
Increased stress related to gender-minority status is associated with greater alcohol use among transgender and gender-diverse (TGD) youth and young adults, according to an innovative study.
TGD people, whose gender identity differs from their sex assumed at birth, experience greater alcohol use and hazardous drinking than their cisgender and heterosexual peers. Evidence suggests that alcohol use in TGD people is linked to a risk of negative academic or social consequences, being victimized and assaulted, and developing alcohol use disorder (AUD).
This is endorsed by the gender minority stress and resilience model (GMSRM), which identifies external stressors (e.g., victimization) and internal stressors (e.g., internalized transphobia) that may contribute to negative health and behavioral outcomes, including increased drinking. Better understanding gender-minority stress and resilience could inform interventions designed to reduce alcohol-related harms.
For the study in Alcohol: Clinical & Experimental Research, investigators examined the extent to which gender-minority stress and resilience influence alcohol use and harms in TGD young adults. To home in on the moment of drinking, the researchers used ecological momentary assessment (EMA), an approach not previously tested with this population.
The researchers worked with 40 TGD Canadians aged 18–29 who drank alcohol regularly. The participants underwent a 2-hour baseline interview that assessed their drinking and substance use. During the 21 days of EMA, participants completed a brief daily morning survey on their previous day’s substance use, which was delivered via a smartphone application. They also reported on gender-minority stressors (e.g., rejection or harassment), resilience factors (e.g., feeling part of a community), negative affect, psychological distress, drinking motives, alcohol craving, and harms (e.g., victimization or blackouts).
In addition, they received twice-daily random surveys assessing negative affect, craving, and drinking motives during the past 30 minutes. In a 1-hour exit interview, they rated the appropriateness of the EMA intervention. The researchers used statistical analysis to explore associations between stressors, resilience, alcohol risk processes (drinking motives, craving, distress, and negative affect), and alcohol use and harms.
On average, each participant drank on 6 of the 21 days, an average of 3 drinks per occasion, and reported 1–2 alcohol-related harms. The participants, on average, experienced gender-minority stress on 10 of the 21 days, and a similar frequency of gender-related resilience factors. On days of relatively high gender stress and resilience, they reported increased drinking but not increased alcohol-related harms. It’s possible that harms may unfold over longer periods of time, since the participants who reported more gender stress on average also reported higher harms on average. Gender-minority stress was associated with alcohol risk factors, including psychological distress, negative affect, drinking to cope (e.g., with difficult feelings), and alcohol craving. Other drinking motives, like enhancement (e.g., to boost pleasure) and social (e.g., to foster bonds), were predicted by daily or momentary shifts in gender-minority stress.
Resilience factors, including community connection and pride, were mostly not linked to alcohol outcomes and risk processes. That said, participants who reported generally higher resilience also reported generally lower alcohol use—and in moments of higher resilience, they were less likely to drink to cope. Resilience, however, also drove other drinking motives: conformity (e.g., to fit in), enhancement, and social. It’s possible that resilience factors relate to increased drinking in the moment— e.g., manifesting in social contexts (queer spaces) where drinking is common—and to reduced alcohol use across time, e.g., protecting against psychological distress. The participants were reasonably favorable about the EMA app, though they reported technical issues that seemed to reduce random survey completion rates.
The findings support the GMSRM framework’s premise that gender-minority stressors contribute to alcohol use and related harms over time. Gender-minority stressors are pervasive in the lives of TGD youth, underlining the importance of structurally dismantling transphobic and discriminatory policies and practices. Additional research is needed, with improved phone and app compatibility for EMA, addressing broader resilience factors and alcohol-specific harms.
Reference:
1) https://onlinelibrary.wiley.com/doi/10.1111/acer.70081
(Newswise/SH)