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Link to Survey (page 45 is the SUD data)

Lifetime Illicit Drug Use

• 45% of respondents reported ever using illicit drugs (not including alcohol or marijuana).

  • This includes drugs like cocaine, methamphetamines, ecstasy/MDMA, heroin, LSD, or prescription medications used non-medically.

Past-Year Drug Use

• 18% reported using illicit drugs in the past 12 months.

Substance Use Treatment

• 5% reported needing substance use treatment in the past year but not getting it.

• Among those who needed treatment:

  • 40% said they couldn’t afford it.

  • 31% feared mistreatment because they are transgender.

  • 28% had previous bad experiences in healthcare settings.

  • 27% didn’t know where to go for care.

Alcohol Use

• 59% of respondents reported drinking alcohol in the past year.

• 14% engaged in what the study describes as “heavy alcohol use” (defined similarly to binge drinking: 5+ drinks in a sitting for AMAB people, 4+ for AFAB people).

• 3% reported needing alcohol use treatment in the past year but not receiving it.

Key Disparities

• Youth and young adults reported the highest rates of recent drug use.

• Multiracial and Indigenous respondents also reported higher drug use than other racial groups.

• Nonbinary people were slightly more likely than binary trans people to report past-year drug use.

Barriers to Care for Substance Use

Barriers were heavily influenced by:

• Cost

• Trans-specific discrimination or fear of mistreatment

• Inaccessibility of trans-affirming providers

• Lack of knowledge about where to access services

These findings point to structural barriers in both accessing substance use treatment and navigating safe, affirming care environments.

Key Insights

1. High Prevalence of Lifetime and Recent Drug Use

• Nearly 1 in 5 (19.7%) participants reported using illicit drugs in the past year, excluding alcohol and marijuana.

• Drugs used included: sedatives (7.4%), opioids (6.0%), MDMA/GHB/club drugs (6.1%), cocaine/crack (5.6%), and methamphetamines (2.6%).

• Polysubstance use was common: 38.6% reported using two or more substances in the past year.

Implication: Many LGBTQ+ people in treatment may have experience with multiple substances, and services should be equipped for polysubstance patterns and overlapping risk factors.

2. Elevated Substance Use Among Certain Identity Groups

• Transmasculine individuals had higher—but not statistically significant—odds of other drug use compared to cisgender women.

• Nonbinary individuals were significantly less likely to report recent drug use than cis women (aOR = 0.51).

• No significant differences were found among LGB groups when using lesbian participants as the reference.

Implication: Programs should not assume uniform risk across the LGBTQ+ umbrella. Identity-specific interventions—especially tailored for transmasculine and gender-diverse clients—may be more effective.

3. Self-Perceived Substance Use Problems Are Common

• 30.1% of gender minority participants said they had experienced a problem with alcohol or drugs at some point in their life.

• Substance use problems were more common among:

  • Youth

  • Masculine-presenting individuals

  • Pansexual or multiorientation individuals (one group showed near-significant elevated odds)

Implication: Many LGBTQ+ individuals have self-awareness of substance use issues, making early engagement and motivational interventions (e.g. MI, harm reduction) potentially effective.

4. Social Factors Contribute to Risk

• Substance use in this population is not only clinically driven, but also linked to:

  • Experiences of social marginalization (e.g., discrimination, isolation)

  • Lack of gender-affirming spaces

  • Coping with mental health distress, often untreated

Implication: Treatment settings should not just be trauma-informed, but also gender-affirming and identity-affirming. Staff should be trained in LGBTQ+ cultural humility, pronoun usage, and trauma-sensitive practices.

5. Binary Labels Are Limiting

• Participants often identified across multiple gender or sexual orientation categories, and the study design emphasized the need to go beyond binary classification.

Implication: Intake forms, group structures, and treatment frameworks should allow for fluid and expansive identities—recognizing that labeling limitations may discourage LGBTQ+ clients from fully engaging.

Takeaways

• Avoid generalizing LGBTQ+ clients as a monolith—risk varies significantly across identities.

• Nonbinary individuals may have lower recent use but still deserve identity-specific support.

• Offer inclusive, affirming care that explicitly acknowledges gender identity, sexual orientation, and lived experience.

• Train staff to recognize how intersectional oppression contributes to substance use and avoidance of care.

• Consider integrating peer navigators, support groups, or advisory boards with LGBTQ+ people who have lived experience in recovery.

It all begins with an idea. Maybe you want to launch a business. Maybe you want to turn a hobby into something more. Or maybe you have a creative project to share with the world. Whatever it is, the way you tell your story online can make all the difference.

It all begins with an idea. Maybe you want to launch a business. Maybe you want to turn a hobby into something more. Or maybe you have a creative project to share with the world. Whatever it is, the way you tell your story online can make all the difference.