Alcohol use, drug use and alcohol-related problems among men who have sex with men: the Urban Men's Health Study

Aims. To measure the prevalence and independent associations of heavy and p roblematic use of alcohol and recreational drugs among a household-based sa mple of urban MSM (men who have sex with men). Design. Cross-sectional surv ey. Participants. Men who identified as being gay or bisexual or who report ed sex with another man in the prior 5 years were included in this analysis (n = 2172). Setting. A probability telephone sample of MSM was taken withi n Zip Codes of four large American cities (Chicago, Los Angeles, New York a nd San Francisco) estimated to have total concentrations of at least 4% of all households with one resident MSM. Measurements. Standard measures of al cohol use, problems associated with alcohol use, and recreational drug use were administered by trained telephone interviewers. Findings. Both recreat ional drug (52%) and alcohol use (85%) were highly prevalent among urban MS M, while current levels of multiple drug use (18%), three or more alcohol-r elated problems (12%), frequent drug use (19%) and heavy-frequent alcohol u se (8%) were not uncommon. The associations of heavy and/or problematic sub stance use are complex, with independent multivariate associations found at the levels of demographics, adverse early life circumstances, current ment al health status, social and sexual practices and connection to gay male cu lture. Conclusions. The complex pattern of associations with heavy and/or p roblematic substance use among urban MSM suggests that heavy and/or problem atic substance use is grounded in multiple levels: the individual, the inte rpersonal and the socio-cultural.