Substance use affects people of every age and from every walk of life. But some groups have higher rates of substance use than others. Substance use is more common in the LGBTQIA+ community.
Data on substance use comes from the Substance Abuse and Mental Health Services Administration (SAMHSA). According to SAMHSA, LGBTQIA+ people are more likely to use alcohol and drugs and more likely to smoke than their straight or cisgender peers. LGBTQIA+ people are more likely to use substances and are less likely to stop using them.
According to SAMHSA, 2.6 million lesbian, gay, and bisexual adults had a substance use disorder in 2019. Also, more LGBTQIA+ adults are using marijuana. The number of LGBTQIA+ adults who used marijuana rose from 38% in 2018 to 44% in 2019.
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LGBTQIA+ Substance Use
LGBTQIA+ smoking rates
According to the Centers for Disease Control and, about one in six LGBTQIA+ people smoke cigarettes. That’s compared to one in eight straight people. Trans people have the highest rates of smoking.
About one in three transgender adults (33%) uses tobacco in any form, including e-cigarettes. Only one in four (24%) cis adults use tobacco.
LGBTQIA+ people also face more barriers when trying to quit smoking. They are less likely to seek treatment for quitting smoking. Often, they fear poor treatment from doctors.
They are less likely to use counseling or medicines to quit smoking, and are more likely to be targeted by tobacco companies, according to the Pennsylvania Department of Health’s LGBTQ Health Needs Assessment.
The CDC reports that LGBTQIA+ people are less aware of tobacco quitlines. A quitline is a phone helpline that helps people get treatment for substance use.
LGBTQIA+ alcohol use
Rates of alcohol use and use are also higher in LGBTIQIA+ people. Alcohol use disorder is highest in gay and bisexual men between 18 and 45. More than half (55%) of 25-year-old gay and bisexual men have alcohol use disorder, according to a 2020 study in the American Journal of Preventive Medicine.
Compared to straight women, LGBTQIA+ women are three times more likely to have an alcohol use disorder in their lifetime, according to a 2016 study in Alcohol Research.
LGBTQIA+ drug use
LGBTQIA+ people also use marijuana, pain medicines, and illegal drugs more often than straight people. According to the National Institute of Drug Abuse, 7% of LGTBQIA+ people misused opioid pills or heroin in 2020. That figure is just 4% in the broader adult population.
Forty-one percent of LGTBQIA+ adults used marijuana in 2020, according to the National Institute of Drug Abuse. That figure is only 19% of adults in the broader population.
Reasons for LGBTQIA+ Substance Use
People often use alcohol, tobacco, marijuana, and illegal drugs to cope with mental health problems or stress. LGBTQIA+ people may have depression, anxiety, anger, fear, or trauma.
LGBTQIA+ people may experience more stress than straight, cisgender people. They have to deal with stigma, discrimination, and other hurdles. More than half of LGTBQIA+ people say they hold back from talking about their partners at work to avoid hostility.
LGBTQIA+ people are more likely to be lonely. Two out of five report living in areas of the U.S. that are hostile to openly LGBTQIA+ people, according to the National Sexual Violence Resource Center.
LGBTQIA+ people are also more likely to face harassment or physical violence. People facing discrimination in the past year were more likely to drink than those who didn’t found a 2020 study.
Less likely to have secure, stable housing
LGBTQIA+ people are more likely to be poor than their straight cisgender peers, according to the Williams Institute. This risk is especially higher for racial minorities, bisexual people, women, trans people, and LGBTQIA+ youth.
Further, LGBTQIA+ people are less likely to own their home than cisgender straight people. Also, LGBTQIA+ youth are twice as likely to be unhoused because of family rejection and similar reasons.
More violence and harassment
LGBTQIA+ people are more likely to be harassed and face violence than non-LGBTQIA+ people. Facing violence or harassment can lead to substance use.
For instance, 70% of LGBTQIA+ people have been sexually harassed at work. More than half were afraid to tell their boss.
Bisexual women are the most likely of any group to be the victim of rape or sexual assault, according to the CDC. Two out of five lesbians and one out of four gay men have physical violence from their partners. This includes rape, abuse, or stalking.
LGBTQIA+ people are almost four times more likely to be victims of violent crime than the broader population, found a 2020 study. They are six times more likely to have been violently attacked by someone they know well. And 2.5 times more likely to have been violently attacked by a stranger.
