Substance Use and Mental Health Disorders Among Heterosexual Identified Men and Women Who Have Same-Sex Partners or Same-Sex Attraction: Results from the National Epidemiological Survey on Alcohol and Related Conditions

This study examined sexual orientation discordance, a mismatch between self-reported sexual identity and sexual behavior or
sexual attraction, by describing the characteristics, substance use disorders, and mental health risks of heterosexual identified
individuals who endorsed this pattern of sexual identification, behavior, and attraction. Using data from the National Epidemiological
Survey on Alcohol and Related Conditions (NESARC), we created three groups based on participants’ reported sexual identity
and either their sexual behavior or sexual attraction: heterosexual concordant, homosexual concordant, and heterosexual discordant.
Bivariate models assessed the relationship of discordant status and demographic correlates, lifetime substance use disorders,
and mental health diagnoses. Logistic regression models tested associations between both behavior discordance and attraction
discordance and the likelihood of having lifetime disorders of substance use, major depression, and generalized anxiety. Results
of this study provided evidence of varying levels of substance use and mental health disorder risk by gender, discordance
status, and discordance type. Behavioral discordance was associated with increased risk of mental health and substance use
disorder among women (compared to heterosexual concordance). Findings among men were less consistent with heightened risk
of alcohol and inhalant use only. Attraction discordance was notably different from behavioral discordance. The odds of substance
use and mental health disorders were the same or lower compared with both the heterosexual and homosexual concordance groups.
Future research should begin to test theoretical explanations for these differences.