There’s an urgent need to better understand why substance use (including alcohol, marijuana, and other drugs) is so high among bisexual people. Today, an increasing and growing percentage of the U.S. population identifies as bisexual. Yet, research continues to show higher rates of substance use and consequences related to it (addiction, accidents, depression, anxiety) among bisexual people compared to both heterosexual and gay/lesbian people.
The problem has been so well documented that the National Institutes of Health (NIH) and the Institute of Medicine (IOM) have made calls for research to better understand substance use for bisexual people. Yet, bisexual people remain overlooked in general. Until recently, studies have tended to group all lesbian, gay, bisexual, trans and queer plus (LGBTQ+) people together rather than looking at them as distinct groups with their own health needs. And, while there have been increases overall in attention focused on LGBTQ+ people, there has been little focused on bisexual individuals, even though bisexual people make up the largest proportion of the LGBTQ+ population.
When researchers do separate gay/lesbian and bisexual individuals in analyses, they find that bisexual individuals report more substance use compared to monosexual (i.e., heterosexual, lesbian, and gay) individuals. For instance, recent studies show that alcohol use, cigarette smoking, and other drug use are more common among bisexual people than lesbian/gay and heterosexual people. To better understand some of these trends, I explore a few current explanations for these differences below, as well as areas for future work.
Different Types of Substance Use
First, it’s important to note that higher rates of substance use have been found among bisexual people for all types of drugs (alcohol, cigarettes, marijuana, cocaine, heroin, prescription drugs etc.). These higher use rates also exist across different timeframes (e.g., current vs. past year vs. lifetime use) and personal characteristics. For instance, one study found that shows that across all genders, sexual orientation groups, and age groups, bisexual individuals have the highest rates of drinking.
Distal and Proximal Risk Factors
Why might bisexual people be using more drugs? In general, research suggests that bisexual people may be facing more discrimination, stress, and dealing with negative feelings about themselves. Part of this may be related to the fact that the general population is less familiar with bisexuality. For instance, research shows that binegativity (i.e., negative attitudes toward and worse treatment of bisexual people) and monosexism (i.e., the belief that everyone is, or should be, monosexual) are generallyare associated with more drug use and addiction problems among bisexual people. Bisexual individuals also consistently report less social support than heterosexual and lesbian/gay individuals. Research shows that social belonging, safety, and support are all related to substance use. Low self-esteem and expectations of rejection also increase bisexual people’s substance use.
Finally, a growing body of evidence suggests that more substance use is not just explained by discrimination and stress, it’s related to bisexual people’s multiple embodied identities (gender, race/ethnicity, education level). It’s also linked to bisexual people’s exposure to trauma in childhood and adulthood and societal factors (e.g., disproportionate rates of poverty). Understanding these intersecting identities and realities for bisexual people is key to also understanding their substance use. For example, bisexual people of color may experience racism and other forms of stress that white bisexual people may not experience.
New Directions
Where do we go from here? There are undeniable links between bisexuality and substance use. To be clear, bisexuality itself is not a risk factor for substance use. Rather, bisexual people experience unique risk factors (e.g., binegativity, discrimination, stress) that put them at higher risk for substance use.
Moving forward, one way to address high rates of bisexual people’s substance use would be to combat discrimination across all levels of society. For instance, by creating more awareness of bisexuality—more role models and more bisexual people in TV shows. There’s been some progress in this area, for example, Kat, a recent bisexual character on Law & Order, but there could be more. In trying to support bisexual people, we must remain wary of focusing only on why this group is vulnerable and at high risk, emphasizing their forms of resilience and resistance instead. Finally, let us not forget that bisexual people are one of the fastest-growing demographic groups. As more people identify as bisexual, we must as a society find ways to support their growth, health, and wellbeing.