Newly identifying as LGBQ+ was associated with nearly triple the risk of starting cannabis use | Research

The takeaway

In a prospective cohort of 1,896 young adults, those who newly adopted an LGBQ+ identity had 2.9 times the risk of initiating cannabis use compared to consistently heterosexual peers.

LGBQ+ health researchers, substance use prevention professionals, and clinicians working with young adults exploring sexual identity.

2.9x cannabis initiation risk during identity transition

What the researchers found

Consistently LGBQ+ individuals had higher frequency of cannabis use (OR 1.36) compared to consistently heterosexual peers. Those who newly identified as LGBQ+ had 2.9 times the risk of initiating cannabis use (aRR 2.90). Those who transitioned from LGBQ+ to heterosexual identity reported lower substance use frequency.

Why it matters

Sexual identity is dynamic in young adulthood, and the period of identity change appears to carry heightened substance use risk. This suggests a window for targeted prevention during identity exploration.

The numbers in context

1,896 young adults. Consistently LGBQ+ cannabis OR: 1.36. New LGBQ+ identity: cannabis initiation aRR 2.90 (95% CI 1.81-4.64). LGBQ+ to heterosexual: lower alcohol (OR 0.35) and tobacco (OR 0.15) use.

How the study worked

Two-wave prospective cohort of 1,896 young adults (mean age 21.2). Baseline October 2018-October 2019; follow-up May-October 2020. Four groups: consistently heterosexual (1,567), consistently LGBQ+ (244), heterosexual to LGBQ+ (65), LGBQ+ to heterosexual (20).

What this study cannot tell us

Small identity-change groups (65 and 20). Two time points cannot capture the full trajectory of identity development. Follow-up during COVID-19 pandemic may confound results. Self-reported identity and substance use.

How to read the evidence

Prospective cohort with validated measures but small identity-change groups and pandemic-era follow-up.

When this study was published

Published in 2022, data from 2018-2020.

The bigger picture

The finding that substance use risk is specifically elevated during identity transition, not just among LGBQ+ individuals generally, suggests that the process of identity change itself may involve stress or social context changes that increase risk.

Questions still open

What drives elevated substance use risk specifically during identity transition? Would LGBQ+ affirming support during identity exploration reduce substance use initiation?

Common questions

Are LGBQ+ young adults more likely to use cannabis?

Yes. Consistently LGBQ+ young adults had 36% higher odds of cannabis use than heterosexual peers. Those who newly identified as LGBQ+ had nearly triple the risk of starting cannabis for the first time.

Why might changing sexual identity affect substance use?

The study suggests that the process of identity transition, not just being LGBQ+, carries elevated risk. The specific mechanisms, whether minority stress, new social contexts, or other factors, need further research.

Read the original research

Changes in sexual identity and substance use during young adulthood.

Drug and alcohol dependence, 241, 109674

View on PubMed ↗Publisher’s paper ↗

Citation

Krueger, Evan A; Repati, Mykala L; Harlow, Alyssa F; Unger, Jennifer B; Lee, Jungeun Olivia; Pedersen, Eric R; Conn, Bridgid M; Wong, Carolyn; Young, Lindsay E; Barrington-Trimis, Jessica L; Leventhal, Adam M. (2022). Changes in sexual identity and substance use during young adulthood.. Drug and alcohol dependence, 241, 109674. https://doi.org/10.1016/j.drugalcdep.2022.109674