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Substance Abuse

Sexual minority teens experiment with alcohol and drugs at higher rates than their straight peers.


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Drug use is often described as a “rite of passage” for teens in many books, movies, and television shows. Research shows that, generally, most people do “experiment” for the first time in adolescence with either alcohol or cannabis. While most media has reflected the heterosexual experience, the same issues affect rainbow teens.  Given that drug use is a consistent and growing issue for the rainbow community, this article will explore the landscape of adolescent drug use, data on LGBTQ+ specific struggles and addiction, and basic considerations for discussing and mitigating drug use with your teen. Before we begin, let’s go over some of the basic terms related to drugs and drug use.

  • Intoxication: a state of being, subjectively or objectively, noticeably influenced by mind-altering substances (seen in mood/affect/thinking/behavior).
  • Drug: any mind-altering substance that can be consumed to achieve a particular state of euphoria or mood/awareness alteration (alcohol, nicotine, cannabis, etc.).
  • Psychotropic drug: (typically) synthetics for treatment of mental disorders.
  • Experimentation: a one-time use of a mind-altering substance, typically the first time using drugs, wherein the person is naïve to the substance/its effects and has the intention of seeing if the effects of said substance produce a desirable mind-body state.
  • Substance abuse (drug abuse): continued use of substances despite consequences.
  • Tolerance: needing to consume more of a drug to get the same “effect” that was achievable when previously using less of a drug (ex. Needing more weed to feel the same degree of “relaxed” compared to a month ago).
  • Withdrawal: a characteristic syndrome of mood/affect, cognitive, and bodily states for given drugs after abstinence.
    • Depends upon: tolerance, length of use, route of administration, half-life.
    • Two types of withdrawal: Acute vs post-acute withdrawal
    • Acute withdrawal, typically lasts between 2 and 14 days for most drugs, represents the changes in the body/brain after cessation of drugs and how the body responds to not having the same level of drug in the blood stream compared to when using the same/similar dose/amount consistently prior to cessation.
    • Post-acute withdrawal is a slightly less intense but longer period (up to 18 months for chronic amphetamine use) of the brain returning to a normal homeostasis upon prolonged abstinence from drugs.
  • Cross tolerance: a state of easier tolerance/sensitivity to a pharmacologically similar type of drug when already tolerant to one drug.
      • Example: Easily develop a Benzodiazepine (e.g., “Bars” or Xanax) tolerance when already dependent upon Alcohol or Cannabis
  • Reverse tolerance: or “sensitization”, smaller and smaller amounts cause a desired “effect.”
  • Dependence: when the body and brain develop a literal “need” for substance due to tolerance to either a) keep a normal mood/alertness or similar state and/or b) to prevent withdrawal states that cause the person intense psychological and/or physical (ex. panic or vomiting).
  • Addiction:
    • Compulsive drug use + physical dependence+ Psychological dependence
    • A “Relationship to intoxication.” (Think romantic relationship)
    • The characteristic brain disease wherein shifts in mood/memory/attention/motivation occur to the point at which both tolerance and withdrawal have developed and the person now believes that they need to have the substance to function. This includes psychosocial issues such as “denial,” “manipulation,” lying about substance use, and many more symptoms associated with a classical notion of an “addict.”
  • Relapse: the return to regular and compulsive/impulsive use of drugs after a period of sustained abstinence.
  • Slip: (typically) a one-time, brief use of a drug that is not impulsive/compulsive after a period of sustained abstinence in which the person immediately goes back to a recovery plan and is honest with all important persons in their life about said slip.
    • Example: A newly sober person feels peer-pressured when a friend unexpectedly brings out a vaporizer with THC in it, immediately regrets said decision to vape the THC vaporizer, and tells family/therapist/sponsor about the incident, returns to recovery plans and recommits to abstinence.

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Drugs have been integral to human cultures for thousands of years, and there are numerous reasons why people use them. Of the 488 cultures on the planet, 437 have been using mind-altering substances throughout their history. Often, drugs had ritual or spiritual significance and were used to reach a higher/transcendent state of mind [1]. Today, many people use drugs in a minimally problematic or non-problematic manner, for euphoria (pleasure), coping with emotions, and/or peer-communal rituals.

