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LGBTQ Substance Use: What the Research Shows

Consistent findings, the reasons researchers give, and the gaps in what we know.

LGBTQ Substance Use: What the Research ShowsLGBTQ Rehab Centers

If you are searching for LGBTQ substance abuse statistics, you will find a lot of numbers online, many of them out of date or pulled from studies that measured different things in different ways. This guide takes a different approach. It summarizes what federal health agencies and peer-reviewed research consistently find, explains why researchers think the differences exist, and is honest about what the data still cannot tell us.

The consistent finding: higher rates of substance use

Across federal surveys and research reviews, one pattern holds up. The National Institute on Drug Abuse (NIDA) reports that sexual minority adults, including lesbian, gay and bisexual people, report higher rates of substance use and substance use disorders than the overall adult population. NIDA's summary covers marijuana use, opioid misuse and alcohol use disorder, along with higher smoking and e-cigarette use among LGBT people compared with heterosexual people. NIDA also notes that bisexual women and men report more e-cigarette use, a reminder that groups within the LGBTQ community do not all share the same patterns.

Federal youth data point the same direction. SAMHSA's National Survey on Drug Use and Health found that lesbian, gay and bisexual adolescents were more likely than straight peers to have used marijuana and other illicit drugs and to have a substance use disorder, though not every measure differed (for example, binge drinking and alcohol use disorder did not differ significantly). The CDC's school-based surveillance similarly finds LGBTQ students more likely than their cisgender and heterosexual peers to have used illicit drugs and misused prescription opioids.

A finding about a group is not a description of individuals. Most LGBTQ people do not have a substance use disorder, and the CDC notes that many LGBTQ youth thrive during adolescence.

Severity, mental health and treatment

NIDA reports that LGBTQ people often enter treatment with more severe substance use disorders. Mental health is closely connected. NIDA notes higher rates of depression, suicidality and other conditions among LGBT people, and SAMHSA's youth data found that having both a major depressive episode and a substance use disorder was more common among LGB adolescents than among straight adolescents.

That overlap is why NIDA recommends screening LGBT patients for co-occurring psychiatric disorders and treating all identified conditions at the same time. Our LGBTQ dual diagnosis guide explains what integrated care looks like, and the dual diagnosis listings show programs that offer it.

On treatment itself, NIDA reports that approaches such as motivational interviewing, contingency management, cognitive behavioral therapy and social support therapy have been shown to work for gay and bisexual men, and that specialized programs for gay and bisexual men have been associated with better outcomes. NIDA also notes that only a small share of treatment programs offer specialized services for LGBT clients.

Why researchers think the gaps exist

Minority stress

The leading explanation is minority stress. NIDA describes how LGBTQ people often face social stigma, discrimination, harassment and violence that heterosexual and cisgender people do not, and attributes the higher risk mainly to these stressors. The CDC similarly points to stigma in many forms, including discrimination, harassment, family disapproval, social rejection and violence.

A review in Psychological Bulletin laid out how stigma-related stress may lead to mental health and substance use problems. It proposed three pathways: difficulty regulating emotions (such as rumination), social and interpersonal strain (such as isolation and less support), and negative thinking patterns (such as hopelessness and negative self-views). For alcohol, the review suggested that stress may increase drinking to cope, while noting the evidence there was less developed than for depression and anxiety. See minority stress and addiction for a plain-language walk-through.

Family rejection

A study of lesbian, gay and bisexual young adults published in Pediatrics found that those who reported more family rejection during adolescence were more likely to report depression, suicide attempts and illegal drug use than those who reported little or no rejection. The finding is one reason treatment programs are encouraged to include chosen family. More in family rejection and recovery.

Factors specific to transgender people

A systematic review of research on transgender adults, published in BJPsych Open, found correlates of substance use tied to gender minority experience, including transphobic discrimination and violence and unemployment. The authors suggested that a lack of trans-inclusive treatment services may make things worse, and recommended screening for substance use when people report high gender minority stress. Our transgender rehab guide covers what to look for.

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The limits of the data

LGBTQ substance use research has real gaps. Knowing them helps you read any statistic with the right amount of caution.

  • Federal surveys started asking recently. NIDA notes that many federal surveys only recently began asking about sexual orientation and gender identity, so long-term trends cannot yet be established.
  • Gender identity is measured less often than sexual orientation. The national drug use survey asks adults about sexual identity and attraction, but its adolescent report used only a male-or-female sex-at-birth measure and noted that estimates for transgender youth were not yet available.
  • Transgender people are under-studied. NIDA describes research on substance use disorder rates among transgender people as limited. The BJPsych Open review found the evidence too thin to estimate prevalence or compare risk with cisgender people, and noted that studies have focused heavily on transgender women facing multiple disadvantages, who do not represent the wider transgender community.
  • Some studies leave groups out. NIDA notes that some earlier youth studies covered lesbian, gay and bisexual youth but excluded transgender and questioning youth.
  • Categories get combined. Reports often group lesbian, gay, bisexual and other identities together, which can hide real differences, such as those NIDA describes for bisexual people.
  • Some people are not counted. The national household survey excludes people without a fixed address and people in institutions such as jails, groups in which LGBTQ people may be overrepresented.

Because of these limits, be wary of any single percentage presented as "the" LGBTQ addiction rate. The direction of the findings is consistent; the exact size of the gap varies by group, substance and survey.

What this means if you are looking for help

The research has a practical takeaway: treatment works best when it addresses the stressors behind substance use, treats mental health at the same time and includes the people who actually support you. That is the case for LGBTQ-specific addiction treatment.

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