Opinion: Between euphoria and escape—why LGBTQIA+ individuals are vulnerable to substance use
Efforts to improve mental health outcomes in the LGBTQIA+ community must confront structural forces perpetuating their marginalisation
By Saumyaa Shah, Jiya Talpallikar and Dr. Moulika Mandal
We still live in a world where expressing one’s authentic identity can invite prejudice, misunderstanding, or even hostility. While mental health challenges and substance use disorders affect individuals across all demographics, the LGBTQIA+ community disproportionately bears the brunt of these issues, largely due to systemic discrimination and enduring social stigma.
The World Health Organization (2019) defines mental health as ‘a state of mental well-being that enables people to cope with the stresses of life, realise their abilities, learn well and work well, and contribute to their community.’ The acronym LGBTQIA+ encompasses individuals who identify as lesbian, gay, bisexual, transgender, queer or questioning, intersex, asexual, as well as other sexual orientations and gender identities that do not align with exclusively heterosexual or cisgender norms (American Psychological Association, 2022). A critical concept in this context is heteronormativity—the pervasive and often unchallenged assumption that heterosexuality is the default or normative orientation. This assumption forms the foundation of many societal biases that negatively impact LGBTQIA+ individuals.
Social Exclusion
Historically, queer identities have been pathologised, framed as disorders or deviant behaviours, and in many parts of the world, they remain criminalised. Even in regions where legal recognition and protections exist, LGBTQIA+ individuals continue to face marginalisation, discrimination, and overt hostility. These experiences of social exclusion, victimisation, and systemic bias are not merely background challenges; they are central drivers of the elevated rates of mental health conditions and substance use seen within the LGBTQIA+ population (Moagi et al., 2021).
Building on this, the heightened prevalence of mental health disorders within the LGBTQIA+ community can be traced to a complex interplay of risk factors, including limited social support, internalised homophobia, and broader societal discrimination. Prejudice from mainstream society often isolates LGBTQIA+ individuals, subjecting them to cultural practices and norms that can be deeply dehumanising. The minority stress model provides a useful framework for understanding these dynamics. According to Frost and Meyer (2023), LGBTQ+ individuals face unique, chronic stressors related to their marginalised status, which contribute significantly to poorer mental health outcomes.
The consequences of these stressors are particularly acute among LGBTQ youth. Research indicates that LGBTQ+ adolescents are nearly six times more likely to exhibit symptoms of depression compared to their non-LGBTQ+ peers (Anxiety and Depression Association of America [ADAA], 2025). Additionally, they are approximately 1.75 times more likely to experience anxiety and depression.
Minority Stress Dynamics
Efforts to improve mental health outcomes in the LGBTQIA+ community must go beyond individual-level interventions and confront the structural forces that perpetuate marginalisation. The heightened mental health challenges faced by LGBTQIA+ individuals frequently intersect with elevated rates of substance use disorders, propagating a cyclical pattern of distress. Research demonstrates that these minorities are 2.89 times more likely to engage in substance use compared to heterosexual peers, with bisexual adolescents facing 340% higher odds of substance abuse and bisexual women showing 400% greater risk than heterosexual women (Marshal et al., 2008). This disparity emerges from minority stress dynamics, where the distinctive stressors lead to substance use as a maladaptive coping mechanism (Siu et al., 2023).
Solace in Drugs
The constant lived reality of experiencing homophobia, bullying, harassment, and even hate crimes leads many LGBTQ+ individuals to seek solace in drugs and alcohol. Thus, turning to substance use could be a manifestation of trying to find a way to escape the gritty reality they are faced with. Addiction works in such a way that it activates reward pathways within the brain, which means that unhealthy coping mechanisms could easily result in overuse (American Psychiatric Association, 2013). The subsequent implications of substance use range from common withdrawal symptoms to serious medical conditions.
Substance use, including drug and alcohol consumption, impairs cognitive and motor functions (American Psychiatric Association, 2013), which leads to numerous consequences such as strained relationships and employment difficulties, among a plethora of others. This simultaneously reinforces harmful queer stereotypes that depict LGBTQ+ individuals as reckless or self-destructive.
Addressing substance use among LGBTQ+ individuals requires an approach that mixes biological, social, and psychological interventions. Harm reduction strategies, such as queer-affirmative therapy and support groups, are crucial in providing safe spaces for individuals to seek help without fear of judgment. Biologically, medical professionals should prioritise treatments that address both addiction and underlying mental health disorders. On a social level, advocacy efforts must focus on reducing structural inequalities that contribute to substance use.
Safe Spaces Essential
While immediately changing the worldviews of the general public is not realistically possible, especially in the Indian context, we must focus on providing education about queer identities. Subsequently, this might drive governmental reforms that prioritise the well-being of LGBTQ+ individuals and provide accessible mental healthcare, which is essential in managing the societal stressors that drive LGBTQ+ individuals toward substance use.
Community-based interventions, such as culturally competent rehabilitation centres, are also instrumental in addressing addiction within this population. It is critical to note that queer socialisation often takes place in bars, which can be risky for those struggling with mental health and substance abuse. Creating more alternative safe spaces is essential to promote socialisation without this risk. Queer-affirmative therapies ensure that mental health professionals understand the specific struggles faced by this community and provide appropriate support.
Substance use among LGBTQ+ individuals is not a personal failing or a lifestyle choice. Rather, it is a complex response to a world that too often marginalises them. The issue is deeply rooted in biological vulnerabilities, social injustice, and ongoing psychological distress. Meaningful solutions require more than surface-level interventions; they call for comprehensive medical, psychological, and social support systems that are inclusive and affirming of LGBTQ+ identities. The higher rates of substance use in this community are not just about addiction but reflect the weight of discrimination, isolation, and chronic stress. People do not turn to substances out of weakness; they do so to cope with a world that fails to create a space for them.
Real change begins when we stop asking individuals to adapt to an unjust reality and start working to transform that reality into one where everyone can thrive. That transformation starts with each of us: by educating ourselves, challenging stigma, advocating for inclusive policies, and creating safe spaces where LGBTQ+ individuals feel seen, supported, and valued.
(Saumyaa Shah is Psychology major and Environmental Studies minor at FLAME University, Jiya Talpallikar is undergraduate student at FLAME University, majoring in Psychology with a minor in Environmental Studies, and Dr. Moulika Mandal is Assistant Professor in Psychology at FLAME University)
