UMD Psychologist Leads Massive Analysis of Youth Substance Use

Ethan Mereish and Colleagues Reviewed Data from Nearly 6 Million Youth to See Sexual Orientation Differences in Substance Use

A comprehensive look at the degree to which youths’ drugs and alcohol use varies according to their sexual orientation has not happened since 2008—until recently.

A new meta-analysis led by University of Maryland Department of Psychology Associate Professor Ethan Mereish and published in Addiction looked at data from nearly six million youths across 304 research studies that were published between 2008 and 2024. Over the course of those 17 years studied, Mereish and his research colleagues found that sexual minority youths—those under the age of 25 who identify as lesbian, gay, bisexual, queer, or report being attracted to the same sex, gender, or multiple genders (plurisexual)—had a greater likelihood to engage in substance use than heterosexual youths.

In particular, lesbian, gay, bisexual and queer youth had a 34% greater likelihood of using alcohol, and 363% greater odds of using heroin compared to heterosexual youth.

“Despite some improvements in LGBTQ rights and representation in some parts of the U.S. and the world over the past 17 years, disparities in substance use have not declined,” said Mereish. “Substance use is an issue for all youth, including heterosexual youth, but it's a bigger concern facing queer youth: Queer youth use at higher rates and are more likely to be diagnosed with a substance use disorder than their heterosexual peers, and these disparities continue into adulthood.”

The researchers found that sexual minority youths consumed alcohol, nicotine, cannabis, opioids, stimulants, or other drugs more frequently, and in greater quantities, than their heterosexual peers. The sexual minority youths studied also exhibited higher rates of using more than one substance at a time (polysubstance use), and hazardous substance use, such as binge drinking. The study also found that queer youth start using substances at younger ages than heterosexual youths.

Sex/gender and sexual orientation also played a role in deepening disparities: Sexual orientation differences in substance use were bigger for females/women than males/men, and for bisexual/plurisexual youths than lesbian/gay youths.

“Some substance use among youth is actually declining overall, like alcohol and cigarette use,” noted Mereish. “However, despite these declines, we still find significant disparities between queer and heterosexual youth, and youth substance use is still an important public health priority as use in adolescence can have many negative biopsychosocial effects that can be risk factors in adulthood.”

Given these findings, Mereish and colleagues hope to see an increase in youth substance use screenings in schools, primary care offices, emergency departments, and other community settings; in access to substance use treatment for youths; and in services that are de-stigmatizing, affirming, and confidential. They also hope to see more intervention efforts that fight oppression and stigma, saying that they are foundational for explaining why these differences in substance use exist.

Mereish plans to conduct subsequent studies on this topic to help those hopes come to light.

“In order to prevent harmful substance use among youths, we'd like to continue examining etiological factors that help us understand these disparities, such as oppression-based stressors; identify protective factors that help queer youth be resilient against oppression and other stressors; and develop affirming and accessible interventions that help queer youth cope and resist oppression and thrive,” he said.

Read “A meta-analysis of sexual orientation inequities in substance use among youth”

Published on Thu, Jan 29, 2026 - 9:16AM