Minority stress and the development of problem alcohol use among sexual minority youth: A scoping review synthesizing multidisciplinary mechanisms of risk

Abstract Beginning in adolescence, lesbian, gay, and bisexual (LGB) individuals exhibit higher levels of problem alcohol use relative to heterosexual populations. Based in minority stress theory, psychological mediation frameworks of LGB psychopathology typically serve as explanatory models of these disparities, suggesting that LGB identity-related stressors lead to social and affect-related mechanisms that proximally influence alcohol use disorder risk. While stress and its psychological consequences are considered universal risk factors, minority stress research has yet to be synthesized with theory and evidence from general adolescent studies of alcohol use. This is needed to translate and refine minority stress theory to the developmental context of emerging use, and to determine plausible targets for prevention and early intervention of alcohol-related health risk. Here, I compare theories from LGB and general youth populations articulating psychological mechanisms linking stress with the development of problem drinking behaviors. I then review studies examining these mechanisms in the prediction of LGB alcohol behaviors in youth. Finally, incorporating multidisciplinary findings, I highlight understudied areas of inquiry in a developmental pathway model of sexual minority alcohol use and disorder that may guide future alcohol research involving LGB youth. This review demonstrated that while studies have focused primarily on negative affect-based mechanisms of alcohol risk, few have examined stress-related changes in positive affect, social contexts, and interactions among these pathways. Studies addressing a confluence of these mechanisms of risk over time are critically needed to better inform etiology, prevention, and intervention of problem alcohol use among younger LGB populations.