Lesbian, Gay, 

and Bisexual 

Behavioral Health: 

Results from the 

2021 and 2022 National 

Surveys on Drug Use 

and Health
Lesbian, Gay, and Bisexual Behavioral Health: 

Results from the 2021 and 2022 National Surveys on Drug Use and Health

Acknowledgments

This report was prepared for the Substance Abuse and Mental Health Services Administration (SAMHSA), under 

Contract No. HHSS283201700002C with SAMHSA, U.S. Department of Health and Human Services (HHS). Marlon 

Daniel served as the government project officer and as the contracting officer representative. SAMHSA review was led 

by Douglas Richesson, Iva Magas, Samantha Brown, and Jennifer Hoenig. Tenecia Smith was an additional reviewer.

Public Domain Notice

All material appearing in this report is in the public domain and may be reproduced or copied without permission 

from SAMHSA. Citation of the source is appreciated. However, this publication may not be reproduced or 

distributed for a fee without the specific, written authorization of the Office of Communications, SAMHSA, HHS.

Electronic Access

This publication may be downloaded at https://store.samhsa.gov. Or call SAMHSA at 

1-877-SAMHSA-7 (1-877-726-4727) (English and Español).

Recommended Citation

Substance Abuse and Mental Health Services Administration. (2023). Lesbian, gay, and bisexual behavioral health: 

Results from the 2021 and 2022 National Surveys on Drug Use and Health (SAMHSA Publication No. PEP23-07-01-001). 

Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. 

https://www.samhsa.gov/data/report/LGB-Behavioral-Health-Report-2021-2022

Originating Office

Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, 

5600 Fishers Lane, Room 15-E09D, Rockville, MD 20857. For questions about this report, please email 

CBHSQrequest@samhsa.hhs.gov.

Nondiscrimination Notice

The Substance Abuse and Mental Health Services Administration (SAMHSA) complies with applicable Federal civil 

rights laws and does not discriminate on the basis of race, color, national origin, age, disability, religion, or sex (including 

pregnancy, sexual orientation, and gender identity). SAMHSA does not exclude people or treat them differently because 

of race, color, national origin, age, disability, religion, or sex (including pregnancy, sexual orientation, and gender identity).

Substance Abuse and Mental Health Services Administration

Center for Behavioral Health Statistics and Quality

Office of Population Surveys

SAMHSA Publication Number PEP23-07-01-001

June 2023
Substance use and mental health issues have significant 

impacts on people, families, communities, and societies. 

A higher prevalence of substance use and mental health 

issues has been well documented among people who 

identify as lesbian, gay, or bisexual (also referred to as 

sexual minorities) than among those who identify as 

heterosexual or straight.1,2,3 Sexual minorities experience 

unique stressors that can contribute to adverse 

substance use and mental health outcomes.4,5,6 People 

who identify as bisexual may experience additional 

problems with substance use and mental health due 

to sexual orientation-based discrimination, bisexual 

invisibility and erasure, and a lack of bisexual-affirmative 

support.7 Challenges faced by members of sexual 

minorities can be further compounded by the experience 

of being female or a person of color.8,9,10 

Survey Background

The National Survey on Drug Use and Health (NSDUH) 

is an annual survey sponsored by the Substance Abuse 

and Mental Health Services Administration (SAMHSA) 

within the U.S. Department of Health and Human 

Services. NSDUH covers residents of households 

and people in noninstitutional group settings. The 

survey excludes people with no fixed address, military 

personnel on active duty, and residents of institutional 

group settings, such as jails, nursing homes, mental 

health institutions, and long-term care hospitals. Further 

information about the NSDUH design and methods 

can be found in the 2021 National Survey on Drug Use 

and Health (NSDUH): Methodological Summary and 

Definitions.

11 Appendix A in the 2021 Methodological 

Summary and Definitions report also defines relevant 

measures and terms.

Presentation of Estimates and Statistical Testing

This report focuses on substance use and mental health 

indicators among adults aged 18 or older in the United 

States based on pooled NSDUH data from 2021 and 

2022. Estimates are presented by adults’ sexual identity 

(i.e., gay/lesbian, bisexual, straight) and gender. All estimates 

(e.g., percentages and numbers) presented in the report are 

derived from survey data that are subject to sampling errors 

and have met the criteria for statistical precision.12

Because of differences in the age distributions for sexual 

identity groups in the 2021 and 2022 NSDUH samples, 

estimates were age adjusted to the adult age distribution 

of the 2000 U.S. standard population in accordance 

with federal agency best practices.13 Figures in this 

report present the age-adjusted estimates. Tables in 

Appendix A present both unadjusted and age-adjusted 

estimates; the unadjusted estimates indicate the actual 

prevalence estimates among sexual identity groups 

before differences in age distributions were taken 

into account. 

Comparisons of age-adjusted estimates across 

groups were performed according to statistical testing 

procedures described in the 2021 Methodological 

Summary and Definitions report.14 Differences in 

age-adjusted estimates were considered statistically 

significant at the .05 level of significance. Statistically 

significant differences resulting from these testing 

procedures are described using terms such as “higher,” 

“lower,” “more likely,” or “less likely.” Statements use 

terms such as “similar” or “the same” when a difference 

was not statistically significant. When estimates are 

presented without reference to differences across 

groups, statistical significance is not implied.

INTRODUCTION

In the 2021 and 2022 National Surveys on Drug Use and 

Health (NSDUHs), only a binary measure of male or female 

was collected. The 2021 and 2022 NSDUHs also collected 

information on sexual identity only from adults. Therefore, 

this report does not present findings for transgender 

people, non-binary people, or those people with any 

other identity besides binary male or female, and it does 

not present findings on sexual identity for adolescents 

younger than 18. Beginning with the 2023 NSDUH, the 

survey asks respondents their sex at birth and their gender 

identity, including whether they identify as male, female, 

transgender, or another identity. The 2023 NSDUH also 

asks all respondents about their sexual identity, regardless 

of age. In addition to choices for heterosexual/straight, gay 

or lesbian, and bisexual, NSDUH respondents in 2023 can 

report that they use a different term (and specify the other 

term), they are not sure about their sexual identity, or they 

do not know what the sexual identity question is asking.