As for drug use amongst rainbow adolescents, social scientists have various theories why they typically consume drugs more frequently than their heterosexual peers [5,8,21]. First, they struggle more often with stigma and bullying than their heterosexual peers. Second, internalized homophobia (intense shame and/or disgust about one’s sexual identity) also plays a role in stress and social isolation, which can lead to wanting to cope with drugs. Third, non-conforming teens are greater at risk of trauma and depression disorders, which can result in using drugs to cope. The popularity and ubiquity of certain drugs in gay youth cultures make them easily available and can make younger teens seeking gay friends vulnerable to peer pressure. They may think they won’t fit in with the gay scene of they do not drink and use the substances they see others enjoying.

According to the nationally representative data from the 2019 “Monitoring the Future” survey [2] put out by the National Institute of Drug Abuse (NIDA) and National Institute of Health (NIH), illicit drug use is down since 2001. However, nicotine “vaping” is up dramatically. For example, the prevalence (how many total) of vaping was at ~5% among 12th graders in 2017, and in 2019 it was at 14%. The number of teens who reported vaping in the past month increased from 12% to 25%. Between 12 and 36% of teens smoked or vaped cannabis in the past year, with daily cannabis use rates increasing in 8th, 10th, and 12th graders. Misuse of psychotropic drugs and prescription opiates (pain killers) is also on a continual decline due to stricter enforcement of their distribution, but parents need to be aware that many pills circulate on the black market that claim to be pharmaceutical grade prescription drugs, but are actually laced with deadly substances like fentanyl. Roughly 6 of 10 students will drink by the time they graduate, but only ~1.7% drink daily, and roughly ~9% of teens have been “drunk” in the past month.

While the vast majority of teens have consumed alcohol or smoked cannabis by the time they graduate high school, most teens do not regularly use mind-altering substances. However, use of nicotine and cannabis are on the rise and can have adverse effects on the developing minds of teenagers if overused.

Rainbow teens are at greater risk of regular use of drugs compared to their heterosexual peers. According to different studies, up to 20% of LGBT teens used drugs in the past month. [4]. This trend, however, is not new. For decades, LGBT teens have disproportionately struggled with substance use problems [5,26-27]. This is true in both big cities and rural areas alike [6], and it does not vary much by age either (i.e., younger versus older adolescents) [29]. As for trans (female) youth, some studies reveal that upwards of 69% reported past month drug use [32].

Common risk factors for trans youth include trauma/victimization history, gender discrimination, and/or parental drug use [32]. Adolescent lesbian girls appear to be at greater risk for cannabis, alcohol, and cigarette use compared to their heterosexual counterparts [28], and other studies show that bisexual youth are at even greater risk of polysubstance use than their gay or lesbian peers [30,37].

In some studies, gay, lesbian, and bisexual adolescents abused substances at a rate 190% higher than heterosexuals of the same age, with bi-sexual youth 340% higher and sexual minority female adolescents 400% higher [34]. Another longitudinal study of 12,644 people aged 12-23 over the period 1999-2005, found that 49.6% of lesbian females and 59.9% of bi females had used marijuana during the last year, as opposed to 18.6% of completely heterosexual females [35]. A smaller, yet substantial, difference was seen for gay and bi males (32.1% and 38.5% respectively) as opposed to straight males (20.9%). The contrasts were even greater for use of other illegal drugs during the last year: 21.0% of lesbian females and 31.1% of bi females vs. 4.4% of completely straight females, 13.3% of gay males and 20.4% of bi males vs. 5.9% of completely straight males. A study of over 35,000 high school  students from 2005 to 2007 showed concerning rates for experimentation with heroin: 16.6% for gay or lesbian-identified teens and 27.9% for bi-sexual teens, as opposed to only 2.1% for heterosexuals [36]op

Given that it’s such a growing trend among our youth, here’s what we know about short-term and long-term use of cannabis in adolescence. Daily smoking, which is often classified as “heavy” smoking, is associated with poorer quality of life outcomes like homelessness [3]. Cannabis use through adolescence has been connected to attention issues, dependence, anxiety rebound, and a greater risk of adult mental health issues, especially psychosis [9-18,33].

