Substance use patterns among sexual minority women: a mini review
Department of Psychiatry, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
Abstract
Background
Sexual minority women (SMW), including lesbian, bisexual, and other non-heterosexual women, experience higher rates of substance use (SU) and substance use disorders (SUDs) than heterosexual women, yet remain relatively underrepresented in the literature.
Objectives
This structured mini-review aimed to synthesize evidence on prevalence patterns, determinants, intersectional influences, treatment barriers, and intervention approaches related to substance use among SMW.
Methods
A structured narrative review of epidemiological studies, reviews, and meta-analyses was undertaken using predefined thematic domains: epidemiology, determinants/pathways, intersectionality, and treatment-related issues. Evidence was synthesized narratively because of heterogeneity in populations, outcome measures, and study designs.
Results
Across much of the available literature, SMW show elevated prevalence of alcohol, tobacco, cannabis, and polysubstance use compared with heterosexual women, with bisexual women frequently identified as the highest-risk subgroup. Reported determinants include minority stress-related processes, internalized stigma, discrimination, victimization, and adverse childhood experiences. Intersectional disadvantage, including racial/ethnic minority status and socioeconomic marginalization, may further amplify vulnerability. Treatment access is hindered by stigma, limited LGBTQ+-affirming services, and gaps in provider cultural competence. Evidence for SMW-specific interventions remains limited.
Conclusions
Available evidence suggests that substance use disparities among SMW are shaped by minority stress, intersecting social disadvantage, and barriers to inclusive care. More methodologically rigorous, intersectionally informed, and geographically diverse research is needed, alongside development of identity-affirming and trauma-informed interventions.
Untitled section
Keywords: LGBTQ, Lesbian, pattern, sexual minorities, substance & alcohol use, women
Article notes
Untitled section
Received 2025 Dec 2; Revised 2026 Apr 13; Accepted 2026 Apr 20; Collection date 2026.
1.Introduction
Sexual identity and gender identity are distinct concepts that are frequently confused. Sexual identity is a person's identity based on their romantic or physical attraction. Conversely, gender identity is a person's physiological sense of being a specific gender, such as man or woman, neither gender, or a combination of these. Gender identity is classified as cisgender (someone who acknowledges their physiological identity as being identical with their assigned gender at birth) or transgender (someone who recognizes their physiological identity as being different from their assigned gender at birth). Nowadays, sexual and gender minority identities are frequently recognized in tandem, these being, lesbian, gay, bisexual, transgender, queer, questioning, and other emerging sexual (and gender) identities, which are commonly referred to as LGBTQ + (1).
Compared to heterosexual populations, sexual minorities have a higher risk of substance use (SU) and substance use disorders (SUD). Sexual minority women (SMW) appear to be disproportionately affected in much of the available literature with these higher rates of SU and SUDs, whereas results for sexual minority men are more inconsistent (2–5). Despite being a part of the broader LGBTQ + research, SMW are often underrepresented, which obscures female-specific drug use patterns and creates gaps in knowledge about their unique risks.
2.Objectives
The present review was guided by four review questions concerning prevalence, determinants, intersectional variation, and treatment-related issues among SMW. This mini-review aimed to synthesize evidence on: (1) prevalence and patterns of substance use and substance use disorders among sexual minority women;(2) determinants and explanatory pathways, particularly minority stress-related processes;(3) intersectional and sociodemographic variations in risk; and (4) treatment barriers and available intervention approaches.
3.Methodology
This mini-review used a structured narrative review approach to synthesize evidence on substance use and substance use disorders among sexual minority women (SMW). The review aimed to address the following questions:
- What patterns of alcohol, tobacco, cannabis, polysubstance use, and substance use disorders have been reported among SMW?
- What psychosocial and structural determinants have been associated with these outcomes?
- How do intersectional factors such as race/ethnicity and socioeconomic position shape risk?
- What treatment barriers and intervention approaches have been described for SMW?
A literature search was conducted in PubMed, Scopus, PsycINFO, and Google Scholar for studies published in English. Search terms included combinations of: “sexual minority women,” “lesbian,” “bisexual women,” “women who have sex with women,” “substance use,” “substance use disorder,” “alcohol,” “tobacco,” “cannabis,” “polysubstance use,” “minority stress,” “intersectionality,” “treatment,” and “barriers.” To ensure comprehensive coverage, reference lists of key review articles and relevant retrieved papers were also hand-searched for additional sources. We prioritized epidemiological studies, systematic/scoping reviews, and meta-analyses relevant to prevalence, determinants, treatment access, and interventions.
Titles and abstracts of retrieved records were screened for relevance to the review objectives, followed by full-text assessment of potentially eligible articles. Studies were considered for inclusion if they: (a) reported findings specifically relating to SMW or presented subgroup analyses permitting interpretation of SMW-related outcomes;(b) addressed substance use patterns, substance-related harms, determinants, treatment barriers, or intervention strategies; and (c) were empirical studies, systematic/scoping reviews, or meta-analyses. Studies focusing exclusively on sexual minority men, opinion pieces without substantive data synthesis, and articles lacking direct relevance to the review objectives were excluded. Article eligibility and thematic relevance were discussed among the authors during manuscript preparation to ensure consistency in study selection and interpretation.
