Sexual orientation and drug of choice
D. Zullino, S. Achab, G. Thorens, R. Khan, R. Manghi and Y. Khazaal
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WHO collaborating center
Introduction
Substance use problems usually found to be more prevalent in
lesbian, gay, and bisexual (LGB) populations
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Green & Feinstein, 2012; Meyer, 1995, 2003
Hypotheses
Affiliation with gay culture
LGB communities centered on activities involving consumption (e.g. bars, circuit
parties).
Can lead to social networks of LGB individuals with heavier consumption
Can make it more difficult to avoid triggers for substance use (e.g. bars, peers who
drink)
Demographic factors (female, older age) less robust protective factors
Stress related to being a sexual minority (Minority stress model)
Bisexual identity : particularly related to increased risk for substance
abuse
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Bux, 1996
Methodological flaws in the existing research
Recruitment of participants from bars
Lack of appropriate comparison groups
Poor assessment of multiple dimensions of sexual
orientation
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Green & Feinstein, 2012; McCabe et al., 2009
Sexual orientation: multidimensional construct
at least 3 components
sexual attraction
sexual behavior
refers to the desire to have sexual relations with one or both sexes
refers to any mutually voluntary activity with another person that involves genital
contact and sexual arousal, even if intercourse or orgasm did not occur
sexual identity
refers to personally selected labels attached to the perceptions and meanings
individuals have about their sexuality
The 3 components are not perfectly correlated with one another
May be differentially associated with psychological outcomes
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Rationale
Longitudinal studies on substance consumption rare and costly
Mostly realized in North America, where youth culture is
multiple
Studies are rare in Europe
Switzerland stands in the head of European countries with
regard to substance consumption rates by teenagers
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C-SURF
Cohort study
Coordinated by
Centre hospitalier universitaire vaudois (CHUV), Lausanne
Social and Preventive Medicine Institute at Zürich University
Financial support of the Swiss National Research Foundation
Seeks to follow substance consumption by 19-year-old-young adults
during at least 10 years
concerns young Swiss adults who have to go through the mandatory recruitment
process at the Swiss army
covers 98% of the Swiss male 18-year-old
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Collaborating centers
Division of Addictology, Department of mental health and psychiatry, Geneva
CHUV, University Hospital Center of the Canton of Vaud, Lausanne
IUMSP Institute of Social and Preventive Medicine, Lausanne
DUMSC, Department of Medicine and Community Health, Lausanne
AS Addiction Switzerland, Lausanne
ISPM, Institute for Social and Preventive Medicine, Zürich
Institute for Social and Preventive Medicine, Geneva
ISGF, Institute for Research in Addiction and Health, Zürich
University Hospital of Erlangen, Germany
Center for Alcohol and Addiction Studies, USA
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Subjects
All young men at the army recruitment centers in Lausanne,
Windisch and Mels invited to participate
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n = 5,387
Data collected between August 2010
and November 2011
Questionnaire
Online questionnaire (a hard copy sent by post if wished)
45 - 60 minutes
socioprofessional and family background
lifestyle and personality
consumption of tobacco, alcohol, cannabis and other drugs
gambling and gaming activities and use of internet
sexuality
physical and mental health
knowledge about other health-related aspects
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Analyses
Proportions, mean values and standard deviations to describe
general characteristics
Between-group differences by one-way ANOVAs and chisquare
Significance set at p<0.05
Multinomial logistic regression for association between sexual
preference and a set of independent variables
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Sexual preferences
89.7% considered themselves exclusively
heterosexuals and 1% exclusively homosexuals
Bisexual attraction reported by 7.4%
1.9% avoided the question regarding their sexual
preference
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Lifetime consumption
Ever drunk > 12 alcoholic
beverages?
Ever smoke > 50 cigarettes
Ever smoked cannabis
Magic mushrooms
Other hallucinogens (LSD,
PCP/Angeldust, etc.)
