What Risks Does the LGBTQIA+ Student Population Face When It Comes to Alcohol and Drug Use?

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LGBTQIA+ youth are likelier to adopt maladaptive coping mechanisms or engage in self-defeating behaviors like substance abuse.

Hazelden Betty Ford's Prevention Solutions division works to keep healthy kids healthy. How do we do that? We share accurate health information that dispels the myths around alcohol and other drug use. We partner with schools and communities to help kids build protective lifestyle skills that prevent the use of alcohol and other drugs. And we discuss the FACTS about alcohol, nicotine and other drug use—family, age, cravings, tolerance and surroundings—and how those factors interact with substance misuse and addiction.

Some students face higher risk of substance abuse and addiction compared to their peers, and could benefit from extra attention and added prevention efforts. Many of these risks are linked to a student's learning style, mental wellness and identity expression. And this article focuses particularly on the health of lesbian, gay, bisexual, transgender, queer, intersex and asexual students (LGBTQIA+).

Why is the LGBTQIA+ student population at higher risk of substance misuse and addiction?

According to a 2017 national survey, an estimated 10.5 percent of US high school students (ages 13-18) identified as LGBTQIA+. Many LGBTQIA+ teenagers are happy and thriving during their teenage years. However, compared to their peers, these young people are dramatically more likely to use substances. Why is that?  

For many LGBTQIA+ teenagers, it's difficult to find their identities and navigate heterosexual societies that contain specific gender expectations. Teens who identify as transgender, gay or bisexual, for example, may not find the adult mentorship they need to openly explore and express their identities.

It's already difficult for youth to develop the prosocial skills and experiences that protect them against substance use and addiction, and it's made harder for LGBTIA+ students who lack social support. This makes them more vulnerable to shame or anger, and they may struggle with emotional intimacy. Consequently, LGBTQIA+ youth are likelier to adopt maladaptive coping mechanisms or engage in self-defeating behaviors like substance abuse.

What are the risk factors?

LGBTQIA+ teenagers are 90 percent more likely to engage in alcohol or other drug use compared to other teens. Looking more closely at the LGBTQIA+ community, bisexual teenagers use alcohol and other drugs at over three times the rate of heterosexual counterparts, and lesbian and bisexual females use at four times the rate of their heterosexual peers.

LGBTQIA+ teens often use alcohol or other drugs in order to mask or self-medicate their unwanted feelings. Experts identified a variety of factors correlated to risky substance use that LGBTQIA+ teenagers may face including:

  • Stress about openly expressing their identity to family and peers for fear of rejection
  • Family and/or peer rejection, resulting in negative health consequences such as verbal abuse, physical abuse and homelessness
  • Memories or situations that involve homophobia, transphobia or other forms of identity-based discrimination
  • Misgendering of transgender and non-binary students
  • Anxiety about using gendered restrooms
  • Body dysmorphia that causes increased anxiety and/or depression, often experienced more acutely during puberty

A Boston College sophomore shares their experience: "I have engaged in the use of alcohol and [other] drugs in an attempt to mask the pain and fear of not being accepted by my family members, to the point of extreme incapacitation. I know that this [risky use in response to pain and fear] exists in all populations; I am a white, well-off suburbanite. Substance [misuse] does not have borders."  

Is nonconformity an inherent risk?

It's important to note that belonging to the LGBTQIA+ community is not itself a risk factor for substance misuse. Rather, homophobia, transphobia and other forms of prejudice are common in many communities, and identifying as transgender or bisexual, for example, will often result in traumatic or negative experiences related to identity. When prejudice exists within a teen's life or community, it threatens their healthy development and causes an increased likelihood of alcohol and drug use.

What are the best prevention opportunities? How can educators and other adults protect these students from addiction?

Risk does not equal destiny. LGBTQIA+ youth may be at a higher risk for substance misuse and addiction, but an affirming school environment can make a world of difference and reduce the likelihood of or outright prevent any negative outcomes.

Scientific research has linked an affirming school environment for LGBTQIA+ youth to a wide variety of significant health protections. These protections include, but are not limited to, decreased depressive symptoms, decreased suicidal ideation, decreased substance use and fewer unexcused school absences among LGBTQIA+ students.  

Here are some steps you can take to create a more affirming environment that supports the overall health of your LGBTQIA+ students and contributes to your prevention efforts:

  • Implement nondiscriminatory policies explicitly including sexuality and gender identity
  • Incorporate LGBTQIA+ content into classroom curriculum
  • Respect students' preferred names and pronouns (he/him, she/her, they/their, or other pronouns)
    Tip: Instead of asking for students' pronouns out loud in front of their classmates, at the beginning of the semester or term, pass out notecards and ask that all students write down and turn in their preferred name and pronouns
  • Ensure that everyone is allowed to participate in groups/activities/events in accordance with their gender identity
  • Avoid gender segregation  
  • If applicable, ensure dress code is inclusive for all gender identities
  • Create support groups that are openly LGBTQIA+ friendly (GSAs, PFLAG, affinity groups, etc.)

Creating safe, supportive spaces for LGBTQIA+ students is a highly intentional process that takes effort, humility and time. This process benefits the health and well-being of the entire school community, and helps to build a safe environment that also protects and prevents against risky alcohol or drug use.

It's our job to encourage the health of all our students. To do so requires that we continually educate ourselves about what our students need to make their own healthiest choices regarding alcohol, nicotine and other drugs. When we show up for each and every one of our students in this way, we do our part as a school community to create the most affirming, health-promoting environment for everyone.  


Centers for Disease Control and Prevention. (August 22, 2018.)  "Youth Risk Behavior Surveillance System." Accessible at https://www.cdc.gov/healthyyouth/data/yrbs/index.htm

Espelage, D.L., Aragon, S.R., Birkett, M., and Koenig, B.W. (2008). Homophobic teasing, psychological outcomes, and sexual orientation among high school students: What influence do parents and schools have?” School Psychology Review 37(2): 202-216. https://doi.org/10.1080/02796015.2008.12087894  

Marshal, M.P., Friedman, M.S., Stall, R., King, K.M., Miles, J., Gold, M.A., Bukstein, O.G. and 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  

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