Experiences of alcohol and other drugs among lesbian, gay, bisexual, transgender, intersex or queer people

Introduction

According to the 2022 population Census, around 1 in 20 people in Australia aged 16 years and over are LGBTI+ (4.5%, or just under 911,000 people) (ABS 2024). In 2022, around 0.3% of people in Australia reported that they know they were born with variations of sex characteristics, 3.6% of people were LGB+, and around 0.9% of people were trans and gender diverse (including trans men, trans women and non-binary people) (ABS 2024). National data on alcohol and other drug use among the general population has consistently shown high rates of substance use among gay, lesbian, or bisexual people relative to the heterosexual Australian population (AIHW 2024). 

This page focuses on alcohol and other drug use, harms and treatment among lesbian, gay, bisexual, transgender, intersex or queer people in Australia. The reporting uses data from a range of sources, mostly national administrative and survey data. 

What data sources are available?

There is a lack of publicly available and comprehensive data examining the use of alcohol and other drugs by LGBTIQ+ people. The AIHW’s National Drug Strategy Household Survey is the only national data source that specifically disaggregates by sexual orientation and provides comprehensive estimates. In addition to this, several smaller surveys are also available:

• The Private Lives survey series provides snapshots of the health and wellbeing of LGBTIQ+ people in Australia, though the sample size of participants with an intersex variation is very small and is not representative of the population.
• The Writing Themselves In survey series reports similar information but does not include people with an intersex variation. The surveys cover a range of topics including questions on alcohol and other drug use with reporting disaggregated by:
  • gender (this includes cisgender female, cisgender male, trans woman, trans man and non-binary)
  • sexual orientation (this includes lesbian, gay, bisexual, pansexual, queer, asexual and ‘something else’). 

The Private Lives survey includes people aged 18 and over and the Writing Themselves In survey includes young people aged 14–21 years, with disaggregation provided for those aged 14–17 and 18–21. Private Lives and Writing Themselves In surveys use convenience sampling and draw participants from a range of recruitment efforts including social media, online LGBTIQA+ community networks and through promotional posters. Therefore, these surveys are not considered representative of the Australian population and care should be taken when interpreting this data as results are indicative of the respondents but should not be generalised to the broader population.

For more information about each data source, see Technical notes.

What do we know about alcohol and other drug use among lesbian, gay, bisexual, transgender, intersex or queer people in Australia?

In 2022–2023, the National Drug Strategy Household Survey (NDSHS) reported 5.1% of participants aged 14 and over were lesbian, gay or bisexual (AIHW 2024). Since 2010, the NDSHS has consistently shown high rates of substance use among gay, lesbian, or bisexual people relative to the heterosexual Australian population (AIHW 2024, Table 10.5). These proportions have declined for smoking and alcohol use but remained relatively stable for illicit drug use. After adjusting for differences in age, people who were lesbian, gay or bisexual were still far more likely than others to smoke daily, consume alcohol in risky quantities, use illicit drugs and use pharmaceuticals non-medically in 2022–2023 (AIHW 2024, Table 10.6). 

Tobacco smoking

Estimates from the 2022–2023 NDSHS indicate that daily tobacco smoking among lesbian, gay or bisexual people has steadily declined from 28% in 2010 to 14.2% in 2022–2023 (AIHW 2024, Table 10.5; Figure 1). After adjusting for age differences, lesbian, gay or bisexual people were 2 times as likely to smoke tobacco daily as people who are heterosexual (AIHW 2024, Table 10.6).

In 2019, the Private Lives 3 survey found 1 in 10 (10.2%) participants aged 18 and reported smoking daily (Hill et al. 2020). There was variation when the proportion of people who smoke daily in the Private Lives 3 survey was examined by sexual orientation and gender (Table LGBTIQ1, Figure 2).

The 2019 Writing Themselves In 4 survey found:

• 1.8% of participants aged 14–17 smoked daily.
• 5.4% of participants aged 18-21 smoked daily (Hill et al. 2021; Table LGBTIQ2, Figure 3).

Vaping and e-cigarette use

After adjusting for age differences, lesbian, gay and bisexual people are 2.1 times as likely to use e-cigarettes as the general population (AIHW 2024). The 2022–2023 NDSHS showed that around 1 in 5 (21%) lesbian, gay and bisexual people aged 14 and over currently used e-cigarettes, up from 7.1% in 2019 (AIHW 2024).

In 2019, higher proportions of participants of the Private Lives 3 survey reported lifetime and current use of e-cigarettes when compared to the general Australian population aged 18 and over:

• lifetime use (12.9% compared to 11.4%)
• current use (5.7% compared to 2.6%) (AIHW 2020, Hill et al. 2020).

A higher proportion of participants aged 14–17 years in the Writing Themselves In 4 survey reported current use of e-cigarettes (4.2%) (Hill et al. 2021) when compared to the general Australian population in this age range (1.8%, noting this estimate has a relative standard error of 25% to 50% and should be used with caution) (AIHW 2020).

Of the Writing Themselves In 4 participants aged 18–21, 87% (5,540) reported never using vapes/e-cigarettes and 0.9% (58) use them daily (Hill et al. 2021; Table LGBTIQ2). This is consistent with the general youth population (AIHW 2024).