Salvia divinarum
Speed
Amphetamines
Chrystal Meth (Ice)
Poppers
Glue sniffing
Ecstasy, MDMA
Cocaine, crack, freebase
Heroin
Ketamines
GHB/GBL/1-4 butandiol (BDB)
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Exclusively
heterosexual
Exclusively
homosexual
Bisexually
attracted
(n=5’371)
86.7
(n=62)
77.4
(n=442)
88.7
38.6
46.5
5.4
4
5.1
4.5
3.1
1.1
4.7
4.4
5.3
3
0.4
0.5
0.4
41.9
45.4
11.3
11.3
6.5
11.3
14.5
1.6
25.8
11.3
14.5
9.7
1.6
4.8
3.2
49.2
58.5
9.4
7
5.9
6.3
5.2
1.6
7.7
7.7
9.9
5.4
0.7
0.9
1.1
ns
<0.001
<0.001
<0.001
<0.001
ns
<0.05
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
Last year consumption
Exclusively
heterosexual
(n=5’371)
92
Exclusively
homosexual
(n=62)
90.3
Bisexually
attracted
(n=442)
91.6
> 50 cigarettes
46.4
51.6
56.9
Cannabis
29.7
30.6
40.8
Magic mushrooms
2.6
6.5
3.8
- Other hallucinogens (LSD,
PCP/Angeldust, etc.)
- Salvia divinarum
2.1
9.7
3.9
2.1
3.2
2.5
- Speed
2.5
3.1
4.1
- Amphetamines
1.7
9.7
4.7
- Chrystal Meth (Ice)
0.4
1.6
0.5
- Poppers
2
19.4
4.5
- Glue sniffing
2
6.5
3.9
3.4
11.3
6.6
3
9.7
5.4
- Heroin
0.4
1.6
0.7
- Ketamines
0.5
4.8
0.9
- GHB/GBL/1-4 butandiol (BDB)
0.4
3.2
1.1
The last 12 months
> 12 alcoholic beverages?
- Ecstasy, MDMA
- Cocaine, crack, freebase
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ns
ns
ns
ns
ns
ns
ns
<0.05
ns
<0.01
ns
ns
ns
ns
ns
ns
Multinomial logistic regression:
Independent variables
Number of alcoholic beverages consumed during a typical day
Frequency of alcohol consumption during a typical week
Number of cigarettes smoked during a typical day
Smoking frequency in the past year
Number of illicit substances used in the past year (composite
variable)
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Multinomial logistic regression
bisexually attracted
exclusively homosexual
Sexual
preferencea
Variable
Sig.
Exp (B)
95% C.I. for exp (B)
Lower
Upper
Intercept
0.00005
-
-
-
Number of alcoholic beverages
0.06
0.88
0.78
1
Number of cigarettes smoked
0.08
1.05
0.99
1.11
Number of illicit substances used
0.002
1.23
1.08
1.41
- 4-7 days a week
0.3
0.58
0.19
1.75
- 3 days a week or less
0
-
-
-
- 5-7 days a week
0.6
0.78
0.29
2.08
- 4 days a week or less
0
-
-
-
Intercept
0.00005
-
-
-
Number of alcoholic beverages
0.009
0.95
0.91
0.99
Number of cigarettes smoked
0.2
0.98
0.96
1.01
Number of illicit substances used
0.003
1.12
1.04
1.2
- 4-7 days a week
0.4
1.15
0.8
1.66
- 3 days a week or less
0
-
-
-
- 5-7 days a week
0.8
1.04
0.73
1.48
- 4 days a week or less
0
-
-
-
Frequency of alcohol consumption
Smoking frequency
Frequency of alcohol consumption
Smoking frequency
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Jasinski & Ford, 2008; McCabe et al, 2005
College studies
Gay men significantly less likely to binge drink than
heterosexual men
Gay men significantly less likely to endorse norms that are
permissive of binge drinking
Elevated rates of binge drinking in college samples canceling out the
typical LGB/heterosexual differences during this period ?
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Conclusions
Homosexual men
Higher proportion of lifetime drug use (excepted alcohol and cannabis)
Maintain popper and amphetamine consumption until age 20
Hypothesis: gay culture effect?
Bisexual men
Higher proportion of lifetime cigarette and cannabis use
Higher tendency to maintain cigarette and cannabis use until age 20
Less drinks/day
Maintain popper and amphetamine use, but at lesser proportion than
homosexual men
Hypothesis: less affiliated to gay culture, more tendency to consume for
(minority)stress-reduction?
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Service d’addictologie
Centre collaborateur OMS
pour l’enseignement et la recherche sur les addictions
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