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Associations of sexual identity change and identity–attraction discordance with symptomatic alcohol and other drug use

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Abstract

Purpose

National studies examining alcohol and other drug use by sexual orientation have been primarily cross-sectional. Understanding changes in sexual orientation over time may further elucidate the mechanisms behind sexual orientation differences in alcohol and other drug use. This national longitudinal study examines changes in sexual orientation across four waves (2013–2019), and the associations with symptomatic alcohol and other drug use.

Methods

Data from Waves 1 through 5 of the Population Assessment of Tobacco and Health (PATH) study were used to examine associations of sexual identity change/stability and sexual identity–attraction discordance/concordance from baseline to follow-up with symptomatic substance use at follow-up. We examined four outcomes: any symptomatic substance use, symptomatic alcohol use, symptomatic other drug use, and symptomatic alcohol + other drug use. Mixed effects logistic regression models were used and all analyses were weighted and stratified by sex.

Results

In models adjusting for potential confounders, greater likelihood of symptomatic alcohol and other drug use outcomes was found among males and females experiencing a change from a heterosexual to sexual minority identity and among females with new or consistent sexual identity–attraction discordance.

Conclusion

These findings highlight important sex differences and suggest that the period of transitioning to a sexual minority identity is a particularly vulnerable period for symptomatic alcohol and other drug use. For females, incongruent sexual identity and attraction is also a risk factor. Interventions that assist individuals during this transitional period and during a time when identity and attraction are incongruent, may reduce symptomatic substance use during this period.

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Data availability

This study used data from the Population Assessment of Tobacco and Health (PATH) Study Restricted-Use Files [34].

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Funding

This work was supported by the National Institute for Alcohol Abuse and Alcoholism (NIAAA) at the National Institutes of Health (R01 AA030243, PI: Evans-Polce). The NIAAA and National Institutes of Health had no role in the study design; collection, analysis, or interpretation of the data; writing of the manuscript; or the decision to submit the paper for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Author information

Authors and Affiliations

  1. Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 N. Ingalls St, Ann Arbor, MI, 48108, USA

    Rebecca J. Evans-Polce, Philip Veliz, Carol J. Boyd & Sean Esteban McCabe

  2. School of Social Work, Wayne State University, Detroit, MI, USA

    Luisa Kcomt

  3. Institute for Social Research, University of Michigan, Ann Arbor, MI, USA

    Philip Veliz & Sean Esteban McCabe

  4. Institute for Research On Women and Gender, University of Michigan, Ann Arbor, MI, USA

    Carol J. Boyd & Sean Esteban McCabe

  5. Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA

    Carol J. Boyd

  6. Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, MI, USA

    Carol J. Boyd & Sean Esteban McCabe

  7. Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA

    Sean Esteban McCabe

Authors
  1. Rebecca J. Evans-Polce
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  2. Luisa Kcomt
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  3. Philip Veliz
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  4. Carol J. Boyd
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  5. Sean Esteban McCabe
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Contributions

REP developed the research questions, conducted analyses, created tables and figures, and wrote the initial draft of the manuscript. LK assisted with refining the research questions and editing of the manuscript. PV provided feedback on analyses and edited the manuscript. CB edited the manuscript. SEM assisted with refining research questions and editing of the manuscript. All authors reviewed the final version of the manuscript.

Corresponding author

Correspondence to Rebecca J. Evans-Polce.

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The authors have no relevant financial or non-financial interests to disclose.

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Evans-Polce, R.J., Kcomt, L., Veliz, P. et al. Associations of sexual identity change and identity–attraction discordance with symptomatic alcohol and other drug use. Soc Psychiatry Psychiatr Epidemiol (2023). https://doi.org/10.1007/s00127-023-02600-2

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