Examining multiple substance use among Lesbian, Gay, and bisexual US adults

Using two or more substances (≥2) is a health risk behavior that is more frequent among lesbian, gay, and bisexual (LGB) female adults. Understanding recent trends of using ≥2 substances is essential to make decisions about how to mitigate the exacerbated risks among LGB adults. We aim to assess the trends in using multiple substances among LGB US adults by sex.

We analyzed the National Survey on Drug Use and Health dataset of US adults from 2021 to 2023 (age ≥18; n = 127,645; 1.1 % are lesbian female, 1.6 % gay male, 3.8 % bisexual female and 1.5 % bisexual male adults). We examined use of ≥2 substances (of 16 measured) in the past 30 days. The independent variable was sexual identity (self-identity of sexuality). We did linear and quadratic trend tests to estimate differences by sexual identity and sex over time adjusted for other sociodemographic factors.

Both lesbian (β = 0.12; p < 0.001) and bisexual (β = 0.07; p < 0.001) female adults had an increase in using ≥2 substances from 2021 to 2023. Lesbian female adults had the highest increase of using ≥2 substances use from 2021 to 2023 (17.3 %; p < 0.001), followed by bisexual female adults (10.6 %; p < 0.001).

Using ≥2 substances increased the most among LGB female adults than heterosexual male, heterosexual female and LGB male adults from 2021 to 2023. Providing additional resources to develop effective strategies that address using ≥2 substances among LGB female adults may help mitigate their related risks.