Differences in Substance Use Disorder Severity Among Sexual Minority Adolescents and Emerging Adults: Results from the 2023 National Survey on Drug Use and Health
Restricted accessResearch articleFirst published online April, 2026
Differences in Substance Use Disorder Severity Among Sexual Minority Adolescents and Emerging Adults: Results from the 2023 National Survey on Drug Use and Health
The purpose of this study was to describe disparities in the severity of substance use disorders (SUDs) between sexual minority (SM) and heterosexual youth.
Methods:
The current study analyzed data from the 2023 National Survey on Drug Use and Health to examine differences in SUDs between SM and heterosexual youth. Analyses were limited to participants aged 12–25 years (n = 23,333). Participants reported on their sexual identity and completed items on past-year substance use. SUDs were classified using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria. A separate multinomial regression model was conducted for each outcome (alcohol use disorder [AUD] severity, cannabis use disorder [CUD] severity, and drug use disorder severity), stratified by age and sex. Each model included sexual identity as the primary predictor.
Results:
Odds for meeting criteria for an SUD at any severity level were generally highest for bisexual youth compared with all other youth, with few exceptions. AUD severity varied slightly among adolescents, and CUD varied slightly among males.
Conclusion:
This study is the first to identify differences in DSM-5 SUD severity between SM and heterosexual youth. The findings underscore the importance of developing clinical interventions tailored to the distinct challenges faced by SM youth, especially bisexual youth, to help reduce disparities in substance use outcomes.
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