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Suchttherapie 2018; 19(04): 168-175
DOI: 10.1055/a-0732-8207
Schwerpunktthema
© Georg Thieme Verlag KG Stuttgart · New York

Sexuelle Identität, der Konsum von Alkohol und anderen Drogen, gesundheitliche Probleme und Behandlungsansätze: Ein unsystematischer Forschungsüberblick

Sexual Identity, Consumption of Alcohol and other Drugs, Health Problems and Treatment Programmes: A Unsystematic Review
Irmgard Vogt
1   Frankfurt University of Applied Sciences, Frankfurt am Main
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Publication History

Publication Date:
05 October 2018 (online)

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Zusammenfassung

Hintergrund Die Zahlen von Menschen, die ihre sexuelle Identität nicht als heterosexuell sondern als schwul, lesbisch, bisexuell oder in einer anderen Kategorie definieren, steigen seit Jahren leicht an; man schätzt, dass in westlichen Ländern ca. 5% der Bevölkerung zu den sexuellen Minderheiten zu rechnen sind. Diese Studie ist darauf angelegt, die psychischen Problemlagen der sexuellen Minoritäten anhand US-amerikanischer Bevölkerungsstudien sowie weiterer wichtiger Studien aus anderen Ländern genauer darzustellen.

Ergebnisse Zusammenfassend ergibt sich Folgendes: Unabhängig vom Geschlecht liegt der Konsum von Alkohol und anderen Drogen sowie die Abhängigkeit von diesen Stoffen mindestens auf dem Niveau der heterosexuellen Männer. Lesbisch/schwule und bisexuelle Frauen sind noch etwas stärker durch den Konsum von psychoaktiven Substanzen belastet als schwule und bisexuelle Männer. Untersucht man Belastungen durch Depressionen und Suizidversuche, findet man wiederum bei den sexuellen Minoritäten höhere Belastungen. LSB-Frauen haben die höchsten Raten hinsichtlich Depressionen und Ängsten. Darüber hinaus weisen die Daten darauf hin, dass bisexuelle Männer und Frauen hohe psychische Belastungen haben. Alles in allem genommen ist davon auszugehen, dass die sexuellen Minoritäten einen relativ hohen Bedarf an Behandlungen ihrer psychischen Störungen haben. Dennoch gibt es bislang nur sehr wenige Behandlungsprogramme mit der Zielgruppe: sexuelle Minoritäten.

Schlussfolgerungen Wir benötigen dringend deutsche Studien zu sexuellen Minoritäten allgemein und besonders zu trans*  Personen mit ihren sehr spezifischen Problemlagen. Die Studien sollten neben den Substanzkonsumstörungen der sexuellen Minoritäten auch andere psychische Störungen erfassen. Kenntnisse über die psychische Befindlichkeit sexueller Minoritäten sind die Grundlage für optimale Behandlungsgestaltungen.

Abstract

Background The number of persons who do not identify as heterosexual but as gay, lesbian, bisexual or any other category increase since the last 20 years; in Western countries it is estimated that around 5% of the population belong to the groups of sexual minorities. This study is aimed at describing in more detail the substance use and mental health problems of sexual minorities along the results of US-American population studies as well as important studies form other countries.

Results In summary, the results are as follows: Consumption of alcohol and other drugs as well as substance dependence of sexual minorities are as high as those of heterosexual men. Women who identify as lesbian/gay or bisexual have somewhat higher problems than gay and bisexual men. Regarding mental health problems, especially depression and suicidal attempts, once again the problem rates of sexual minorities are higher than those of heterosexuals. LGB-women have highest rates with depressions and anxieties. Furthermore, data indicate a high burden of male and female bisexuals with mental health problems. Thus, sexual minorities have a rather high need of treatment for their mental health problems. Still, there are only a few treatment programs around which are designed for sexual minorities.

Conclusions German studies of sexual minorities and more so of trans* persons with their specific problems are dearly needed. The studies should produce as well data on substance use and abuse disorders as of mental disorders in general of sexual minorities. Knowledge regarding the mental wellbeing of sexual minorities is the basis to work out optimal treatment plans.