However, it is still debated how greatly cannabis use in adolescents is linked to long-term decreased cognition and mental illness. Findings have been inconsistent, which means that many confounding variables are at play including psychiatric and other substance use comorbidities, frequency of use, and duration of abstinence period prior to testing. According to a SR/MA by Scott et al (2018), that last factor, duration of abstinence period prior to testing, had a particularly strong influence on results [39]. For example, studies that required participants abstain from cannabis for 72 hrs had a negligible effect size compared to studies that required shorter periods of abstinence [39].

Furthermore, the cognitive performance of adolescent cannabis users was not significantly associated with the cannabis use age of onset [39,40]. Thus, evidence suggests that even moderate amounts of cannabis use should not lead to permanent cognitive issues and that any lost brain function should return after cannabis use has ceased. This does not mean that cannabis should be treated lightly, however. First of all, teenagers need their brains at all times, not only after they reach adulthood. Ongoing intoxication can negatively affect academic performance, something that can damage their future prospects [41]. It can also lead to poor decision making, such as unprotected sex or reckless behavior. Moreover, frequent and heavy use can cause a dependency, making quitting in adulthood difficult [42,43].  

The three drugs that teens are most likely to struggle with are nicotine, cannabis, and alcohol, and this is true for rainbow teens as well. In fact, we know that generally speaking more rainbow teens smoke than heterosexual teens, on average [21]. There are, however, some drugs that are generally used more in the LGBTQ teen community, often for cultural/sexual reasons.

One example of this is amyl nitrate, often called “poppers.” Many LGBT teens, especially gay males, use these drugs, and it’s a risk for problematic alcohol use and condomless sex. Poppers serve the purpose of providing a short yet intense euphoria and mild dissociation experience, and are typically used during sex. They may also act as a muscle relaxant during receptive anal sex. Poppers look like a small brown glass bottle, about the size of a credit card or so, typically wrapped in a colorful label like “PWD” or “Rush” or something similar. These drugs have some unexpected risks, including burns on the skin where the chemicals touch, blood flow problems (after long-term use), vision loss, and worsening of underlying medical conditions.

Another drug commonly seen in gay male sex subcultures is crystal methamphetamine, or “Tina.” Meth is a highly addictive substance that can cause long-term problems from dental degeneration to violent or aggressive behavior [44]. Many “circuit” and “rave’ LGBT subcultures often involve ecstasy/MDMA and ketamine or “K.” Other common “club” drugs include cocaine, GHB, and rohypnol [22-24].

Starting with ecstasy, research reveals that this is a relatively benign drug, with mild long-term adverse effects [45]. However, precautions must be taken. In high doses, ecstasy disrupts the body’s ability to regulate internal temperature, which can lead to fever, organ damage, and in rare cases, death [46]. Ecstasy is most dangerous when it is not actually ecstasy. What dealers label as ecstasy often contains other substances such as methamphetamine or cocaine, which people consume without realizing [46].

Ketamine is a drug used for anesthesia and pain management, and is sometimes used to treat depression. Long-term use has been linked to cystitis and other urinary issues [47]. Heavy users also show increased cognitive deficits [48]. However, infrequent and recreational use was not associated with any significant cognitive impairments [48]. Tolerance to ketamine is built quickly, though, and can become addictive if taken too often [49]. It can also cause death or injury via accidents such as drowning, falling, etc., as it causes a state of dissociation and derealization.

Cocaine is a drug that causes temporary periods of euphoria and high energy. It is, however, one of the most addictive drugs, and people develop a tolerance to it very fast, making the threat of overdose great [50]. Cocaine is even more dangerous when combined with other substances like alcohol [50] and especially opioids. According to a press release by NYU Langone Health, three-quarters of all deaths involving cocaine (and half of those involving methamphetamine/other stimulants) also involved opioids [19]. In short, these drugs should be avoided at all costs.

Lastly, GHB and rohypnol are depressants, or “downers,” and they are used to facilitate sleep, or sometimes recreationally to create a relaxed and euphoric state. These are also two of the most commonly used date rape drugs. They lower self-awareness and inhibition, and can leave one vulnerable to sexual assault, as well as other types of violence [20]. GHB is a clear and flavorless liquid that can easily be slipped into a drink, while Rohypnol is made as a light green pill with a blue center [20]. Drug companies design them to turn a drink blue in order to warn potential victims, though the effect is minimal in a dark drink like root beer. Rainbow teens are very prone to sexual assault, so make sure they know not to leave their drinks unattended, and to always stay in a group.

