Substance Use Higher Among Non-Heterosexual Individuals, New Research Shows

A new study from the University of California San Diego School of Medicine reveals significantly higher rates of substance use among individuals identifying as non-heterosexual, including those with uncertain or diverse sexual identities. The findings, published February 18, 2026, in the American Journal of Psychiatry, are based on analysis of the 2023 National Survey on Drug Use and Health (NSDUH), the first nationally representative dataset to comprehensively include a broader range of sexual identity options ¹.

Expanding Sexual Identity Data in Research

The 2023 NSDUH included individuals who identify as uncertain about their sexual identity or use terms beyond lesbian, gay, or bisexual, addressing a gap in previous research. More than 52,000 people participated in the survey, which also, for the first time, asked respondents aged 12-17 about their sexual identity ¹. “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. These are populations that we’ve been missing in prior research,” explained Dr. Kevin Yang, first author and resident physician at UC San Diego School of Medicine ¹.

Key Findings on Substance Use

Compared to heterosexual individuals, all other sexual identity groups demonstrated significantly higher rates of substance use, including cannabis, hallucinogens, inhalants, methamphetamine, and cocaine. Misuse of prescription drugs was also more prevalent among non-heterosexual individuals. Specific findings include:

• Bisexual Respondents: Exhibited the highest odds of using inhalants, hallucinogens, cannabis, and methamphetamine. Nearly 50% reported cannabis use in the past year, compared to 20% of heterosexual respondents ¹.
• Gay and Lesbian Respondents: Showed elevated rates for most substances, with inhalant use particularly prominent among gay men (13.3% vs. 0.7% of heterosexual men) ¹.
• Diverse and Uncertain Identities: Individuals using different terms to describe their sexual identity, or those unsure of their identity, also showed increased rates of substance use, particularly hallucinogens and cannabis ¹.
• Sex-Specific Differences: Female respondents identifying as bisexual, lesbian, using different terms, or unsure of their identity generally exhibited elevated risk across more substances than their male counterparts. However, researchers noted limitations in male estimates due to smaller sample sizes for some substances ¹.

Implications for Public Health and Clinical Practice

This research highlights the importance of recognizing a broader spectrum of sexual identities in public health research and clinical settings. The findings suggest a need for deeper investigation into the social and psychological factors contributing to substance use within these communities, as well as the development of targeted prevention and treatment strategies ¹.

“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,” said co-author Letitia Mueller, a medical student at UC San Diego School of Medicine ¹. Researchers encourage clinicians to incorporate sexual identity as a key component of comprehensive health assessments and to create safe, supportive environments where patients feel comfortable discussing both their identity and substance use, particularly for adolescents and young adults ¹.

The National Survey on Drug Use and Health (NSDUH) is conducted annually and provides nationally representative data on substance use, mental health, and treatment ². Data from the 2023 NSDUH is available in detailed reports and tables ².