Lesbian and Bisexual Women at Elevated Risk of Problem Drinking but Lack Appropriate, Effective Treatment Options

Newswise — Many lesbian and bisexual women lack access to culturally sensitive and effective alcohol and mental health treatments, according to a new study. The findings suggest that sexual minority women (SMW), especially younger women, women of color, and those with low incomes, face multiple barriers to addressing problematic alcohol use. Previous research has shown that SMW experience higher rates of problem drinking and its negative consequences than heterosexual women. This partly reflects the impact of discrimination and its associated stress. Yet SMW appear relatively unlikely to seek help, and when they do, are less satisfied with it, for reasons including a lack of identity-affirming care and provider bias. Better understanding of SMW’s recognition of alcohol problems, motivation to reduce drinking, and treatment experiences — important influences on outcomes — as well as how their alcohol experiences vary by demographic characteristics can potentially help identify women at risk and inform more effective prevention and treatment options. For the study in Alcoholism: Clinical & Experimental Research, researchers examined associations between alcohol outcomes, behavioral health help-seeking and treatment satisfaction, and demographic characteristics among SMW.

Investigators worked with data collected in 2010–12 from 695 White, Black, and Latinx adult SMW. Three in four identified as lesbian, the others as bisexual. Participants were interviewed about their past-year experience of heavy episode drinking (HED), alcohol-related consequences (e.g., drunk driving), whether they’d ever thought they were developing an alcohol problem or had recently wanted to reduce or stop drinking, and their experiences around seeking treatment. Researchers used statistical analysis to explore potential links between these factors.

Overall, 43% of participants reported past-year HED, 10% met criteria for alcohol dependence, and 22% had recently wanted to reduce their drinking. Alcohol outcomes varied by age and race/ethnicity, but not by sexual identity or income. Younger women were more likely than older women to report HED and alcohol-related consequences. Black and Latinx women were more likely than White women to report HED and to meet criteria for alcohol dependence. Although Black women did not report more negative consequences, they were more than twice as likely as White women to be motivated to reduce their drinking.

Women who sought help were far more likely than others to meet criteria for alcohol dependence, report alcohol-related consequences, recognize their drinking problem and/or be motivated to reduce their alcohol use. Overall, 4% reported seeking help for alcohol problems and 14% said they had been unable to access needed mental health or alcohol services. Of those who received help, half reported that some needs were met; one in ten said their providers either hurt or did not help them. Younger SMW reported less access to services and more treatment dissatisfaction than older women. Black women were more likely than White women to access needed services but were more dissatisfied with their treatment, potentially reflecting institutional racism. Those with incomes below $15,000 were more than eight times as likely to have sought help but were relatively dissatisfied with their providers compared to SMW with more financial means. SMW reporting HED in the past year were more likely to recognize they had a drinking problem yet less able to access behavioral health services.

The study confirms lesbian and bisexual women’s elevated risk for alcohol-related problems and limited help-seeking and treatment satisfaction. It highlights the importance of developing identity-affirming, multimodal, tailored mental health treatments for SMW. The findings imply that interventions that enhance treatment motivation may be particularly useful. Young, Black, and low-income SMW who drink heavily but don’t meet criteria for an alcohol use disorder may benefit from brief behavioral interventions, such as motivational interviewing. Further research is needed to assess risk factors, including drinking to cope with discrimination, and treatment outcomes.

Alcohol use, behavioral and mental health help-seeking, and treatment satisfaction among sexual minority women. J. Scheer, A. Batchelder, L. Bochicchio, J. Kidd, T. Hughes (pp xxx)

ACER-21-5040.R3