Substance use patterns among sexual minority women: a mini review

Sexual minority women (SMW), including lesbian, bisexual, and other non-heterosexual women, experience higher rates of substance use (SU) and substance use disorders (SUDs) than heterosexual women, yet remain relatively underrepresented in the literature.

This structured mini-review aimed to synthesize evidence on prevalence patterns, determinants, intersectional influences, treatment barriers, and intervention approaches related to substance use among SMW.

A structured narrative review of epidemiological studies, reviews, and meta-analyses was undertaken using predefined thematic domains: epidemiology, determinants/pathways, intersectionality, and treatment-related issues. Evidence was synthesized narratively because of heterogeneity in populations, outcome measures, and study designs.

Across much of the available literature, SMW show elevated prevalence of alcohol, tobacco, cannabis, and polysubstance use compared with heterosexual women, with bisexual women frequently identified as the highest-risk subgroup. Reported determinants include minority stress-related processes, internalized stigma, discrimination, victimization, and adverse childhood experiences. Intersectional disadvantage, including racial/ethnic minority status and socioeconomic marginalization, may further amplify vulnerability. Treatment access is hindered by stigma, limited LGBTQ+-affirming services, and gaps in provider cultural competence. Evidence for SMW-specific interventions remains limited.

Available evidence suggests that substance use disparities among SMW are shaped by minority stress, intersecting social disadvantage, and barriers to inclusive care. More methodologically rigorous, intersectionally informed, and geographically diverse research is needed, alongside development of identity-affirming and trauma-informed interventions.