In response to PAR-14-338: Secondary Analyses of Existing Alcohol Epidemiology Data, this project Sexual Orientation, Discrimination, and Health Disparities in DSM-5 Alcohol Use Disorders proposes to use existing alcohol epidemiological data to examine relationships among sexual orientation, childhood adversity, sexual orientation discrimination (individual-level and institutional-level), recent stressful events and DSM-5 alcohol use disorders (AUDs). AUDs are among the most prevalent mental health disorders and contribute substantially to morbidity and mortality worldwide. Over 65 million adults in the U.S. will meet criteria for a DSM-5 AUD, with past research finding that sexual minorities are at disproportionately high risk for AUD. To date, no large-scale nationally representative studies have examined sexual-orientation-related health disparities in DSM-5 AUD and there is limited data on DSM-5 AUD severity, comorbidity, and disability among sexual minorities. A significant gap in knowledge remains regarding the underlying reasons why sexual minorities are more likely to meet criteria for DSM-5 AUD. Thus, we propose to build on our prior work by conducting secondary analyses using the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III), a nationally representative sample of 36,309 U.S. adults. The NESARC-III is the only nationally representative study that has sufficient measures and sample size to test for potential age, gender, racial/ethnic and sexual orientation differences and to meet the objectives of our study, which aims to: (1) estimate the prevalence of (a) DSM-5 AUD diagnoses including severity (mild, moderate and severe), (b) identify potential differences in AUD diagnoses between DSM-IV and DSM-5 criteria, and (c) examine DSM-5 psychiatric comorbidity associated with DSM-5 AUD based on sexual orientation (attraction, behavior, and identity); (2) assess the disability (social functioning), help seeking (e.g., self-help), and recovery (e.g., abstinence) associated with DSM-5 AUD based on sexual orientation; and (3) examine risk factors (e.g., individual- and institutional-level sexual orientation discrimination, and stressful life events). Analyses will focus on multiple developmental domains (i.e., childhood, adolescence, adulthood, past-year) and potential moderators (e.g., age, sex, race/ethnicity, and childhood adversity) associated with DSM-5 AUD severity, psychiatric comorbidity, and disability among sexual minorities. The proposed project will benefit from the unique opportunities afforded by the 2012-2013 NESARC such as: the largest nationally representative sample of sexual minority women and men currently available; the assessment of all three major dimensions of sexual orientation (attraction, behavior and identity); and the wealth of data on DSM-5 AUD and other psychiatric disorders. We will also examine the impact of changes from the DSM-IV to DSM-5 for AUDs among sexual minorities. The project uses a theory-driven approach in assessing how childhood adversity, sexual orientation discrimination, and recent stressors contribute to alcohol-related health disparities based on sexual orientation.

Public Health Relevance

To date, there is limited knowledge regarding the epidemiology and etiology of DSM-5 alcohol use disorders among sexual minorities in the United States. The proposed study will help inform prevention and intervention efforts to reduce DSM-5 alcohol use disorders by examining the prevalence, severity, comorbidity, disability, help seeking, recovery, and risk factors associated with DSM-5 alcohol use disorders across sub-groups based on dimensions of sexual orientation in the United States. Findings will help guide future research by providing new information about the underlying mechanisms associated with alcohol use disorders across dimensions of sexual orientation, and about the impact of individual-level sexual orientation discrimination, institutional-level sexual orientation discrimination, and recent stressful life events on DSM-5 alcohol use disorders among sexual minorities.

National Institute of Health (NIH)
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Research Project (R01)
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Health Disparities and Equity Promotion Study Section (HDEP)
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Freeman, Robert
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University of Michigan Ann Arbor
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Ann Arbor
United States
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