People who identify as lesbian, gay, bisexual, transgender, or questioning (LGBTQ) often face social stigma, discrimination, and other challenges not encountered by people who identify as heterosexual. They also face a greater risk of harassment and violence. As a result of these and other stressors, sexual minorities are at increased risk for various behavioral health issues.1
Many federally funded surveys have only recently started to ask about sexual orientation and gender identification in their data collections.1 Surveys thus far have found that sexual minorities have higher rates of substance misuse and substance use disorders (SUDs) than people who identify as heterosexual. Therefore, it is not yet possible to establish long-term trends about substance use and SUD prevalence in LGBTQ populations.
Substance Use and Misuse
Data from the 2020 National Survey on Drug Use and Health (NSDUH)** suggest that substance use patterns reported by sexual minority adults differ from those reported by heterosexual adults. (In this survey, sexual minority adults include individuals who describe themselves as lesbian, gay, or bisexual.) In 2020, approximately 41.3% of sexual minority adults 18 and older reported past-year marijuana use,1 compared to 18.7% of the overall adult population (2020 DT 1.3B).2 Approximately 6.7% of sexual minority adults in 2020 misused opioids (prescription opioids or heroin use) in the past year,1 compared to 3.6% of the overall adult population (2020 DT 1.19B).2
The NSDUH survey also found that, in 2020, approximately 21.8% of sexual minority adults had an alcohol use disorder in the past year, 1 compared to 11.0% in the overall population (2020 DT 5.4B).2
Vaping and Tobacco Products
A recent review on the use of tobacco products by LGBT individuals show elevated rates of smoking and ever e-cigarette use compared to their heterosexual counterparts3. Among LGB adults, bisexual women report greater use of ever trying e-cigarettes compared to heterosexual women4 and greater dual use of tobacco cigarettes and e-cigarettes compared to both lesbian and heterosexual women.5 Bisexual men were more likely to report ever or current e-cigarette use, compared to heterosexual men.6 Taken together, these findings suggest that targeted health messages may be needed.
Substance Use Disorders and Comorbidities
LGBTQ individuals often enter treatment with more severe SUDs.7 Some common SUD treatment modalities have been shown to be effective for gay or bisexual men, including motivational interviewing, social support therapy, contingency management, and cognitive-behavioral therapy (CBT).8
Addiction treatment programs offering specialized groups for gay and bisexual men showed better outcomes for those clients compared to gay and bisexual men in non-specialized programs; but in one study, only 7.4 percent of programs offered specialized services for LGBT patients.9,10 Research is currently limited on rates of SUD among transgender populations, although research shows that transgender individuals are more likely to seek SUD treatment than the non-transgender population.11 Current research suggests that treatment should address unique factors in these patients' lives that may include homophobia/transphobia, family problems, violence, and social isolation.12
Sexual minorities with SUDs are more likely to have additional (comorbid or co-occurring) psychiatric disorders. For example, gay and bisexual men and lesbian and bisexual women report greater odds of frequent mental distress and depression than their heterosexual counterparts.13 Transgender children and adolescents have higher levels of depression, suicidality, self-harm, and eating disorders than their non-transgender counterparts.14 Thus, it is particularly important that LGBT people in SUD treatment be screened for other psychiatric problems (as well as vice versa), and all identifiable conditions should be treated concurrently.
LGBTQ people are also at increased risks for human immunodeficiency virus (HIV) due to both intravenous drug use and risky sexual behaviors. HIV infection is particularly prevalent among gay and bisexual men (men who have sex with men, or MSM) and transgender women who have sex with men.15 SUD treatment can also help prevent HIV transmission among those at high risk. For example, addiction treatment is associated not only with reduced drug use but also with less risky sexual behavior among MSM, and those with HIV report improvements in viral load.16
* Variations of this acronym are used throughout the web page to reflect relevant populations. Some studies have historically considered lesbian, gay, and bisexual youth, but have not included transgender and questioning youth.
**The COVID-19 pandemic had an impact on data collection for the 2020 National Survey on Drug Use and Health (NSDUH). For more information, please see the 2020 NSDUH Frequently Asked Questions from the Substance Abuse and Mental Health Services Administration.
