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Calling for nuanced, intersectional approaches to address substance use within LGBTIQ+ communities

Introduction by Croakey: The release of national mental health and wellbeing data last year prompted Nicky Bath, CEO of LGBTIQ+ Health Australia, to call for whole-of-government action and investment to address the burnout, discrimination, distress and harms experienced by LGBTIQ+ people.

The recent release of data from the National Drug Strategy Household Survey (NDSHS) reveals several concerning trends and, despite limitations of the data, demonstrates the need for the upcoming inaugural 10 Year National LGBTIQA+ Health and Wellbeing Action Plan, Bath writes below.

“The NDSHS data underscores the need for a nuanced, intersectional approach to address substance use within LGBTIQ+ communities,” Bath says. “Policymakers, clinicians, services, and communities must collaborate to implement inclusive policies, educational campaigns, and support services.”


Nicky Bath writes:

Recent data from the Australian Institute of Health and Welfare’s (AIHW) National Drug Strategy Household Survey (NDSHS) 2022-2023 sheds light on the substance use patterns among Lesbian, Gay, Bisexual and Trans (LGBT) communities in Australia.

The NDSHS data indicates that, in 2022–2023, 5.1 percent of individuals aged 14 and over identified as gay, lesbian, or bisexual, with 0.9 percent identifying as transgender or gender diverse.

For the first time, the survey captured data on trans and gender diverse people, and this is great progress.  I encourage the AIHW to ensure future surveys also capture information on intersex people.

While progress is evident in some areas, the findings reveal concerning trends, especially in relation to use of electronic cigarettes and illicit drugs.

Concerning trends

Use of electronic cigarettes has nearly tripled, reaching 21 percent, compared to 7.1 percent in 2019. Additionally, almost half of gay, lesbian and bisexual (LGB) individuals reported using illicit drugs in the previous 12 months, a significant increase since 2019.

This data shines a spotlight on the differences in substance use patterns between LGBT people and heterosexual, cisgender people and should drive panic in the echelons of all Australian governments.

When compared to heterosexual people, the rate of daily smoking among LGB people is two times higher and risky alcohol consumption is 1.2 times higher.

LGB people were 2.4 times more likely to have used any illicit drug in the previous 12 months. They were 8.6 times more likely to have used inhalants in the previous 12 months, 6.6 times more likely to have used methamphetamine and amphetamine in the previous 12 months, and 3.4 times more likely to have used ecstasy in the previous 12 months.

Transgender and gender diverse people are 1.3 times as likely as cisgender people to drink more than four standard drinks in a single day at least once a month and 1.6 times as likely to have used any illicit drug in the previous 12 months.

I hope you are uncomfortable. These are persisting disparities that contribute to the potential risk of harm, and the burden of adverse mental health outcomes experienced by LGBT people.

It is of course important to note that high rates of drug use amongst LGBT people are not because of who we intrinsically are.

It is due to the compounded experiences of stigma, prejudice, discrimination and abuse that LGBT people have experienced and continue to experience. Additionally, historical factors and entrenched social norms within LGBT culture, particularly those related to social dynamics and the pursuit of pleasure, contribute to these patterns.

Research limitations

Policymakers and researchers must prioritise inclusive survey methodologies using the variables in the Australian Bureau of Statistics’ 2020 Standard, and we must include them in the 2026 Census.

Only by asking questions on sex, gender, variations of sex characteristics and sexual orientation in all surveys can we gain much-needed insights, as the NDSHS has partially achieved.

It is difficult to accurately estimate the LGBTIQ+ population due to the absence of comprehensive questions in population-based surveys and the current limited inclusion in research hinders our understanding of the nuanced challenges faced by various subgroups within LGBTIQ+ communities.

We need this data so that we can drive change, have a more strategic lens on service and program planning to ensure that scarce resources are well invested, and we can see an end to the unrelenting health disparities across LGBTIQ+ communities.

Responses needed

How can we respond to the NDSHS data?

We need to ensure that the upcoming inaugural 10 Year National LGBTIQA+ Health and Wellbeing Action Plan creates an effective framework for action that tackles the root causes and ensures optimal responses. We need to develop tailored community-led education campaigns that are informed by harm-reduction principles.

We must increase access to mental health and substance-use support services and programs that are sensitive to the unique experiences of LGBTIQ+ people, run by and for LGBTIQ+ people, and ensure that generalist services are safe and appropriate.

We also need to invest in specific resources for transgender and gender diverse people who face additional challenges.

Tackling the societal stigma and discrimination directed at LGBTIQ+ people head on is critical. Public awareness campaigns must target reducing societal prejudice to create a more supportive environment for us all to live in.

The intersectionality of people across LGBTIQ+ communities also requires more attention and we need to deep dive into the NDSHS data to understand them and any compounding factors.

We must empower LGBTIQ+ communities, especially those within First Nations communities, to lead initiatives addressing substance use. Community-driven solutions are more effective and are a better return on investment.

The NDSHS data underscores the need for a nuanced, intersectional approach to address substance use within LGBTIQ+ communities. Policymakers, clinicians, services, and communities must collaborate to implement inclusive policies, educational campaigns, and support services.

By identifying and dismantling barriers to action, we can create a more equitable and supportive environment for all members of the LGBTIQ+ communities, fostering better mental and physical health outcomes for everyone.

• Nicky Bath is CEO of LGBTIQ+ Health Australia


Seeking help

Lifeline: 13 11 14
Suicide Call Back Service: 1300 659 467
beyondblue: 1300 224 636
13Yarn: 13 92 76
Kids Helpline: 1800 551 800
QLife: 1800 184 527
Check-In (VMIAC, Victoria): 1800 845 109
Lived Experience Telephone Line Service: 1800 013 755


See Croakey’s archive of articles on LGBTIQ+ peoples’ health and wellbeing