Discrimination linked to heavy and hazardous drinking

In the late 1980s, researchers across the United States began reporting a link between discrimination against African Americans and poor cardiovascular health within the African American population. Eventually, the scope of these studies broadened, uncovering a connection between discrimination and other health disparities among minority groups.

Now, researchers at the University of Iowa have found another negative health outcome linked to discrimination: alcohol abuse.

"We've had this idea that discrimination is associated with heavier drinking and drinking-related problems, but we didn't have a clear understanding of the evidence underneath that," says Paul Gilbert, assistant professor of the Department of Community and Behavioral Health at the UI College of Public Health and lead author of the study. "I wanted to uncover what we know and how we know it. What does the science actually say?"

The paper, "Discrimination and Drinking: A Systematic Review of the Evidence," was published online in June in Social Science & Medicine.

Experts have known for decades that drinking is a common coping response to stress--a phenomenon called stress-reactive drinking, Gilbert says.

"We recognize discrimination as a stressor, and we recognize people drink in response to stress," Gilbert says. "But do they drink in response to discrimination?"

Gilbert searched six online databases for studies related to discrimination and drinking, winnowing his potential sources down to about 1,200 scientific studies that met his criteria. From there, he identified 97 peer-reviewed, published research papers with quantitative evidence that showed a link between discrimination and heavy and hazardous drinking. Seventy-one studies involved racial discrimination, and the rest examined discrimination based on sexual orientation and gender.

"Our study supports the notion that discrimination is harmful to health, specifically through alcohol," says Gilbert.

The UI study also identified gaps in the research. For example, the majority of studies involved interpersonal discrimination against African Americans, such as being treated poorly in a store or being called a name. Gilberts says more studies need to be done about discrimination against other groups, including other racial and ethnic groups, and discrimination due to religion, sexual orientation, gender, age, or disability status.

He also would like to see a more nuanced look at what types of discrimination might be linked to heavy and hazardous drinking. Those studies could involve systematic or structural discrimination, such as school and neighborhood segregation, or internalized discrimination, which refers to when members of a racial minority absorb the racist messages they hear, resulting in self-hatred or hatred of their minority group.

Finally, Gilbert hopes researchers will take a closer look at the types of alcohol abuse linked to being discriminated against.

"The basic knowledge is now there," he says. "The next step to advance science is to say what specific groups are involved, what specific type of discrimination are they experiencing, and what specifically were the alcohol outcomes. Was it just heavier drinking, or was it heavy drinking that led to dependence--or is it alcohol-related problems like getting in a car crash or work and family problems?"