Associations Among Childhood Household Dysfunction, Sexual Orientation, and DSM-5 Alcohol, Tobacco and Other Substance Use Disorders in Adulthood: Evidence from a National U.S. Survey

OBJECTIVES: This study examined the associations between childhood household dysfunction and adulthood past-year DSM-5 alcohol, tobacco, and other substance use disorders across sexual orientation subgroups (eg, lesbian/gay, bisexual, and heterosexual).METHODS: Prevalence estimates were based on National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III) data collected from structured diagnostic face-to-face interviews in a nationally representative sample of 36,309 U.S. adults. Multivariable regression was used to examine associations between childhood household dysfunction and past-year substance use disorders in adulthood.
RESULTS: Sexual minorities, particularly sexual minority women, reported higher rates of childhood household dysfunction (eg, parental/household history of substance-related problems) and adulthood DSM-5 alcohol, tobacco, and substance use disorders. Results of multivariable analyses indicated that childhood histories of parental/household substance-related problems were associated with greater odds of past-year substance use disorders among sexual minorities than heterosexuals, and that such histories may moderate differences among sexual orientation subgroups. The risk of substance use disorders among sexual minority women relative to exclusively heterosexual women (ie, heterosexual-identified women without same-sex attraction or behavior) remained high, even when accounting for household dysfunction. In contrast, there were no such differences between sexual minority men and exclusively heterosexual men.
CONCLUSIONS: Sexual minorities are more likely to have childhood household dysfunction which in turn is associated with a higher risk of developing DSM-5 alcohol, tobacco, and substance use disorders in adulthood, especially among sexual minority women. Healthcare providers who care for individuals raised in dysfunctional households should carefully assess risk for substance use disorders and intervene as needed.