1
DEFINITIONS

SUBSTANCE USE

Binge drinking means consumption of four or more 

drinks on the same occasion for females and five or more 

drinks on the same occasion for males on at least 1 day in 

the past 30 days. Heavy drinking means binge drinking 

on 5 or more days in the past 30 days.

Illicit drug use includes the use of marijuana, cocaine, 

heroin, hallucinogens, inhalants, and methamphetamine, 

as well as the misuse of prescription drugs (pain relievers, 

tranquilizers, stimulants, or sedatives). Misuse of 

prescription drugs means use in any way not directed 

by a doctor, such as use without a prescription of one’s 

own, or use in greater amounts, more often, or longer than 

told to take a drug.

MENTAL HEALTH

Any mental illness (AMI) refers to the presence of a 

mental, behavioral, or emotional disorder in the past year 

of sufficient duration to meet criteria from the Diagnostic 

and Statistical Manual of Mental Disorders, 4th edition, 

excluding developmental disorders and substance use 

disorders.16 Serious mental illness (SMI) refers to 

the presence of a mental, behavioral, or emotional disorder 

that substantially interfered with or limited one or more 

major life activities. AMI and SMI were estimated based 

on a statistical prediction model. For more details on the 

estimation of AMI and SMI, see the 2021 National Survey 

on Drug Use and Health (NSDUH): Methodological Summary 

and Definitions report.11

National Survey on Drug Use and Health respondents were 

classified as having a major depressive episode 

(MDE) in the past 12 months if (1) they had at least one 

period of 2 weeks or longer in the past year when for most 

of the day nearly every day they felt depressed or lost 

interest or pleasure in daily activities; and (2) they also 

had problems with sleeping, eating, energy, concentration, 

self-worth, or having recurrent thoughts of death or 

recurrent suicidal ideation. The MDE questions are based 

on diagnostic criteria from the Diagnostic and Statistical 

Manual of Mental Disorders, 5th edition.15

SUBSTANCE USE DISORDERS

Substance use disorders (SUDs) are characterized 

by impairment caused by the recurrent use of alcohol or 

other drugs (or both), including health problems, disability, 

and failure to meet major responsibilities at work, school, or 

home. Respondents who used alcohol or drugs in the past 

12 months were classified as having SUDs in that period if 

they met criteria specified in the Diagnostic and Statistical 

Manual of Mental Disorders, 5th edition.15

SEXUAL IDENTITY

Sexual identity among adults refers to whether adults 

consider themselves to be straight (i.e., heterosexual), 

lesbian (if female), gay (if male), or bisexual.

2
SUBSTANCE USE

Cigarettes | Alcohol

CIGARETTE SMOKING

Percentage using in past month

ALCOHOL USE

Percentage using in past month

Bisexual

Gay

Straight

Lesbian

Bisexual

Straight

27.2

24.6

13.8

20.8

25.0

18.7

Female

Male

0

70

Lesbian Gay

10

20

30

40

50

60

Bisexual Straight

ANY ALCOHOL USE

BINGE ALCOHOL USE

HEAVY ALCOHOL USE

Bisexual Straight

57.9 59.3

49.6

65.0

57.9

55.8

Female Male

9.1

4.4

8.6 7.9 8.2

10.9

29.0

31.6

21.4

31.1

26.3 27.2

⬣ For sexual minority females, the prevalence of 

cigarette smoking in the past month was roughly

twice that for straight females.

⬣ Bisexual males were more likely than straight 

males to have been cigarette smokers in the past 

month, but the prevalence of cigarette smoking did 

not differ between gay males and straight males.

⬣ There was no difference in the 

prevalence of binge or heavy drinking 

in the past month between sexual 

minority males and straight males.

⬣ Sexual minority females were 

more likely than straight females to 

have been binge drinkers in the past 

month. Sexual minority females

were about twice as likely as 

straight females to have been heavy 

drinkers in the past month.

BINGE DRINKING means consumption of four or more 

drinks on the same occasion for females and five or more 

drinks on the same occasion for males on at least 1 day in 

the past 30 days. HEAVY DRINKING means binge drinking 

on 5 or more days in the past 30 days.

Note: Estimates were age adjusted to the adult age 

distribution of the 2000 U.S. standard population.

Note: Estimates were age adjusted to the adult age distribution of the 2000 U.S. 

standard population.

3
ILLICIT DRUG USE

Percentage using in past year

⬣ Marijuana was by far the most commonly used illicit 

drug in the past year regardless of sexual identity

or gender.

⬣ Sexual minority females were 2 to 3 times 

more likely than straight females to have used 

marijuana in the past year. The prevalence was 

40% to 45% for sexual minority females.

⬣ Marijuana use in the past year among sexual 

minority males was nearly twice as high

compared with marijuana use among straight males. 

The prevalence was roughly 40% for sexual 

minority males.

⬣ Sexual minority males were 2 to 3 times more 

likely than straight males to have used illicit drugs 

other than marijuana in the past year.

⬣ Sexual minority females were 2 to 3 times 

more likely than straight females to have used illicit 

drugs other than marijuana in the past year.

SUBSTANCE USE

Any Illicit Drugs | Marijuana | Illicit Drugs Other Than Marijuana

0

50

Lesbian Gay

10

20

30

40

Bisexual Straight

ANY ILLICIT 

DRUG USE

MARIJUANA USE

ILLICIT DRUG USE 

OTHER THAN 

MARIJUANA

Bisexual Straight

39.0

13.8

19.4

6.7

23.5

26.7

9.7

45.9

17.5

40.8

42.9

23.9

49.7

20.4

47.8

49.5

26.7

43.2

Female Male

ILLICIT DRUG USE includes the use of marijuana, cocaine, heroin, 

hallucinogens, inhalants, and methamphetamine, as well as the misuse of 

prescription drugs (pain relievers, tranquilizers, stimulants, or sedatives). 

MISUSE OF PRESCRIPTION DRUGS means use in any way not directed 

by a doctor, such as use without a prescription of one’s own, or use in greater 

amounts, more often, or longer than told to take a drug.

Note: Estimates were age adjusted to the adult age distribution of the 2000 

U.S. standard population.