Given the increased risk of medical consequences and/or sexual assault, we advise against allowing teens to attend circuit parties or “raves,” especially if you know they have substance use issues


According to the American Psychiatric Association (2013), problematic substance use is called a substance use disorder (SUD) and can be either mild, moderate, or severe. A mild SUD is the endorsement of two to three symptoms. A moderate SUD contains four to five symptoms, and a severe SUD contains six to 11 symptoms. These symptoms have to be present in any year period (continuous 12 months) and cause impairment. Common symptoms of a substance use disorder include:

  • Using more of the drug than you originally intended.
  • Using the drug despite role failures (ex. At work or school or home).
  • Using the drug despite known medical consequences (ex. Continuing to smoke cannabis when you have a breathing problem like asthma).
  • Using the drug in hazardous situations (ex. Drinking and driving).
  • Giving up, or significantly lessening, previously important/enjoyable activities to use drugs (ex. Skipping out on friend time or sports to get high).
  • A great deal of time is spent using/obtaining/recovering from the drug.
  • Cravings
  • Tolerance
  • Withdrawal (each drug has its own specific syndrome)

First, it’s best to start by trying a simple, open-minded, curious, and non-accusatory conversation. Many, if not most, teens will respond well to this approach. If you encounter any resistance, try not to fight it. Fighting or confrontational approaches to touchy topics rarely work well. If you experience resistance, do your best to reaffirm that there’s no punishment or anger, simply curiosity and mild concern. If worst comes to worst, you can ask them to take a urine test. These are cups with test-strips on them, and they are easily available at stores such as Walgreens. However, even if they truly do have a drug problem, there are better ways to provide them with help. If you can show them that you are trustworthy and are concerned with their well-being instead of judging or moralizing, the chances are they will open up to you on their own. To help you both get on the same page, here are useful articles on how to address sensitive issues with your teen:,,

If your teen is struggling with a substance use disorder, one of the tactics they may use to convince you they do not have a drug problem is by pointing to your own substance use. How you should respond to this depends on your own relationship with drugs and alcohol. Teenagers turning the table on you like this can quite possibly be a misdirection technique, similar to those used by illusionists. However, this could be their way of letting you know that whether or not they have a problem, you’re in no position to correct it.

If you do take substances, and you don’t believe you have a problem, then take the time to discuss your substance use with them. If it is infrequent and it does not interfere with your health or your duties, they can compare their situation to yours and they may realize that theirs is more problematic. However, when explaining your substance use to them, it may become clear that you have a problem as well. If this is the case, you can think of it as an opportunity for the two of you to help each other.     

Either way, if your teen does have a drug problem and is ready to address it, the best way to start is to find a qualified mental health/addictions specialist to explore the problem with them, because, as a parent, fully understanding the scope/seriousness of the issue is likely beyond your expertise. A professional in these areas can best communicate the risks of drugs on an adolescent’s brain, body, and future. He or she is also necessary for getting to the root of the issue. For some teens, drug use is because of peer pressure, for others it’s mainly a poor coping skill, yet for others it could only be for sexual purposes, and yet others may have legitimate drug dependence issues.

There are multiple ways to find a qualified professional, including Psychology Today and SAMHSA’s “Treatment Finder.” You are also welcome to contact this website and we can put you in contact with an experienced LGBTQ addiction specialist for consultation.

Positive reactions and supportive stances towards “coming out” are correlated with less drug use [4].  More recent research also shows that teens living in communities with more rainbow-friendly services used drugs less often and less problematically [8]. Another overall finding is parents being more aware and involved with their teens helps prevent mental health and substance use disorder issues [7]. Moreover, medical professionals (i.e., doctors) knowing the signs of drug misuse have an important role to play in reducing the frequency/problematic nature of drug use [7].  Another factor that helps prevent the onset of drug misuse in a few studies is feeling a stronger sense of connection in a school community [25]: schools with a “Gay-Straight Alliance” (GSA) club of some sort are protective against drug use behavior, whereas kids at schools with no GSA were up to twice as likely to report drug misuse [31].

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