- Substance Abuse and Mental Health Services Administration. 2020 National Survey on Drug Use and Health: Lesbian, Gay, & Bisexual (LGB) Adults (Annual Report). samhsa.gov. https://www.samhsa.gov/data/report/2020-nsduh-lesbian-gay-bisexual-lgb-adults Published July 22, 2022. Accessed February 7, 2023.
- Substance Abuse Center for Behavioral Health Statistics and Quality. Results from the 2020 National Survey on Drug Use and Health: Detailed Tables, SAMHSA. Accessed February 2023.
- Blackwell CW, et al. Use of electronic nicotine delivery systems (ENDS) in lesbian, gay, bisexual, transgender and queer persons: Implications for public health nursing. Journal of Public Health Nursing. Published May 2020. doi: https://doi.org/10.1111/phn.12746
- Hoffman L, Delahanty J, Johnson SE, Zhao X. Sexual and gender minority cigarette smoking disparities: An analysis of 2016 Behavioral Risk Factor Surveillance System data. Prev Med. 2018;113:109-115. doi:10.1016/j.ypmed.2018.05.014
- Ridner SL, Ma JZ, Walker KL, et al. Cigarette smoking, ENDS use and dual use among a national sample of lesbians, gays and bisexuals. Tob Prev Cessat. 2019;5:51. doi:10.18332/tpc/114229
- Johnson SE, et al. Sexual and gender minority U.S. youth tobacco Uuse: Population Assessment of Tobacco and Health (PATH) study wave 3, 2015-2016. American Journal Preventive Medicine. 2019;57:256-261. doi: doi.org/10.1016/j.amepre.2019.03.021
- Cochran BN, Cauce AM. Characteristics of lesbian, gay, bisexual, and transgender individuals entering substance abuse treatment. J Subst Abuse Treat. 2006;30(2):135-146. doi:10.1016/j.jsat.2005.11.009.
- Green KE, Feinstein BA. Substance use in lesbian, gay, and bisexual populations: an update on empirical research and implications for treatment. Psychol Addict Behav J Soc Psychol Addict Behav. 2012;26(2):265-278. doi:10.1037/a0025424.
- Senreich E. Are specialized LGBT program components helpful for gay and bisexual men in substance abuse treatment? Subst Use Misuse. 2010;45(7-8):1077-1096. doi:10.3109/10826080903483855.
- Cochran BN, Peavy KM, Robohm JS. Do specialized services exist for LGBT individuals seeking treatment for substance misuse? A study of available treatment programs. Subst Use Misuse. 2007;42(1):161-176. doi:10.1080/10826080601094207.
- Keuroghlian AS, Reisner SL, White JM, Weiss RD. Substance use and treatment of substance use disorders in a community sample of transgender adults. Drug Alcohol Depend. 2015;152:139-146. doi:10.1016/j.drugalcdep.2015.04.008.
- Lombardi EL, van Servellen G. Building culturally sensitive substance use prevention and treatment programs for transgendered populations. J Subst Abuse Treat. 2000;19(3):291-296.
- Gonzales G, Henning-Smith C. Health Disparities by Sexual Orientation: Results and Implications from the Behavioral Risk Factor Surveillance System. J Community Health. May 2017. doi:10.1007/s10900-017-0366-z.
- Connolly MD, Zervos MJ, Barone CJ, Johnson CC, Joseph CLM. The Mental Health of Transgender Youth: Advances in Understanding. J Adolesc Health Off Publ Soc Adolesc Med. 2016;59(5):489-495. doi:10.1016/j.jadohealth.2016.06.012.
- Who Is at Risk for HIV? HIV.gov. https://www.hiv.gov/hiv-basics/overview/about-hiv-and-aids/who-is-at-risk-for-hiv. Published May 15, 2017. Accessed July 25, 2017.
- Carrico AW, Flentje A, Gruber VA, et al. Community-based harm reduction substance abuse treatment with methamphetamine-using men who have sex with men. J Urban Health Bull N Y Acad Med. 2014;91(3):555-567. doi:10.1007/s11524-014-9870-y.