Why Is Substance Use and Abuse Higher Among Gay and Bisexual Men?

Key Takeaways

• A substance use disorder (SUD) occurs when alcohol and/or drugs lead to significant problems in a person’s life
• When compared with the general population, gay and bisexual men have significantly higher rates of alcohol and drug use
• Many gay and bisexual men partake in alcohol and drug use to cope with homophobia, violence, or discrimination experienced due to their sexual orientation
• Gay and bisexual men suffering from addiction should seek facilities providing LGBTQ-specific addiction treatment

Is Substance Use and Abuse Higher Among Gay and Bisexual Men?

When compared with the general population, gay, bisexual men, lesbian, and transgender people are more likely to:²

• Use alcohol and drugs
• Have higher rates of substance abuse
• Continue heavy drinking later in life
• Not withhold from alcohol and drug use

Research published in LGBT Health noted significantly high rates of substance use disorders among people in the LGBTQ community.³ 

Out of 36,309 adults surveyed, approximately 6 percent fell under the sexual minorities category. This means they don’t identify as heterosexual.³

People who identified as gay or lesbian were more than twice as likely to experience a ‘severe’ alcohol or tobacco use disorder as those who identified as heterosexual. People who identified as bisexual were three times as likely to have these substance use disorders.³

Past studies on the topic have been far less comprehensive. For example, people conducting this research would usually speak to gay men at bars about their drug and alcohol use. 

Some older studies focus only on alcohol rather than other addictive drugs. However, the LGBT Health study focused on alcohol, tobacco, and other drugs.

Why Substance Abuse is Higher Among Gay and Bisexual Men

Many gay and bisexual men engage in alcohol and drug use because it’s a reaction to homophobia, violence, or discrimination experienced due to their sexual orientation. 

These experiences can contribute to other mental and physical health problems. They can also affect relationships, employment, and financial stability.

Many gay and bisexual men remain ‘in the closet,’ keeping their sexual preferences a secret to avoid discrimination. Living this kind of double life can lead to feelings of loneliness and anxiety. 

Some men who choose to come out often experience rejection from family and friends. They may turn to substance abuse to self-medicate from the pain.

Internalized Homophobia

Whether or not their friends and families accept them, many gay and bisexual men suffer from internalized homophobia. This occurs when they self-identify with anti-gay stigmas. As a result, they may experience self-loathing and an inability to feel comfortable in their skin.

For men suffering from internalized homophobia, alcohol and drugs can be effective methods for ridding negative thoughts. Some gay and bisexual men can temporarily enjoy living as their authentic selves when high or drunk.

For some gay and bisexual men, drug and alcohol use can contribute to a higher chance of HIV and other STDs. This is especially if they use methamphetamines (meth), nitrite (poppers), and drugs used to address erectile dysfunction.

People using drugs and alcohol may also increase their chances of contracting HIV or giving it to others by engaging in risky sexual practices and behaviors or sharing needles or other injection equipment. 

Treatment for Substance Abuse

Many sexual minorities experiencing addiction problems hesitate to seek treatment from a traditional facility. 

Group therapy participants and some counselors may show homophobic behaviors or make inappropriate comments. This stops people from recovering from feeling like they can let their guard down, which is essential for successful treatment.

Additionally, most traditional treatment centers don’t address the specific needs of LGBTQ people.

Treatment for LGBTQ people recovering from addiction should include learning successful coping practices for dealing with:

• Social isolation
• Family problems
• Homophobia 
• Violence

Many rehab facilities have recognized this need and offer LGBTQ-specific addiction treatment programs. 

People need to know that there are suitable options available. Reaching out for support takes strength and courage, which can be particularly hard for LGBTQ people. However, it’s the first step toward recovery.

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Substance Abuse Resources for Gay and Bisexual Men

Here are some substance abuse resources that can help gay and bisexual men suffering from alcohol and/or drug addiction.

National Alliance on Mental Illness (NAMI)
4301 Wilson Blvd.,
Suite 300 Arlington,
VA 22203
703-524-7600
https://www.nami.org/

Mentalhealth.gov 
U.S. Department of Health & Human Services
200 Independence Avenue
S.W. Washington
D.C. 20201
https://www.mentalhealth.gov/

CDC LGBT Health
800-232-4636
https://www.cdc.gov/lgbthealth/about.htm

oSTEM LGBTQ Crisis Hotlines and Services
https://ostem.org/page/crisis-hotlines/

Glaad Transgender Resources
https://www.glaad.org/transgender/resources

It Gets Better
https://itgetsbetter.org/get-help/

Mental Health America
500 Montgomery Street,
Suite 820 Alexandria,
VA. 22314
703-684-7722
https://www.mhanational.org/issues/lgbtq-communities-and-mental-health

Substance Abuse and Mental Health Services Administration (SAMHSA)
5600 Fishers Lane,
Rockville, MD 20857
1-877-726-4727
https://www.samhsa.gov/behavioral-health-equity/lgbtqi

U.S. Department of Health & Human Services (HSS) LGBTQ Youth
200 Independence Avenue,
S.W. Washington,
D.C. 20201
1-877-696-6775
https://opa.hhs.gov/adolescent-health?adolescent-development/healthy-relationships/lgbtq/index.html

CDC Gay and Bisexual Men’s Health
800-232-4636
https://www.cdc.gov/msmhealth/for-your-health.htm

CDC Gay and Bisexual Men’s Mental Health
800-232-4636
https://www.cdc.gov/msmhealth/mental-health.htm

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What is a Substance Use Disorder?

A substance use disorder (SUD) occurs when the consistent use of alcohol and/or drugs leads to significant issues in a person’s life, including:¹

• Health problems
• Disability
• A failure to meet essential responsibilities at work, school, or home

These issues often affect how people relate to others and make choices.

Substance use disorders affect people of all ages from all walks of life. SUDs are common, recurrent, and often severe. However, they’re treatable, and many people can recover.¹

Difference between Substance Use and Abuse

Substance use is an umbrella term for when drugs and/or alcohol are used in various ways, including:

• Recreationally
• Following prescription guidelines
• Used irregularly
• Used through a single exposure

These levels are usually relaxed where control is present, and there are intentions to consume moderate levels of substances. Usually, the substances taken have a clear and short-term purpose.

For example, substance use could involve: 

• Celebrating a birthday with alcohol
• Taking painkillers for a headache
• Socializing with drugs and alcohol

Little judgment is usually made of these actions. Substance use is typically normalized and accepted as part of our culture. 

However, substance abuse refers to an uncontrolled experience of taking drugs and alcohol. Typically there’s a degree of neglect. 

Users often continue to consume drugs and alcohol despite negative consequences. 

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