Category: Gay / Lesbian / Bisexual / Transgender Issues
Introduction: Lesbian, gay, and bisexual (LGB) individuals experience higher rates of mental illness than heterosexuals, which is likely due to sexual orientation-related discrimination (Lee et al., 2016; Meyer, 2003). Indeed, such stressors, including family rejection and peer victimization, have been linked to excessive alcohol and substance use (Bregman et al., 2013; Willoughby et al., 2010). Although poor emotion regulation (ER) has been linked to the development of internalizing psychopathology in LGB individuals (Hatzenbuehler et al., 2009), to our knowledge no studies have specifically examined this relationship for substance-related psychopathology. Emotional non-acceptance and deficits in goal directed behavior, most closely linked to distress tolerance and therefore alcohol and substance use (Mennin et al., 2010), will be examined as moderators.
Method: LGB participants (N=305, 53.3% female) were recruited via listservs, craiglist, emails to LGB organizations, and Facebook for two online studies and completed the following self-report measures: Short Michigan Alcohol Screening Test, Drug Abuse Screening Test, Non-acceptance (DERS-NONACC) and goal-directed behavior subscales (DERS-GOALS) of the Difficulties with Emotion Regulation Scale, and the family rejection (DHEQ-FAM) and victimization subscales (DHEQ-VIC) of the Daily Heterosexist Experiences Questionnaire.
Results: A significant DHEQ-FAM by DERS-NONACC interaction significantly predicted substance use (p = 0.02), where DHEQ-FAM was a significant predictor of problematic substance use for the high DERS-NONACC group (OR: 1.80, 95% CI [1.23, 2.63], p < 0.01), but not for the low DERS-NONACC group (OR: 0.92, 95% CI [0.69, 1.21], p > 0.05). DERS-GOALS significantly moderated the relationship between DERS-VIC and alcohol and substance use. DHEQ-VIC was a significant predictor of problematic substance use for the low DERS-GOALS group only (OR: 1.81, 95% CI [1.21, 2.70], p < 0.01). Moreover, DHEQ-VIC predicted problematic alcohol use for those in the low DERS-GOALS only (OR: 2.15, 95% CI [1.56, 2.97], p < 0.001).
Discussion: Findings suggests that ER difficulties may be important to understand why some LGB individuals who experience discrimination misuse alcohol and substances while others do not. As expected, those with more difficulty accepting negative emotions used substances to cope in the face of family rejection, suggesting that an emotional acceptance based treatment may be beneficial for these individuals. However, those with better goal directed behavior chose substances and alcohol more often than those with poor goal-directed behavior in the face of victimization. Future work should seek to elucidate the temporal relationship between goal-directed behavior and substance/alcohol misuse, as well as the potential protective role of ER in the context of minority stress. These results begin to highlight intervention targets to decrease substance and alcohol use in LGB individuals.