High-risk polysubstance use among LGBTQ+ people who use drugs in the United States: An application of syndemic theory.

Autor: Cascalheira CJ; Department of Counseling and Educational Psychology, New Mexico State University, Las Cruces, NM, USA; Department of Psychology, Syracuse University, Syracuse, NY, USA. Electronic address: cjcascalheira@gmail.com., Nelson J; Department of Counseling and Educational Psychology, New Mexico State University, Las Cruces, NM, USA., Flinn RE; Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, GA, USA., Zhao Y; Department of Counseling and Educational Psychology, New Mexico State University, Las Cruces, NM, USA., Helminen EC; Department of Psychology, Syracuse University, Syracuse, NY, USA., Scheer JR; Department of Psychology, Syracuse University, Syracuse, NY, USA., Stone AL; Department of Sociology and Anthropology, Trinity University, San Antonio, TX, USA.
Jazyk: angličtina
Zdroj: The International journal on drug policy [Int J Drug Policy] 2023 Aug; Vol. 118, pp. 104103. Date of Electronic Publication: 2023 Jul 04.
DOI: 10.1016/j.drugpo.2023.104103
Abstrakt: Background: Compared to heterosexual and cisgender people, lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) people are more likely to develop problems with high-risk polysubstance use. According to syndemic theory, this disparity in high-risk polysubstance use is produced by the LGBTQ+ community's increased vulnerability to experiencing psychosocial (e.g., discrimination, unwanted sex) and structural (e.g., food insecurity, homelessness) conditions, greater likelihood of coping with concurrent health problems (e.g., human immunodeficiency virus [HIV]), and decreased opportunities to develop protective factors (e.g., social support, resilience).
Methods: Data from 306 LGBTQ+ participants living in the United States (U.S.) with a lifetime history of alcohol and drug use were analyzed; 21.2% reported lifetime problems with 10 different drugs. Bootstrapped hierarchical multiple regression was used to test demographic correlates and syndemic predictors of high-risk polysubstance use. One-way ANOVA and post-hoc comparison tests were used to test subgroup differences by gender.
Results: Results indicated that income, food insecurity, sexual orientation-based discrimination, and social support were associated with high-risk polysubstance use, explaining 43.9% of the variance of high-risk polysubstance use. Age, race, unwanted sex, gender identity-based discrimination, and resilience were not significant. Group comparison tests revealed that, compared to nonbinary people and cisgender sexual minority men and women, transgender individuals experienced significantly higher levels of high-risk polysubstance use and sexual orientation-based discrimination but significantly lower levels of homelessness and social support.
Conclusion: This study provided further evidence for conceptualizing polysubstance use as an adverse outcome of syndemic conditions. Harm reduction strategies, anti-discrimination laws, and gender-affirming residential treatment options should be considered in U.S. drug policy. Clinical implications include targeting syndemic conditions to reduce high-risk polysubstance use among LGBTQ+ people who use drugs.
Competing Interests: Declarations of Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2023. Published by Elsevier B.V.)
Databáze: MEDLINE
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