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 2018 National Survey on Drug Use and Health (NSDUH), suggests that substance use patterns reported by sexual minority adults (in this survey, sexual minority adults includes individuals who describe themselves as lesbian, gay, or bisexual) are higher compared to those reported by heterosexual adults. More than a third (37.6 percent) of sexual minority adults 18 and older reported past year marijuana use, compared to 16.2% reported by the overall adult population.1 Past year opioid use (including misuse of prescription opioids or heroin use) was also higher with 9% of sexual minority adults aged 18 or older reporting use compared to 3.8% among the overall adult population. Additionally, 9% of sexual minority adults aged 26 or older reported past year misuse of prescription opioids—an increase from the 6.4% who reported misuse in 2017. However, there was a significant decline in past year prescription opioid misuse among sexual minority adults aged 18-25 with 8.3% reporting use in 2018.2
The NSDUH survey also shows that since 2015, there were no significant changes in reported alcohol use disorder among sexual minority young adults (ages 18-25), with 12.4% reporting a disorder, compared to 10.1% in the overall population.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.
- Medley G, Lipari R, Bose J, Cribb D, Kroutil L, McHenry G. Sexual Orientation and Estimates of Adult Substance Use and Mental Health: Results from the 2015 National Survey on Drug Use and Health. NSDUH Data Review. https://www.samhsa.gov/data/sites/default/files/NSDUH-SexualOrientation-2015/NSDUH-SexualOrientation-2015/NSDUH-SexualOrientation-2015.htm. Published October 2016.
- 2018 National Survey on Drug Use and Health: Lesbian, Gay, & bisexual (LGB) Adults. NSDUH Data Review. Published January 2020.
- Blackwell 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, 20 May 2020. https://doi.org/10.1111/phn.12746.
- Hoffman et al, Sexual and Gender Minority Cigarette Smoking Disparities: An Analysis of 2016 Behavioral Risk Factor Surveillance System Data; Preventive Medicine, 2018 Aug;113:109-115. doi: 10.1016/j.ypmed.2018.05.014.Epub 2018 May 12. https://pubmed.ncbi.nlm.nih.gov/29763683/?from_term=Sexual+minority+and+vaping&from_pos=1.
- Ridner et al, Cigarette smoking, ENDS use and dual use among a national sample of lesbians, gays and bisexuals, Tob Prev Cessat. 2019; 5: 51. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7205075/ Published online 2019 Dec 23. doi: 10.18332/tpc/114229.
- Johnson et al, Sexual and Gender Minority U.S. Youth Tobacco Use: Population Assessment of Tobacco and Health (PATH) Study Wave 3, 2015-2016. Research Brief| Volume 57, ISSUE 2, P256-261, August 01, 2019 https://www.ajpmonline.org/article/S0749-3797(19)30192-8/abstract.
- 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.
- MEDLINEplus Health Information on Drug Abuse (National Library of Medicine, NIH)
- Healthfinder.gov (U.S. Department of Health and Human Services)
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