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
According to 2015 data from the National Survey on Drug Use and Health, adults defined as "sexual minority" (in this survey, meaning lesbian, gay, or bisexual) were more than twice as likely as heterosexual adults (39.1 percent versus 17.1 percent) to have used any illicit drug in the past year.1 Nearly a third of sexual minority adults (30.7 percent) used marijuana in the past year, compared to 12.9 percent of heterosexual adults, and about 1 in 10 (10.4 percent) misused prescription pain relievers, compared to 4.5 percent of heterosexual adults.
A 2013 survey conducted by the U.S. Census Bureau found that a higher percentage of LGBT adults between 18 and 64 reported past-year binge drinking (five or more drinks on a single occasion) than heterosexual adults.2 LGBT people in treatment for SUDs initiated alcohol consumption earlier than their heterosexual counterparts.3
Lesbian, gay, and bisexual (LGB) adolescents also reported higher rates of substance use compared to heterosexual adolescents. In one meta-analysis, LGB adolescents were 90 percent more likely to use substances than heterosexual adolescents, and the difference was particularly pronounced in some subpopulations; bisexual adolescents used substances at 3.4 times the rate of heterosexual adolescents, and lesbian and bisexual females used at four times the rate of their heterosexual counterparts.4
Substance Use Disorders and Comorbidities
LGBTQ people also have a greater likelihood than non-LGBTQ people of experiencing an SUD in their lifetime,3 and they often enter treatment with more severe SUDs.5 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).6
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.7,8 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.9 Current research suggests that treatment should address unique factors in these patients' lives that may include homophobia/transphobia, family problems, violence, and social isolation.10
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.11 Transgender children and adolescents have higher levels of depression, suicidality, self-harm, and eating disorders than their non-transgender counterparts.12 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.13 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.14
* 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.
- Ward BW, Dahlhamer JM, Galinsky AM, Joestl SS. Sexual Orientation and Health Among U.S. Adults: National Health Interview Survey, 2013. Hyattsville, Md.: National Center for Health Statistics; 2014. https://www.cdc.gov/nchs/data/nhsr/nhsr077.pdf. Accessed July 25, 2017.
- McCabe SE, West BT, Hughes TL, Boyd CJ. Sexual orientation and substance abuse treatment utilization in the United States: results from a national survey. J Subst Abuse Treat. 2013;44(1):4-12. doi:10.1016/j.jsat.2012.01.007.
- Marshal MP, Friedman MS, Stall R, et al. Sexual orientation and adolescent substance use: a meta-analysis and methodological review. Addict Abingdon Engl. 2008;103(4):546-556. doi:10.1111/j.1360-0443.2008.02149.x.
- 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.
- 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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