Scoping Review of Substance Use Among Sexual and Gender Minorities Finds Most Studies Exclude Women, Transgender Individuals, Ethnic Minorities

hard drugs and alcohol, syringe, pills
hard drugs and alcohol, syringe, pills
With the number of studies reporting sexual orientation and gender identity disparities in mental health rising in the past 20 years, sexual and gender minority individuals have been found to be at a greater risk in accessing and maintaining good health than those identifying as heterosexual. Among the highest disparity are those related to alcohol, tobacco, and other drug use.

A scoping review of alcohol, tobacco, and other substance use prevention and treatment among sexual and gender minority (SGM) individuals found that additional study is needed among minority SGM populations. These findings were published in the Journal of Substance Abuse Treatment.

Publication databases were searched from 1985 through 2019 for studies of substance use treatments and prevention among SGM (eg, lesbian, gay, bisexual, and transgender) communities. A total of 71 articles were included in this review.

Studies of alcohol (n=15) were primarily conducted in the United States (US; n=14), they focused on reducing or preventing high-risk drinking among cisgender sexual minority men (n=12), and were of randomized controlled designs (n=11). Interventions included individual psychotherapy (n=8), couple-level psychotherapy (n=1), group intervention (n=1), online intervention with motivational interview (n=1), and combinatorial therapies (n=4).

Positive outcomes were reported by 7 studies and some promise for efficacy in 3 publications. A study of naltrexone did not identify improvement compared with therapy.

Studies of tobacco (n=7) were mostly conducted in the US (n=6) and focused on smoking cessation (n=6). Interventions included group therapy (n=4), pharmacotherapy (n=2), and an online-based therapy (n=1).

Promising outcomes were reported by 5 of the publications and 3 reported similar results as studies among the general population.

Studies of methamphetamine (n=28) were primarily conducted in the US (n=26) and focused on current users (n=13), individuals at risk for methamphetamine use disorder (MUD; n=10), or any use (n=5). The study participants in 26 of the studies were biased toward non-Hispanic White cisgender sexual minority men and no study included women. Most studies used in-person psychotherapeutic interventions (n=17).

Contingency management was found to be successful in several of the studies. Mirtazapine treatment was found to significantly reduce positive urine samples and treatment with bupropion was not found to be effective.

These findings were limited by possible publication biases and by the fact the investigators restricted their search parameters to studies which evaluated efficacy.

This scoping review identified several gaps in the research landscape of substance use among the SGM population. There was a paucity of data about substances that were not alcohol, tobacco, or methamphetamine (n=9) or studies which focused on non-substance outcomes such as HIV or sexually transmitted infection risk (n=12). Nearly all studies were conducted in the US, which may indicate that cultural differences in other regions may be overlooked in the current understanding of substance use in the SGM community. One of the most striking findings was that women, transgender individuals, and ethnic minorities were frequently excluded in all study areas.

The review authors concluded that research into substance treatment and prevention among the SGM community remains in its infancy compared with the general population. Studies which recruit more diverse individuals, larger sample sizes, and test dyadic medication interventions or specific population-targeted interventions are needed.


Kidd JD, Paschen-Wolff MM, Mericle AA, Caceres BA, Drabble LA, Hughes TL. A scoping review of alcohol, tobacco, and other drug use treatment interventions for sexual and gender minority populations. J Subst Abuse Treat. Published June 15, 2021. doi:10.1016/j.jsat.2021.108539