As this review was conducted as a structured narrative mini-review rather than a formal systematic review, quantitative study selection metrics (e.g., exact numbers of records screened and excluded at each stage) were not prospectively recorded.However, study identification and selection were guided by predefined thematic relevance and eligibility criteria to ensure methodological transparency and conceptual comprehensiveness.
Evidence was narratively synthesized under four predefined thematic domains—epidemiology, determinants/pathways, intersectionality/sociodemographic variation, and treatment access/interventions—which were selected a priori based on the primary objectives of the review and recurring conceptual domains identified during preliminary literature appraisal.Owing to heterogeneity in study populations, definitions of sexual orientation, outcome measures, and study methodologies, quantitative pooling or meta-analysis was not undertaken.
3.1.Consideration of evidence quality
Given the mini-review design and inclusion of heterogeneous evidence sources, a formal risk-of-bias scoring tool was not applied. However, the interpretation of findings considered key indicators of evidence strength, including study design, sample size, representativeness, consistency of findings across studies, and whether results were derived from population-based data, longitudinal designs, or review-level syntheses. Particular caution was applied to findings from cross-sectional studies, convenience samples, and studies conducted primarily in U.S. settings, as these may limit causal inference and generalizability.
3.2.Theoretical framework
To understand why these risks are especially associated with sexual minorities, two explanatory theoretical constructs have been proposed – Minority Stress Theory (6) and Intersectionality Theory. Together, these frameworks help explain both the external pressures and internalized challenges that influence patterns of substance use among SMW.
3.3.Minority stress theory
According to the minority stress theory, first given by Meyer in 2003, health inequalities between heterosexual and sexual minority groups are caused by the extra social stress that these groups endure due to their stigmatized social status. This stress has been referred to as “minority stress” and is distinguished from “general stress” that any of us may face in our daily lives. This theory further describes both distal and proximal stress processes (7).
Distal minority stressors include those that come from individuals or organizations that affect LGBTQ + people, such as unfair laws and regulations and events coloured with stigma and discrimination. These could be acute—including events which could be minor (like being treated disrespectfully) or major (like losing one's job or experiencing violence). Chronic stressors, such as poverty, may also be among them.
Proximal minority stressors include internalized stigma, which is the belief that one is “less than others” simply by virtue of one's identity; perceived stigma, which is the expectation that one will be treated differently because one is aware of the prevailing social stigma. This may lead to an attempt to conceal one's LGBTQ + identity to defend oneself against the distal minority stressors.
Against these detrimental stresses, there exist the coping mechanisms (both individual and collective), resilience and social efforts to thwart such practices in the community. Hence, the overall influence on the health of the sexual minorities is determined by the net effect of both opposing forces at play.
Building upon this framework, the next theory further expands our understanding by examining how multiple social identities interact to influence risk and resilience in SMW.
3.4.Intersectionality theory
The theoretical framework of intersectionality, introduced by Kimberlé Crenshaw in 1990s, is a paradigm for understanding how a person's experiences of privilege and oppression are shaped by the interaction and overlap of several facets of their social identity, including gender, sexual orientation, race, socio-economic status, disability, and religion. It emphasizes that people who are marginalized by several oppressed groups frequently experience distinct, compounded kinds of disadvantage that are missed by single-axis studies (e.g., focusing only on race or gender or sexual orientation/identity) (8).
Throughout history, women, especially those from marginalized backgrounds (including SMW), have been disproportionately impacted by intersecting inequalities, such as poverty, violence, and discrimination at the workplace. Intersectionality has been used in a lot of empirical research and policy work to address historical exclusions of women's experiences. In domains such as public health, psychiatry, and substance use, concentrating on women reveals how gender norms interact with stigma, sexuality, and social roles to influence outcomes differently.
A complementary syndemic perspective further posits that these intersecting disadvantages may cluster and interact synergistically with co-occurring psychosocial burdens such as trauma, depression, victimization, and structural marginalization, thereby magnifying vulnerability beyond the cumulative sum of individual risk factors.
