Sexual minority individuals report greater rates of substance use compared to their heterosexual counterparts. Internalized heterosexism (IH) is one critical factor underlying this disparity. There has been a proliferation of studies examining IH as a correlate of substance use; however, results of these studies have been mixed. The purpose of the current multilevel meta-analysis was to explain these mixed findings by identifying factors that moderate the overall relationship between IH and substance use. Results from the analysis of 49 studies (209 effect sizes and 162,674 participants) demonstrated a positive overall relationship between IH and substance use (r = .065). This relationship was significantly moderated by sexual orientation, gender, and type of substance. Increased IH was linked to increased use of heroin (r = .173), cocaine (r = .135), tobacco (r = .100), and alcohol (r = .070). Implications for research, practice, and policy are discussed.
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