Sexual Minority Youth Show Distinct Substance Use Patterns from Adolescence into Young Adulthood
A new study led by Dr. Clarissa Janousch finds that young people who experience same-sex attraction use substances differently than their heterosexual peers - and that these differences vary by sex and change over time. The study followed participants from the Zurich Project on Social Development from Childhood to Adulthood (z-proso) between ages 17 and 24.
A new study led by Dr. Clarissa Janousch (Karolinska Institutet, Department of Global Publich Health) from the Risk and Resilience group of the Jacobs Center (PI: Prof. Lilly Shanahan) and the Experimental Pharmacopsychology and Psychological Addiction Research Group (PI: Prof. Boris Quednow) finds that young people who experience same-sex attraction use substances differently than their heterosexual peers — and that these differences vary by sex and change over time. The study followed participants from the Zurich Project on Social Development from Childhood to Adulthood (z-proso) between ages 17 and 24.
Among sexual minority (SM) females, substance use was already elevated at 17, peaked around age 20, and then levelled off. SM males started out lower but rose sharply between 20 and 24, ultimately showing the highest rates of polysubstance use of any group. Heterosexual females consistently reported the lowest substance use throughout.
SM youth also reported higher levels of psychological distress and bullying. These factors help explain some of the elevated substance use, consistent with the Minority Stress Model, which links chronic stigma and discrimination to greater vulnerability. However, SM status remained a significant risk factor even after accounting for these, suggesting that additional influences also play a role.
The findings point to clear windows for intervention: SM females need support from early adolescence, while the critical period for SM males is the transition into young adulthood. The study calls for LGBTQ+-inclusive prevention strategies across schools, psychological and primary care, and community settings.
Janousch C, Vock F, Winter BL, Hässler T, Eggenberger L, Bechtiger L, Loher M, Binz TM, Baumgartner MR, Ribeaud D, Eisner M, Quednow BB, Shanahan L. How do substance and polysubstance use trajectories differ by sexual attraction from ages 17 to 24? A community-based longitudinal cohort study in Switzerland. BMJ Public Health 2026;4:e003583. Open access