You are using an outdated browser. Please upgrade your browser to improve your experience and security.

Skip to main
Donate Reach A Counselor Meet Friends

Substance Use, Minority Stress, and Mental Health among LGBTQ+ Young People

LGBTQ+ youth who experienced victimization and discrimination based on their LGBTQ+ identity reported higher rates of current substance use (60% and 57%, respectively) compared to youth who did not report these experiences (51% and 50%, respectively).
Donate

Key Findings

  • Most (54%) study participants reported currently using at least one substance, including alcohol, marijuana, cigarettes, or tobacco vapes/e-cigarettes.
  • Current substance use varied by demographic group, with higher rates reported among  18-24-year-olds (67%), cisgender youth (63%), and youth of color (57%) compared to 13-17-year-olds (36%), TGNB youth (48%), and White youth (48%).
  • Cisgender youth reported higher rates of current cigarette (29% vs. 9%) and alcohol (54% vs. 36%) use, while TGNB youth reported higher rates of current marijuana use (29% vs. 19%).

Background

Substance use is a significant public health concern among young people, with patterns and associated harms varying widely across different substances.1,2 In recent years, the CDC has documented declines in substance use among high school aged-youth, including alcohol and marijuana use.1 However, aligned with prior research, LGBTQ+ young people continue to report higher rates of substance use compared to their cisgender and heterosexual peers.1, 3-5 These disparities are closely tied to minority stress, which includes experiences such as negative identity disclosure reactions, victimization, discrimination, and a lack of support.6-9 Consistent with the Transactional Model of Stress and Coping,10 chronic exposure to stress may lead LGBTQ+ youth to adopt coping behaviors, including maladaptive strategies such as substance use. Minority stress can also contribute to elevated rates of mental health concerns and suicide risk among LGBTQ+ youth.9 Taken together, some LGBTQ+ young people may use substances to manage stress arising from both external stressors and internalized mental health burdens that these stressors create.

Despite this evidence, comparatively limited research has examined substance use exclusively among LGBTQ+ young people, particularly transgender, nonbinary, and gender questioning (TGNB) young people, or explored differences across specific identities and substance types. Using data from The Trevor Project’s Project SPARK (A Longitudinal Study of Protective and Risk Factors in LGBTQ+ Youth Mental Health; Nath et al., 2025), this research brief examines: 1) participant characteristics associated with current substance use, 2) the relationship between substance use and minority stress experiences, and 3) the relationship between substance use, mental health, and considering or attempting suicide.

This research brief uses data from the baseline wave of Project SPARK, which includes 1,689 LGBTQ+ young people between the ages of 13 to 24 in the U.S.

Results

Current substance use is defined as any self-reported use of a substance in the past 30 days, whether once or multiple times. Most (54%) of the sample reported current use of alcohol, marijuana, cigarettes, or vapes/e-cigarettes, and 31% reported current use of two or more substances. By substance type, 43% of participants reported any alcohol use in the past 30 days, 25% reported any marijuana use, 17% reported any cigarette use, and 17% reported any vape/e-cigarette use.

Demographic differences
Current substance use differed by participant characteristics. By age, 18-24-year-olds reported higher rates of current substance use (67%) than 13-17-year-olds (36%). Current substance use also varied by race/ethnicity, with youth of color more likely to report current use (57%) than their White (48%) peers. The highest rates were among Black/African American (66%), Native/Indigenous (59%), and Hispanic/Latinx (59%) LGBTQ+ youth. Differences were also observed by sexual orientation, with lesbian (64%), gay (60%), and queer (55%) young people reporting the highest rates. By gender identity, cisgender youth reported a higher rate of current substance use (63%) than their TGNB (48%) peers.

Patterns varied by substance type. Cisgender youth reported higher rates of current alcohol use (54%) and cigarette use (29%) than their TGNB peers (36% and 9%, respectively); however, TGNB youth reported higher rates of current marijuana use (29% vs. 19%) compared to cisgender LGBQ youth. Additionally, although gay and lesbian youth reported higher rates of current cigarette use (31% and 28%, respectively) and alcohol use (51% and 52%, respectively) than individuals of other sexual orientations, queer, bisexual, and pansexual youth reported higher rates of current marijuana use (34%, 30%, and 28%, respectively; see Data Table for more information).

