The Relationship Between Internalized Sexual Prejudice and Sexualized Substance Use: A Systematic Review and Meta-Analysis

Abstract

LGBQ individuals report higher rates of sexualized drug use (SDU; i.e. the use of alcohol and/or other drugs before or during sex) than heterosexual individuals. Drawing on Minority Stress Theory, this paper explored internalized sexual prejudice (ISP; i.e. the process of internalizing negative societal attitudes toward minority sexual identities) as a theoretically relevant factor underlying this disparity. Relevant studies were identified through a systematic search of the PsycINFO, Cinahl, Medline Complete, Scopus, and Web of Science databases on the 29th of April, 2024, plus a subsequent search of the gray literature. Eighteen studies (N = 16,483) were included in a meta-analysis examining the association between ISP and SDU. The results revealed a small, non-significant overall relationship (r =.012, 95% CI [−.011,.035], p =.316). Subgroup analysis by drug type also yielded non-significant differences (p =.468). Narrative synthesis highlighted wide variability in how ISP and SDU were operationalized across studies, as well as evidence of publication bias. Findings suggest that the relationship between ISP and SDU is complex, inconsistent, and potentially moderated by unmeasured contextual factors. Future research is warranted to explore subgroup differences and incorporate diverse theoretical perspectives to more fully account for the motivations and risks associated with SDU.