LGBTQIAPN+ Youth and Psychoactive Substance Use: What Brazilian Data Reveal

From adolescence onward, LGBTQIAPN+ youth often face experiences marked by rejection, discrimination, invisibility, and a lack of support in environments that should provide safety and acceptance. These experiences can have lasting consequences, one of which—documented by decades of international research—is an increased vulnerability to substance use. Until recently, however, Brazil lacked national data demonstrating how this reality unfolds within its own unique social, cultural, and structural context. A study published in 2025 has begun to fill this gap, providing important new evidence on an issue that affects the health and well-being of millions of Brazilian adolescents and young adults.

Substance use during adolescence is one of the most important public health concerns worldwide. Adolescence is a developmental period characterized by profound neurological, emotional, and social changes that make the brain particularly vulnerable to the effects of psychoactive substances and to the development of problematic patterns of use that may persist into adulthood. Among sexual and gender minority youth, this vulnerability is even greater. Previous research has consistently shown that adolescents who identify as lesbian, gay, bisexual, transgender, queer, and other sexual and gender minorities are at increased risk for substance use. Specifically, queer adolescents are approximately 190% more likely to use illicit drugs than their heterosexual peers.²˒³

Most of the available evidence has come from high-income countries, particularly the United States and Europe. A study published in 2025 in the International Review of Psychiatry helps address this knowledge gap by providing Brazilian data, and its findings deserve careful attention.¹ Researchers analyzed data from 1,492 participants between 12 and 21 years of age. Of these, 247 (16.6%) identified as LGBTQIAPN+, while 1,245 (83.4%) identified as cisgender heterosexual. The study compared lifetime prevalence and age at first use of alcohol, tobacco, cannabis, and cocaine between the two groups.

Lifetime Prevalence of Substance Use

The findings revealed important differences between the groups. Lifetime alcohol use was similar, reported by approximately 84% of cisgender heterosexual participants and 86% of LGBTQIAPN+ participants. Marked differences emerged, however, for other substances:

• Tobacco: Lifetime use was reported by 48% of LGBTQIAPN+ youth, compared with 36.8% of cisgender heterosexual youth.
• Cannabis: Lifetime use was reported by 40.4% of LGBTQIAPN+ participants, compared with 27% of cisgender heterosexual participants.
• Cocaine: Lifetime use was reported by 7.4% of LGBTQIAPN+ youth, compared with 3.6% of cisgender heterosexual youth—more than twice the prevalence observed in the comparison group.

These differences are already substantial when considering the LGBTQIAPN+ population as a whole. However, the findings become even more informative when participants are analyzed according to their sex assigned at birth.

What Changes Among Individuals Assigned Female at Birth?

One of the study's most important findings is that the observed disparities were driven primarily by participants assigned female at birth. Among those assigned male at birth, differences between LGBTQIAPN+ and cisgender heterosexual participants were not statistically significant. In contrast, among those assigned female at birth, the disparities were pronounced:

• Tobacco: Lifetime use was reported by 49% of LGBTQIAPN+ participants, compared with 34.2% of cisgender heterosexual participants.
• Cannabis: Lifetime use was reported by 44.3% of LGBTQIAPN+ participants, compared with 23.3% of cisgender heterosexual participants—nearly twice the prevalence.
• Cocaine: Lifetime use was reported by 7.4% of LGBTQIAPN+ participants, compared with 2.4% of cisgender heterosexual participants, representing more than a threefold higher prevalence.

When participants were further classified according to sexual orientation, bisexual individuals assigned female at birth exhibited the highest lifetime prevalence of alcohol, tobacco, cannabis, and cocaine use compared with heterosexual women. No statistically significant differences were observed among lesbian participants or other sexual minority subgroups.

Earlier Initiation of Substance Use

The study also found that lifetime prevalence of substance use increased progressively with age in both LGBTQIAPN+ and cisgender heterosexual participants. However, LGBTQIAPN+ youth reported initiating alcohol use at younger ages. Among LGBTQIAPN+ participants, 8.7% reported consuming alcohol by age 10, compared with only 1.9% of cisgender heterosexual participants.

Cannabis use was particularly higher among LGBTQIAPN+ participants between 14 and 18 years of age, with 26.5% reporting use compared with 7.5% among cisgender heterosexual youth. Cocaine use remained uncommon during early adolescence but increased considerably among older LGBTQIAPN+ participants.

Why is this important? Because age at first substance use is one of the strongest predictors of future risk. The earlier an individual begins using psychoactive substances, the greater the likelihood of developing substance use disorders, psychiatric comorbidities, and persistent patterns of problematic use later in life.

Implications for Prevention and Public Health

The study's findings highlight the need for prevention strategies that recognize the specific experiences and vulnerabilities of LGBTQIAPN+ youth. The evidence reinforces previous research showing that LGBTQIAPN+ adolescents who experience discrimination related to their sexual orientation or gender identity report higher rates of substance use. Addressing stigma, discrimination, and structural exclusion should therefore be viewed not only as a matter of social justice but also as a public health priority. Experiences from other vulnerable populations similarly demonstrate that, when individuals are unable to access appropriate support and acceptance, psychoactive substances may become a means of coping.

Within the Brazilian context, this study makes an important contribution by providing longitudinal evidence from a middle-income country on a topic that has received relatively little investigation. Its findings confirm patterns previously observed in international studies and demonstrate that disparities in substance use among LGBTQIAPN+ youth are not unique to particular cultural settings.

Importantly, the purpose of these findings is not to stigmatize LGBTQIAPN+ adolescents or reinforce prejudice of any kind. Health disparities do not arise from sexual orientation or gender identity themselves; rather, they reflect the consequences of exclusion, violence, discrimination, and inadequate social support. Robust evidence such as that presented in this study underscores the importance of ensuring equitable access to evidence-based public policies and high-quality healthcare services designed to reduce the health disparities experienced by LGBTQIAPN+ populations.

References:

1. Figueiredo CPM, Bezerra HA, Miguel EC, Rohde LA, Salum GA, Pan PM, Caye A. Patterns of substance use and initiation among LGBTQIAPN+ youth in Brazil: Evidence from a population-based cohort. Int Rev Psychiatry. 2025;37(6–7):639–650. doi:10.1080/09540261.2025.2573758
2. Brown E, Abdelmassih E, Hanna F. Avaliando os determinantes do uso de substâncias em adolescentes LGBTQIA+: uma revisão de escopo. International Journal of Environmental Research and Public Health . 2024; 21(12):1579. doi.org/10.3390/ijerph21121579
3. Marshal MP, Friedman MS, Stall R, King KM, Miles J, Gold MA, Bukstein OG, Morse JQ. Sexual orientation and adolescent substance use: a meta-analysis and methodological review. Addiction. 2008;103(4):546–556.