Research alert: Understanding substance use across the full spectrum of sexual identity

(Press-News.org) A study led by researchers at University of California San Diego School of Medicine reveals higher rates of substance use among all non‑heterosexual groups in the U.S., including people who are uncertain of or who use different terms to describe their sexual identity. The analysis was based on the 2023 National Survey on Drug Use and Health (NSDUH), the first nationally representative dataset to include sexual identity options beyond lesbian, gay, bisexual or heterosexual, and the first to ask respondents ages 12-17 about their sexual identity. More than 52,000 people participated in the survey. The study was published on February 18, 2026 in the American Journal of Psychiatry.

“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,” said first author Kevin Yang, MD, 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.”

Compared to heterosexual individuals, all other sexual identity groups showed significantly higher use of all substances surveyed, including cannabis, hallucinogens, inhalants, methamphetamine and cocaine. Prescription drug misuse was also higher among non-heterosexual groups. The researchers found that:

Bisexual respondents had the highest odds of using inhalants, hallucinogens, cannabis and methamphetamine. Nearly 50% of bisexual respondents reported using cannabis in the last year, compared to 20% of heterosexual respondents. Gay and lesbian respondents had elevated odds for most substances, with inhalant use especially prominent among gay men (13.3% vs. 0.7% of heterosexual men). Respondents who used different terms to identify their sexual identity exhibited increased odds across most substances, with particularly high rates of hallucinogen use. Similar results were found for those who were not sure of their sexual identity including elevated odds of cannabis and hallucinogen use. Sex‑specific analyses revealed that females identifying as bisexual, lesbian, using different terms, or not sure of their identity generally exhibited elevated risk across more substances than their male counterparts. However, male estimates were limited by small sample sizes for some substances. The research sheds light on two emerging identity groups that have been largely missing from national analyses: those uncertain of their sexual identity and those who identify with sexual identities on the gender spectrum using terms other than gay, lesbian, bisexual or heterosexual. Although the study didn’t differentiate substance use among specific sexual identities beyond standardized categories (e.g., queer, pansexual, asexual), the researchers note that the findings underscore the importance of recognizing a broader range of sexual identities in public health research and clinical practice. Distinct substance‑use patterns in these groups call for a deeper exploration of social and psychological factors shaping substance use as well as targeted prevention and treatment strategies.

“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 fourth-year medical student at UC San Diego School of Medicine. “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.”

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