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Exploring equity in AA:

How does sexual minority status impact attendance?

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Exploring equity in AA: How does sexual minority status impact attendance?

Sexual minority (e.g., gay, lesbian, bisexual identified) individuals experience alcohol use disorder at much higher rates than individuals identifying as heterosexual. While Alcoholics Anonymous (AA) serves as the most common source of recovery support for alcohol-related problems in the United States, relatively little is known about sexual minority involvement in AA, including rates and predictors of AA attendance, which has important implications for how we think about alcohol use disorder care for this population. In this study, rates of AA attendance across sexual orientations were explored, as well as the factors associated with AA attendance among sexual minorities.

WHAT PROBLEM DOES THIS STUDY ADDRESS?

Sexual minority individuals (e.g., gay, lesbian, bisexual) experience alcohol dependence at 2-6 times the rates of heterosexual individuals, with 13-20% of sexual minority individuals meeting criteria for past year alcohol dependence (based on DSM-IV criteria, which maps onto moderate and severe alcohol use disorder in DSM-5). Among the general United States population, Alcoholics Anonymous (AA) serves as the most common source of support for alcohol-related problems. Past research shows that AA is effective for addressing alcohol-related problems in clinical populations suffering from alcohol use disorder in general, however, relatively little is known specifically about sexual minority involvement in AA. Because AA is such a commonly utilized recovery resource, it is particularly important from a treatment referral perspective that more is understood about how sexual minority people engage with AA.

HOW WAS THIS STUDY CONDUCTED?

This was a secondary analysis of data from the National Alcohol Survey that sought to establish and compare rates of lifetime AA attendance across sexual orientations, and compare relationships between AA attendance and individual factors (e.g., alcohol use disorder severity, demographic factors). The study sample included 7,862 adults that endorsed at least one lifetime symptom of DSM-5 alcohol use disorder.

The National Alcohol Survey is a nationally representative survey of adults ages 18 and older conducted every 5 years by the Alcohol Research Group, which is funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). To ensure enough data from sexual minority individuals were available for the analyses, this study pooled data from five independent waves of the survey (1995-2015).

Respondents who endorsed ever having spoken to someone about a drinking problem were asked about their lifetime AA attendance with the question: “Have you ever gone to an Alcoholics Anonymous meeting for your drinking?” AA attendance was analyzed as a binary variable (yes/no). The authors also measured lifetime alcohol use disorder severity with a 17-item measure developed by the Alcohol Research Group, and whether individuals identified as religious or not (yes or no).

Questions asked all survey participants to indicate their sexual preference/orientation (“Which of the following statements best describes your sexual preference?” (1995 and 2000); “Which of the following statements best describes your sexual orientation?” (2005, 2010, and 2015)).

Overall, 39.74% of heterosexual male, 40.58% of bisexual male, 45.61% of gay male, 19.52% of heterosexual female, 46.53% of bisexual female, and 48.60% of lesbian female respondents to the National Alcohol Survey reported at least one symptom of alcohol use disorder and were included in this study. After screening out participants with zero symptoms of alcohol use disorder, the combined surveys yielded 4,576 heterosexual male, 2,919 heterosexual female, 56 bisexual male, 94 bisexual female, 130 gay male, and 87 lesbian female respondents.

WHAT DID THIS STUDY FIND?

Both gay/lesbian and bisexual respondents had greater odds of ever attending AA compared to heterosexual respondents, but attendance was also influenced by other individual characteristics like sex and race.

Overall, both gay/lesbian and bisexual respondents had greater odds of ever attending AA compared to heterosexual respondents, after controlling for individual factors like lifetime alcohol use disorder severity, gender, race/ethnicity, age, religiosity, and current income. Other predictors of higher odds of AA attendance included greater alcohol use disorder severity, older age, and lower income. Female gender and Black and Latino/Latina/Latinx race/ethnicity were uniquely associated with lower odds of attending AA relative to male and White respondents, respectively. The model showed no association between religiosity and AA attendance.

AA attendance by participant group. After controlling for individual factors like alcohoi use disorder severity, the apparent above differences between groups for men were not statistically significant, meaning it cannot be determined if the change between male groups was attributable to group differences, or just random chance.

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