Substance use was elevated across all non-heterosexual identity groups, including those using newer identity labels
Analysis of over 52,000 people from the 2023 NSDUH found elevated substance use, including cannabis, across all sexual minority groups compared to heterosexual individuals, with the pattern extending to people using newer identity labels or uncertain about their orientation.
Quick Facts
What This Study Found
Substance use was higher across all non-heterosexual identity groups compared to heterosexual individuals. Bisexual and gay/lesbian individuals showed elevated odds across most substances, particularly inhalants, hallucinogens, and cannabis. People using different terms and those unsure of their identity also showed elevated odds for multiple substances. In sex-disaggregated analyses, females generally showed elevations across more substance categories.
Key Numbers
52,525 participants; 5 sexual identity groups; substances: cannabis, hallucinogens, cocaine, inhalants, methamphetamine, prescription opioid/tranquilizer/stimulant misuse; elevated odds found across all non-heterosexual groups for multiple substances
How They Did This
Analysis of the 2023 NSDUH (N = 52,525, ages 12+) examining past-year substance use across five sexual identity groups: heterosexual, gay/lesbian, bisexual, different term, and unsure. Associations tested with sex-disaggregated analyses using heterosexual reference groups.
Why This Research Matters
Most substance use research among sexual minorities focuses only on LGB categories. This study extends the picture to emerging identity groups, revealing that elevated substance use risk is not limited to traditionally defined categories.
The Bigger Picture
This suggests that the drivers of elevated substance use in sexual minority populations extend beyond any specific identity to the broader experience of minority stress, stigma, and identity development, regardless of what label someone uses.
What This Study Doesn't Tell Us
Cross-sectional design cannot determine causality. Self-reported data. "Different term" and "unsure" categories are heterogeneous. Small sample sizes in some identity-substance combinations led to suppressed estimates. Cannot distinguish recreational from problematic use.
Questions This Raises
- ?What drives elevated substance use in people still exploring their identity?
- ?Would targeted interventions for emerging identity groups reduce substance use disparities?
- ?Are the same minority stress mechanisms at work across all non-heterosexual identity groups?
Trust & Context
- Key Stat:
- Elevated substance use extended beyond LGB categories to emerging identity groups
- Evidence Grade:
- Strong: large nationally representative survey (52,525) with appropriate reference groups and sex-disaggregated analyses.
- Study Age:
- 2026 publication using 2023 NSDUH data.
- Original Title:
- Substance Use Patterns Across the Sexual Identity Spectrum Among U.S. Individuals.
- Published In:
- The American journal of psychiatry, appiajp20250206 (2026)
- Authors:
- Yang, Kevin H(8), Mueller, Letitia A, Han, Benjamin H(9), Palamar, Joseph J
- Database ID:
- RTHC-08726
Evidence Hierarchy
A snapshot of a population at one point in time.
What do these levels mean? →Frequently Asked Questions
Do sexual minority individuals use more substances?
Yes. This study found elevated substance use, including cannabis, hallucinogens, and inhalants, across all sexual minority groups compared to heterosexual individuals, including those using newer identity terms.
Are there sex differences in these patterns?
Females in sexual minority groups generally showed elevated odds across more substance categories than males, though some male estimates were limited by small sample sizes.
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Cite This Study
https://rethinkthc.com/research/RTHC-08726APA
Yang, Kevin H; Mueller, Letitia A; Han, Benjamin H; Palamar, Joseph J. (2026). Substance Use Patterns Across the Sexual Identity Spectrum Among U.S. Individuals.. The American journal of psychiatry, appiajp20250206. https://doi.org/10.1176/appi.ajp.20250206
MLA
Yang, Kevin H, et al. "Substance Use Patterns Across the Sexual Identity Spectrum Among U.S. Individuals.." The American journal of psychiatry, 2026. https://doi.org/10.1176/appi.ajp.20250206
RethinkTHC
RethinkTHC Research Database. "Substance Use Patterns Across the Sexual Identity Spectrum A..." RTHC-08726. Retrieved from https://rethinkthc.com/research/yang-2026-substance-use-patterns-across
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.