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Associations between sexual orientation discrimination and substance use disorders: differences by age in US adults



Sexual minorities are at heightened risk for substance use disorders (SUDs). Discrimination based on sexual orientation may be an important factor in this increased risk, but differences across age have not been systematically examined. We examined age-varying associations of sexual orientation discrimination with alcohol use disorder (AUD), tobacco use disorder (TUD), and drug use disorder (DUD).


We used data from US participants aged 18–50 years who reported non-heterosexual identity, attraction, or behavior (N = 2375) in a nationally representative survey. We examined the prevalence of sexual orientation discrimination across age and its salience as a risk factor for AUD, TUD, and DUD for gay/lesbian, bisexual, and heterosexual identifying individuals using time-varying effect modeling.


Sexual orientation discrimination was most prevalent in early young adulthood but was positively associated with greater odds of AUD, TUD, and DUD only at later ages. We found statistically significant associations at ages 24.5–40.0 for AUD, ages 32.5–42.9 for DUD, and ages 39.3–43.2 for TUD. For example, discrimination at age 30 was associated with 2.1 times greater odds of AUD (95% CI 1.3, 3.3) compared to those who reported no discrimination at that age. Discrimination at age 35 was associated with 2.8 times greater odds of DUD (95% CI 1.2, 6.6) relative to no discrimination.


Sexual orientation discrimination is significantly associated with SUDs and risk varies across age. Thus, age should be considered in the development of prevention and treatment of AUD, TUD, and DUD, particularly for sexual minorities.

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This research was supported by Grants R01AA025684 (PI: McCabe) and R01AA013328 (PI: Hughes) from the National Institute on Alcohol Abuse and Alcoholism, R01DA043696 (PI: Boyd) and R01DA036541 (PI: McCabe) from the National Institute on Drug Abuse, and R01CA212517 (PI: McCabe) from the National Cancer Institute.

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Correspondence to Rebecca J. Evans-Polce.

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Evans-Polce, R.J., Veliz, P.T., Boyd, C.J. et al. Associations between sexual orientation discrimination and substance use disorders: differences by age in US adults. Soc Psychiatry Psychiatr Epidemiol 55, 101–110 (2020). https://doi.org/10.1007/s00127-019-01694-x

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  • Sexual minorities
  • Substance use disorders
  • Discrimination
  • Time-varying effect models