Gay and alcoholic: epidemiologic and clinical issues

Alcohol Health & Research World,  Spring, 1991  by Jay P. Paul,  Ron Stall,  Kim A. Bloomfield

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Although the rate of alcohol abuse in the gay community cannot be stated conclusively, it is clear that a substantial portion of gays, lesbians, and bisexuals drink problematically. The literature has demonstrated a need to address issues specific to the gay community in alcoholism treatment, and supports the notion of gay-specific treatment groups and programs.

Alcohol abuse among homosexual and bisexual men and women has become an area of growing scientific and public interest. In this article, we review the literature on the prevalence rates of alcoholism among gay men and lesbians, as well as the risk factors for alcohol abuse in the gay community.1 We also review recommendations from the treatment literature regarding clinical interventions for gay alcoholics.

This article is organized around a series of questions that we believe are crucial to understanding alcohol abuse and alcoholism within the gay community: (1) Do elevated rates of alcoholism exist in the gay community? (2) Are rates of alcohol abuse in the gay community changing? (3) What are the risk factors for alcohol abuse in the gay community? (4) Is there a need for gay-sensitive alcoholism treatment programs? (5) How can existing treatment programs respond to the needs of gay alcoholics? (6) How can gay alcoholics obtain the social support necessary to maintain sobriety? We have endeavored to present the evidence available to respond to these questions, but we do not imply that these questions have been answered conclusively. There are gaps in the research literature that we hope will be filled in the near future, particularly with regard to the drinking practices of lesbians.

Do Higher Rates of Alcoholism Exist in the Gay Community?

The presumption that rates of alcoholism2 and alcohol abuse within the gay community are higher than within the general population is based primarily upon a number of early studies. These studies reported high prevalence rates of heavy drinking or alcoholism among gay men and lesbians in several disparate communities (Fifield et al. 1977; Lohrenz et al. 1978; Morales and Graves 1983). One study comparing lesbians and heterosexual women (Saghir and Robins 1973) found that 35 percent of the lesbian sample experienced "excessive and/or problem drinking," as compared with 5 percent of the control sample of heterosexual women. Estimates of problematic alcohol use derived from this early literature for both gay men and lesbians have tended to cluster around a prevalence rate of 30 percent. Despite the use of divergent sampling and measurement techniques, these studies as a whole indicated prevalence rates of problematic alcohol use to be far in excess of the figure of 10 percent usually ascribed to the general population.

Before accepting these high prevalence rates of alcohol and other drug abuse within the gay community, however, the methodological limitations of the supporting literature should be considered. Each of the studies cited above describes data derived using opportunistic sampling techniques; these data may or may not accurately represent the community from which they were drawn. Gay bars and their surrounding environs have traditionally been a significant source for recruitment of samples, as they are one of the few public settings in which gay Americans congregate freely. This sampling practice is especially problematic for alcohol or other drug studies, as it can lead to an oversampling of bar patrons. Bar patrons are more likely to be heavy drinkers than individuals in the general population (Clark 1981), and also may be more likely to use drugs other than alcohol. To the extent that research protocols rely on methods that overrepresent bar patrons, they risk overestimating the prevalence of alcohol and other drug abuse among homosexual and bisexual men and women. Furthermore, most of the samples obtained through opportunistic sampling techniques have been predominantly white and middle class, thereby limiting our knowledge of the drinking practices of ethnic minority gay men and women.

Since the start of the AIDS epidemic, however, studies have been designed that approximate representative samples of specific gay male communities. Data from these projects often can be used to generate estimates of gay male alcohol and other drug use more rigorous than those possible through opportunistic samples. Stall and Wiley (1988), for example, compared the alcohol and other drug consumption patterns of self-identified gay and heterosexual men who lived in the 19 census tracts of San Francisco with the highest cumulative incidence of AIDS. The rate of heavy drinking among gay men in this sample was 19 percent, as compared with 11 percent among heterosexual men in the sample, but few other differences were found between the drinking habits of the sample's gay men and heterosexual men. Although gay men did use a greater variety of drugs than their heterosexual male neighbors, differences in the frequency with which they used these drugs were comparatively minor.