ArticleAddictive behaviors reports2026
The indirect effects of discrimination on substance use in bisexual adults through internalized binegativity, concealment, and distress tolerance.
Article in Addictive behaviors reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Purpose: Bisexual people experience bisexual-specific stressors (e.g., anti-bisexual discrimination, internalized binegativity) that impact health outcomes. Still, little research has explored relationships between bisexual-specific stressors and substance use. Additionally, distress tolerance is negatively associated with substance use in non-sexual-minority samples, but only one study has examined distress tolerance in sexual minorities, and none have examined its relations to substance use in bisexual samples. This study examined the indirect relationship between anti-bisexual discrimination and substance use through internalized binegativity, sexual orientation concealment, and distress tolerance. Methods: Bisexual adults aged 18-70 (M = 35, N = 97) were recruited locally and nationally, and reported experiences of anti-bisexual discrimination, internalized binegativity, sexual orientation concealment, distress tolerance, and substance use (i.e., 90-day marijuana and cocaine use, 30-day number of daily standard drinks, 30-day binge drinking). Results: Anti-bisexual discrimination was significantly related to cocaine use indirectly through sexual orientation concealment and directly associated with internalized binegativity and sexual orientation concealment. There were also significant indirect effects for the relationship between anti-bisexual discrimination and cocaine use through internalized binegativity and for the relationship between anti-bisexual discrimination and alcohol use through internalized binegativity. Neither anti-bisexual discrimination nor internalized binegativity, sexual orientation concealment, or distress tolerance were significantly, directly associated with alcohol use, binge drinking, or marijuana use. Conclusion: As the first study to examine the role of distress tolerance in the relationship between bisexual-specific minority stressors and substance use, the findings provide a novel contribution to the exploration of bisexual-specific health disparities and highlight a need for targeted clinical interventions.
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