4
SUBSTANCE USE

CNS Stimulants | Cocaine | Rx Stimulants | Methamphetamine | Opioids

CNS STIMULANTS

Percentage using or misusing in past year

⬣ Sexual minority adults were at 

least twice as likely as straight adults 

to have misused any CNS stimulant in 

the past year. Roughly similar patterns 

held for each individual CNS stimulant 

(cocaine, methamphetamine, or 

prescription stimulants).

⬣ Bisexual females were almost twice as likely 

as lesbian females and more than 3 times 

as likely as straight females to have misused 

opioids in the past year.

⬣ Bisexual males were about twice as likely as 

straight males to have misused opioids in the past 

year. The prevalence did not differ between gay 

males and straight males.

OPIOID MISUSE

Percentage misusing in past year

10.1

7.4

2.8

5.4

5.5

3.5

Bisexual

Gay

Straight

Lesbian

Bisexual

Straight

Female

Male

0

12

Lesbian Gay

3

6

9

Bisexual Straight

ANY CNS STIMULANT MISUSE

COCAINE USE

Bisexual Straight

3.3

2.1

2.9

1.3

3.7

2.8

1.7

4.5

1.0

4.1

6.7

2.6

7.8

2.4 2.5

0.6

9.7

5.3

11.1

3.7

4.6

1.2

METHAMPHETAMINE USE

5.0

0.9

MISUSE OF Rx STIMULANTS

Female Male

CNS = central nervous system; Rx = prescription.

Note: Estimates were age adjusted to the adult age distribution 

of the 2000 U.S. standard population.

Note: Estimates were age adjusted to the adult age distribution of the 2000 U.S. 

standard population. 5
SUBSTANCE USE

Inhalants | Hallucinogens | Rx Tranquilizers or Sedatives

Female

9.3 Gay

4.0 Bisexual Bisexual 13.8 

Male

Lesbian 0.7 

Bisexual 0.9 

Straight 0.2 0.6 Straight

12 8 4 0 4 8 12

Female

Straight 1.8 3.7 Straight

8.2 Gay

Bisexual 11.1 

Lesbian 4.1

Bisexual 6.3

Male

12 8 4 0 4 8 12

Female

4.3 Gay

3.8 Bisexual Bisexual 4.8

Lesbian 4.0

Male

Straight 1.7 1.6 Straight

12 8 4 0 4 8 12

Note: Estimates were age adjusted to the adult age 

distribution of the 2000 U.S. standard population.

Note: Estimates were age adjusted to the adult age 

distribution of the 2000 U.S. standard population.

INHALANT USE

Percentage using in past year

HALLUCINOGEN USE

Percentage using in past year

MISUSE OF Rx TRANQUILIZERS 

OR SEDATIVES

Percentage misusing in past year

⬣ Gay males were about twice as 

likely as bisexual males and 

about 15 times as likely as 

straight males to have used inhalants 

in the past year.

⬣ The prevalence of inhalant use in the 

past year among females was low.

⬣ Sexual minority adults were 

more likely than straight adults 

to have misused prescription 

tranquilizers or sedatives in the past 

year, a pattern similar to the findings 

for hallucinogen use. The prevalence 

for sexual minority adults was 

roughly twice as high as for 

straight adults.

⬣ Regardless of gender, bisexual 

adults were about 3 times 

more likely than their straight 

counterparts to have used 

hallucinogens in the past year.

⬣ Lesbian or gay adults were 

about twice as likely as their 

straight counterparts to have used 

hallucinogens in the past year.

Rx = prescription.

Note: Estimates were age adjusted to the adult age 

distribution of the 2000 U.S. standard population. 6
0

35

Lesbian Gay

30

25

20

15

10

5

Bisexual Straight Bisexual Straight

14.3

15.9

17.3

9.1

15.7

13.5

22.2

6.7

19.2

21.3

10.7

32.2

5.9

13.8

1.9

32.2

3.5

32.4

5.0

20.7

2.1

26.5

3.0

SUBSTANCE USE DISORDER (SUD)

DRUG USE DISORDER (DUD)

ALCOHOL USE DISORDER (AUD)

OPIOID USE DISORDER (OUD)

18.9

Female Male

SUBSTANCE USE DISORDERS

Percentage with disorder in past year

SUBSTANCE USE DISORDERS

Drug Use Disorder | Alcohol Use Disorder | Opioid Use Disorder

Note: Estimates were age adjusted to the adult age distribution of the 2000 U.S. standard population.

Sexual minority females were more 

likely than straight females to have had 

an AUD in the past year.

Gay males were more likely than 

straight males to have had an AUD in the 

past year. Percentages were similar 

between bisexual males and straight 

males.

Sexual minority adults were more 

likely than straight adults to have had a 

DUD in the past year; the same pattern 

held for any SUD.

About 1 in 5 bisexual males, 

bisexual females, and gay males had 

a DUD in the past year. 

Sexual minority adults were more 

likely than straight adults to have had an 

SUD in the past year.

About one third of bisexual males, 

bisexual females, and gay males

had an SUD in the past year. About one 

fourth of lesbian females had an SUD 

in the past year.

Bisexual females were 3 times as 

likely as straight females to have had an 

OUD in the past year.

For males, there were no differences in 

past year OUD by sexual identity.

SUBSTANCE USE DISORDERS (SUDs) are characterized by 

impairment caused by the recurrent use of alcohol or other drugs (or 

both), including health problems, disability, and failure to meet major 

responsibilities at work, school, or home. Respondents who used 

alcohol or drugs in the past 12 months were classified as having 

SUDs in that period if they met criteria specified in the Diagnostic 

and Statistical Manual of Mental Disorders, 5th edition.15 7
MENTAL ILLNESS

Percentage in past year

!

! !

MENTAL HEALTH

Any Mental Illness | Serious Mental Illness

Note: Estimates were age adjusted to the adult age 

distribution of the 2000 U.S. standard population.

⬣ Sexual minority females

were more likely than 

straight females to have had 

SMI in the past year, a pattern 

similar to the findings for past 

year AMI. Bisexual females

also were more likely than 

lesbian females to have had 

SMI; about 1 in 5 bisexual 

females had SMI.

⬣ The prevalence of SMI in the 

past year was more than 

3 times higher among 

bisexual males than among 

straight males and more than 

twice as high among gay 

males than among straight 

males. Bisexual males also 

were more likely than gay 

males to have had SMI. 

