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    Why LGBTQ+ Youth Are at Increased Risk for Substance Use & How You Can Help

    Youth who identify as LGBTQ+, an umbrella acronym that encompasses different sexual orientations and gender identities, face a heightened risk for substance use because of the stigma and discrimination they often experience.

    You can help protect your LGBTQ+ child from substance use by being supportive of their identity, offering unconditional love and support, and responding quickly and effectively if your child shows signs of risk.

    Mental health & substance use

    LGBTQ+ individuals are about twice as likely to suffer from a mental health disorder as those who identify as heterosexual.[1] A 2019 national survey of mental health among LGBTQ+ youth found they continue to face numerous mental health challenges despite societal progress.[2]

    The fact that LGBTQ+ youth are at increased risk of experiencing mental health problems helps explain their increased risk of substance use and addiction. Youth who identify as a sexual minority (LGBTQ+) are about twice as likely to use substances as youth identifying as heterosexual.[3] Sexual minority youth are also at increased risk of using multiple substances (polysubstance use), which exacerbates the harms.[4]

    Mental health and substance use disorders are linked. Youth who suffer from one are more likely to experience the other. Approximately 60-75% or adolescents with mental illness have a co-occurring substance use disorder.[5]

    Note that being LGBTQ+ is not inherently a risk factor for experiencing a mental health or substance use disorder. The heightened risk comes from the stigma and discrimination they face as a result of their sexual orientation and/or gender identity. Being LGBTQ+ is not a mental illness, nor is it a choice, and should not be referred to as such.

    Special considerations for transgender youth

    Transgender youth face even higher levels of stigmatization and discrimination, corresponding to higher rates of mental health challenges and suicidality[6]. One research study shows that transgender youth have a 2.5 to 4 times higher risk of substance use relative to their cisgender peers.[7] Research conducted by the Human Rights Campaign explores the greater challenges faced by transgender youth and the consequences of growing up in unsupportive home, school or social environment.

    Additional risk factors

    LGBTQ+ youth often encounter additional circumstances – likewise stemming from stigma and a lack of acceptance – that increase their risk for substance use.

    Lack of family connection

    Parents and caregivers are the biggest influence on their children’s decisions to use nicotine, alcohol or other drugs. A poor relationship can interfere with the type of open and honest communication that protects against substance use. Research from the Family Acceptance Project found that sexual minority young adults who experience family rejection during adolescence are more than three times as likely to use illicit drugs[8] as those who are accepted by their family.

    Social anxiety

    Anxiety among LGBTQ+ youth in social situations, such as when they first begin socializing within the community or when they are around others who may not be accepting of their identity, can fuel substance use.


    LGBTQ+ youth are at heightened risk of experiencing homelessness due to family rejection, which puts them at significant risk for using substances.[9] Up to 40% of the homeless youth population identify as LGBTQ+[10], and this population uses substances at a higher rate and more frequently than other homeless youth.[9]


    Physical and verbal harassment toward LGBTQ+ youth – often in school settings – takes a significant toll on mental health. Research has found an association between victimization against LGBTQ+ students in schools and increased likelihood of substance misuse.[11]

    Protecting your LGBTQ+ child

    Because your child may face additional pressures and challenges, demonstrating your love, acceptance and support is essential to reducing their substance use and addiction risk. Research shows that family support and acceptance can help significantly decrease an LGBTQ+ adolescent’s likelihood of substance use and improve their mental health.[12] This means actively affirming their identity rather than merely tolerating it.

    Ways to actively support your LGBTQ+ child and minimize their risk of substance use include:

    Learn about and get involved with the LGBTQ+ community

    You can demonstrate support by encouraging your child to get involved in LGBTQ+ community activities, and by getting involved yourself. Helping your child find community social activities to overcome isolation and stigma that don’t involve substances can help prevent or stop their substance use.

    Explore the unique issues faced by LGBTQ+ youth and communicate openly with your child about these topics. Learn and use affirming, respectful language when referring to your child and other members of the LGBTQ+ community, and help to normalize this show of support in your larger family and community.

    Help your child access additional support

    Many behavioral health care providers specialize in or have professional experience with issues unique to LGBTQ+ youth. It can benefit your child to receive support from these providers. Affirmation-based therapy, which consists of supporting LGBTQ+ individuals and increasing their confidence, can improve mental health. Engaging in community and school programs that address specific LGBTQ+ risk factors can also help prevent substance use.

    Get support for you and your family

    Personal support can better equip you to care for your child and keep them safe. Working with a support group specifically for parents of LGBTQ+ youth or seeking family or individual therapy can be helpful for you and your child’s mental health. You can learn more about the community, how your behaviors can affect your child and talk about your thoughts and feelings. For many parents, this may include concerns about how they will be treated in society and how best to support them with other family members, friends and the community at large.

    Use and share correct pronouns

    It has become more common for people to introduce themselves with their personal gender pronouns (e.g., she/her, he/him, they/them) – for example, in group settings or in their email signature. Not everyone has a gender identity that we perceive to match their gender appearance. Many individuals do not fall within the gender binary at all. Making a conscious effort to express your pronouns to others – and not assume another’s pronouns – is a simple way to normalize the full range of gender identity. It also helps ensure that all individuals feel included and affirmed regardless of gender.

    Have open and on-going conversations

    On-going conversations will help you recognize when they need support and how best to help. Consider asking these questions:

    • What name/pronouns would you like me to use?
    • What safety concerns do you have? What can I do to help?
    • If someone asks me about your gender identity, expression or sexual orientation, how would you like me to respond?
    • How do you feel that your friends and others are supporting you? What can I do to help?

    Overall, you want the message to be that they are loved for who they are and they can come to you at any time to discuss their concerns.

    Where to find support

    Many organizations and programs can help support you and your child with everything from connecting to other families who share your experiences to finding helpful information to seeking professional help: