Intersectionality in substance use disorders: Examining gender, race/ethnicity, and sexual orientation in the 2021-2022 National Survey on Drug Use and Health.

This study examines the impact of the intersection of gender, racial/ethnic identity, and sexual orientation among adults on substance use disorders (SUDs) from 2021 to 2022. We conducted an analysis of persons (ages 18 and older) who responded to the 2021 and 2022 National Survey on Drug Use and Health (NSDUH). Logistic regression models were constructed to examine odds of past-year SUDs at the intersection of gender, sexuality, and race/ethnicity. All analyses were design-corrected to enhance population representativeness and generalizability. Prevalence varied by race/ethnicity and sexual orientation across both sexes (total n = 83,722). Non-Hispanic multiracial lesbian/gay individuals had the highest prevalence of any SUD in both sexes (46.6 % in women, 52.3 % in men). Bisexual women showed consistently elevated odds of SUD across most racial/ethnic groups (aORs 1.48-2.99) compared to White heterosexual women. Men had higher prevalence of SUD than women (21.1 % compared to 15.0 %, p < 0.0001). Only White gay and bisexual men had significantly increased odds for any SUD compared to heterosexual White men (aOR 1.73 and 1.57, respectively). White bisexual men had higher odds of reporting cannabis use disorder (CUD; aOR 1.87). Hispanic men demonstrated lower odds of any SUD or CUD (aORs 0.85 and 0.71, respectively). Women demonstrated more pronounced SUD disparities between intersectional identity. While men had higher SUD prevalence overall, few disparities were observed between intersectional identities. To effectively address these disparities and their consequences (e.g., differential minority stress and mental/physical health outcomes), prevention and intervention efforts should prioritize an intersectionality approach.