⬣ Sexual minority females

were more likely than straight 

females to have had AMI in the 

past year. Bisexual females

also were more likely than 

lesbian females to have 

had AMI; more than half of 

bisexual females had AMI.

⬣ Sexual minority males were 

at least twice as likely as 

straight males to have had AMI 

in the past year.

9.6

37.5

14.4

4.2

43.3

18.1

Gay

Bisexual

Straight

12.6

38.7

19.5

5.9

53.9

25.4

Lesbian

Bisexual

Straight

ANY MENTAL ILLNESS (AMI)

SERIOUS MENTAL ILLNESS (SMI)

0

0

0

0

0

0

100

100

100

100

100

100

Female Male

ANY MENTAL ILLNESS (AMI) refers to the presence of a mental, behavioral, or emotional disorder in the past year of 

sufficient duration to meet criteria from the Diagnostic and Statistical Manual of Mental Disorders, 4th edition,16 excluding 

developmental disorders and substance use disorders. 

SERIOUS MENTAL ILLNESS (SMI) refers to the presence of a mental, behavioral, or emotional disorder that substantially 

interfered with or limited one or more major life activities. Estimates of SMI are a subset of estimates of AMI because SMI is 

limited to people with AMI that resulted in serious functional impairment.

AMI and SMI were estimated based on a statistical prediction model. For more details on the estimation of AMI and SMI, see 

the 2021 National Survey on Drug Use and Health (NSDUH): Methodological Summary and Definitions report.11

8
MAJOR DEPRESSIVE EPISODE

Percentage in past year

MENTAL HEALTH

Major Depressive Episode | Co-Occurring AMI and SUD

Note: Estimates were age adjusted to the adult age distribution of 

the 2000 U.S. standard population.

Note: Estimates were age adjusted to the adult age distribution of the 

2000 U.S. standard population.

⬣ Although nearly 1 in 10 straight females had a major depressive 

episode (MDE) in the past year, sexual minority females were 

even more likely to have had an MDE. More than 1 in 4 

bisexual females and more than 1 in 7 lesbian females

had an MDE. Bisexual females also were more likely than 

lesbian females to have had an MDE.

⬣ Sexual minority males were 2 to 3 times more likely than 

straight males to have had an MDE in the past year. Bisexual 

males also were more likely than gay males to have had an 

MDE; nearly 1 in 5 bisexual males had an MDE.

⬣ Sexual minority females were about 

2 to 3 times more likely than straight 

females to have had both AMI and an SUD in 

the past year. Bisexual females also were 

more likely than lesbian females to have 

had both AMI and an SUD; more than 1 in 5 

bisexual females had an SUD and AMI.

⬣ Sexual minority males were more than 

twice as likely as straight males to have 

had both AMI and an SUD in the past year. 

However, the prevalence was similar for 

bisexual males or gay males.

Bisexual

Gay

Straight

Lesbian

Bisexual

Straight

26.1

19.9

9.1

13.7

15.2

6.3

Female

Male

NSDUH respondents were classified as having a MAJOR DEPRESSIVE EPISODE (MDE) in the 

past 12 months if (1) they had at least one period of 2 weeks or longer in the past year when for 

most of the day nearly every day they felt depressed or lost interest or pleasure in daily activities; 

and (2) they also had problems with sleeping, eating, energy, concentration, self-worth, or having 

recurrent thoughts of death or recurrent suicidal ideation. The MDE questions are based on 

diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition.15

CO-OCCURRING AMI AND SUD

Percentage in past year

!

! !

Gay

Bisexual

Straight

Lesbian

AMI

38.7

SUD

26.5

AMI

53.9

SUD

32.2

AMI

25.4

SUD

13.8

Bisexual

Straight

Female Male

16.7

22.8

7.1

AMI

37.5

SUD

32.2 16.4

AMI

43.3

SUD

32.4 18.7

AMI

18.1

SUD

20.7 7.3

9
HAD SERIOUS THOUGHTS 

OF SUICIDE

Percentage in past year

⬣ Sexual minority females were more 

likely than straight females to have had 

serious thoughts of suicide in the past 

year. Bisexual females also were more 

likely than lesbian females to have had 

serious thoughts of suicide; more than 

1 in 7 bisexual females had serious 

thoughts of suicide.

⬣ Bisexual males and gay males were 

more likely than straight males to have 

had serious thoughts of suicide in the 

past year (about 3 times as likely for 

bisexual males and more than twice 

as likely for gay males). However, the 

prevalence of serious thoughts of suicide in 

the past year did not differ for bisexual 

males or gay males.

⬣ The prevalence of making a suicide plan 

in the past year was 5 times higher

among bisexual females than among 

straight females. The prevalence among 

lesbian females was more than

4 times higher than among straight 

females. 

⬣ The prevalence of making a suicide plan 

in the past year was highest among

bisexual males, followed by gay 

males, then by straight males.

⬣ Bisexual females were the most likely

to have attempted suicide in the past year, 

followed by lesbian females, then by 

straight females. The prevalence among 

bisexual females was 6 times higher

than among straight females.

⬣ The prevalence of past year suicide 

attempts was higher among bisexual 

males than among straight males. 

!

! !

SUICIDAL THOUGHTS & BEHAVIORS

Had Serious Thoughts of Suicide | Made a Suicide Plan | Attempted Suicide

Female

Straight 4.2 4.4 Straight

10.1 Gay

Bisexual 13.8 14.7 Bisexual

Lesbian 10.4

Male

15 10 5 0 5 10 15

Female

Straight 1.0 1.2 Straight

2.3 Gay

4.6 Bisexual Bisexual 5.0

Lesbian 4.2

Male

15 10 5 0 5 10 15

Female

2.3 Bisexual Bisexual 2.4

Male

Lesbian 1.3 

Straight 0.4 

 1.7 Gay

 0.5 Straight

15 10 5 0 5 10 15

MADE A SUICIDE PLAN

Percentage in past year

!

!

! 

ATTEMPTED SUICIDE

Percentage in past year

Note: Estimates were age adjusted to the adult age 

distribution of the 2000 U.S. standard population.