Schlüsselwörter

Sexuelle Minoritäten - Konsum von Alkohol und anderen Drogen - psychische Störungen - Behandlungsansätze

Key words

sexual minorities - consumption of alcohol and other drugs - mental health problems - treatment approaches
 

  • Literatur

  • 1 Sexual Minority Assessment Research Team (SMART). Best Practices for Asking Questions about Sexual Orientation on Surveys. Los Angeles, CA: The Williams Institute, UCLA School of Law. Im Internet: https://williamsinstitute.law.ucla.edu/wp-content/uploads/SMARTFINAL-Nov-2009.pdf
    PubMed
  • 2 Gesundheitsförderung Schweiz (Hrsg.). Faktenblatt 19. Geschlechtliche und sexuelle Minderheiten in Gesundheitsförderung und Prävention. Bern: Zielgruppe Kinder und Jugendliche; 2016
    PubMed
  • 3 Lombardi E, Banik S. The Utility of the Two-Step Gender Measure within Trans and Cis Populations. Sex Res Soc Pol 2016; 13: 288-296
    PubMedGoogle Scholar
  • 4 Reisner SL, Deutsch MB, Bhasin S. et al. Advancing methods for US transgender health. Curr Opin Endocrinol Diabetes Obes 2016; 23: 198-207
    CrossrefPubMedGoogle Scholar
  • 5 Institute of Medicine . The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding. Washington, DC: National Academies Press; 2011
    Google Scholar
  • 6 McCabe SE, Hughes TL, Bostwick W. et al. Measurement of sexual identity in surveys: Implications for substance abuse research. Arch Sex Behav 2012; 41: 649-657
    CrossrefPubMedGoogle Scholar
  • 7 Bell M. et al. Data collection in relation to LGBTI People. Brüssel: European Commission; 2017
    Google Scholar
  • 8 Kerr DL, Oglesby WH. LGBT Populations and Substance Abuse Research: An Overview. In: VanGeest JB, Johnson TP, Alemagno SA. (eds.) Research Methods in the Study of Substance Abuse. Springer; 2017: 341-355
    CrossrefGoogle Scholar
  • 9 Oberheim ST, DePue MK, Hagedorn WB. SubstanceUe disroders (SUDs) in transgender communities: The need for trans-competent SUD counselors and facilities. Journal of Addiction & Offender Counseling 2017; 28: 33-47
    PubMedGoogle Scholar
  • 10 Drabble L, Midanik LT, Trocki K. Reports of alcohol consumption and alcohol-related problems among homosexual, bisexual and heterosexual respondents: Results from the 2000 National Alcohol Survey. J Stud Alcohol 2005; 66: 111-120
    CrossrefPubMedGoogle Scholar
  • 11 Hughes TL, McCabe SE, Wilsnack SC. et al. Victimization and substance use disorders in a national sample of heterosexual and sexual minority women and men. Addiction 2010; 105: 2130-2140
    CrossrefPubMedGoogle Scholar
  • 12 Ward BW, Schiller JS, Freeman G. Early release of selected estimates based on data from the January– September 2013 National Health Interview Survey. Hyattsville, MD: National Center for Health Statistics; 2014
    Google Scholar
  • 13 Ward BW, Dahlhamer JM, Galinsky AM et al. Sexual orientation and health among U.S. adults: National Health Interview Survey, 2013 (National Health Statistics Reports No. 77). Hyattsville, MD: National Center for Health Statistics 2014; Im Internet: http://www.cdc.gov/nchs/data/nhsr/nhsr077.pdf
    PubMed
  • 14 Gonzalez CA, Gallego JD, Bockting WO. Demographic Characteristics, Components of Sexuality and Gender, and Minority Stress and Their Associations to Excessive Alcohol, Cannabis, and Illicit (Noncannabis) Drug Use Among a Large Sample of Transgender People in the United States. J Prim Prev 2017; 38: 419-445 doi:10.1007/s10935-017-0469-4
    CrossrefPubMedGoogle Scholar
  • 15 Medley G, Lipari RN, Bose J et al.Sexual orientation and estimates of adult substance use and mental health: Results from the 2015 National Survey on Drug Use and Health. NSDUH Data Review. (2016). Im Internet: http://www.samhsa.gov/data/
    PubMed
  • 16 Kerridge BT, Pickering RP, Saha TS. et al. Prevalence, sociodemographic correlates and DSM-5 substance use disorders and other psychiatric disorders among sexual minorities in the United States. Drug Alcohol Depend 2017; 170: 82-92
    CrossrefPubMedGoogle Scholar
