Substance Misuse Among Sexual and Gender Minorities: The Role of Everyday Discrimination and Identity

Background: Sexual and gender minorities (SGMs) often deal with discrimination which can result in maladaptive coping like substance misuse, yet few studies have examined the association between everyday discrimination and various types of substance misuse among SGMs or whether there is heterogeneity in substance misuse or this relationship by SGM identity. Methods: Data from 1,316 adult SGMs in the United States were recruited from Reddit between February and March 2022. SGM identities (sexual minorities assigned male at birth (AMAB), sexual minorities assigned female at birth (AFAB), gender minorities AMAB, gender minorities AFAB), everyday discrimination, depressive symptoms, marijuana and alcohol misuse, over-the-counter drug misuse, prescription drug misuse, and heroin use were measured, along with demographics. Multivariable logistic regressions examined relationships between everyday discrimination and each substance misuse outcome, adjusting for SGM identity, race/ethnicity, age, income, and depressive symptoms. Interaction terms between everyday discrimination and SGM identities were added to each model to test for moderation. Results: In fully adjusted models, with each additional unit of everyday discrimination score, there were significantly increased odds of substance misuse for all outcomes. SGM by everyday discrimination interactions were significant for alcohol misuse, over-the-counter drug misuse, and heroin use, with the association between everyday discrimination and substance misuse stronger among gender minorities. Conclusion: Substance misuse varied by SGM identity. Everyday discrimination was associated with substance misuse, but there was heterogeneity in this relationship by SGM identity and substance. Substance abuse treatment and prevention among SGMs should consider heterogeneity by SGM identity and substance