3.5.Epidemiology of SUDs in sexual minorities
Numerous population-based studies have generally shown that SMW exhibit higher rates of substance use and related disorders than heterosexual women. The table below summarizes key studies exploring prevalence patterns across different samples, age groups, and types of substances used (Table 1).
| Study, Year, Country | Population | Study Sample | Age | SU/SUDs examined | Findings |
|---|---|---|---|---|---|
| Hahm et al. (2008) (9), USA | AAPIs | 1,108 | Adolescence- young adulthood | Tobacco, binge drinking, cannabis, other SU | Increased use in young adulthood, highest prevalence and risk of SU in AAPI SMW than heterosexual women & men, and SMM |
| McCabe et al. (2009) (4), USA | Heterosexuals, 2% LGB; 4% with same-sex partners, 6% with same-sex attraction | 34,653 | >20 years | Alcohol, marijuana and other SU | Non-heterosexual orientation was linked to higher risk of SU & dependence. Risk patterns were more pronounced among women |
| Hughes et al. (2009) (10) | Alcohol and other drug use/ dependence | Strong associations between victimization of SMM&W (especially childhood neglect) and any past-year SUDs | |||
| Marshal et al. (2012) (11), USA | Heterosexuals & 6% with same-sex orientation/ identity/ attraction | 527 females | 17 years | Tobacco and alcohol use | SMW reported higher past-year SU rates |
| Goldberg et al. (2013) (12), USA | Heterosexuals and SMGs | 14,152 | 24–32 years | Tobacco, alcohol, marijuana & other substance abuse/ dependence | SMW are more likely than heterosexual women to experience all SU/SUDs |
| Estrich et al. (2014) (13), USA | 75.4% heterosexuals, 9.3% lesbians, 15.3% bisexuals | 669 | 16–66 years | Alcohol & SU | SMW had twice the odds of SU in the last year, bisexual women had the highest odds of SU overall |
| Dermody et al. (2016) (14), USA | Heterosexuals and SMGs (8% - lesbians/ bisexuals) | 2,064 females | 17 years | Alcohol, cigarette, & marijuana use | SMWs had an increased risk for SU than heterosexuals |
| Kerridge et al. (2017) (3), USA | Heterosexuals and SMGs (1.5% gays/lesbians, 1.3% bisexuals) | 36,309 | ≥18 years | Alcohol, tobacco & other SUDs | SUDs higher in SMGs, bisexual followed by lesbian women showed the highest risk across nearly all SUDs |
| Caputi (2018) (15), USA | Heterosexuals and SMGs | 15,624 | Adolescents | Alcohol, tobacco, marijuana, prescription drug & illicit drug use | SMW, especially bisexuals, had increased risk |
| Dermody (2018) (16), USA | Heterosexuals and SMGs | 15,624 | 14–18 years | Alcohol, tobacco, marijuana use, & binge drinking | SMW, especially bisexuals, had increased risk for all SUDs & polysubstance use |
| Schuler et al. (2018) (17), USA | Heterosexuals and SMGs | 67,354 | 18–49 years | Alcohol, tobacco, marijuana, illicit drug, SUD & binge drinking | Bisexual women: higher risk at all ages; lesbians/gays: higher risk in youth only |
| Boyd et al. (2019) (18), USA | Heterosexuals and SMGs | 36,309 | ≥18 years | Alcohol, tobacco & SUD | Higher prevalence & severity in bisexual & “not sure” women |
| Talley et al. (2019) (19), USA | Heterosexuals and SMGs | 3,48,175 | 14–18 years | Alcohol, tobacco, marijuana use | Bisexual girls > lesbians at higher risk for early onset & persistent use of tobacco & marijuana |
| Dermody et al. (2019) (20), USA | Heterosexual and SMGs (17% lesbian/ bisexual) | 2,263 females | 13–20 years | Alcohol, cigarette, & marijuana use | SMW had higher frequencies of all SU across the entire age continuum, especially early adolescence |
| Schuler & Collins (2020) (5), USA | Heterosexuals and LGBs | 1,26,463 | ≥17 years | Alcohol, tobacco, marijuana, illicit drug, opioid misuse, SUD & binge drinking | SMM & SMW had higher risks than heterosexuals. Bisexual women had higher risks than lesbians |
| Ehlke et al. (2022) (21), USA | Heterosexuals and 18.8% SMW | 3,020 females | ≥18 years | Alcohol, tobacco, marijuana use | SMW had higher prevalence of cannabis and polysubstance use than heterosexuals |
Overall, the epidemiological evidence demonstrates that SMW, especially bisexual women, are at disproportionately higher risk of alcohol, tobacco, and drug use across adolescence and adulthood. These recurring findings underline the need to explore why such disparities persist.
3.6.Determinants and pathways of substance use
There are various determinants of SU and SUDs in SMW. Minority stress, i.e., proximal and distal LGBTQ + stressors and the use of substances as a coping mechanism to counteract the social isolation are widely recognised as being a driving force behind the SU/SUD patterns in sexual minorities, including SMW (22–29). Internalized heterosexism, i.e., the internalization of negative societal attitudes on non-heterosexual identity and orientation, is one stressor that has drawn a lot of attention and is partially, if not fully, associated with AUD/SUD (30, 31).
Additionally, being “out” to more people correlates with higher SU, possibly due to greater exposure to prejudice or social rejection (22), especially for bisexual women (32). In other studies, non-disclosure of sexual orientation is linked with higher illicit drug use (33). Other recognized factors are sociocultural variables such as the widespread availability of drugs within the LGBTQ + communities (23) and discrimination (23, 25, 28, 33–35).