  • 17 Plöderl M, Tremblay P. Mental health of sexual minorities. A systematic review. International Review of Psychiatry 2015; 27: 367-385 doi:10.3109/09540261.2015.1083949
    CrossrefPubMedGoogle Scholar
  • 18 Gonzales G, Przedworski J, Henning-Smith C. Comparison of health and health risk factors between lesbian, gay, and bisexual adults and heterosexual adults in the United States: Results from the National Health Interview Survey. JAMA Intern Med 2016; 176: 1344-1351
    CrossrefPubMedGoogle Scholar
  • 19 Dirks H, Esser S, Specka M. et al. Suchtmittelkonsum bei homo- und bisexuellen Männern. Sucht 2012; 58: 237-246
    CrossrefPubMedGoogle Scholar
  • 20 Jackson CL, Agenor M, Johnson DA. et al. Sexual orientation identity disparities in health behaviors, outcomes, and services use among men and women in the United States: A cross-sectional study. BMC Public Health 2016; 16: 807 doi:10.1186/s12889-016-3467-1. http://dx.doi.org/10.1186/s12889-016-3467-1
    CrossrefPubMedGoogle Scholar
  • 21 Roxburgh A, Lea T, de Wit J. et al. Sexual identity and prevalence of alcohol and other drug use among Australians in the general population. Int J Drug Policy 2016; 28: 76-82
    CrossrefPubMedGoogle Scholar
  • 22 Demant D, Hides L, Kavanagh DJ. et al. Differences in substance use between sexual orientations in a multi-country sample: findings from the Global Drug Survey 2015. J Public Health (Oxf) 2016; 39: 523-541
    PubMedGoogle Scholar
  • 23 Slater ME, Godette D, Huang B. et al. Sexual orientation-based discrimination, excessive alcohol use, and substance use disorders among sexual minority adults. LGBT Health 2017; 4: 337-344
    CrossrefPubMedGoogle Scholar
  • 24 Substance Abuse and Mental Health Services Administration . Building Bridges: LGBT Populations: A Dialogue on Advancing Opportunities for Recovery from Addictions and Mental Health Problems. HHS Pub. No. (SMA 13-4774 Rockville, MD: Substance Abuse and Mental Health Services Administration; 2012
    Google Scholar
  • 25 Kessler RC, Barker PR, Colpe LJ. et al. Screening for serious mental illness in the general population. Archives of General Psychiatr 2003; 60: 184-189
    PubMedGoogle Scholar
  • 26 Kessle RC, Aguilar-Gaxiola S, Alonso J et al. The global burden of mental disorders: An update from the WHO. 2009
    PubMed
  • 27 Whiteford HA, Ferrari AJ, Louisa Degenhardt L. et al. The global burden of mental, neurological and substance use disorders: An analysis from the global burden of disease study 2010. PLoS ONE 2015; 10: e0116820. doi:10.1371/journal.pone.0116820
    CrossrefPubMedGoogle Scholar
  • 28 Jacobi F, Höfler M, Strehle J. et al. Psychische Störungen in der Allgemeinbevölkerung. Nervenarzt 2014; 85: 77-87 doi:10.1007/s00115-013-3961-y
    CrossrefPubMedGoogle Scholar
  • 29 Plöderl M. LSBTI und psychische Gesundheit: Fakten und Erklärungsmodelle. Psychotherapie-Wissenschaft 2016; 6: 140-151
    PubMedGoogle Scholar
  • 30 Kessler RC, Andrews G, Colpe LJ. et al. Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med 2002; 32: 959-956
    CrossrefPubMedGoogle Scholar
  • 31 Kidd SA, Howison M, Pilling M. et al. Severe Mental Illness in LGBT Populations: A Scoping Review. Psychiatric Services 2016; 67: 779-783. doi:10.1176/appi.ps.201500209
    CrossrefPubMedGoogle Scholar
  • 32 Elliott MN. Sexual Minorities in England Have Poorer Health and Worse Health Care Experiences: A National Survey. Journal of Genetics and Internal Medicine 2014; 30: 9-16
    PubMedGoogle Scholar
  • 33 Semlyen J, Kind M, Varney J. et al. Sexual orientation and symptoms of common mental disorder or low wellbeing: combined meta-analysis of 12 UK population health surveys. BMC Psychiatry 2016; 16: 67. doi:10.1186/s12888-016-0767-z
    CrossrefPubMedGoogle Scholar
  • 34 Becker I, Birken P, Nieder TO. Trans im Jugendalter – Aktuelle Forschungsergebnisse. Psychotherapie im Dialog 2017; 18: 41-45 doi:10.1055/s-0043-103881
    Article in Thieme ConnectPubMedGoogle Scholar