Note: Estimates were age adjusted to the adult age distribution of the 2000 U.S. standard population.

Note: Estimates were age adjusted to the adult age 

distribution of the 2000 U.S. standard population.

10
Results from the 2021 and 2022 NSDUHs indicate that 

lesbian, gay, and bisexual adults are more likely than 

straight adults to use substances, experience mental 

health issues including major depressive episodes, and 

experience serious thoughts of suicide. The findings in 

this report particularly underscore how these issues affect 

bisexual adults. However, these findings do not explain 

the reasons for these differences, such as the influence 

of stressors that are unique to people who identify as 

lesbian, gay, bisexual, transgender, queer, or intersex 

(LGBTQI+).

SAMHSA is committed to eliminating health inequities 

experienced by the LGBTQI+ community. As such, 

SAMHSA has several efforts focused on LGBTQI+ 

people, including encouraging states to consider 

LGBTQI+ needs in administering SAMHSA block grant 

resources, issuing funding announcements focused 

on sexual and gender minorities, and expanding data 

collection efforts to capture the experiences of LGBTQI+ 

people more accurately. For more information, see 

https://www.samhsa.gov/behavioral-health-equity/lgbtqi. 

SUMMARY & IMPLICATIONS

ENDNOTES

1. Medley, G., Lipari, R. N., Bose, J., Cribb, D. S., Kroutil, L. A., & 

McHenry, G. (2016, October). Sexual orientation and estimates of adult 

substance use and mental health: Results from the 2015 National 

Survey on Drug Use and Health. NSDUH Data Review. https://www.

samhsa.gov/data/report/sexual-orientation-and-estimates-adultsubstance-use-and-mental-health-results-2015-national

2. Plöderl, M., & Tremblay, P. (2015). Mental health of sexual minorities. A 

systematic review. International Review of Psychiatry, 27(5), 367-385. 

https://doi.org/10.3109/09540261.2015.1083949

3. Jones, C. M., Clayton, H. B., Deputy, N. P., Roehler, D. R., Ko, J. Y., 

Esser, M. B., Brookmeyer, K. A., & Hertz, M. F. (2020). Prescription 

opioid misuse and use of alcohol and other substances among high 

school students — Youth Risk Behavior Survey, United States, 2019. 

MMWR Supplement, 69(1), 38-46. https://doi.org/10.15585/mmwr.

su6901a5

4. Substance Abuse and Mental Health Services Administration. (2023). 

Moving beyond change efforts: Evidence and action to support and 

affirm LGBTQI+ youth (SAMHSA Publication No. PEP22-03-12-001). 

U.S. Department of Health and Human Services. https://store.samhsa.

gov/sites/default/files/pep22-03-12-001.pdf

5. Meyer, I. H. (2003). Prejudice, social stress, and mental health in 

lesbian, gay, and bisexual populations: Conceptual issues and research 

evidence. Psychological Bulletin, 129(5), 674-697. https://doi.

org/10.1037/0033-2909.129.5.674

6. Parent, M. C., Arriaga, A. S., Gobble, T., & Wille, L. (2019). Stress and 

substance use among sexual and gender minority individuals across 

the lifespan. Neurobiology of Stress, 10, 100146. https://doi.

org/10.1016/j.ynstr.2018.100146

7. Ross, L. E., Salway, T., Tarasoff, L. A., MacKay, J. M., Hawkins, B. W., & 

Fehr, C. P. (2018). Prevalence of depression and anxiety among bisexual 

people compared to gay, lesbian, and heterosexual individuals: A 

systematic review and meta-analysis. Journal of Sex Research, 55(4-5), 

435-456. https://doi.org/10.1080/00224499.2017.1387755

8. Hughes, T. L., Veldhuis, C. B., Drabble, L. A., & Wilsnack, S. C. (2020). 

Research on alcohol and other drug (AOD) use among sexual minority 

women: A global scoping review. PLoS One, 15(3), e0229869. https://

doi.org/10.1371/journal.pone.0229869

9. Kipke, M. D., Kubicek, K., Akinyemi, I. C., Hawkins, W., Belzer, M., 

Bhandari, S., & Bray, B. (2020). The Healthy Young Men’s Cohort: 

Health, stress, and risk profile of Black and Latino young men who 

have sex with men (YMSM). Journal of Urban Health, 97(5), 653-667. 

https://doi.org/10.1007/s11524-019-00398-6

10. Freitag, T. M., Chen-Sankey, J. C., Duarte, D. A., Ramsey, M. W., & 

Choi, K. (2021). Variations in substance use and disorders among 

sexual minorities by race/ethnicity. Substance Use and Misuse, 56(7), 

921-928. https://doi.org/10.1080/10826084.2021.1899225

11. Center for Behavioral Health Statistics and Quality. (2022). 2021 

National Survey on Drug Use and Health (NSDUH): Methodological 

summary and definitions. https://www.samhsa.gov/data/report/2021-

methodological-summary-and-definitions

12. For a discussion of the criteria for suppressing (i.e., not publishing) 

unreliable estimates, see Section 3.2.2 in the following reference: 

Center for Behavioral Health Statistics and Quality. (2022). 2021 

National Survey on Drug Use and Health (NSDUH): Methodological 

summary and definitions. https://www.samhsa.gov/data/report/2021-

methodological-summary-and-definitions

13. Surveillance, Epidemiology, and End Results Program. (n.d.). Use 

of the 2000 U.S. standard population for age-adjustment. National 

Cancer Institute. https://seer.cancer.gov/stdpopulations/2000stdpopuse.html

14. See Section 3.2.3 in the following reference: Center for Behavioral 

Health Statistics and Quality. (2022). 2021 National Survey on Drug 

Use and Health (NSDUH): Methodological summary and definitions. 

https://www.samhsa.gov/data/report/2021-methodological-summaryand-definitions

15. American Psychiatric Association. (2013). Diagnostic and statistical 

manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.

books.9780890425596

16. American Psychiatric Association. (1994). Diagnostic and statistical 

manual of mental disorders (4th ed.).

