Experiences of Rural Lesbian, Gay, and Bisexual Individuals Who Use Substances: Risk Factors of Substance Use and Barriers to Harm Reduction Services

Subst Use Misuse. 2026 Jul 21:1-13. doi: 10.1080/10826084.2026.2704624. Online ahead of print.

ABSTRACT

BACKGROUND: This study explored substance use and harm reduction service utilization among rural lesbian, gay, and bisexual (LGB) individuals.

METHODS: A survey explored substance use patterns, history of abuse and stigma, and treatment and support group utilization, with subsequent interviews providing contextual and thematic data. Participants were recruited January to July 2023 in southern Illinois. All completed the survey, and a subset were interviewed. Chi-square and independent samples t-test analyses were conducted on the quantitative data, and Interpretative Phenomenological Analysis was used for the interviews (n = 9).

RESULTS: LGB survey participants (n = 17) had similar rates of substance use versus their heterosexual peers (n = 128), but increased frequency of reported adverse childhood experiences (score of 6.71 vs. 3.69; p < 0.001) and post-traumatic stress disorder (score 3.65 vs. 2.44; p = 0.006). Thematically, substance use risk factors included homophobic/biphobic environment(s), childhood trauma/abuse, familial histories of abuse, and mental health disorders.

CONCLUSION: Barriers to treatment and harm reduction service utilization included stigma from clinic staff and police, addiction to treatment medication, long treatment waitlisting, and lack of rehabilitation services. Rural LGB individuals may experience substance use, mental health issues, homonegativity, adverse family histories, and harm reduction barriers, which is reflective of non-LGB rural people who use substances except for homonegativity.

PMID:42480016 | DOI:10.1080/10826084.2026.2704624