  • 35 Grossman AH, D’Augelli AR. Transgender youth and life-threatening behaviors. Suicide Life Threat Behav 2007; 37: 527-537
    CrossrefPubMedGoogle Scholar
  • 36 Haas AP, Eliason M, Mays VM. et al. Suicide and suicide risk in lesbian, gay, bisexual, and transgender populations: Review and recommendations. J Homosex 2011; 58: 10-51
    PubMedGoogle Scholar
  • 37 McDermott E, Hughes E, Rawlings V. The social determinants of lesbian, gay, bisexual and transgender youth suicidality in England: a mixed methods study. J Public Health (Oxf) 2017; Oct 17 1-8 doi:10.1093/pubmed/
    PubMedGoogle Scholar
  • 38 Mustanski B, Liu RT. A longitudinal study of predictors of suicide attempts among lesbian, gay, bisexual, and transgender youth. Arch Sex Behav 2013; Apr 42: 437-448 doi:10.1007/s10508-012-0013-9 Epub 2012 Oct 5
    CrossrefPubMedGoogle Scholar
  • 39 Perez-Brumer A, Day JK, Russel ST. et al. Prevalence and Correlates of Suicidal Ideation Among Transgender Youth in California: Findings From a Representative, Population-Based Sample of High School Students. J Am Acad Child Adolesc Psychiatry 2017; 56: 739-746
    CrossrefPubMedGoogle Scholar
  • 40 Smith E, Jones T, Ward R. et al. From Blues to Rainbows: Mental Health and Wellbeing of Gender Diverse and Transgender Young People in Australia. Melbourne, Australia: The Australian Research Centre in Sex, Health, and Society; 2014. https://www.beyondblue.org.au/docs/default-source/research-project-files/bw0268-from-blues-to-rainbows-report-final-report.pdf
    Google Scholar
  • 41 Stroumsa D. The state of transgender health care: Policy, law, and medical frameworks. Am J Public Health 2014; 104: e31-e38 doi:10.2105/AJPH.2013.301789
    PubMedGoogle Scholar
  • 42 Veale JF, Watson RJ, Peter T. et al. The mental health of Canadian transgender youth compared with the Canadian population. J Adolesc Health 2017; 60: 44-49
    CrossrefPubMedGoogle Scholar
  • 43 Cochran SD, Mays VM. Mortality risks among persons reporting same-sex sexual partners: Evidence from the 2008 General Social Survey – National Death Index Data Set. Am J Public Health 2015; 105: 358-364
    CrossrefPubMedGoogle Scholar
  • 44 King M, Semlyen J, Tai SS. et al. A systematic review of mental disorder, suicide, and deliberate self harmin lesbian, gay and bisexual people. BMC Psychiatry 2008; 8: 1-17
    CrossrefPubMedGoogle Scholar
  • 45 Plöderl M, Wagenmakers EJ, Tremblay P. Suicide Risk and Sexual Orientation: A Critical Review. Arch Sex Behav 2013; 42: 715-727
    CrossrefPubMedGoogle Scholar
  • 46 Plöderl M, Sellmeier M, Fartacek C. Explaining the suicide risk of sexual minority individuals by contrasting the minority stress model with suicide models. Arch Sex Behav 2014; n43: 1559-1570
    CrossrefPubMedGoogle Scholar
  • 47 Haas AP, Lane A. et al. Collecting Sexual Orientation and Gender Identity Data in Suicide and Other Violent Deaths: A Step Towards Identifying and Addressing. LGBT Health 2015; 2: 84-87
    CrossrefPubMedGoogle Scholar
  • 48 Hottes TS, Bogaert L, Rhodes AE. et al. Lifetime prevalence of suicide attempts among sexual minority adults by study sampling strategies: A systematic review and meta-analysis. Am J Public Health 2017; 106: e2
    PubMedGoogle Scholar
  • 49 Hottes TS, Ferlatte O, Gesink D. Suicide and HIV as leading causes of death among gay and bisexual men: a comparison of estimated mortality and published research. Crit Public Health 2015; 25: 513-526
    CrossrefPubMedGoogle Scholar
  • 50 Pompili M, Lester D, Forte A. et al. Bisexuality and suicide: A systematic review of the current literature. J Sex Med 2014; 1: 1903-1913
    PubMedGoogle Scholar
  • 51 Blosnich J-R, Nasuti LJ, Mays VM. et al. Suicidality and sexual orientation: Characteristics of symptom severity, disclosure, and timing across the life course. Am J Orthopsychiatry 2016; 86: 69-78 doi:10.1037/ort0000112
    CrossrefPubMedGoogle Scholar
  • 52 Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull 2003; 129: 674-697