11
Table 1. Substance Use: Among Adults Aged 18 or Older; by Gender and Sexual Identity, Percentages and Corresponding Standard Errors, Annu

and 2022

Unadjusted Age Adjusted

Male Female Male Fe

Substance Gay Bisexual Straight Lesbian Bisexual Straight Gay Bisexual Straight Lesbian Bis

PAST MONTH

Cigarette Smoking 20.2 (1.91) 22.5c (1.88) 18.3b (0.42) 22.2f (2.10) 23.5f (0.88) 13.8de (0.33) 20.8 (1.92) 24.6c (2.58) 18.7b (0.41) 25.0f (2.58) 27.2f 

Alcohol 65.3bc (2.37) 57.7a (2.30) 55.3a (0.49) 57.5f (2.32) 61.6f (1.08) 48.2de (0.48) 65.0c (2.40) 57.9 (3.24) 55.8a (0.47) 57.9f (2.78) 59.3f Binge Alcohol1 31.3c (2.19) 28.1 (1.77) 26.2a (0.42) 29.6f (2.44) 34.8f (1.02) 19.4de (0.33) 31.1 (2.25) 26.3 (2.23) 27.2 (0.41) 29.0f (2.87) 31.6f Heavy Alcohol 8.7 (1.20) 8.0 (1.07) 7.9 (0.24) 9.5f (2.15) 9.8f (0.60) 4.0de (0.15) 8.6 (1.22) 7.9 (1.30) 8.2 (0.24) 10.9f (2.62) 9.1f 

PAST YEARIllicit Drugs 48.5c (2.38) 51.9c (2.05) 25.4ab (0.41) 45.3ef (2.58) 55.0df (1.07) 18.5de (0.33) 47.8c (2.43) 49.5c (3.02) 26.7ab (0.39) 43.2f (3.11) 49.7f 

Marijuana 41.6c (2.34) 46.5c (2.11) 22.6ab (0.39) 41.5ef (2.51) 51.9df (1.08) 15.6de (0.31) 40.8c (2.40) 42.9c (3.10) 23.9ab (0.37) 39.0f (3.06) 45.9f Cocaine 4.3c (0.76) 5.6c (1.41) 2.4ab (0.13) 3.3ef (1.02) 5.7df (0.50) 0.9de (0.06) 4.1c (0.77) 6.7 (2.11) 2.6a (0.14) 3.3 (1.15) 4.5f Hallucinogens 8.4c (1.37) 12.1c (1.54) 3.3ab (0.14) 4.8ef (0.84) 10.5df (0.61) 1.5de (0.09) 8.2c (1.40) 11.1c (2.20) 3.7ab (0.15) 4.1f (0.85) 6.3f Inhalants 9.5bc (1.15) 4.0ac (0.73) 0.5ab (0.05) 0.8e (0.36) 2.0df (0.27) 0.2e (0.03) 9.3bc (1.16) 4.0ac (1.00) 0.6ab (0.06) 0.7 (0.49) 0.9f Methamphetamine 5.1c (1.41) 2.8 (0.87) 1.2a (0.11) 0.8e (0.32) 2.1df (0.33) 0.5e (0.06) 5.3c (1.47) 3.7 (1.33) 1.2a (0.11) 0.9e (0.34) 2.4dMisuse of Prescription 

Stimulants 3.7c (1.04) 4.0c (0.61) 1.5ab (0.09) 2.6ef (0.60) 4.4df (0.39) 1.0de (0.07) 3.7 (1.07) 2.8c (0.52) 1.7b (0.10) 2.1 (0.50) 2.9f 

Misuse of Prescription 

Tranquilizers or Sedatives 4.0c (0.85) 4.2c (0.70) 1.5ab (0.09) 3.7f (0.92) 4.8f (0.45) 1.6de (0.10) 4.3c (0.97) 3.8c (0.72) 1.6ab (0.09) 4.0f (1.19) 4.8f 

Misuse of Opioids 5.2 (1.21) 6.2c (1.08) 3.3b (0.16) 5.3f (1.18) 7.2f (0.57) 2.7de (0.14) 5.4 (1.24) 7.4c (1.65) 3.5b (0.16) 5.5ef (1.23) 10.1dMisuse of Central Nervous 

System Stimulants 9.7c (1.53) 10.5c (1.62) 4.3ab (0.18) 5.4ef (1.17) 9.3df (0.61) 2.1de (0.10) 9.7c (1.61) 11.1c (2.36) 4.6ab (0.18) 5.0f (1.24) 7.8f 

Illicit Drugs Other Than 

Marijuana2 23.4c (1.90) 25.6c (1.95) 9.1ab (0.24) 14.2ef (1.75) 21.3df (0.83) 6.1de (0.20) 23.5c (1.99) 26.7c (2.84) 9.7ab (0.24) 13.8ef (1.88) 19.4d

* Low precision; no estimate reported.Age adjusted = Estimates were age adjusted to the adult age distribution of the 2000 U.S. standard population.NOTE: Estimates shown are percentages with standard errors included in parentheses. 

a The difference between this estimate and the estimate for gay males is statistically significant at the .05 level. b The difference between this estimate and the estimate for bisexual males is statistically significant at the .05 level. c The difference between this estimate and the estimate for straight males is statistically significant at the .05 level. d The difference between this estimate and the estimate for lesbian females is statistically significant at the .05 level. e The difference between this estimate and the estimate for bisexual females is statistically significant at the .05 level. f The difference between this estimate and the estimate for straight females is statistically significant at the .05 level. 1 Estimates of binge alcohol use include use by those who were heavy alcohol users.2 Illicit Drugs Other Than Marijuana excludes respondents who used only marijuana but includes those who used marijuana in addition to other illicit drugs. 

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2021 and 2022.

