LGBTQ+ Individuals who Abuse Substances Are More Likely to Have Psychiatric Disorders


Sexual minorities with alcohol and tobacco addictions are at a higher risk for comorbid psychiatric disorders, bisexual women in particular.


According to a University of Michigan study,1 more than half of gay, lesbian, and bisexual individuals who abuse alcohol or tobacco also have a co-occurring psychiatric disorder, whereas only one-third of heterosexual individuals have the same correlation.

“The degree of disparities in alcohol, tobacco and other psychiatric disorders by sexual identity was very surprising,” Rebecca Evans-Polce, assistant research scientist at the University of Michigan School of Nursing and first author of the study, said to the press. “The differences for women are more striking.”2

Previous studies have demonstrated that LGBTQ+ individuals are at greater risk for both substance use disorders and psychiatric disorders. Evans-Polce noted that the new study, which gathered data from 35,796 responses from the National Epidemiologic Survey on Alcohol and Related Conditions, is 1 of the few to examine this risk.

An interesting finding of note is the prevalent comorbidities for bisexual women. When compared to heterosexual women, bisexual women were found much more likely to have an anxiety disorder (32.5% bisexual, 16% heterosexual), mood disorder (35% bisexual, 15% heterosexual), and post-traumatic stress disorder (21% bisexual, 6% heterosexual). According to the data, 63% of bisexual women misusing tobacco also had an anxiety disorder, mood disorder, or PTSD. In contrast, only 46% of heterosexual women with a tobacco use disorder also had a psychiatric issue.

Bisexual individuals overall were 4 times more likely to have PTSD than heterosexual individuals.

The reason for this association is unconfirmed, but researchers suspect discrimination and trauma may be to blame. Sexual orientation discrimination, the number of stressful life events, and the number of adverse childhood experiences were strongly associated with greater risk of comorbidities.

Researchers determined that the data demonstrates a need for integrated substance use and mental health prevention and treatment programs, particularly for individuals who identify as sexual minorities. Additionally, more research is needed to comprehend why data repeatedly points to such a high risk for bisexual women.


1. Evans-Polce RJ, Kcomt L, Veliz PT, Boyd CJ, et al. Alcohol, Tobacco, and Comorbid Psychiatric Disorders and Associations With Sexual Identity and Stress-Related Correlates. Am J Psychiatry. 2020;177(11):1073-1081.

2. University of Michigan. Sexual minorities, especially women, who misuse substances more likely to have psychiatric disorders. News release. Medical Xpress. November 20, 2020.

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