Drivers of Problematic Alcohol Use

Sexuality and gender diverse people use alcohol for many of the same reasons as heterosexual and cisgender people. Two further explanations are extended in the literature. 

Alcohol use as a stress response to experiences of discrimination and rejection  

Sexuality and gender diverse people may experience stigma, discrimination, rejection, and physical abuse from a range of sources including family, friends, and strangers (see Chapter 3). Over one-quarter of LGB people and up to half of gender diverse people report verbal harassment or abuse in the preceding year, with many changing their behaviour or hiding their sexuality and/or gender with family, in public, and when accessing services. Removal of criminalisation and legally enshrined discrimination against sexuality and gender diverse people is relatively recent in Australia, with some institutionalised discrimination remaining. Many sexuality and gender diverse people have a cultural background where sexuality or gender diversity is criminalised; consensual same-sex activity between adults is punishable by death in 11 countries. There is mixed evidence of a positive association between stress related to being a sexual or gender minority and substance use. 

Normative influences of alcohol-based socialising 

Sexuality and gender diverse communities have historically organised around licensed venues for safety, to meet like-minded people, and to express their identities. It is theorised that this alcohol-based socialising has normalised alcohol (and illicit substance use). Sexuality and gender diverse people perceive a heavy drinking culture to be normal; more frequent bar attendance is associated with overestimating heavy alcohol use among peers and with increased alcohol use.