Parental Rejection, Cannabis Craving, and Alcohol Craving among Sexual Minority Youth

Abstract

Parental rejection is associated with poor mental health and addiction liability outcomes for sexual minority youth (SMY; e.g., lesbian, gay, bisexual). Theoretical models purport that SMY who experience greater parental rejection and non-acceptance related to their sexual orientation may have greater risk for substance use, including cannabis and alcohol use. Cross-sectional and longitudinal studies provide initial support for this contention by showing that SMY who perceive heterosexist rejection from their parents have greater substance use as young adults. However, research has yet to examine whether experiencing greater parental rejection is associated with drug craving as an adolescent. Understanding the impact of parental rejection at this level may be of particular importance, as sexual minority young adults report greater alcohol craving in response to heterosexist stigma, above and beyond general negative mood. Since adolescent cannabis and alcohol use are influenced by contextual factors (e.g., availability), craving has been examined as a salient proxy for substance use in this population. This study leveraged data collected from ecological momentary assessment (EMA) to examine how varying levels of heterosexist parental rejection may influence in-the-moment levels of cannabis and alcohol craving. SMY who used nicotine were recruited for an EMA study. Participants completed a baseline survey measuring lifetime parent rejection experiences (M = 0.34, SD = 0.33) and a timeline followback of past-month substance use. Next, participants completed a 30-day EMA period where they responded to approximately 5 random prompts per day measuring current level of cannabis and alcohol craving (range 0 to 10). The analytic sample included a subset of SMY who reported baseline cannabis (n = 37) or alcohol (n = 32) use. Craving was dichotomized to either no craving (0) or any craving (1). Multilevel logistic regression was conducted using N = 2,885 observations to examine the associations between baseline parental rejection and momentary substance craving, controlling for baseline substance use frequency, weekday versus weekend, time of day, age, and presence of peers. Results indicated that greater baseline parental rejection was associated with greater odds of reporting momentary cannabis craving (b = 1.71, p = .05, OR = 5.51) and alcohol craving (b = 2.53, p = .035, OR = 12.55) in the natural environment. Findings underscore the influence of parental rejection on adolescent substance craving. SMY who experience greater parental rejection likely perceive having less supportive parental relationships. Consistent with the minority stress model, SMY may be more likely to experience identity-related distress (e.g., heterosexist parental rejection) and, in turn, may use cannabis and alcohol to cope. This may explain why parental rejection experiences were related to greater day-to-day substance cravings. Clinical implications support the importance of providing family interventions to reduce parental rejection for SMY, as these may result in a myriad of benefits, possibly including reduced substance use craving. Future research should examine how lifetime versus recent parental rejection experiences may influence SMY substance craving.