Being LGBTQ does not cause substance use, nor is substance use always related to an individual’s LGBTQ identity. LGBTQ people may use substances for the same reasons that other people do. However, it is also important to realize that there are some culturally specific reasons that LGBTQ people have high rates of substance use:
Lack of non-bar space: For many years, discrimination against LGBTQ people made visibility unsafe, and there were few options for socializing in LGBTQ environments apart from bars or parties. As a result, many LGBTQ people associate socializing with the use of alcohol and other drugs. When bars are a primary social outlet LGBTQ people may develop a peer set that uses alcohol or other substances regularly. Even now, not everyone within our communities has safe non-bar space in which to socialize.
Cultural acceptance: The use of some substances may be accepted within LGBTQ communities, or may be considered a part of cultural life, demonstrating or confirming personal identity and group belonging. A Toronto study of racial minority gay and bisexual men who attended circuit parties and clubs, for example, found that some participants reported feeling a sense of pressure or obligation to use drugs, especially if their friends were using them.
Criminalization History: Until 1969, homosexuality was illegal in Canada, and police repression of LGBTQ communities was constant. As a result, the fact that a drug is illegal may not communicate the same certainty of risk to LGBTQ people as it might to their straight peers—the lived experience of many LGBTQ people is that not everything that is criminalized is wrong.
Coping with Stigma: Some LGBTQ people use substances to cope with the stress of coming out, rejection from family and friends, discrimination, harassment, or internalized biphobia, transphobia, or homophobia.(12-13) Since LGBTQ people may deal with stigma throughout their lives, they may not exhibit the reduction in substance use with aging that is seen within the general population.
Coping with trauma: A small US study found that experiences of violence, feeling unsafe on campus, and stress were associated with increased substance use among LGB students (trans students were not included in this study). A US study of HIV+ people found that traumatic stress related to their HIV status was associated with increased use of cocaine and crack.
Altering Mood: Studies with HIV+ trans people and men who have sex with men (MSM) found that feelings such as shame and internalized homophobia were associated with methamphetamine (meth) use. Researchers speculate that this may be a causal relationship.
Self-Medicating: Some LGBTQ people use substances to reduce the effects of health problems. The use of marijuana, for example, has been associated with anxiety and other mood disorders, but the directionality of the association (whether cannabis increases anxiety or whether anxiety draws people to use cannabis) has not been determined.
Recreation: The Addiction Research Foundation of Ontario noted that cannabis use enhances sensual pleasure, facilitates socializing, supports introspection and alleviates pain.(20) Other substances may offer similar benefits that outweigh or reduce the perceived risks of use.