The curvilinear effects of sexual orientation on young adult substance use

- Sexual orientation was studied as a continuous, not categorical, variable.
- Mixed orientation women report higher substance use than exclusively hetero or homosexual women.
- Mixed orientation men report higher marijuana use than exclusively hetero or homosexual men.

Alcohol, tobacco, and marijuana are commonly used by adolescents and linked with harmful health-related outcomes (e.g. injury, dependence). Moreover, heavy episodic (binge) drinking predicts more severe consequences. When examined by sexual orientation, highest rates of substance use have been found among bisexual individuals, with lower use at either end of the spectrum. When examined also by sex, this curvilinear trend is maintained among women but not men. These substance use patterns were identified using group differences (i.e. heterosexual vs. bisexual vs. homosexual). However, evidence suggests that sexual orientation is a continuous, not categorical, variable. This study examined the hypotheses that sexual orientation and commonly used substances (heavy episodic drinking, tobacco, marijuana) would have a quadratic relation among women, but not among men. Six negative binomial regressions tested study hypotheses using data from 7372 participants. Results indicated that sexual orientation had a quadratic relation with heavy episodic drinking, tobacco use, and marijuana use among women, as hypothesized. Additionally, a quadratic relation was found between marijuana use and sexual orientation among men. These findings indicate that women identifying as having mixed sexual orientation are at higher risk than women at either end of the sexual orientation continuum for substance use and related negative outcomes. For men, this is only true for marijuana use and resultant negative consequences. This observed increased use may relate to coping with increased stressors, which has been linked to more problematic use. By better understanding LBG identities and behaviors, clinicians and researchers will be more adept at identifying risk factors and better understanding the nuances across the sexual orientation spectrum.