多物质使用问题。根据综合征理论，这种高危多物质使用的差异是由 LGBTQ+群体更容易经历心理社会（例如歧视、非意愿性行为）和结构（例如食物不安全、无家可归）条件、更有可能应对并发健康问题（例如人类免疫缺陷病毒 [HIV]）以及减少发展保护因素（例如社会支持、适应力）所导致的。
对居住在美国、有终生酒精和药物使用史的 306 名 LGBTQ+参与者进行了数据分析；21.2%的人报告有 10 种不同药物的终生问题。采用自举分层多元回归检验人口统计学相关性和综合征预测因子与高危多物质使用的关系。采用单因素方差分析和事后比较检验测试了按性别划分的亚组差异。
结果表明，收入、食物不安全、基于性取向的歧视和社会支持与高危多物质使用有关，解释了高危多物质使用变异的 43.9%。年龄、种族、非意愿性行为、基于性别认同的歧视和适应力没有显著影响。组间比较测试表明，与非二元性别者和顺性别性少数群体男性和女性相比，跨性别者经历了更高水平的高危多物质使用和基于性取向的歧视，但经历了更低水平的无家可归和社会支持。
本研究进一步证明了将多物质使用视为综合征条件不良后果的概念。减少歧视的法律和性别肯定的住院治疗选择应被纳入美国毒品政策。临床意义包括针对综合征条件，以减少使用毒品的 LGBTQ+人群中的高危多物质使用。
