Oppression-Based Stress and Alcohol Inequities Among Sexual and Gender Minority People: An Intersectional Multilevel Framework

Ethan H. Mereish

Sexual and gender minority (SGM) people—particularly girls and women—are more likely to use and misuse alcohol than their heterosexual and cisgender peers. Moreover, the association between gender identity, sexual orientation, and alcohol use behaviors may differ among racial and ethnic groups. This review examines the hypothesis that SGM individuals’ experiences of oppression (e.g., heterosexism, anti-bisexual prejudice, cissexism) in many domains of their lives may lead to stress that contributes to their alcohol use and misuse. It analyzes the associations between different, often intersecting types of oppression at the personal/interpersonal and structural level and alcohol use among SGM people, including racial/ethnic minorities. The findings suggest that interventions and treatments that help affirm SGM individuals and promote coping skills and resilience but also acknowledge nuances between different subgroups may help prevent alcohol misuse in these populations. The authors provide future research directions that would address the gaps in the field, including more attention to culturally and developmentally relevant mechanisms across the lifespan, application of sophisticated methodologies, and integration of intersectional and addiction frameworks.

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