In a scoping review, adverse childhood experiences was considered a risk factor for SU/SUDs (36). A systematic literature review outlined childhood sexual abuse as being a potential risk factor for adverse mental health outcomes and SUDs in SMW (37).
In a meta-analysis by Goldbach et al. (2014) (38), various minority stressors were noted to be linked to SU, the strongest of these being victimization (24, 25, 27, 33, 39), lack of a supportive environment, externalizing behaviours like conduct problems and truancy, internalizing behaviours such as depression and anxiety, psychological stress (general and gay-related stress), facing rejection after coming out, and homelessness.
In general population, SU is known to decrease as age advances, however, this is not always true for sexual minorities (24). Even though younger LGBTQ + adults display heavier alcohol and drug use, evidence suggests that older age is less pronounced as protective a factor as it is in heterosexuals (22, 28, 33). Some evidence also suggests that alcohol use may elevate as age advances in lesbian/bisexual women (40). This may be due persistent stressors, social isolation or delayed social milestones like marriage/parenthood.
In heterosexual communities, men tend to have greater incidence of SU/SUD; however, this gender disparity is less noticeable in sexual minority groups. Lesbian/bisexual women have comparable or higher rates of alcohol use than gay/bisexual men (3, 41). This is termed as the gender paradox (24). On the contrary, gay/bisexual men are more likely to engage in club drug/illicit drug use (22). This has been hypothesized to be due to weaker adherence to traditional gender norms within sexual minority communities.
Bisexuality has consistently emerged as a standalone risk factor for highest levels of alcohol and drug use across studies (4, 15, 18, 22). This persists even after controlling for openness about sexual orientation. Possible explanations for this include minority stress from both sides, i.e., heterosexual and gay/lesbian communities (3, 18, 42), having lower social support (43), and a mismatch between sexual identity and behaviour (18, 22).
SU/SUDs, including club drug use, have also been linked to high involvement in gay culture, i.e., frequent attendance at bars, sex clubs, and bathhouses, especially among men who have sex with men (MSM). This may be attributed to peer influence which reinforces SU (22–24, 27, 28, 33). Higher community involvement was notably a risk factor for SU in bisexual women, but not for lesbians or queer women (32, 44). On the other hand, some studies have notes that community belonging can act as a protective factor by providing social support (27, 28).
There appears to be a bidirectional link between HIV/AIDS (human immunodeficiency virus/acquired immunodeficiency syndrome) and SU/SUD. SU increase high risk behaviours and being HIV-positive predicts higher poly-substance use and club drug use. SU may serve as a coping mechanism for HIV-related stress, stigma, or emotional distress (22).
It has been seen that countries with anti-LGBT laws show higher AUD rates among sexual minorities. Legal protection and acceptance correlate with better mental health outcomes (24, 27, 33).
Religious affiliation has been shown to be protective for heterosexuals but not for SMW (33, 45).
3.7.Intersectionality and sociodemographic variations
According to the Intersectionality Framework, SMW are affected differently by race, ethnicity, socioeconomic status, and geography, leading to varied risk profiles for substance use and disorders. While existing data are largely from high-income nations like the USA, findings suggest that SMW of colour experience greater risks than White SMW, often due to compounded stigma and reduced access to culturally responsive care (Table 2).
| Study, Year, Country | Population | Study Sample | Age | SU/SUDs examined | Findings |
|---|---|---|---|---|---|
| Mereish & Bradford (2013) (46), USA | Heterosexuals and SMGs | 2,556 | 18–72 years | Lifetime SU problem | SMW of colour had greater risks than White SMW & heterosexual women of colour. No difference in SMM of colour & heterosexual men. |
| Jeong et al. (2016) (47), USA | Latina, African American, and white SMW | 700 | ≥18 years | Alcohol dependence | Lesbian and bisexual women had high levels of alcohol dependence (Latina, African American > White SMW) |
| Slater et al. (2017) (35), USA | Gay/lesbian, bisexual, or unsure adults | 1,351 | ≥18 years | Association of discrimination with alcohol use & SUD | High risk of alcohol use among bisexuals & less literate. Increased risk of any SUD among Hispanics |
| Freitag et al. (2021) (48), USA | Heterosexuals, gay/lesbian, bisexual, and conflicting adults | 35,981 | ≥18 years | Alcohol, tobacco, marijuana use | Bisexual women and racial minorities (Blacks, Hispanics) had highest prevalence of any SUD |
Beyond additive disadvantage, emerging scholarship suggests that substance use disparities among SMW may be better conceptualized through a syndemic framework, wherein multiple co-occurring psychosocial and structural adversities interact synergistically rather than independently to worsen health outcomes. In this context, stigma related to sexual orientation may intersect with sexism, racism, poverty, trauma exposure, and mental health burden to create mutually reinforcing pathways toward substance use vulnerability. For example, racial/ethnic minority SMW may simultaneously experience heterosexism within their ethnic communities and racial discrimination within LGBTQ + spaces, compounding stress exposure and reducing access to affirming support networks.