    CrossrefPubMedGoogle Scholar
  • 53 Balsam KF, Mohr JJ. Adaptation to sexual orientation stigma: A comparison of bisexual and lesbian/gay adults. J Couns Psychol 2007; 54: 306-319
    CrossrefPubMedGoogle Scholar
  • 54 Brewster ME, Moradi B, Deblaere C. et al. Navigating the borderlands: The roles of minority stressors, bicultural self-efficacy, and cognitive flexibility in the mental health of bisexual individuals. J Couns Psychol 2013; 60: 543-556
    CrossrefPubMedGoogle Scholar
  • 55 Kramer J. Entwicklung der VLSP-Empfehlungen zur Psychotherapie und Beratung mit lesbischen, schwulen und bisexuellen Klient_innen. Verhaltenstherapie und psychosoziale Praxis 2015; 47: 9-19
    PubMedGoogle Scholar
  • 56 Proujansky RA, Pachankis JE. Toward Formulating Evidence-Based Principles of LGB-Affirmative Psychotherapy. Pragmat Case Stud Psychother 2014; 10: 117-131
    PubMedGoogle Scholar
  • 57 O’Shaughnessy T, Speir Z. The State of LGBQ Affirmative Therapy Clinical Research: A Mixed-Methods Systematic Synthesis. American Psychological Association; 2017. DOI: 10.1037/sgd0000259
    CrossrefGoogle Scholar
  • 58 Pachankis JE, Hatzenbuehler ML, Rendina HJ. et al. LGB-affirmative cognitive behavioral therapy for young adult gay and bisexual men: A randomized controlled trial of a transdiagnostic minority stress approach. J Consult Clin Psychol 2015; 83: 875-889
    CrossrefPubMedGoogle Scholar
  • 59 Substance Abuse and Mental Health Services Administration, National Survey of Substance Abuse Treatment Services (N-SSATS): 2016 . Data on Substance Abuse Treatment Facilities. BHSIS Series S-93, HHS Publication No. (SMA) 17-5039. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2017
    Google Scholar
  • 60 Shoptaw S, Reback CJ, Peck JA. Behavioral treatment approaches for methamphetamine dependence and HIVrelated sexual risk behaviors among urban gay and bisexual men. Drug and Alcohol Dependence 2005; 78: 125-134
    CrossrefPubMedGoogle Scholar
  • 61 Shoptaw S, Reback CJ, Larkins S. et al. Outcomes using two tailored behavioral treatments for substance abuse in urban gay and bisexual men. Journal of Substance Abuse Treatment 2008; 35: 285-293
    CrossrefPubMedGoogle Scholar
  • 62 Reback CJ, Shoptaw S. Development of an Evidence-based, Gay-specific Cognitive Behavioral Therapy Intervention for Methamphetamine-abusing Gay and Bisexual Men. Addict Behav 2014; 39: 1286-1291 doi:10.1016/j.addbeh.2011.11.029
    CrossrefPubMedGoogle Scholar
  • 63 Nyamathi A, Reback CJ, Shoptaw S. et al. Impact of Tailored Interventions to Reduce Drug Use and Sexual Risk Behaviors Among Homeless Gay and Bisexual Men. Am J Mens Health 2017; 11: 208-220
    CrossrefPubMedGoogle Scholar
  • 64 Austin A, Craig SL. Transgender Affirmative Cognitive Behavioral Therapy: Clinical Considerations and Applications. Professional Psychology Research and Practice 2015; 46: 21-29
    CrossrefPubMedGoogle Scholar
  • 65 Beard C, Kirakosian N, Silverman AL. et al. Comparing treatment response between LGBQ and heterosexual individuals attending a CBT- and DBT-skills-based partial hospital. J Consult Clin Psychol 2017; 85: 1171-1181 http://dx.doi.org/10.1037/ccp0000251
    CrossrefPubMedGoogle Scholar
  • 66 Plöderl M, Kunrath S, Cramer RJ. et al. Sexual orientation differences in treatment expectation, alliance, and outcome among patients at risk for suicide in a public psychiatric hospital. BMC Psychiatry 2017; 17: 184
    CrossrefPubMedGoogle Scholar
  • 67 Parsons JT, Lelutiu-Weinberger C, Botsko M. et al. A randomized controlled trial utilizing motivational interviewing to reduce HIV risk and drug use in young gay and bisexual men. J Consult Clin Psychol 2014; 82: 9-18. doi:10.1037/a0035311
    CrossrefPubMedGoogle Scholar
  • 68 Gilbert PA, Pass LE, Greenfield TK. et al. Alcohol research with transgender populations: A systematic review and recommendations to strengthen future studies. Drug and Alcohol Depencence 2018; 186: 138-146
    PubMedGoogle Scholar