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.
LGBTQ+ health researchers, substance use prevention programs, mental health providers serving sexual minorities
Elevated substance use extended beyond LGB categories to emerging identity groups
What the researchers 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.
Why it 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 numbers in context
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 the study worked
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.
What this study cannot 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.
How to read the evidence
Strong: large nationally representative survey (52,525) with appropriate reference groups and sex-disaggregated analyses.
When this study was published
2026 publication using 2023 NSDUH data.
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.
Questions still open
- 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?
Common questions
Do sexual minority individuals use more substances?
Are there sex differences in these patterns?
Read the original research
Substance Use Patterns Across the Sexual Identity Spectrum Among U.S. Individuals.
The American journal of psychiatry, appiajp20250206
Citation
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
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