A groundbreaking investigation led by researchers at the University of California San Diego School of Medicine has unveiled significant disparities in substance use rates across diverse sexual identity groups in the United States. Utilizing data from the 2023 National Survey on Drug Use and Health (NSDUH), this study marks a pivotal advance in public health research by including a wider spectrum of sexual identities beyond the traditional lesbian, gay, bisexual, and heterosexual categories. Crucially, the survey incorporated sexual identity questions for adolescents aged 12 to 17, providing an unprecedented insight into youth demographics that were previously underexplored. With over 52,000 individuals participating, the dataset offers a robust foundation for analyzing substance use trends in varied sexual minority populations.
Prior research on substance use frequently limited its scope to well-defined sexual minorities and often excluded individuals who identify with emerging or less common sexual identities. The inclusion of identities such as queer, pansexual, asexual, and individuals uncertain about their sexuality provides a richer understanding of how nuanced sexual identity may influence substance use behaviors. As Kevin Yang, MD, the study’s lead author and psychiatry resident at UC San Diego, emphasizes, “many people, especially younger individuals, identify with these less conventional terms or are still exploring their sexual identity. Previously, research failed to adequately represent these populations, leaving knowledge gaps around their health risks.”
The findings reveal that non-heterosexual groups consistently reported higher usage rates of a broad array of substances compared to heterosexual counterparts, highlighting an urgent public health concern. These substances include cannabis, hallucinogens, inhalants, methamphetamine, and cocaine among others. The analysis also pointed to a troubling increase in prescription drug misuse within these communities. The multifaceted nature of these disparities underscores the complexity of substance use risk factors that intersect with sexual identity.
Among the various groups studied, bisexual respondents emerged with the highest odds of substance use across multiple categories. Remarkably, nearly 50% of bisexual individuals reported cannabis use within the past year, a stark contrast to the 20% reported by heterosexual respondents. This pronounced vulnerability signals an urgent need for targeted outreach and intervention strategies tailored specifically to bisexual community members, who may face unique social and psychological stressors contributing to elevated substance use.
Similarly, respondents identifying as gay or lesbian exhibited elevated odds of engaging with most substances measured in the survey. Inhalant use was particularly notable among gay men, with usage rates reported at 13.3%, drastically exceeding the 0.7% rate among heterosexual men. Such data suggest that certain substance use patterns are highly specific within sexual minority subpopulations, reflecting potentially differential social contexts or coping mechanisms that warrant further investigation.
Notably, individuals using alternative terms to define their sexual identity or unsure about their identity presented significantly increased odds of consuming several substances. Hallucinogen use was especially prominent in these cohorts, signaling a pattern of substance involvement that may be intertwined with identity exploration or psychosocial stresses linked to uncertainty or fluidity in sexual identity. This nuanced understanding challenges conventional categorizations and calls for more inclusive frameworks in epidemiological research.
Sex-specific analyses added another layer of complexity to the findings. Females who identified as bisexual, lesbian, or used alternative sexual identity labels generally demonstrated elevated risks across a wider spectrum of substances compared to their male counterparts. It’s important to highlight that conclusions regarding males were somewhat constrained by smaller sample sizes for particular substances, indicating the necessity for further large-scale research to clarify gender-based variations in substance use within sexual minorities.
The inclusion of adolescents in the 2023 NSDUH survey represents a significant leap forward, acknowledging that identity development during youth is a critical period influencing risk behaviors, including substance use. Early recognition and appropriate intervention strategies during these formative years could mitigate long-term harms and enhance mental health outcomes among sexual minority youth, who historically have been underserved in both research and clinical settings.
This study sheds vital light on two emergent identities that have gone largely unexamined in national substance use discourse: individuals uncertain of their sexual identity and those who identify with a broader gender spectrum utilizing nontraditional sexual identity labels. Although the data do not dissect substance use patterns within each specific non-traditional identity (such as pansexual or asexual), the overarching revelation that these groups experience heightened substance use challenges researchers and clinicians to consider complexity and diversity beyond rigid categories.
The researchers highlight the urgent need for expanded public health frameworks that incorporate an inclusive range of sexual identities. This approach is pivotal for designing more personalized, effective prevention and treatment programs that resonate authentically with the lived experiences of sexual minority individuals, especially those navigating the fluidity and nuances of sexual identity in contemporary society.
Clinicians are urged to incorporate comprehensive assessments of sexual identity in their health evaluations to better identify individuals at elevated risk of substance use. Creating affirming clinical environments where patients feel safe disclosing both their sexual identity and substance use behaviors is paramount, particularly for adolescents and young adults still in the process of identity formation. This culturally competent practice is essential in bridging gaps in healthcare access and fostering more effective therapeutic relationships.
The findings from this study represent a crucial step towards unmasking the multifaceted and often overlooked substance use challenges faced by sexual minorities, especially those whose identities do not fit neatly within traditional categories. As society continues to embrace the spectrum of human sexual identity, public health research must evolve accordingly, recognizing the unique vulnerabilities and strengths of these communities.
Ultimately, this nuanced exploration serves as a call to action for policymakers, healthcare providers, and researchers alike. It underscores the importance of embracing complexity in sexual identity to develop targeted, effective strategies that not only address substance use disparities but also promote holistic health and well-being across all sexual minority groups.
Subject of Research: Substance use disparities among diverse sexual identity groups in the United States, including emerging and less traditionally categorized identities.
Article Title: (Not explicitly provided in the source content)
News Publication Date: February 18, 2026
Web References:
https://doi.org/10.1176/appi.ajp.20250206
References:
Published study in the American Journal of Psychiatry.
Keywords:
Drug abuse, substance use, sexual identity, sexual minorities, bisexual, gay, lesbian, queer, pansexual, asexual, adolescent health, public health, epidemiology
