Why Is Substance Use So High Among Bisexual People?

This piece examines why bisexual people experience significantly higher rates of substance use than both heterosexual and gay or lesbian individuals, despite being the largest and fastest-growing segment of the LGBTQ+ population. Although federal agencies like NIH and the IOM have called for more research, bisexual people remain understudied, often lumped into broad LGBTQ+ categories that obscure their distinct health needs. Evidence shows that bisexual individuals consistently have the highest rates of alcohol, tobacco, and drug use across substances, ages, and genders, a pattern linked to unique stressors such as binegativity, monosexism, social isolation, low self-esteem, and expectations of rejection. These risks are further compounded by intersecting identities and experiences, including racism, poverty, and trauma, which disproportionately affect bisexual people, especially bisexual people of color. Bisexuality itself is not the risk factor; rather, discrimination and social marginalization create conditions that elevate substance use. Addressing these disparities requires increasing bisexual visibility, combating stigma, and building supportive environments that affirm bisexual people’s identities, health, and wellbeing.