Out in the open: Alcohol use and harm in LGBTQ+ communities

Background

Reports consistently highlight that GSM individuals, including lesbian, gay, transgender, queer, questioning and ace/asexual (LGBTQ+) individuals and those with non-heterosexual or non-cisgender identities, are more prone to high-risk alcohol consumption compared to the general population, making them vulnerable to various harms.^1,2,3

In 2022, we published a systematic scoping review on alcohol use amongst GSM individuals, which highlighted the inconsistency and incomparability of data, as well as paucity of data for certain gender and sexual minority subgroups (including transgender, non-binary, asexual, and intersex populations).

This report aims to provide a comprehensive overview of alcohol consumption, drinking behaviour, and experiences of GSM individuals in the UK to identify health risks and disparities, fill knowledge gaps, as well as inform messaging, support services, interventions, and public health initiatives to reduce alcohol harm.

What did we do?

Each year, we commission YouGov to conduct our Drinkaware Monitor – a large representative survey of UK adults used to track and understand the nation’s drinking. In 2022, we boosted the sample to include over 3,000 individuals who identified as LGBTQ+, along with more than 5,000 individuals who identified as cisgender and heterosexual to identify alcohol use and harm specific to LGBTQ+ communities. More information on methodology can be found in the report.

What did we find?

In comparing LGBTQ+ respondents to cis-heterosexual respondents, we found that:

• Whilst LGBTQ+ and cis-heterosexual adults tend to drink about the same amount of alcohol in terms of how often and how much overall, LGBTQ+ drinkers are more likely to binge drink.
• As a result of this greater propensity to binge drink, LGBTQ+ individuals are more likely to score positive for hazardous drinking both on the Alcohol Use Disorders Identification Test (AUDIT) and its short form version, AUDIT-Consumption (AUDIT-C)—screening tools developed by the World Health Organization to identify hazardous or harmful alcohol use.
• Drinking to fit in and drinking to cope are more common among LGBTQ+ drinkers, particularly those who drink at higher-risk levels.
• LGBTQ+ individuals are disproportionately affected by alcohol-related harm because of other people’s drinking.
• LGBTQ+ adults face higher rates of depression, anxiety, and overall life dissatisfaction when compared to cis-heterosexual adults and these challenges are linked to hazardous alcohol use.
• Compared to their cis-heterosexual drinkers, LGBTQ+ drinkers were more likely to recognise that their current level of drinking will increase their chance of future health problems.
• LGBTQ+ drinkers were also twice as likely to reach out to a service or organisation for help or advice regarding alcohol, on their own behalf.
• However, LGBTQ+ higher risk drinkers were less inclined to approach a General Practitioner or other health professional than their cis-heterosexual counterparts – instead being most likely to seek support from alternative support options, such as an app or digital service.

And when looking at intersectionality, we focused on LGBTQ+ people living with a disability, LGBTQ+ people from an ethnic minority background and LGBTQ+ people who live in the most deprived areas. Some of the key findings from these groups include:

• As seen for the broader LGBTQ+ population, LGBTQ+ adults living with disabilities, LGBTQ+ adults from ethnic minority backgrounds, and LGBTQ+ adults living in the most deprived areas are more likely to engage in binge drinking than their cis-heterosexual counterparts.
• LGBTQ+ adults living with a disability and LGBTQ+ adults living in the most deprived areas also reported a significantly higher likelihood of experiencing negative impacts from someone else’s drinking, compared to their cis-heterosexual counterparts.
• The mental health of LGBTQ+ adults from ethnic minority backgrounds also tended to be poorer than that of their cis-heterosexual counterparts, as they were more likely to screen positive for depression and anxiety.

Our report also delves into LGBTQ+ subgroups to uncover subtle distinctions and variations in alcohol consumption patterns and experiences.

When comparing sexual minority subgroups (i.e., Lesbian, Gay and Bi/Pansexual men and women), we found that:

• Sexual minority men, (i.e., gay and bi/pansexual men), tend to be more frequent drinkers and exceed the drinking guidelines, compared to sexual minority women (i.e., lesbian and bi/pansexual women), who drink less and less often.
• Binge drinking is common across all LGBTQ+ groups, but bi/pansexual women are more likely to engage in it, and lesbian women are least likely to engage in it.
• Bi/pansexual women are much more prone to experiencing symptoms associated with alcohol dependence and negative consequences from drinking.
• Discrimination experiences and ‘openness’ about sexual orientation and/or gender identity vary among LGBTQ+ subgroups.
• Bi/pansexual women experience significantly more negative impacts or harms from others’ drinking, are much more likely to experience poorer mental health, and face barriers in accessing alcohol support.

And finally, when comparing gender minority subgroups (i.e., Transgender, Non-binary) the report found:

• Gender minorities, (i.e., LGBTQ+ individuals who identify as transgender or non-binary), tend to drink less frequently and consume fewer units of alcohol when they do drink compared to LGBTQ+ adults who identify as cisgender. They are also less likely to engage in binge drinking and exceed the drinking guidelines.
• As a result, gender minorities are more likely to be classified as ‘low-risk’ drinkers on alcohol screening tools (AUDIT-C, AUDIT), with individuals who identify as non-binary having the lowest risk profile. Drinkers who identify as transgender display a polarised pattern, with a higher proportion of ‘low risk’ drinkers, but a similar proportion of ‘higher risk’ drinkers compared to cisgender drinkers.
• LGBTQ+ individuals, regardless of their gender identity, report similar rates of negative impacts resulting from others’ drinking. However, cisgender individuals are more likely to experience individual impacts.
• Gender identity also plays a role in confidence in finding alcohol support services, with cisgender individuals displaying higher levels of confidence compared to transgender and non-binary individuals.
• Gender minorities feel a stronger sense of belonging to LGBTQ+ communities. However, they also experience higher rates of discrimination based on sexual orientation and/or gender identity, both within and outside these communities.
• In healthcare, LGBTQ+ gender minorities face more adverse experiences, including difficulties in accessing healthcare services and unequal treatment from medical staff. They are also more likely to forgo treatment due to concerns about discrimination.

For more information, you can download the full report and summary report below.

For more information on GSM groups that had too few respondents to feature within the report (i.e. those who identified as Unsure, Asexual, Another way, and Intersex), download the small group data tables below.