Bisexual women had the highest rates of polysubstance use combinations involving cannabis and binge drinking
Using national survey data, bisexual women were disproportionately represented in nearly every polysubstance combination involving binge alcohol drinking, cannabis, or both.
Quick Facts
What This Study Found
The most commonly used substances in polysubstance combinations were binge alcohol drinking, cannabis, cigarettes, and nicotine vaping. Bisexual women used most of the assessed polysubstance combinations at higher rates than other groups. Sex differences in polysubstance patterns varied among heterosexual and bisexual adults but not among gay/lesbian adults.
Key Numbers
66,634 adults surveyed; 8.59% identified as LGB. Cannabis and binge alcohol drinking were the most common substances in polysubstance combinations. Bisexual women had elevated rates across most multi-substance patterns involving 3 or 4 substances.
How They Did This
Analysis of the 2021-2022 National Survey on Drug Use and Health (NSDUH), including 66,634 adults (8.59% LGB). Survey-weighted multinomial logistic regression assessed polysubstance combinations by sexual identity and sex.
Why This Research Matters
Bisexual individuals, especially women, face elevated substance use risks that are often invisible in data that groups all LGB people together. This study provides the granularity needed to design targeted prevention efforts.
The Bigger Picture
Public health campaigns often treat substance use risks as uniform across populations. This research underscores that sexual identity and sex intersect to create distinct risk profiles, and interventions should reflect that specificity.
What This Study Doesn't Tell Us
Cross-sectional design. Self-reported data. Past-30-day use window may miss episodic patterns. NSDUH does not capture frequency or quantity within substance categories.
Questions This Raises
- ?What drives the elevated polysubstance use among bisexual women specifically?
- ?Would interventions tailored to this population reduce these disparities?
- ?How do these patterns change with age?
Trust & Context
- Key Stat:
- Bisexual women used most polysubstance combinations involving cannabis at higher rates than all other groups
- Evidence Grade:
- Large nationally representative sample with robust survey-weighted analyses, though cross-sectional design limits causal interpretation.
- Study Age:
- 2026 publication using 2021-2022 NSDUH data
- Original Title:
- Disproportionate use of polysubstance combinations varies by sexual identity among US adults.
- Published In:
- PloS one, 21(2), e0340454 (2026)
- Authors:
- Mestre, Luis M, White, Marney A, Lee, Juhan(3), Parker, Maria A, Bold, Krysten W
- Database ID:
- RTHC-08487
Evidence Hierarchy
A snapshot of a population at one point in time.
What do these levels mean? →Frequently Asked Questions
What counts as polysubstance use?
Using two or more substances in the same time period, such as cannabis plus binge drinking, or cannabis plus cigarettes plus nicotine vaping.
Why are bisexual women at higher risk?
The study documented the pattern but did not test mechanisms. Minority stress, dual stigma, and social factors have been proposed in other research.
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Cite This Study
https://rethinkthc.com/research/RTHC-08487APA
Mestre, Luis M; White, Marney A; Lee, Juhan; Parker, Maria A; Bold, Krysten W. (2026). Disproportionate use of polysubstance combinations varies by sexual identity among US adults.. PloS one, 21(2), e0340454. https://doi.org/10.1371/journal.pone.0340454
MLA
Mestre, Luis M, et al. "Disproportionate use of polysubstance combinations varies by sexual identity among US adults.." PloS one, 2026. https://doi.org/10.1371/journal.pone.0340454
RethinkTHC
RethinkTHC Research Database. "Disproportionate use of polysubstance combinations varies by..." RTHC-08487. Retrieved from https://rethinkthc.com/research/mestre-2026-disproportionate-use-of-polysubstance
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.