BACKGROUND AND AIMS Sexual minority (SM) populations experience higher rates of substance use disorder (SUD) associated with increased sexual orientation-related stress. Social support may moderate the impact of stress on SUD among SM adults. This study assessed associations between social support and DSM-5 SUD by sex and sexual minority identity. DESIGN Cross-sectional study using data from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III). SETTING AND PARTICIPANTS A nationally representative cross-sectional sample of adults (n=36,309) in the United States. MEASUREMENTS SUD were defined based on the DSM-5 criteria for alcohol use (AUD), tobacco use (TUD) and drug use (DUD) disorders. Structural social support was measured as the type and frequency of kin and non-kin contact, and functional social support was measured by the Social Provision Scale. FINDINGS SM adults had higher odds of all SUD compared to heterosexual adults (AUD: 1.56, 95%CI 1.28-1.84; TUD: 1.51, 95%CI 1.23-1.85; DUD: 1.52, 95%CI 0.41-0.63); SM women experienced the highest proportion of all SUD (AUD: 27.1%, TUD: 29.1%, DUD: 10.9%). Type of social support was differentially associated with SUD by sex and sexual identity status. Higher social provision was associated with lower rates of AUD (adjOR 0.77, 95%CI 0.71-0.84), TUD (adjOR 0.75, 95%CI 0.69-0.80) and DUD (adjOR 0.56, 95%CI 0.49-0.64). Marriage was associated with lower SUD among heterosexual men (AUD: adjOR 0.50, 95%CI 0.43-0.58); TUD: adjOR 0.60, 95%CI 0.52-0.70; DUD: adjOR 0.50, 95%CI 0.37-0.69) and women (AUD: adjOR 0.64, 95%CI 0.53-0.77; TUD: 0.0.58, 95%CI 0.51-0.67; DUD: adjOR 0.52, 95%CI 0.37-0.71). Compared to heterosexual adults, SM women with at least one child under the age of 18 had higher odds of TUD (adjOR 1.99, 95%CI 1.33-2.99). SM-related discrimination was not associated with SUD among some SM subgroups, but discrimination among male heterosexually-identifying individuals reporting same-sex attraction or behavior was associated AUD (adjOR 4.61, 95%CI 1.62-13.14) CONCLUSIONS: In the U.S. there are significant associations between functional support (quality or provision of support) and structural support (type and frequency of social networks) and substance use disorder (SUD) which differ by sex and sexual identity status.

中文翻译：

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来自具有全国代表性的美国成年人样本的功能性和结构性社会支持、药物使用和性取向

背景和目标 性少数 (SM) 人群经历与性取向相关压力增加相关的物质使用障碍 (SUD) 发生率较高。社会支持可能会减轻压力对 SM 成年人 SUD 的影响。本研究通过性别和性少数身份评估了社会支持与 DSM-5 SUD 之间的关联。设计 横断面研究使用 2012-2013 年全国酒精及相关疾病流行病学调查 (NESARC-III) 的数据。设置和参与者 具有全国代表性的美国成年人 (n=36,309) 横断面样本。测量 SUD 是根据酒精使用 (AUD)、烟草使用 (TUD) 和药物使用 (DUD) 障碍的 DSM-5 标准定义的。结构性社会支持被衡量为亲属和非亲属接触的类型和频率，功能性社会支持由社会供给量表衡量。发现与异性恋成年人相比，SM 成年人所有 SUD 的几率更高（AUD：1.56，95%CI 1.28-1.84；TUD：1.51，95%CI 1.23-1.85；DUD：1.52，95%CI 0.41-0.63）；SM 女性在所有 SUD 中的比例最高（AUD：27.1%，TUD：29.1%，DUD：10.9%）。社会支持类型与 SUD 的性别和性身份状态存在差异。较高的社会供给与较低的 AUD (adjOR 0.77, 95%CI 0.71-0.84)、TUD (adjOR 0.75, 95%CI 0.69-0.80) 和 DUD (adjOR 0.56, 95%CI 0.49-0.64) 的比率相关。婚姻与异性恋男性的较低 SUD 相关（AUD：adjOR 0.50，95%CI 0.43-0.58）；TUD: adjOR 0.60, 95% CI 0.52-0.70; DUD：adjOR 0.50，95%CI 0.37-0.69）和女性（AUD：adjOR 0.64，95%CI 0.53-0.77；TUD：0.0.58，95%CI 0.51-0.67；DUD：adjOR 0.52，95% CI 0.37-0.71)。与异性恋成年人相比，至少有一个 18 岁以下孩子的 SM 女性患 TUD 的几率更高（adjOR 1.99，95%CI 1.33-2.99）。在一些 SM 亚组中，与 SM 相关的歧视与 SUD 无关，但在报告同性吸引或行为的男性异性恋个体之间的歧视与 AUD (adjOR 4.61, 95%CI 1.62-13.14) 相关联 结论：在美国有功能支持（支持的质量或提供）和结构支持（社交网络的类型和频率）与物质使用障碍 (SUD) 之间的显着关联，这些关联因性别和性身份状态而异。