In a national survey of over 10,000 adolescents, bisexual youth had 85% higher odds of past-year marijuana use compared to heterosexual peers, with notable differences by sex and age.
School counselors, adolescent health providers, LGBTQ+ youth services, substance use prevention programs
What the researchers found
Among 10,361 adolescents aged 12-17, 11.2% reported past-year marijuana use. Bisexual youth had significantly higher odds of marijuana use (OR=1.85) compared to heterosexual youth. Gay/lesbian youth did not have significantly higher marijuana use odds. The disparities varied by sex and age group, with the substance use gap between bisexual and heterosexual youth being particularly pronounced.
Why it matters
Bisexual adolescents face distinct stressors from both heterosexual and gay/lesbian peers, including identity invalidation and dual discrimination. Understanding that these stressors correlate with significantly higher marijuana use can guide targeted prevention that addresses root causes rather than just substance use.
The numbers in context
10,361 adolescents; 11.2% past-year marijuana use; bisexual youth marijuana OR=1.85 (95% CI: 1.43-2.40); bisexual tobacco OR=2.00; bisexual alcohol OR=1.32; gay/lesbian tobacco OR=0.47 (lower odds)
How the study worked
Secondary analysis of the 2023 National Survey on Drug Use and Health (N=10,361 youth aged 12-17). Weighted logistic regression examined relationships between sexual orientation and past-year substance use (tobacco, marijuana, alcohol), stratified by age and sex assigned at birth.
What this study cannot tell us
Cross-sectional design cannot establish causation. Self-reported sexual orientation among 12-17 year olds may be unstable or underreported. Single-year survey data. Cannot assess frequency or quantity of use beyond past-year prevalence.
How to read the evidence
Strong: nationally representative sample, 2023 data, appropriate statistical methods with stratified analyses.
When this study was published
2025 publication using 2023 NSDUH data
The bigger picture
Prevention programs typically treat LGBTQ+ youth as a single group, but this data shows bisexual youth have distinctly different risk profiles from gay/lesbian youth for substance use, requiring tailored approaches.
Questions still open
- What specific stressors drive the elevated substance use rates among bisexual versus gay/lesbian adolescents?
- Would identity-affirming interventions reduce substance use disparities for bisexual youth?
Read the original research
Substance use and sexual orientation among adolescents: Differences by age group and sex in the 2023 National Survey of Drug Use and Health.
The American journal on addictions
Citation
Grigsby, Timothy J; Hoopsick, Rachel; Barker, Dylan; Devier, Elise; Amis, Amber; Yockey, R Andrew. (2025). Substance use and sexual orientation among adolescents: Differences by age group and sex in the 2023 National Survey of Drug Use and Health.. The American journal on addictions. https://doi.org/10.1111/ajad.70087
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