Importantly, these intersecting disadvantages should not be viewed as isolated risk factors but rather as interacting systems of oppression that may amplify one another. For instance, bisexual women from racial minority backgrounds may experience “double marginalization” due to invalidation from both heterosexual and lesbian/gay communities in addition to racial discrimination, potentially increasing emotional distress, maladaptive coping, and treatment disengagement. Such findings support moving beyond single-axis analyses toward integrated intersectional and syndemic models when conceptualizing substance use disparities among SMW.
Although most available evidence originates from the United States, emerging data from LMICs suggest that substance use disparities among sexual and gender minority populations may also extend beyond high-income settings. For instance, Figueiredo et al. (2025), in a Brazilian population-based cohort study of LGBTQIAPN + youth, reported elevated rates of substance use initiation and polysubstance involvement among sexual and gender minority participants compared with heterosexual/cisgender peers, suggesting that these disparities may persist across diverse sociocultural environments despite contextual variation in stigma and healthcare systems (49). However, sex-disaggregated and SMW-specific analyses remain limited in such settings.
Overall, intersectional research highlights that multiple layers of disadvantage, such as being female, a racial/ethnic minority, and a sexual minority, magnify vulnerability to substance use and limit access to protective social resources. Yet, there remains a striking lack of data from low- and middle-income countries, including India, underscoring a major global research gap.
3.9.Research gaps and future directions
Despite growing recognition of substance use disparities among SMW, significant research and implementation gaps remain.
Much of the available literature remains cross-sectional and predominantly U.S.-based, although emerging evidence from LMIC settings such as Brazil (49) suggests similar disparities may exist internationally; nevertheless, SMW-specific data outside Western contexts remain scarce. Further, these studies are solely dependent on self-reported substance use measures, with variable definitions of sexual orientation and substance-related outcomes (54, 59). These features limit causal interpretation and cross-context generalizability. Bisexual, racial/ethnic minority, and rural SMW continue to be significantly underrepresented, and few interventions specifically incorporate minority stress, stigma, or trauma-informed frameworks (50). Furthermore, there are differing definitions of “LGBT-specific” care; many inclusive programs lack significant modifications (52, 53), which makes it challenging to determine the actual scope or significance of LGBT-sensitive care.
Future studies should concentrate on creating and thoroughly evaluating interventions tailored to SMWs, embracing intersectional designs, and creating standardized assessments of LGBT cultural competency. To find out how affirming practices affect engagement, retention, and recovery, longitudinal and implementation studies are required. Barriers to equitable service delivery can be identified at the systems level through structural analyses of funding, policy, and organizational aspects. Enhancing treatment access and outcomes for SMW and the larger LGBT community will require developing a stronger body of evidence supporting stigma-informed, trauma-integrated, and scalable care models.
3.10.Limitations of the review
This review has several limitations. First, it is a mini-review rather than a full systematic review or meta-analysis, and therefore may not have captured all eligible studies. The search strategy, while structured, was not prospectively registered and therefore may be subject to selection bias. Second, no formal risk-of-bias instrument was applied. Third, the evidence base is heavily weighted toward U.S. populations, limiting transferability to low- and middle-income settings. Fourth, heterogeneity in sexual orientation definitions, sampling methods, and substance use outcomes complicates direct comparison across studies. Additionally, the absence of prospectively recorded study selection metrics reflects the narrative design of the review and may limit reproducibility. These limitations should be considered when interpreting the conclusions.
4.Conclusion
In conclusion, the combined effects of intersectional disadvantage, minority stress, and limited access to culturally competent treatment lead to disproportionate substance use and associated harms among SMW. Theoretical and empirical evidence together highlight the critical need for integrated, identity-affirming, and trauma-informed approaches, even though epidemiological data clearly show higher prevalence rates. Reducing these disparities and enhancing SMW's general well-being will require closing the research-to-practice gap through intersectional frameworks, inclusive policies, and contextually tailored interventions. Future work should prioritize multinational longitudinal studies to clarify culturally specific vs. universal determinants of substance use disparities among SMW.
Funding Statement
The author(s) declared that financial support was not received for this work and/or its publication.
Footnotes
Footnote Group
Conflict of interest
The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Generative AI statement
The author(s) declared that generative AI was not used in the creation of this manuscript.
Any alternative text (alt text) provided alongside figures in this article has been generated by Frontiers with the support of artificial intelligence and reasonable efforts have been made to ensure accuracy, including review by the authors wherever possible. If you identify any issues, please contact us.
