UM Graduates’ Study Shows LGBTQ Individuals at Greater Risk for Substance Use Following Discrimination

December 07, 2017

MISSOULA – Not only are daily discrimination experiences painful, they also are associated with greater risk of subsequent nicotine, alcohol and drug use among lesbian, gay, bisexual, transgender and queer people, according to new research conducted at the University of Montana.

The study, led by recent UM doctoral graduate Nicholas Livingston, in partnership with fellow UM alumni researchers at the University of California-San Francisco and Marquette University, used a smart phone-based application that prompted 50 LGBTQ participants to fill out short surveys several times a day for two weeks. The survey asked participants, all of whom were either current or recent UM students between the ages of 18 and 45, about their daily interactions and moods, as well as their recent nicotine, alcohol and drug use.

The findings, published this month in the Journal of Consulting and Clinical Psychology, showed that LGBTQ-based discrimination that had occurred in the previous few hours was associated with greater immediate and prolonged risk for engaging in nicotine, alcohol and drug use. By comparison, the effects of other forms of mistreatment throughout the day, which included mistreatment attributed to gender, race/ethnicity, disability, or mental or physical health status, were weaker.

“These findings are disheartening in the sense that we believe discrimination is something that should not be happening in the first place,” said Livingston, who earned his doctorate in UM’s clinical psychology program earlier this year and who is now a postdoctoral research fellow at the U.S. Department of Veterans Affairs Boston Medical Center. “However, knowing this may help guide researchers toward developing interventions that promote healthy and effective coping among LGBTQ individuals who experience discrimination.”

According to co-author Nicholas Heck, an assistant professor of psychology at Marquette University who earned his doctoral and master’s degrees from UM, the study was the first known attempt to investigate how discrimination experienced by LGBTQ people can increase their risk for substance use on a daily, real-time basis. The results changed the researchers’ understanding of how discrimination events can impact the LGBTQ community, according to another co-author, Annesa Flentje.

“Previously, we were seeing higher rates of nicotine, drug and alcohol use among the LGBTQ community and had evidence that it was related to discrimination generally,” said Flentje, who earned her bachelor’s, master’s, and doctoral degrees from UM and is now an assistant professor at the University of California-San Francisco School of Nursing. “This study showed us that experiencing LGBTQ-based discrimination is related to substance use within several hours.”

The findings also raise concerns because substance use remains a national public health issue, and rates of substance use have been shown to be higher among LGBTQ individuals, Livingston said.

“This is due to the fact that LGBTQ individuals experience elevated rates of minority stress, which is a function of discrimination experiences that we have now shown to increase risk for daily nicotine, alcohol and drug use,” he said. “Above all, we believe these findings speak to the fact that further work is needed to address this disparity on a social level by working to reduce prejudicial attitudes that lead to discrimination against LGBTQ individuals. In the meantime, we believe these findings have implications for future clinical science innovation. We look forward to contributing to these efforts.” 

The researchers hope those innovations include the development of technology-based interventions, such as web-based and mobile applications that provide real-time support to LGBTQ individuals who face discrimination.

 “These technologies could include self-report tracking capabilities – for example, logging moods, cravings or number of drinks consumed – as well as self-guided therapeutic modules that facilitate adaptive coping in response to discrimination, and other stressors, in real time,” he said.

Livingston, Heck and Flentje are all UM alumni, and their collaboration began as they worked with Professor Bryan Cochran in the UM Department of Psychology. The full article on their study is available online at

The study was funded by research grants awarded to the lead author from the American Psychological Association, Association for Psychological Science and the UM Office of Research and Creative Scholarship. Flentje’s work on this project was funded, in part, by a grant from the National Institute on Drug Abuse.

For more information, email Livingston at

Contact: Nicholas A. Livingston, UM doctoral alumnus,