12
Table 2. Substance Use: Among Adults Aged 18 or Older; by Gender and Sexual Identity, Numbers in Thousands and Corresponding Standard E

Averages, 2021 and 2022

Unadjusted

Male Female

Substance Gay Bisexual Straight Lesbian Bisexual Straight

PAST MONTH

Cigarette Smoking 781 (87) 897 (83) 20,595 (568) 605 (65) 2,346 (110) 15,615 (421)

Alcohol 2,530 (155) 2,295 (141) 62,066 (968) 1,564 (111) 6,135 (196) 54,554 (874)Binge Alcohol1 1,212 (105) 1,116 (80) 29,426 (598) 807 (86) 3,465 (136) 22,012 (474)Heavy Alcohol 336 (49) 318 (44) 8,913 (292) 258 (64) 975 (67) 4,525 (185)

PAST YEARIllicit Drugs 1,879 (131) 2,066 (133) 28,484 (579) 1,233 (105) 5,484 (181) 20,952 (440)

Marijuana 1,614 (125) 1,850 (124) 25,361 (533) 1,129 (99) 5,178 (175) 17,682 (404)Cocaine 167 (30) 222 (60) 2,747 (155) 89 (28) 566 (52) 982 (68)Hallucinogens 326 (55) 482 (67) 3,713 (162) 131 (24) 1,048 (67) 1,700 (105)Inhalants 369 (46) 158 (29) 568 (61) 21 (10) 200 (27) 197 (34)Methamphetamine 197 (57) 112 (36) 1,302 (124) 22 (9) 210 (34) 616 (72)Misuse of Prescription 

Stimulants 144 (41) 160 (25) 1,732 (101) 70 (16) 443 (41) 1,185 (80)

Misuse of Prescription 

Tranquilizers or Sedatives 153 (33) 168 (28) 1,679 (101) 100 (26) 482 (48) 1,804 (119)

Misuse of Opioids 202 (48) 247 (46) 3,736 (188) 144 (33) 714 (61) 3,049 (158)Misuse of Central Nervous 

System Stimulants 375 (63) 418 (72) 4,821 (209) 147 (33) 931 (65) 2,371 (120)

Illicit Drugs Other Than 

Marijuana2 908 (83) 1,018 (98) 10,226 (303) 388 (53) 2,120 (101) 6,865 (232)

* Low precision; no estimate reported. NOTE: Estimates shown are numbers in thousands with standard errors included in parentheses. 

1 Estimates of binge alcohol use include use by those who were heavy alcohol users.2 Illicit Drugs Other Than Marijuana excludes respondents who used only marijuana but includes those who used marijuana in addition to other illicit drugs. 

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2021 and 2022.

13
Table 3. Substance Use Disorder in Past Year: Among Adults Aged 18 or Older; by Gender and Sexual Identity, Percentages and Corresponding 

Annual Averages, 2021 and 2022

Unadjusted Age Adjusted

Male Female Male Fe

Substance Use Disorder Gay Bisexual Straight Lesbian Bisexual Straight Gay Bisexual Straight Lesbian Bis

DRUGS OR ALCOHOL 32.4c (2.18) 35.2c (2.03) 19.7ab (0.37) 28.0ef (2.14) 37.4df (1.03) 12.7de (0.29) 32.2c (2.24) 32.4c (2.78) 20.7ab (0.36) 26.5ef (2.18) 32.2d

Drugs 19.6c (1.92) 23.5c (1.78) 10.0ab (0.27) 16.3ef (1.59) 26.6df (0.90) 6.1de (0.21) 19.2c (1.97) 21.3c (2.44) 10.7ab (0.27) 14.3ef (1.55) 22.2d

Opioids 3.5 (1.05) 3.9 (1.16) 2.0 (0.14) 2.6 (0.72) 3.6f (0.40) 2.0e (0.12) 3.5 (1.04) 5.0 (1.82) 2.1 (0.13) 3.0e (0.93) 5.9dDrugs Other Than 

Marijuana 10.1c (1.69) 7.4c (1.30) 3.7ab (0.17) 5.4ef (0.94) 8.6df (0.58) 3.2de (0.16) 10.2c (1.69) 8.1c (1.92) 3.9ab (0.17) 5.7ef (1.12) 9.5d

Alcohol 18.8c (1.76) 17.9c (1.46) 12.9ab (0.32) 16.2f (1.80) 20.0f (0.86) 8.2de (0.24) 18.9c (1.81) 15.7 (1.85) 13.5a (0.32) 15.9f (1.89) 17.3f 

* Low precision; no estimate reported.Age adjusted = Estimates were age adjusted to the adult age distribution of the 2000 U.S. standard population.NOTE: Estimates shown are percentages with standard errors included in parentheses. NOTE: Substance use disorder estimates are based on criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition.

a The difference between this estimate and the estimate for gay males is statistically significant at the .05 level. b The difference between this estimate and the estimate for bisexual males is statistically significant at the .05 level. c The difference between this estimate and the estimate for straight males is statistically significant at the .05 level. d The difference between this estimate and the estimate for lesbian females is statistically significant at the .05 level. e The difference between this estimate and the estimate for bisexual females is statistically significant at the .05 level. f The difference between this estimate and the estimate for straight females is statistically significant at the .05 level. 

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2021 and 2022.

Table 4. Substance Use Disorder in Past Year: Among Adults Aged 18 or Older; by Gender and Sexual Identity, Numbers in Thousands and CorrStandard Errors, Annual Averages, 2021 and 2022

Unadjusted

Male Female

Substance Use Disorder Gay Bisexual Straight Lesbian Bisexual Straight

DRUGS OR ALCOHOL 1,255 (110) 1,402 (102) 22,160 (502) 762 (69) 3,725 (135) 14,339 (378)

Drugs 761 (86) 935 (82) 11,239 (336) 444 (47) 2,656 (109) 6,934 (253)

Opioids 135 (42) 155 (48) 2,300 (155) 70 (20) 362 (41) 2,282 (140)Drugs Other Than 

Marijuana 391 (70) 294 (54) 4,206 (201) 147 (27) 858 (62) 3,595 (182)

Alcohol 730 (77) 711 (64) 14,529 (403) 442 (56) 1,989 (99) 9,291 (299)

* Low precision; no estimate reported. NOTE: Estimates shown are numbers in thousands with standard errors included in parentheses. NOTE: Substance use disorder estimates are based on criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition.Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2021 and 2022.