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
References
Untitled section
References
- 1.Russell ST, Bishop MD, Fish JN. Expanding notions of LGBTQ+. Annu Rev Sociol. (2023) 49:281–96. 10.1146/annurev-soc-030320-032256
- 2.Krueger EA, Fish JN, Upchurch DM. Sexual orientation disparities in substance use: investigating social stress mechanisms in a national sample. Am J Prev Med. (2020) 58(1):59–68. 10.1016/j.amepre.2019.08.034
- 3.Kerridge BT, Pickering RP, Saha TD, Ruan WJ, Chou SP, Zhang H, et al. Prevalence, sociodemographic correlates and DSM-5 substance use disorders and other psychiatric disorders among sexual minorities in the United States. Drug Alcohol Depend. (2017) 170:82–92. 10.1016/j.drugalcdep.2016.10.038
- 4.McCabe SE, Hughes TL, Bostwick WB, West BT, Boyd CJ. Sexual orientation, substance use behaviors and substance dependence in the United States. Addiction. (2009) 104(8):1333–45. 10.1111/j.1360-0443.2009.02596.x
- 5.Schuler MS, Collins RL. Sexual minority substance use disparities: bisexual women at elevated risk relative to other sexual minority groups. Drug Alcohol Depend. (2020) 206:107755. 10.1016/j.drugalcdep.2019.107755
- 6.Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull. (2003) 129(5):674–97. 10.1037/0033-2909.129.5.674
- 7.Frost DM, Meyer IH. Minority stress theory: application, critique, and continued relevance. Curr Opin Psychol. (2023) 51:101579. 10.1016/j.copsyc.2023.101579
- 8.Bowleg L. The problem with the phrase Women and Minorities: intersectionality—an important theoretical framework for public health. Am J Public Health. (2012) 102(7):1267–73. 10.2105/AJPH.2012.300750
- 9.Hahm HC, Wong FY, Huang ZJ, Ozonoff A, Lee J. Substance use among Asian Americans and Pacific islanders sexual minority adolescents: findings from the national longitudinal study of adolescent health. J Adolesc Health. (2008) 42(3):275–83. 10.1016/j.jadohealth.2007.08.021
- 10.Hughes T, McCabe SE, Wilsnack SC, West BT, Boyd CJ. Victimization and substance use disorders in a national sample of heterosexual and sexual minority women and men. Addiction. (2010) 105(12):2130–40. 10.1111/j.1360-0443.2010.03088.x
- 11.Marshal MP, Sucato G, Stepp SD, Hipwell A, Smith HA, Friedman MS, et al. Substance use and mental health disparities among sexual minority girls: results from the Pittsburgh girls study. J Pediatr Adolesc Gynecol. (2012) 25(1):15–8. 10.1016/j.jpag.2011.06.011
- 12.Goldberg S, Strutz KL, Herring AA, Halpern CT. Risk of substance abuse and dependence among young adult sexual minority groups using a multidimensional measure of sexual orientation. Public Health Rep. (2013) 128(3):144–52. 10.1177/003335491312800304
- 13.Estrich CG, Gratzer B, Hotton AL. Differences in sexual health, risk behaviors, and substance use among women by sexual identity: chicago, 2009–2011. Sex Transm Dis. (2014) 41(3):194. 10.1097/OLQ.0000000000000091
- 14.Dermody SS, Marshal MP, Cheong J, Chung T, Stepp S D, Hipwell A. Adolescent sexual minority girls are at elevated risk for use of multiple substances. Subst Use Misuse. (2016) 51(5):574–85. 10.3109/10826084.2015.1126743
- 15.Caputi TL. Sex and orientation identity matter in the substance use behaviors of sexual minority adolescents in the United States. Drug Alcohol Depend. (2018) 187:142–8. 10.1016/j.drugalcdep.2018.01.012
- 16.Dermody SS. Risk of polysubstance use among sexual minority and heterosexual youth. Drug Alcohol Depend. (2018) 192:38–44. 10.1016/j.drugalcdep.2018.07.030
- 17.Schuler MS, Rice CE, Evans-Polce RJ, Collins RL. Disparities in substance use behaviors and disorders among adult sexual minorities by age, gender, and sexual identity. Drug Alcohol Depend. (2018) 189:139–46. 10.1016/j.drugalcdep.2018.05.008
- 18.Boyd CJ, Veliz PT, Stephenson R, Hughes TL, McCabe SE. Severity of alcohol, tobacco, and drug use disorders among sexual minority individuals and their “not sure” counterparts. LGBT Health. (2019) 6(1):15–22. 10.1089/lgbt.2018.0122
- 19.Talley AE, Turner B, Foster AM, Phillips G. Sexual minority youth at risk of early and persistent alcohol, tobacco, and marijuana use. Arch Sex Behav. (2019) 48(4):1073–86. 10.1007/s10508-018-1275-7
- 20.Dermody SS, McGinley J, Eckstrand K, Marshal MP. Sexual minority female youth and substance use disparities across development. J LGBT Youth. (2020) 17(2):214–29. 10.1080/19361653.2019.1598313
