Substance use care for LGBTQ+ individuals: A Pride Month perspective on inclusion, access, and quality

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For Employers
4 min read


Recent Pelago research has revealed that nearly half of all American workers have experienced personal or family problems involving substance or alcohol use. This includes more than 1 in 3 workers who report having a family member struggle with substance use. 

Among the general population, stigma surrounding substance use disorders (SUDs) is one of the most formidable barriers to effective substance use care. During Pride Month, it’s even more important to remember the heightened challenges faced by people who identify as lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+). So, when we talk about family and inclusiveness in the spirit of PrideMonth, it’s important to acknowledge and address the unique challenges faced by the LGBTQ+ community. 

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), a higher prevalence of substance use and mental health issues has been well documented among people who identify as lesbian, gay, or bisexual than among those who identify as heterosexual or straight.

Differing substance use patterns

Coming out of the COVID-19 pandemic, for example, the Kaiser Family Foundation found that compared to non-LGBTQ+, larger shares of those who identify as LGBTQ+ said worry or stress related to the Coronavirus caused them to experience difficulty with sleep, worsening chronic conditions (e.g. blood pressure or diabetes), and increased alcohol or drug use. LGBTQ+ individuals are more likely to report that they have experienced at least one of these impacts than non-LGBTQ+ individuals (55% v 34%).


SAMHSA’s 2021 and 2022 National Surveys on Drug Use and Health (NSDUH) further details how substance use patterns reported by LGBTQ+ adults differ from those reported by heterosexual adults. 

  • LGBTQ+ individuals experience unique stressors that can contribute to adverse substance use and mental health outcomes.
  • People who identify as bisexual may experience additional problems with substance use and mental health due to sexual orientation-based discrimination, bisexual invisibility and erasure, and a lack of bisexual-affirmative support. 
  • Challenges faced by the LGBTQ+ population can be further compounded by the experience of being female or a person of color.

Specifically, the NSDUH 2021-2022 findings included:

  • For sexual minority females,* the prevalence of cigarette smoking was roughly twice that for straight females.
  • There was no difference in the prevalence of binge or heavy drinking between sexual minority males and straight males, but sexual minority females were about twice as likely as straight females to have been heavy drinkers.
  • Regarding illicit drug use, 
    • sexual minority males were 2 to 3 times more likely than straight males to have used illicit drugs other than marijuana in the past year. 
    • sexual minority females were 2 to 3 times more likely than straight females to have used illicit drugs other than marijuana in the past year.

A focus on inclusive care 

Prioritizing inclusive healthcare for LGBTQ populations is essential for promoting health equity, reducing disparities, and improving the overall well-being of these individuals. Inclusive care is core to the Pelago philosophy of substance use management; it acknowledges and respects the identities, experiences, and healthcare needs of all members, resulting in more equitable care for all.


Inclusive care is inextricably intertwined with affirming care, or health care that attends to not only the physical well-being of transgender and gender-diverse individuals, but also their mental and social health care needs while respectfully affirming their gender identity.
AJMC, Apr 23, 2023

For its substance use programs, Pelago ensures a safe environment by employing culturally competent providers, coaches, and counselors, including LGBTQ+ individuals. This fosters an inclusive approach by embracing a care culture that understands and meets the specific needs of different populations.

Pelago Medical Director Justin Yang, M.D., M.P.H., F.A.C.P. described four key factors that contribute to effective substance use care at Pelago: 

  • Access through physician-led, virtually delivered care, available whenever and wherever a person needs help. 
  • Cost for treatment that’s a fraction of the cost of traditional approaches.
  • Efficacy-based substance use treatment standards
  • Personalization, which is critical for inclusive care, because no two members face the same challenges or require the same treatment.

“There’s a pervasive stigma surrounding SUDs that affects all individuals, but the LGBTQ+ community often encounters more pronounced levels of social stigma, discrimination, harassment, and stressors unique to their experience,” noted Dr. Yang. “Employers and health plans should be aware of the profound impact these issues have and consider inclusive virtual substance use management solutions such as Pelago in caring for diverse populations.”

Dr. Yang also proposed that employers and health plans view substance use management as an extension of their existing diversity, equity, and inclusion programs. 

By raising awareness, fostering understanding, and advocating for equal rights during Pride Month and throughout the year, we can realize our vision to create a world where everyone has access to substance use support, and where sexual minorities thrive without fear or limitations.


Pelago is the world’s leading virtual clinic for substance use management, transforming substance use support by delivering education, management skills, and opportunities for positive change to members struggling with substance use disorders. To learn more about how your workplace benefits or health plan team can best support employees and members, contact a solutions expert today.


*In this SAMHSA survey, sexual minority adults include individuals who describe themselves as lesbian, gay, or bisexual.

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