14
Table 5. Mental Health Issues and Suicidal Thoughts and Behaviors in Past Year: Among Adults Aged 18 or Older; by Gender and Sexual Identit

and Corresponding Standard Errors, Annual Averages, 2021 and 2022

Mental Health Issues 

and Suicidal Thoughts and Behaviors

Unadjusted Age Adjusted

Male Female Male Fe

Gay Bisexual Straight Lesbian Bisexual Straight Gay Bisexual Straight Lesbian Bis

Any Mental Illness1 37.3bc (2.24) 48.2ac (2.05) 17.1ab (0.35) 42.8ef (2.46) 62.9df (1.03) 23.5de (0.37) 37.5c (2.25) 43.3c (2.71) 18.1ab (0.34) 38.7ef (2.48) 53.9d

Serious Mental Illness1 9.8bc (1.27) 17.5ac (1.40) 3.9ab (0.16) 15.4ef (1.66) 27.0df (0.89) 5.3de (0.18) 9.6bc (1.25) 14.4ac (1.72) 4.2ab (0.17) 12.6ef (1.49) 19.5d

Major Depressive Episode 13.8bc (1.51) 24.1ac (1.64) 5.9ab (0.19) 19.3ef (1.71) 34.4df (1.03) 8.2de (0.21) 13.7bc (1.54) 19.9ac (2.19) 6.3ab (0.20) 15.2ef (1.46) 26.1dCo-Occurring Any Mental 

Illness and Substance Use Disorder1,2

16.5bc (1.68) 21.8ac (1.66) 6.8ab (0.21) 19.0ef (1.85) 28.6df (0.90) 6.3de (0.20) 16.4c (1.71) 18.7c (2.12) 7.3ab (0.22) 16.7ef (1.69) 22.8d

Had Serious Thoughts of 

Suicide 10.4bc (1.40) 18.4ac (1.49) 4.1ab (0.17) 13.1ef (1.37) 22.0df (0.82) 3.7de (0.15) 10.1c (1.38) 13.8c (1.73) 4.4ab (0.17) 10.4ef (1.30) 14.7d

Made a Suicide Plan 2.3bc (0.50) 7.1ac (0.83) 1.1ab (0.08) 5.5ef (0.96) 8.4df (0.60) 0.9de (0.06) 2.3bc (0.50) 4.6ac (0.69) 1.2ab (0.08) 4.2f (0.90) 5.0f Attempted Suicide 1.7 (0.71) 3.5c (0.61) 0.5b (0.05) 2.1ef (0.53) 4.4df (0.43) 0.4de (0.05) 1.7 (0.74) 2.3c (0.51) 0.5b (0.06) 1.3ef (0.32) 2.4d

* Low precision; no estimate reported.Age adjusted = Estimates were age adjusted to the adult age distribution of the 2000 U.S. standard population. NOTE: Estimates shown are percentages with standard errors included in parentheses. 

a The difference between this estimate and the estimate for gay males is statistically significant at the .05 level. b The difference between this estimate and the estimate for bisexual males is statistically significant at the .05 level. c The difference between this estimate and the estimate for straight males is statistically significant at the .05 level. d The difference between this estimate and the estimate for lesbian females is statistically significant at the .05 level. e The difference between this estimate and the estimate for bisexual females is statistically significant at the .05 level. f The difference between this estimate and the estimate for straight females is statistically significant at the .05 level. 1 Mental Illness aligns with criteria from the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, and is defined as having a diagnosable mental, behavioral, or emotional disorder, other than a developmental or substanc

of serious mental illness (SMI) are a subset of estimates of any mental illness (AMI) because SMI is limited to people with AMI that resulted in serious functional impairment. These mental illness estimates are based on a predictive measures of diagnostic status.

2 Substance use disorder estimates are based on criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Beginning with the 2021 NSDUH, questions on prescription drug use disorder were asked of all pas

drugs, regardless of whether they misused prescription drugs. The estimates in this row include prescription drug use disorder data from all past year users of prescription drugs. See the 2021 National Survey on Drug Use and HeaSummary and Definitions for details on these changes. 

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2021 and 2022.

15
Table 6. Mental Health Issues and Suicidal Thoughts and Behaviors in Past Year: Among Adults Aged 18 or Older; by Gender and Sexual Identit

Thousands and Corresponding Standard Errors, Annual Averages, 2021 and 2022

Mental Health Issues 

and Suicidal Thoughts and Behaviors

Unadjusted

Male Female

Gay Bisexual Straight Lesbian Bisexual Straight

Any Mental Illness1 1,447 (106) 1,919 (109) 19,178 (472) 1,164 (84) 6,269 (191) 26,613 (528)

Serious Mental Illness1 378 (49) 695 (59) 4,332 (188) 419 (48) 2,687 (112) 6,029 (215)

Major Depressive Episode 534 (60) 957 (75) 6,586 (236) 527 (49) 3,426 (136) 9,243 (260)Co-Occurring Any Mental 

Illness and Substance Use Disorder1,2

641 (70) 866 (72) 7,661 (261) 517 (56) 2,853 (114) 7,163 (238)

Had Serious Thoughts of 

Suicide 403 (55) 731 (62) 4,592 (200) 356 (38) 2,190 (97) 4,135 (173)

Made a Suicide Plan 91 (19) 281 (34) 1,233 (88) 149 (26) 837 (62) 976 (69)Attempted Suicide 68 (28) 138 (25) 525 (56) 57 (14) 442 (44) 412 (56)

* Low precision; no estimate reported. NOTE: Estimates shown are numbers in thousands with standard errors included in parentheses. 

1 Mental Illness aligns with criteria from the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, and is defined as having a diagnosable mental, behavioral, or emotional disorder, other than a developmental or substanc

of serious mental illness (SMI) are a subset of estimates of any mental illness (AMI) because SMI is limited to people with AMI that resulted in serious functional impairment. These mental illness estimates are based on a predictive measures of diagnostic status.

2 Substance use disorder estimates are based on criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Beginning with the 2021 NSDUH, questions on prescription drug use disorder were asked of all pas

drugs, regardless of whether they misused prescription drugs. The estimates in this row include prescription drug use disorder data from all past year users of prescription drugs. See the 2021 National Survey on Drug Use and HeaSummary and Definitions for details on these changes. 

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2021 and 2022.

16
SAMHSA’s mission is to reduce the 

impact of substance abuse and mental 

illness on America’s communities.

1-877-SAMHSA-7 (1-877-726-4727) 

1-800-487-4889 (TDD)

www.samhsa.gov

SAMHSA Publication No. PEP23-07-01-001

2023

Substance Abuse and Mental Health 

Services Administration