Compared to straight women, LGBTQIA+ women are five times more likely to be victims of violence. The risk of violence for LGTBQIA+ men is more than double that for cisgender straight men. Also, one out of three LGBTQIA+ youth has already been physically threatened or harmed because of their identity.
Higher rates of mental health problems
Substance use is more common among people with anxiety, depression, and other mental health issues. LGBTQIA+ people are twice as likely to have mental health issues than straight people. Rates of depression the LGBTQIA+ people are more than double the broader population.
Mental health issues are prevalent among LGBTQIA+ youth. According to The Trevor Project, nearly half of all LGTBQIA+ youth harmed themselves on purpose in the past year. LGBTQIA+ youth are more than five times more likely to attempt suicide than their straight classmates.
The problem goes beyond depression and anxiety. Eating disorders are also more common in LGBTQIA+ people, especially among youth. LGBTQIA+ youth get bullied, rejected by their family, are homeless, abused, and face traumas more often than their peers.
Not enough support for LGBTQIA+ people
According to The Trevor Project, 46% of LGBTQIA+ youth wanted — but could not get — counseling in the past year. LGBTQIA+ people have a harder time receiving health care than straight people. This is especially true for LGBTQIA+ people of color.
Doctors discriminate against LGBTQIA+ people, leading to mistrust of the healthcare system. This group is also often underinsured or uninsured.
Lack of social support plays a role in substance use as well. The Trevor Project found that 29% of LGBTQIA+ youth had housing issues. They were homeless, ran away from home, or had to leave their homes.
Nearly half of the homeless LGBTQIA+ youth had to go because their family disowned them because of their identity.
Help Is Available
There are many more reasons for the high rates of LGBTQIA+ substance abuse.
LGBTQIA+ people are more likely to have health issues like HIV, hepatitis C, and sexually transmitted infections. It’s also harder for them to get healthcare for these issues. They may use substances to cope.
There is help for LGBTQIA+ people with substance use disorders. The following can help with substance dependence:
- The GLBT National Resource Database.
- SAMHSA’s National Helpline: 1-800-662-4357.
- National Alliance on Mental Illness.
- LGBT National Help Center.
- It Gets Better.
- SAMHSA Behavioral Health Resources.
- Association of Gay and Lesbian Psychiatrists.
- Mental Health American Peer Support.
- More Resources.
2019 National Survey on Drug Use and Health: Lesbian, Gay, & Bisexual (LGB) Adults. September 2020. Substance Abuse and Mental Health Services Administration. U.S. Department of Health and Human Services. Link
A Provider's Introduction to Substance Abuse Treatment for Lesbian, Gay, Bisexual, and Transgender Individuals. Substance Abuse and Mental Health Services Administration. Link
Andrew R. Flores, et al. Victimization rates and traits of sexual and gender minorities in the United States: Results from the National Crime Victimization Survey, 2017. October 2, 2020. Science Advances. Link
Fact Sheet on Injustice in the LGBTQ community. National Sexual Violence Resource Center. Link
Five Reasons Why Calling a Quitline Can Be Key to Your Success. Smokefree.gov, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention. Link
Ikram I. Mohamed, et al. Assessment of anxiety and depression among substance use disorder patients: a case-control study. June 3, 2020. Middle East Current Psychiatry. Link
Jessica N. Fish and Cara Exten. Sexual Orientation Differences in Alcohol Use Disorder Across the Adult Life Course. September 2020. American Journal of Preventive Medicine. Link
Lesbian, Gay, Bisexual, and Transgender (LGBT) People.Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion. Centers for Disease Control and Prevention. Link
LGBTQ Youth. The National Child Traumatic Stress Network. Link
National Survey on LGBTQ Youth Mental Health 2020. The Trevor Project. Link
Pride Month: An Equal Chance at a Smokefree Life. Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion. Centers for Disease Control and Prevention. Link
QTBIPOC Mental Health and Well-Being. Human Rights Campaign. Link
Substance Use and SUDs in LGBTQ* Populations. National Institute on Drug Abuse. Link
The National Intimate Partner and Sexual Violence Survey: 2010 Findings on Victimization by Sexual Orientation. National Center for Injury Prevention and Control. Division of Violence Prevention. Centers for Disease Control and Prevention. Link
Tonda Hughes, et al. The Influence of Gender and Sexual Orientation on Alcohol Use and Alcohol-Related Problems. 2016. Alcohol Research. Link
Unfair and Unjust Practices Harm LGBTQ+ People and Drive Health Disparities. Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion. Centers for Disease Control and Prevention. Link
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