Bisexual women had the highest rates of polysubstance use combinations involving cannabis and binge drinking | Research

The takeaway

Using national survey data, bisexual women were disproportionately represented in nearly every polysubstance combination involving binge alcohol drinking, cannabis, or both.

Public health researchers, LGBTQ+ health advocates, substance use prevention planners

Bisexual women used most polysubstance combinations involving cannabis at higher rates than all other groups

What the researchers 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.

Why it 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 numbers in context

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 the study worked

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.

What this study cannot 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.

How to read the evidence

Large nationally representative sample with robust survey-weighted analyses, though cross-sectional design limits causal interpretation.

When this study was published

2026 publication using 2021-2022 NSDUH data

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.

Questions still open

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?

Common 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.

Read the original research

Disproportionate use of polysubstance combinations varies by sexual identity among US adults.

PloS one, 21(2), e0340454

View on PubMed ↗Publisher’s paper ↗

Citation

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