Minority stress
Current substance use was related to experiencing discrimination and victimization based on one’s LGBTQ+ identity in the past year. Youth who experienced victimization and discrimination on the basis of their sexual orientation or gender identity in the past year reported higher rates of current substance use (60% and 57%, respectively) compared to youth who did not report these experiences (51% and 50%, respectively). These findings were mostly consistent for each individual substance, as well (see chart).

Current Substance Use by Experiences of Discrimination and Victimization in the Past Year among LGBTQ+ Young People chart

Substance use and mental health
Regarding mental health, those who reported currently using substances had lower rates of anxiety symptoms (54%) compared to their peers who were not currently using (60%). All other mental health concerns and suicide measures were not associated with current substance use as a broad category.

Mental Health Symptoms by Current Substance Use among LGBTQ+ Young People chart

However, they were related to specific types of current substance use. In general, higher rates of mental health concerns and suicide-related outcomes were observed among youth who reported current marijuana use and vape/e-cigarette use, while lower rates were observed among youth who reported current alcohol or cigarette use (see charts).

Considering and Attempting Suicide by Current Substance Use among LGBTQ+ Young People chart

Looking Ahead

Among LGBTQ+ young people, we learned that substance use varies by sexual and gender identity, and that victimization and discrimination based on one’s identity are consistently associated with substance use. We also found that the relationship between substance use and mental health and suicide consideration and attempts is nuanced, varying based on both the specific substance and the outcome examined. For example, mental health concerns and suicidal thoughts and behaviors were often related to higher rates of current marijuana and vape/e-cigarette use, but lower rates of current alcohol and cigarette use. This pattern may reflect the focus on any current use, rather than substance misuse. These findings reinforce the need to examine substances individually, as their differing associations with mental health and suicide consideration and attempts suggest a complexity of factors including motivation, access, and substance-specific effects for LGBTQ+ young people.

We also observed differences in current substance use by participant characteristics, with older youth, youth of color, and cisgender youth reporting higher rates than their younger, White, and TGNB peers. However, these patterns varied by substance type, with cisgender, gay, and lesbian youth reporting higher rates of current cigarette and alcohol use, and TGNB, queer, bisexual, and pansexual youth reporting higher rates of current marijuana use. Differences between older LGBTQ+ young people and their younger peers may also be due to increased exposure and access to substances, as it is legal for young adults over 18 or 21 to purchase or use some of these substances.

There are some important limitations to this research. This brief features a non-representative sample of LGBTQ+ young people. The data analyzed is also examining a single point in time, meaning we cannot determine causality between variables. Furthermore, our results differ from some published literature on identity differences in substance use,4,11 which identified that individuals who identify as bisexual, or being attracted to multiple genders, had higher risk for substance use than their gay and lesbian peers, which was only true for marijuana use in this research. This difference may be due to characteristics of our sample, such as the time in which we collected data, or its age or gender distribution.

Future research should continue to clarify pathways that lead LGBTQ+ young people to use specific substances including how different forms of minority stress, coping motives, and environments may contribute to substance-specific patterns. For example, though there is a documented history of tobacco companies marketing products to LGB people,12,13 less is known about the extent to which other substances have been directly or indirectly marketed to others in LGBTQ+ communities. Additionally, research should continue beyond assessing current use of substances and focus more on patterns of substance misuse over time, which may signal elevated risk for health problems and need for intervention. Interventions that help youth healthily cope with minority stressors, as well as education about substance use (especially for those ages 17 and under), are both critical. Further, policy change and broader societal shifts are necessary in order to limit exposure to minority stress for LGBTQ+ young people, which may reduce the likelihood of mental health concerns and substance use. Finally, youth, caregivers, and others who are seeking guidance on substance use can access support through the 24/7 Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline: 1-800-662-HELP (4357). For an overview of available services, you can also visit: American Addiction Centers.

