Rates of substance use are significantly higher among individuals who identify as lesbian, gay, bisexual, or with sexual identities beyond those categories, according to a novel study published February 18, 2026, in the American Journal of Psychiatry. The research, led by scientists at the University of California San Diego School of Medicine, analyzed data from the 2023 National Survey on Drug Use and Health (NSDUH), marking the first time the survey included a broad range of sexual identity options and asked respondents aged 12-17 about their sexual orientation.
The findings reveal a concerning disparity, with all non-heterosexual groups demonstrating increased use of substances like cannabis, hallucinogens, inhalants, methamphetamine, and cocaine compared to their heterosexual peers. Misuse of prescription drugs was also more prevalent within these communities. This study underscores the importance of understanding substance use patterns across the full spectrum of sexual identity, particularly as younger generations embrace more nuanced and diverse ways of self-identification.
Broader Definitions, New Insights
Historically, large-scale health surveys have largely categorized sexual identity into four groups: heterosexual, lesbian, gay, and bisexual. The 2023 NSDUH, with over 52,000 participants, expanded these options, allowing individuals to identify with terms not previously captured in national datasets or to indicate uncertainty about their sexual identity. This inclusive approach revealed significant substance use differences that were previously obscured.
“Many people – especially younger individuals – identify as queer, pansexual or asexual, or they use other terms, and some are actually still figuring out their identity,” explained Kevin Yang, MD, first author of the study and a resident physician in the Department of Psychiatry at UC San Diego School of Medicine. “These are populations that we’ve been missing in prior research.”
Substance Use Trends Across Identities
The analysis revealed distinct patterns of substance use among different sexual identity groups. Bisexual respondents exhibited the highest odds of using inhalants, hallucinogens, cannabis, and methamphetamine. Nearly half (50%) of bisexual respondents reported cannabis use in the past year, compared to 20% of heterosexual respondents. Gay and lesbian individuals also showed elevated rates of substance use, with inhalant use particularly prominent among gay men (13.3% versus 0.7% among heterosexual men).
Those who identified using terms beyond the traditional categories, or who were unsure of their sexual identity, also demonstrated increased substance use, particularly hallucinogens and cannabis. Researchers noted that sex-specific analyses showed females identifying as bisexual, lesbian, using different terms, or unsure of their identity generally exhibited elevated risk across more substances than their male counterparts, though data for males was limited by smaller sample sizes for some substances.
Gender Differences and the Require for Tailored Support
The study highlighted key gender-specific differences. While females identifying with non-heterosexual orientations generally faced higher risks across a wider range of substances, the researchers cautioned that limited data for males made definitive comparisons challenging. This underscores the need for further investigation into the unique factors influencing substance use within different gender and sexual identity groups.
Co-author Letitia Mueller, a fourth-year medical student at UC San Diego School of Medicine, emphasized the importance of a more nuanced approach to patient care. “Illuminating substance use patterns for those who identify on a nuanced spectrum beyond the categories of lesbian, gay or bisexual is a step towards building stronger safety nets for folks at risk,” she said. “We encourage clinicians to provide more tailored support by including sexual identity as a meaningful part of a comprehensive health assessment. Creating safe environments where patients feel comfortable discussing both their identity and substance use is also especially important for adolescents and young adults who may still be navigating their identity development.”
Implications for Public Health and Future Research
The findings from this study have significant implications for public health initiatives and clinical practice. Recognizing the diverse range of sexual identities and understanding the associated substance use patterns is crucial for developing targeted prevention and treatment strategies. The researchers call for further exploration of the social and psychological factors that contribute to these disparities, with the goal of reducing harm and improving the well-being of all individuals.
The Substance Abuse and Mental Health Services Administration (SAMHSA), which conducts the NSDUH, provides resources and support for individuals struggling with substance use disorders. Information about these services can be found on the SAMHSA website: https://www.samhsa.gov/.
Researchers will continue to analyze the 2023 NSDUH data, with further reports expected in the coming months. These analyses will likely provide more detailed insights into the specific factors driving substance use disparities within different sexual identity groups and inform the development of more effective interventions.
This research represents a vital step toward a more inclusive and informed approach to public health, acknowledging the complex interplay between sexual identity and substance use. Share your thoughts and experiences in the comments below.
