Commentary on Mereish et al.: Supporting sexually diverse youth requires a full spectrum understanding of substance use

Better understanding the higher rates of substance use among sexually diverse youth requires engaging with the full spectrum of use. This includes the nuances of using for coping purposes, identity‐based use and the potential for positive impacts of use.

Mereish et al. [1] report important, updated meta‐analytic findings on the higher rates of substance use among sexually diverse youth compared with their heterosexual counterparts. The authors ground the importance of examining these disparities specifically in hazardous substance use adding to the health inequities experienced by sexually diverse youth. Tying to systems of oppression, the authors also note that substance use can support coping and resistance among sexually diverse youth. This point merits further elaboration to fully contextualize the meta‐analytic results, especially considering ongoing tendencies to conceptualize differences seen in sexually diverse communities as deficiencies [2].

Motives for substance use can be particularly helpful to contextualize these findings. Commonly used motivational models propose five purposes for substance use: enhancement (increasing positive emotions), coping (reducing distress), expansion (altering perception), socialization (enjoying social activities) and conformity (fitting in) [3, 4]. Among these, coping motives are consistently the strongest predictor of hazardous use [5, 6, 7]. However, for sexually diverse youth, using substances to cope can reflect a lack of other safe and accessible mental health resources [8, 9]. As sexually diverse youth have few options to support their mental health, it becomes difficult to distinguish between adaptive and maladaptive practices, complicating what we describe as hazardous use. This speaks to the importance, in research and practice, of identifying the source of health inequities without vilifying individuals' responses.

Among sexually diverse youth, there is also an emerging body of literature that highlights identity‐based substance use motives, including self‐discovery, introspection and affirmation [10, 11]. In this research, mostly focused on cannabis use, participants describe the cognitive flexibility afforded by substance use as instrumental toward better understanding and expressing themselves. Through an intersecting analysis using queer theory and critical drug studies, Race [12] argues that identifying this type of purposeful substance use is crucial to recognize the agency of sexually (and gender) diverse individuals. Indeed, while coping with minority stressors or ‘self‐medication’ may be a notable characteristic of sexually diverse youth's substance use, acknowledging other identity‐based motives is an important part of positioning these youth as active rather than as solely reactive. Furthermore, recognizing the positive effects sexually diverse youth can experience while using substances may give us pause when examining the issue of higher substance use in this group.

Identity‐based motives also extend to the social contexts particular to sexually diverse youth. For example, practices such as chemsex/party and play (using substances to facilitate and/or enhance sexual encounters) are common among sexually diverse individuals, including youth [13]. Chemsex is associated with higher sexual health risks [14], yet can also be an avenue for more fulfilled sexual experiences, particularly when it comes to the shame certain sexually diverse individuals carry [15]. More generally, social norms around substance use are also more permissive in lesbian, gay, bisexual, transgender and queer (LGBTQ+) communities [16]. Although this may create social pressure to use substances to gain access to LGBTQ+ community [17], sexually diverse youth have also reported that substance use can facilitate connection and social wellbeing [11]. These nuances underscore the importance of considering the many idiosyncrasies of social substance use among sexually diverse youth.

Overall, Mereish et al.’s [1] findings clearly show that sexually diverse youth engage in substance use at higher levels than heterosexual youth. Addressing hazardous substance use in sexually diverse youth is essential to reduce health inequities, while also supporting the agency of sexually diverse youth for engaging in substance use that may provide benefits for them. A key area of future research is then to clarify how diverse types and patterns of use relate to social, mental and physical health outcomes among sexually diverse youth. Specifically, to properly define hazardous substance use, a better understanding of the types and patterns of use related to poor outcomes is needed. Integrating mixed methods, identity‐based motives and a full spectrum of outcomes in this research (rather than only negative outcomes) [18] will help differentiate when benefits of substance use may outweigh risks and vice‐versa. In turn, this will help properly inform practitioners and policy makers. In the meantime, evidence already suggests that practitioners should take a holistic approach to substance use when working with sexually diverse youth, adopting affirmative approaches [19] while having a keen awareness toward motives and contexts of substance use.

AUTHOR CONTRIBUTIONS

Kira London‐Nadeau: Conceptualization (equal); writing—original draft (lead); writing—review and editing (equal). Charlie Rioux: Conceptualization (equal); supervision (lead); writing—original draft (supporting); writing—review and editing (equal).

DECLARATION OF INTERESTS

None.