The Trevor Project’s free, 24/7 crisis services are committed to making sure that all LGBTQ+ young people receive high-quality crisis care that addresses the unique challenges they face, including substance use and its role in mental health. We train our crisis counselors to provide culturally competent and non-judgmental support, consistently respecting each caller’s experience and background. Our TrevorSpace platform is a safe and supportive online space for LGBTQ+ young people ages 13 to 24. Here, youth can connect with peers, find support in a moderated community, and share experiences related to mental health in a safe environment. Finally, our Research team is committed to the ongoing dissemination of research related to LGBTQ+ young people, including their mental health and its relation to substance use, to help ensure all LGBTQ+ young people can live healthy lives.

To read more on this topic, check out Substance Use and Suicide Risk Among LGBTQ Youth and Substance Use Disparities by Sexual Identity. To read more about our longitudinal study, check out Project SPARK.

Data Tables

Demographics of LGBTQ+ Young People who Endorsed Currently Using a Substance

Demographics of LGBTQ+ Young People who Endorsed Currently Using a Substance table

Methods

Sample
Data were collected through The Trevor Project’s Project SPARK. In total, 1,689 LGBTQ+ young people between the ages of 13 to 24 were recruited via ads on social media and participated in five waves of data collection. This brief features data from the first wave, which recruited participants from between September 2023 and February 2024.

Measures
Demographics (i.e., age, race/ethnicity, sexual orientation, gender identity) were collected by asking participants to select a single category from a provided list.14 Participants were asked if they felt physically threatened because of their sexual orientation or gender identity in the past year (two separate questions). Additionally, they were asked if they felt discriminated against because of their sexual orientation or gender identity in the past year (two separate questions). If they responded Yes to any of these four questions, then they were considered to have experienced victimization or discrimination in the past year on the basis of their sexual orientation or gender identity.

Substance use questions were either directly taken or adapted from the CDC’s Youth Risk Behavior Survey.15 Participants were asked the following questions: “Have you ever… 1) smoked a cigarette, even one or two puffs, 2) used an electronic vapor product for tobacco (like a vape or e-cig), and 3) had a drink of alcohol, other than a few sips?” They could respond Yes or No to each question. If they answered Yes, they were then asked: “During the past 30 days, how many days did you 1) smoke cigarettes, 2) use an electronic vapor product for tobacco (like a vape or e-cig), and 3) have at least one drink of alcohol?” They could respond with the following options: 0 days, 1 or 2 days, 3 to 5 days, 6 to 9 days, 10 to 19 days, 20 to 29 days, or All 30 days for each question. For marijuana usage, participants were asked: How many times have you ever used marijuana?” and could respond with 0 times, 1 or 2 times, 3 to 9 times, 10 to 19 times, 20 to 39 times, 40 to 99 times, 100 or more times. If they reported ever using marijuana, they were asked: “During the past 30 days, how many times did you use marijuana?” and could respond with 0 times, 1 or 2 times, 3 to 9 times, 10 to 19 times, 20 to 39 times, or 40 or more times. Each of these substance use variables was made into a binary variable to measure current substance use (Yes or No to use of a specific substance). Participants were considered to be currently using any substance if they used any one of these substances in the past 30 days, whether once or multiple times. 

Symptoms of depression and anxiety were assessed using the PHQ-2 and GAD-2, respectively, and recommended cutoffs were applied.16,17 Considering and attempting suicide in the past year was assessed with items from the CDC’s Youth Risk Behavior Survey.15

Analysis
Chi-square tests were run to examine differences between groups. Unless otherwise noted, all reported differences are statistically significant at p<0.05, meaning documented differences would be expected less than 5% of the time if there were no true difference in the population (i.e., the null hypothesis).