- 21.Ehlke SJ, Kendzor DE, Smith MA, Sifat MS, Boozary LK, Cohn AM. Single-use, co-use, and polysubstance use of alcohol, tobacco, and cannabis in sexual minority and heterosexual females. The American Journal on Addictions. (2023) 32(1):66–75. 10.1111/ajad.13344
- 22.Green KE, Feinstein BA. Substance use in lesbian, gay, and bisexual populations: an update on empirical research and implications for treatment. Psychol Addict Behav. (2012) 26(2):265–78. 10.1037/a0025424
- 23.Felner JK, Wisdom JP, Williams T, Katuska L, Haley SJ, Jun HJ, et al. Stress, coping, and context: examining substance use among LGBTQ young adults with probable substance use disorders. PS (Wash DC). (2020) 71(2):112–20. 10.1176/appi.ps.201900029
- 24.Hughes TL, Wilsnack SC, Kantor LW. The influence of gender and sexual orientation on alcohol use and alcohol-related problems. Alcohol Res. (2016) 38(1):121–32. 10.35946/arcr.v38.1.15
- 25.Kidd JD, Jackman KB, Wolff M, Veldhuis CB, Hughes TL. Risk and protective factors for substance use among sexual and gender minority youth: a scoping review. Curr Addict Rep. (2018) 5(2):158–73. 10.1007/s40429-018-0196-9
- 26.Dyar C, Newcomb ME, Mustanski B. Longitudinal associations between minority stressors and substance use among sexual and gender minority individuals. Drug Alcohol Depend. (2019) 201:205–11. 10.1016/j.drugalcdep.2019.03.032
- 27.Mereish EH. Substance use and misuse among sexual and gender minority youth. Curr Opin Psychol. (2019) 30:123–7. 10.1016/j.copsyc.2019.05.002
- 28.Parent MC, Arriaga AS, Gobble T, Wille L. Stress and substance use among sexual and gender minority individuals across the lifespan. Neurobiol Stress. (2019) 10:100146. 10.1016/j.ynstr.2018.100146
- 29.McCabe CJ, Hipwell AE, Keenan K, Stepp SD, Chung T, King KM. Substance use and sexual-minority Status: examining the mediating roles of stress and emotion dysregulation in young adult women. Clin Psychol Sci. (2021) 9(6):1095–114. 10.1177/2167702621999359
- 30.Brubaker. Examining the Relationship between Internalized Heterosexism and Substance Abuse among Lesbian, Gay, and Bisexual Individuals: A Critical Review: Journal of LGBTQ Issues in Counseling: Vol 3, No 1 - Get Access [Internet]. 2009. Available online at: https://www.tandfonline.com/doi/full/10.1080/15538600902754494 (Accessed November 9, 2025).
- 31.Hequembourg AL, Dearing RL. Exploring shame, guilt, and risky substance use among sexual minority men and women. J Homosex. (2013) 60(4):615–38. 10.1080/00918369.2013.760365
- 32.Feinstein BA, Dyar C, London B. Are outness and community involvement risk or protective factors for alcohol and drug abuse among sexual minority women? Arch Sex Behav. (2017) 46(5):1411–23. 10.1007/s10508-016-0790-7
- 33.Hughes TL, Veldhuis CB, Drabble LA, Wilsnack SC. Research on alcohol and other drug (AOD) use among sexual minority women: a global scoping review. PLoS One. (2020) 15(3):e0229869. 10.1371/journal.pone.0229869
- 34.Lee JH, Gamarel KE, Bryant KJ, Zaller ND, Operario D. Discrimination, mental health, and substance use disorders among sexual minority populations. LGBT Health. (2016) 3(4):258–65. 10.1089/lgbt.2015.0135
- 35.Slater ME, Godette D, Huang B, Ruan WJ, Kerridge BT. Sexual orientation-based discrimination, excessive alcohol use, and substance use disorders among sexual minority adults. LGBT Health. (2017) 4(5):337–44. 10.1089/lgbt.2016.0117
- 36.Dowling BA, Grigsby TJ, Ziomek GJ, Schnarrs PW. Substance use outcomes for sexual and gender minority adults with a history of adverse childhood experiences: a scoping review. Drug and Alcohol Dependence Reports. (2023) 6:100129. 10.1016/j.dadr.2022.100129
- 37.Bochicchio. Mental health and substance use among sexual minority women who report childhood sexual abuse: A systematic literature review. (2024). Available online at: https://psycnet.apa.org/buy/2023-70239-001 (Accessed November 8, 2025).
- 38.Goldbach JT, Tanner-Smith EE, Bagwell M, Dunlap S. Minority stress and substance use in sexual minority adolescents: a meta-analysis. Prev Sci. (2014) 15(3):350–63. 10.1007/s11121-013-0393-7
- 39.Hinds Z. Hazardous Substance Use Among Sexual and Gender Minority Adults: A Deeper Look Into Distal Minority Stressors. (2022). Available online at: https://psycnet.apa.org/buy/2022-66914-001 (Accessed November 8, 2025).
- 40.Brugard. Alcohol and tobacco use patterns among heterosexually and homosexually experienced California women - PubMed. (2005). Available online at: https://pubmed.ncbi.nlm.nih.gov/15607842/ (Accessed November 9, 2025).
