Mini review notes elevated substance use in sexual minority women compared to heterosexual women

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Frontiers in Medicine Published May 7, 2026 Medically reviewed May 7, 2026 Study authors: Swapnajeet Sahoo, Arshia Sood DOI ↗ By Dr. Ji-eun Park, MD · Brain, Mind & Pain

Key Takeaway

Note elevated substance use in sexual minority women, particularly bisexual women, requiring tailored interventions.

This narrative mini review focuses on substance use disorders in sexual minority women, including lesbian, bisexual, and other non-heterosexual women. The authors compare these findings against heterosexual women to highlight disparities in substance use prevalence. The review does not report specific sample sizes or absolute numbers for the aggregated data. Instead, it synthesizes qualitative conclusions regarding the direction of the differences observed across various studies.

The primary finding indicates an elevated prevalence of alcohol, tobacco, cannabis, and polysubstance use among sexual minority women compared with heterosexual women. Additionally, bisexual women are frequently identified as the highest-risk subgroup within this population. The review notes that specific effect sizes, p-values, or confidence intervals were not reported in the source material.

The authors acknowledge significant limitations, including heterogeneity in populations, outcome measures, and study designs. There is limited evidence for SMW-specific interventions, and a need for more methodologically rigorous, intersectionally informed, and geographically diverse research is emphasized. The practice relevance centers on the development of identity-affirming and trauma-informed interventions rather than specific pharmacological treatments.

Study Details

Study typeSystematic review

EvidenceLevel 1

PublishedMay 2026

View Original Abstract ↓

Sexual minority women (SMW), including lesbian, bisexual, and other non-heterosexual women, experience higher rates of substance use (SU) and substance use disorders (SUDs) than heterosexual women, yet remain relatively underrepresented in the literature. This structured mini-review aimed to synthesize evidence on prevalence patterns, determinants, intersectional influences, treatment barriers, and intervention approaches related to substance use among SMW. A structured narrative review of epidemiological studies, reviews, and meta-analyses was undertaken using predefined thematic domains: epidemiology, determinants/pathways, intersectionality, and treatment-related issues. Evidence was synthesized narratively because of heterogeneity in populations, outcome measures, and study designs. Across much of the available literature, SMW show elevated prevalence of alcohol, tobacco, cannabis, and polysubstance use compared with heterosexual women, with bisexual women frequently identified as the highest-risk subgroup. Reported determinants include minority stress-related processes, internalized stigma, discrimination, victimization, and adverse childhood experiences. Intersectional disadvantage, including racial/ethnic minority status and socioeconomic marginalization, may further amplify vulnerability. Treatment access is hindered by stigma, limited LGBTQ+-affirming services, and gaps in provider cultural competence. Evidence for SMW-specific interventions remains limited. Available evidence suggests that substance use disparities among SMW are shaped by minority stress, intersecting social disadvantage, and barriers to inclusive care. More methodologically rigorous, intersectionally informed, and geographically diverse research is needed, alongside development of identity-affirming and trauma-informed interventions.