References

  1. 1. Casey, C. G. (2024). Youth Risk Behavior Surveillance–United States, 2023. Morbidity and Mortality Weekly Report (MMWR) Supplements, 73(4).
  2. 2. U.S. Department of Health and Human Services (HHS), Office of the Surgeon General. (2016). Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health.
  3. 3. De Pedro, K. T., Gilreath, T. D., Jackson, C., & Esqueda, M. C. (2017). Substance use among transgender students in California public middle and high schools. Journal of School Health, 87(5), 303-309. https://doi.org/10.1111/josh.12499
  4. 4. Marshal, M. P., Friedman, M. S., Stall, R., King, K. M., Miles, J., Gold, M. A., … & Morse, J. Q. (2008). Sexual orientation and adolescent substance use: a meta‐analysis and methodological review. Addiction, 103(4), 546-556. https://doi.org/10.1111/j.1360-0443.2008.02149.x
  5. 5. The Trevor Project. (2020). Substance use disparities by sexual identity. https://doi.org/10.70226/JOHZ3907
  6. 6. Brown, E., Abdelmassih, E., & Hanna, F. (2024). Evaluating the determinants of substance use in LGBTQIA+ Adolescents: A scoping review. International Journal of Environmental Research and Public Health, 21(12), 1579. https://doi.org/10.3390/ijerph21121579
  7. 7. Goldbach, J. T., Tanner-Smith, E. E., Bagwell, M., & Dunlap, S. (2014). Minority stress and substance use in sexual minority adolescents: A meta-analysis. Prevention Science, 15(3), 350-363. https://doi.org/10.1007/s11121-013-0393-7
  8. 8. Huebner, D. M., Thoma, B. C., & Neilands, T. B. (2015). School victimization and substance use among lesbian, gay, bisexual, and transgender adolescents. Prevention Science, 16(5), 734-743. https://doi.org/10.1007/s11121-014-0507-x
  9. 9. Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychological Bulletin, 129(5), 674-697. https://doi.org/10.1037/0033-2909.129.5.674
  10. 10. Lazarus, R. S. & Folkman, S. (1984). Stress, Appraisal, and Coping. New York: Springer.

    11. Ford, J. V., Pearlman, L. R., & Feinstein, B. A. (2023). Bisexuality and substance use. Current Sexual Health Reports, 15(3), 187-195. https://doi.org/10.1007/s11930-023-00369-8
  11. 12. Smith, E. A., Offen, N., & Malone, R. E. (2005). What makes an ad a cigarette ad? Commercial tobacco imagery in the lesbian, gay, and bisexual press. Journal of Epidemiology & Community Health, 59(12), 1086-1091. https://doi.org/10.1136/jech.2005.038760
  12. 13. Washington, H. A. (2002). Burning love: big tobacco takes aim at LGBT youths. American Journal of Public Health, 92(7), 1086-1095. https://doi.org/10.2105/ajph.92.7.1086
  13. 14. Nath, R., Matthews, D.D., Hobaica, S., Eden, T., DeChants, J.P., Clifford, A., Taylor, A.B., & Suffredini, K. (2025). Project SPARK interim report: A longitudinal study of risk and protective factors in LGBTQ+ youth mental health (2023-2025). West Hollywood, California: The Trevor Project. https://doi.org/10.70226/OSCY3344
  14. 15. Mpofu, J. J., Underwood, J. M., Thornton, J. E., Brener, N. D., Rico, A., Kilmer, G., Harris, W. A., Leon-Nguyen, M., Chyen, D., Lim, C., Mbaka, C. K., Smith-Grant, J., Whittle, L., Jones, S. E., Krause, K. H., Li, J., Shanklin, S. L., McKinnon, I., Arrey, L., Queen, B. E., & Roberts, A. M. (2023). Overview and methods for the Youth Risk Behavior Surveillance System—United States, 2021. MMWR Supplements, 72(1), 1–12. https://doi.org/10.15585/mmwr.su7201a1
  15. 16. Löwe, B., Kroenke, K., & Gräfe, K. (2005). Detecting and monitoring depression with a two-item questionnaire (PHQ-2). Journal of Psychosomatic Research, 58(2), 163–171. https://doi.org/10.1016/j.jpsychores.2004.09.006
  16. 17. Löwe, B., Decker, O., Müller, S., Brähler, E., Schellberg, D., Herzog, W., & Herzberg, P. Y. (2008). Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population. Medical Care, 46, 266–274. https://doi.org/10.1097/MLR.0b013e318160d093

The Trevor Project. (2026). Substance Use, Minority Stress, and Mental Health among LGBTQ+ Young People. https://doi.org/10.70226/ISOK7592

For more information please contact: Research@TheTrevorProject.org

© The Trevor Project 2026

Download the Research Brief Return to Research Briefs Page