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Section 15
Substance Abuse Prevalence & Prevention among Gay, Lesbian, Bisexual and Questioning Adolescents

Question 15 | Test | Table of Contents

There have been numerous reports that substance abuse is more prevalent among gay, lesbian, and bisexual adolescents than among their heterosexual counterparts. For example, Remafedi (1987) found that 58% of his small sample of Minneapolis gay and bisexual youth met criteria for substance abuse. Another study found high rates of alcohol abuse (76%), marijuana use (42%), and cocaine/crack use (25%) among a sample of predominantly Hispanic and African-American gay and bisexual males in New York City (Rotheram-Borus et al., 1994). Estimates for substance abuse in heterosexual youth vary widely (and often include sexual minority youth because studies neglect to ask questions about sexual orientation), but estimates are that 4% of youth drink alcohol daily, 33% have had 5 or more drinks at one time within the past two weeks, and more than 90% of high school seniors have experimented with alcohol at some time in their life (Adger, 1991). A recent study that surveyed students in 59 schools in Massachusetts found that gay, lesbian, and bisexual students (who represented 2.5% of the population) were more likely than students who did not report they were gay, lesbian, or bisexual to engage in 24 substance-use related behaviors including using alcohol before age 13 (59% vs. 30%), binge drinking (46% vs. 33%), using marijuana (69% vs. 47%), using cocaine (33% vs. 7%), and sharing needles (16% vs. 1%) (Garofalo et al., 1998).

Minimal information exists for substance abuse patterns among lesbian and bisexual female adolescents. However, at least two reports have indicated that similar patterns exist among adult lesbians and adult gay men (Anderson, 1996; Glaus, 1988). McKirnan & Peterson (1989) found slightly lower rates of alcoholism in lesbians than gay men (9% vs. 17%), rates which were similar to those for heterosexual women (7%) and men (21%).

These statistics must be interpreted with caution because the youth included in the studies are not a representative sample of sexual minority youth. Rather, they are youth that have been willing to identify themselves as gay, lesbian, bisexual, transgender or questioning youth to researchers or participate in some organized activity for sexual minority youth. Furthermore, the samples are predominantly male.

It should be noted, as well, that youth with poor coping skills and poor networks of social support are at a greater risk of engaging in self-destructive behavior, regardless of their sexual orientation. Thus, youth with good coping skills will be at less risk of succumbing to substance abuse, even though the stress of "coming out" is great. This is supported by research findings mat many sexual minority youth are engaged in healthy, positive activities (e.g., Jordan, Vaughan, & Woodworth, 1997).

Associated Risks
Substance abuse among this population is of particular concern because of the increased risk of problem behaviors associated with it (e.g., Rotheram-Borus et al., 1995). Such problems include homelessness, running away, prostitution, school and learning problems, dropping out of school, and problems with the law. However, these issues must not be assumed to be the sole result of drug or alcohol abuse. For example, an adolescent may be homeless due to being forced out of his or her home by the parents after disclosing his or her sexual orientation.

Two additional life-threatening issues associated with drug and alcohol abuse are frequent unprotected sexual encounters and suicide attempts. Both of these behaviors have been noted to increase when substance use is present (e.g., Rotheram-Borus et al., 1994). Gibson (1989) reported that as many as 20% to 35% of gay youth have experienced suicidal ideation. Studies have found that substance abuse may be linked to higher levels of suicidal ideation and attempts (Roles, 1983) and that gay-related stressors are more common among adolescents who had attempted suicide than those who had not (Rotheram-Borus, Hunter, & Rosario, 1994). Use of drugs and alcohol may impair judgment and lead youth to engage in more risky sexual behaviors such as sex with multiple partners or unsafe sex practices (Rotheram-Borus et al., 1994).