- 41.Cochran. Prevalence of non-medical drug use and dependence among homosexually active men and women in the US population - PubMed. (2004). Available online at: https://pubmed.ncbi.nlm.nih.gov/15265096/ (Accessed November 9, 2025).
- 42.Israel T, Mohr JJ. Attitudes Toward Bisexual Women and Men: Current Research, Future Directions. Binghamton: Harrington Park Press; (2004). p. 117. (Current Research on Bisexuality).
- 43.Balsam KF, Mohr JJ. Adaptation to sexual orientation stigma: a comparison of bisexual and lesbian/gay adults. J Couns Psychol. (2007) 54(3):306–19. 10.1037/0022-0167.54.3.306
- 44.Demant D, Hides L, White KM, Kavanagh DJ. Effects of participation in and connectedness to the LGBT community on substance use involvement of sexual minority young people. Addict Behav. (2018) 81:167–74. 10.1016/j.addbeh.2018.01.028
- 45.Drabble L, Trocki KF, Klinger JL. Religiosity as a protective factor for hazardous drinking and drug use among sexual minority and heterosexual women: findings from the national alcohol survey. Drug Alcohol Depend. (2016) 161:127–34. 10.1016/j.drugalcdep.2016.01.022
- 46.Mereish EH, Bradford JB. Intersecting identities and substance use problems: sexual orientation, gender, race, and lifetime substance use problems. J Stud Alcohol Drugs. (2014) 75(1):179–88. 10.15288/jsad.2014.75.179
- 47.Jeong YM, Veldhuis CB, Aranda F, Hughes TL. Racial/ethnic differences in unmet needs for mental health and substance use treatment in a community-based sample of sexual minority women. J Clin Nurs. (2016) 25(23–24):3557–69. 10.1111/jocn.13477
- 48.Freitag TM, Chen-Sankey JC, Duarte DA, Ramsey MW, Choi K. Variations in substance use and disorders among sexual minorities by race/ethnicity. Subst Use Misuse. (2021) 56(7):921–8. 10.1080/10826084.2021.1899225
- 49.Figueiredo CPM, Alves Bezerra H, Miguel EC, Rohde LA, Salum GA, Pan PM, et al. Patterns of substance use and initiation among LGBTQIAPN+ youth in Brazil: evidence from a population-based cohort. Int Rev Psychiatry. (2025) 37(6–7):639–50. 10.1080/09540261.2025.2573758
- 50.Mericle AA, de Guzman R, Hemberg J, Yette E, Drabble L, Trocki K. Delivering LGBT-sensitive substance use treatment to sexual minority women. J Gay Lesbian Soc Serv. (2018) 30(4):393–408. 10.1080/10538720.2018.1512435
- 51.Benz MB, Palm Reed K, Bishop LS. Stigma and help-seeking: the interplay of substance use and gender and sexual minority identity. Addict Behav. (2019) 97:63–9. 10.1016/j.addbeh.2019.05.023
- 52.Cochran. Do Specialized Services Exist for LGBT Individuals Seeking Treatment for Substance Misuse? A Study of Available Treatment Programs: Substance Use & Misuse: Vol 42, No 1. 2007 (Accessed 2025 November 8). Available online at: https://www.tandfonline.com/doi/abs/10.1080/10826080601094207
- 53.Williams. The availability of LGBT-specific mental health and substance abuse treatment in the United States - Williams - 2020 - Health Services Research - Wiley Online Library. (2020). Available online at: https://onlinelibrary.wiley.com/doi/abs/10.1111/1475-6773.13559 (Accessed November 8, 2025).
- 54.McGeough B. A systematic review of substance use treatments for sexual minority women. J Gay Lesbian Soc Serv. (2021) 33(2):180–210. 10.1080/10538720.2021.1875346
- 55.O’Farrell TJ, Fals-Stewart W. Behavioral couples therapy for alcoholism and drug abuse. J Subst Abuse Treat. (2000) 18(1):51–4. 10.1016/s0740-5472(99)00026-4
- 56.Ingraham N, Eliason MJ, Garbers S, Harbatkin D, Minnis AM, McElroy JA, et al. Effects of mindfulness interventions on health outcomes in older lesbian/bisexual women. Womens Health Issues. (2016) 26(Suppl 1):S53–62. 10.1016/j.whi.2016.04.002
- 57.Senreich E. Are specialized LGBT program components helpful for gay and bisexual men in substance abuse treatment? Subst Use Misuse. (2010) 45(7–8):1077–96. 10.3109/10826080903483855
- 58.Zajac K, Rash CJ, Ginley MK, Heck NC. Sexual orientation and substance use treatment outcomes across five clinical trials of contingency management. Psychol Addict Behav. (2020) 34(1):128–35. 10.1037/adb0000494
- 59.Drabble L. Substance Use Disorders Treatment for Sexual Minority Women. (2012). Available online at: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1360-0443.2010.03088.x (Accessed November 6, 2025).