International Journal of Public Health

, Volume 63, Issue 5, pp 621–630 | Cite as

Do people with intersecting identities report more high-risk alcohol use and lifetime substance use?

  • Daniel DemantEmail author
  • Oscar Oviedo-Trespalacios
  • Julie-Anne Carroll
  • Jason A. Ferris
  • Larissa Maier
  • Monica J. Barratt
  • Adam R. Winstock
Original Article



We examined protective and non-protective effects of disadvantaged social identities and their intersections on lifetime substance use and risky alcohol consumption.


Data from 90,941 participants of the Global Drug Survey 2015 were analysed. Multivariable logistic regressions were used to calculate adjusted odds ratios for lifetime use of nine psychoactive substances, as well as high-risk/harmful alcohol use. Disadvantaged identities from three categories (ethnicity, sexual identity, gender), and interactions between these were compared.


Findings indicate that participants with disadvantaged ethnic and sexual minority identities are more likely to use psychoactive substances compared to their counterparts. The intersecting identity ‘disadvantaged ethnic identity and sexual minority’ appears to be protective compared to those with just one of these identities. While female gender appears to be highly protective in general, it is not protective among females with disadvantaged social identities.


Stark disparities in substance use between different social identities and their intersections emphasise the importance of intersectionality theories in public health research intervention design. Future research on health equity, particularly substance use, should target individuals with intersecting identities.


Substance use Alcohol use Intersectionality Health inequality Minority health 



Global Drug Survey is a self-funded organisation; its media partners did not have any role in the design, interpretation or write-up of this paper. ARW is the founder and managing director of Global Drug Survey. All authors have contributed to the design, interpretation and write-up of the manuscript. We would like to thank the participants who gave so generously their time to complete the GDS. We are grateful for the promotion of GDS by a long list of world media partners, see Barratt et al. (2017). We are also indebted to Stuart Newman for his programming skills, advice and patience and Chris Parsons for his hard work in managing the translation site for the survey.


The authors received no specific financial support for the research, authorship, and/or publication of this study. MJB and JAF were supported by fellowships from the Australian National Health and Medical Research Council (APP1070140, APP1089395). The National Drug and Alcohol Research Centre and the National Drug Research Institute were supported by funding from the Australian Government under the Substance Misuse Prevention and Service Improvement Grants Fund. We also acknowledge the contribution of the Victorian Operational Infrastructure Support Program received by the Burnet Institute.

Compliance with ethical standards

Ethical statement

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


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Copyright information

© Swiss School of Public Health (SSPH+) 2018

Authors and Affiliations

  1. 1.Faculty of HealthUniversity of Technology SydneyUltimoAustralia
  2. 2.School of Public Health and Social Work and Institute of Health and Biomedical Innovation (IHBI), Faculty of HealthQueensland University of Technology (QUT)BrisbaneAustralia
  3. 3.Centre for Accident Research and Road Safety-Queensland (CARRS-Q) and Institute of Health and Biomedical Innovation (IHBI)Queensland University of Technology (QUT)BrisbaneAustralia
  4. 4.Industrial Engineering Department, Engineering FacultyUniversidad del NorteBarranquillaColombia
  5. 5.Institute for Social Science ResearchUniversity of QueenslandBrisbaneAustralia
  6. 6.University of ZurichZurichSwitzerland
  7. 7.Drug Policy Modelling Program, National Drug and Alcohol Research CentreUNSW SydneySydneyAustralia
  8. 8.Faculty of Health Sciences, National Drug Research InstituteCurtin UniversityPerthAustralia
  9. 9.Behaviours and Health Risks ProgramBurnet InstituteMelbourneAustralia
  10. 10.University College LondonLondonUK
  11. 11.Global Drug Survey LtdLondonUK

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