Prevention
Prevention efforts take two paths. First, prevention tactics based upon increasing the visibility of sexual minority youth can alter the sociopolitical climate of the school, neighborhood, or community and increase acceptance of these youth (Shifrin & Solis, 1992). For example, information on sexual orientation can be presented in the form of fliers, posters, lecture material in classes, special assemblies in schools, or media presentations. These information initiatives, geared toward all youth (and adults as well), would educate them about the realities of gay and lesbian life and dispel myths. Similarly, gay, lesbian, and bisexual issues can be included in existing multicultural curricula. A second prevention approach involves directing information on substance abuse to youth identified as gay, lesbian, bisexual, transgender, or questioning. For example, youth groups at community centers or schools may present substance abuse prevention seminars or workshops. Furthermore, these groups may work at prevention indirectly by building self-esteem and providing alcohol and drug-free activities.

School psychologists are in a unique position to respond to and affect this problem. One growing phenomenon is the presence of gay, lesbian, and bisexual groups or clubs in high schools, often supported by faculty and administration. These groups offer age-appropriate opportunities for socialization and for meeting other gay, lesbian, bisexual, transgender, questioning, or supportive teens thereby providing social support and furnishing opportunities for developing social skills. In addition, these programs may offer avenues for addressing the prevalent harassment of gay, lesbian, bisexual, transgender, and questioning teens in schools, thereby reducing stimuli for substance abuse. In one study of sexual minority youth in the Chicago area, gay, lesbian, and bisexual high school students reported that school-based groups or clubs for gay, lesbian and bisexual students and straight supportive allies, with administrative support and assistance, were an important part of making the school environment amenable to sexual minority students and alleviating their sense of alienation and differentness (Jordan, Vaughan, & Woodworth, 1997).

Jordan, Karen M., Substance Abuse Among Gay, Lesbian, Bisexual, Transgender, and Questioning Adolescents, School Psychology Review, 2000, Vol. 29, Issue 2.

Personal Reflection Exercise #1
The preceding section contained information about substance abuse prevalence and prevention among gay, lesbian, bisexual questioning adolescents.  Write three case study examples regarding how you might use the content of this section in your practice.

Update
Substance Use Behaviors
Among LGBTQ+ Youth of Color:
Identification of the Populations Bearing
the Greatest Burden in Three Large Samples

Eisenberg, M. E., Gower, A. L., Watson, R. J., Rider, G. N., Thomas, D., & Russell, S. T. (2022). Substance Use Behaviors Among LGBTQ+ Youth of Color: Identification of the Populations Bearing the Greatest Burden in Three Large Samples. The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 71(3), 317–323.

Peer-Reviewed Journal Article References:
Boyle, S. C., LaBrie, J. W., & Omoto, A. M. (2020). Normative substance use antecedents among sexual minorities: A scoping review and synthesis. Psychology of Sexual Orientation and Gender Diversity, 7(2), 117–131.

Flentje, A., Heck, N. C., & Sorensen, J. L. (2015). Substance use among lesbian, gay, and bisexual clients entering substance abuse treatment: Comparisons to heterosexual clients. Journal of Consulting and Clinical Psychology, 83(2), 325–334.

Green, K. E., & Feinstein, B. A. (2012). Substance use in lesbian, gay, and bisexual populations: An update on empirical research and implications for treatment. Psychology of Addictive Behaviors, 26(2), 265–278.

Millar, B. M., Rendina, H. J., Starks, T. J., Grov, C., & Parsons, J. T. (2019). The role of chronotype, circadian misalignment, and tiredness in the substance use behaviors of gay and bisexual men. Psychology of Sexual Orientation and Gender Diversity, 6(1), 96–106.

Rosario, M., Reisner, S. L., Corliss, H. L., Wypij, D., Calzo, J., & Austin, S. B. (2014). Sexual-orientation disparities in substance use in emerging adults: A function of stress and attachment paradigms. Psychology of Addictive Behaviors, 28(3), 790–804.

Schulz, C. T., Glatt, E. M., & Stamates, A. L. (2021). Risk factors associated with alcohol and drug use among bisexual women: A literature review. Experimental and Clinical Psychopharmacology.

QUESTION 15
What are associated risks of substance abuse among gay, lesbian, and bisexual questioning adolescents?To select and enter your answer go to Test.

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