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The purposes of this study were threefold: 1) determine the prevalence of drunkorexia among a sample of sexual minority men and explore drunkorexia’s relation to disordered eating and alcohol use factors; 2) assess whether drunkorexia is a community-reinforced behavior; and 3) examine whether drunkorexia and associated partner pressure to engage in drunkorexia vary across gay subcultures. The sample of 177 cisgender men who identified as gay, bisexual, pansexual, or queer was recruited via the dating app Grindr. Participants completed a web-based survey which included the Eating Disorder Examination – Questionnaire (EDE-Q), the Drive for Muscularity (DMS), the Compensatory Eating Behaviors in Response to Alcohol Consumption Scale (CEBRACS), the Alcohol Use Disorders Identification Test (AUDIT), questions about weekly alcohol use and binge drinking, questions about perceived partner pressure to engage in drunkorexia, questions about gay subculture membership, and a series of demographic questions. Results demonstrated that 55.82% of the sample of sexual minority men seeking relationships endorsed engaging in drunkorexia at least once over the past three months. Disordered eating (β = .353), problematic alcohol use (β = .353), and binge drinking (β = .213) predicted drunkorexia engagement. Participants who reported experiencing more pressure to engage in drunkorexia were significantly more likely to engage in drunkorexia than those who received less pressure. Additionally, participants who identified with the Bear and Cub subcultures were significantly more likely to report receiving pressure to engage in drunkorexia. Overall, these results indicate that drunkorexia is a problem that extends beyond college students. Clinicians who work with sexual minority men would be wise to screen for drunkorexia.

Sexual minority men (SMM) have historically been exposed to stressors that translate into poor social and health outcomes. Methamphetamine use is an outcome representing a powerful health disparity for SMM. Sexual compulsivity (SC) has been centered in SMM’s health research; however, its role in SMM’s methamphetamine use remains underdeveloped. Guided by syndemics theory, intersectionality, and revised stress and coping theory, the purpose of this mixed methods study is to contextualize the role of SC in the methamphetamine-using behaviors of SMM living with HIV. Data were collected from 2014-2019 through an RCT testing a positive affect intervention in San Francisco. Cross-sectional survey data (N= 129) were used for quantitative analyses and participants (n = 24) were purposively sampled to take part in semi-structured interviews for qualitative analyses. Narrative analysis revealed that most participants experienced adverse events as youths, specifically related to sexuality. Additionally, they reported that sex was related to methamphetamine initiation and subsequent use, and that methamphetamine was disruptive to relationships. Narrative analyses surfaced a sequential pattern of disconnection at foundational, relational, and recovery levels, revealing themes of negative affect, isolation, SC, depression, trauma, and other mental health issues across the life-course. Network analysis suggests two specific significant positive associations: between depression and negative affect and between PTSD and depression. Constructivist grounded theory analysis highlighted six themes regarding participants’ relationships with/on methamphetamine. Findings highlight the influence of life-long experiences of syndemically related psychosocial factors in the methamphetamine-using behaviors of SMM. Findings suggest peer-based interventions focus on holistic, integrated approaches to tend to SMM’s histories of adverse events and mental health issues, which diminish relational capabilities. SC should be understood as a potentially maladaptive coping strategy developed by SMM as a response to stigmatization and discrimination. Taken together, these findings can help inform cutting-edge methamphetamine use and mental health interventions for SMM.