Alcohol use

Since 2010, risky drinking has been declining among lesbian, gay or bisexual people (Figure 1). Estimates from the NDSHS showed that from 2010 to 2022–2023, there has been a decline in the proportion of lesbian, gay and bisexual people who exceed the guidelines for risk of alcohol-related disease or injury (from 50% to 40%) (AIHW 2024, Table 10.5).

After adjusting for age differences, lesbian, gay or bisexual people are still more likely than heterosexual people to drink at risky levels (AIHW 2024). In 2022–2023, compared with heterosexual people, lesbian, gay or bisexual people were:

• 1.2 times as likely to exceed the risk guidelines
• 1.3 times as likely to consume more than 4 standard drinks in a day at least monthly (AIHW 2024, Table 10.6).

In 2019, one quarter (25%) of participants in the Private Lives 3 survey reported drinking more than 2 standard drinks per day on a typical day (Hill et al. 2020; Table LGBTIQ1, Figure 2). This is higher than the proportion in the general Australian population aged 18 and over who exceeded the lifetime alcohol risk guideline (17.6%) (AIHW 2020). 

Higher proportions exceeding 2 drinks on a typical day were reported in the Private Lives 3 survey for:

• cisgender men (38%)
• trans women (32%)
• people who identified their sexual orientation as gay (39%) or ‘something else’ (33%) (Hill et al. 2020).

More than half (52%) of Writing Themselves In 4 participants aged 14–17 years in 2019 reported that they never drank alcohol (Hill et al. 2021) (Figure 3). This is substantially lower than the proportion of abstainers in the general Australian population aged 14–17 years (73%) (AIHW 2020).

Illicit drug use

Unlike smoking and drinking alcohol at risky levels, recent use of illicit drugs has increased among lesbian, gay or bisexual people between 2010 and 2022–2023. In 2022–2023, almost half (47%) lesbian, gay or bisexual people had recently used any illicit drug, compared with 36% in 2010 (AIHW 2024, Table 10.5). Stability in recent drug use among gay, lesbian or bisexual people was relatively consistent across drug types between 2019 and 2022–2023, with the exception of cocaine, which rose from 10.5% in 2019 to 15.1% in 2022–2023 (AIHW 2024, Table 10.6).

Estimates from the NDSHS show that lesbian, gay and bisexual people continue to be more likely than heterosexual people to use a range of illicit drugs (AIHW 2024). In 2022–2023, after adjusting for age differences, lesbian, gay or bisexual people were 2.4 times as likely as heterosexual people to have recently used any illicit drug (AIHW 2024, Table 10.6). Differences varied by drug type. Compared with heterosexual people, lesbian, gay or bisexual people were (after adjusting for differences in age):

• 8.6 times as likely to have used inhalants in the previous 12 months, likely due to the use of nitrites during sexual activity by men who have sex with men (Vaccher et al. 2020), although use was high among all gay, lesbian, and bisexual people 
• 6.6 times as likely to have used methamphetamine and amphetamine in the previous 12 months.
• 3.4 times as likely to have used ecstasy in the previous 12 months.
• 2.7 times as likely to have used cocaine in the previous 12 months (AIHW 2024, Table 10.6; Figure 1).

In 2019, at least 2 in 5 (44%) participants in the Private Lives 3 survey reported using one or more drugs for non-medical purposes in the previous 6 months. The most frequently reported drugs were cannabis (30%), ecstasy/MDMA (13.9%) and cocaine (9.6%) (Hill et al. 2020; Table LGBTIQ1, Figure 2).

The Private Lives 3 survey reported cannabis use was higher for participants who identified their sexual orientation as queer (38%), pansexual (37%) or bisexual (36%). Cocaine use was higher among participants who identified their sexual orientation as queer or gay (both 13%) and bisexual (8.1%) (Hill et al. 2020).

More than 3 in 10 trans men (38%), cisgender men (43%), trans women (41%) and participants who identified their sexual orientation as queer (38%) in the Writing Themselves In 4 survey reported the use of drugs for non-medical purposes in the past six months (Table LGBTIQ2, Figure 3). The most frequently consumed drugs by Writing Themselves In 4 participants aged 14–17 years were cannabis (22%), antidepressants (5%) followed by ecstasy (3.3%) (Hill et al. 2021; Figure 3).

Injecting drug use

Data on injecting drug use among lesbian, gay or bisexual people are available via the Australian Needle Syringe Program Survey (ANSPS). The ANSPS is an annual survey conducted via NSPs across Australia, designed to monitor blood-borne viral infections and injecting and sexual risk behaviour among people who inject drugs.

The latest ANSPS was conducted in 2024, including 1,760 NSP attendees across 54 NSPs (Heard et al. 2025, Table S1.1.1). In this survey, 1 in 10 respondents (11%) identified as bisexual and a further 5% identified as gay or lesbian. Between 1995 and 2024:

• human immunodeficiency virus (HIV) antibody prevalence was consistently higher among gay men than among bisexual men, heterosexual men, or women
• around half (51%) of the survey respondents who tested positive for HIV were gay men despite making up between 2% and 5% of the annual survey samples (Heard et al. 2025).

What do we know about health and harms for lesbian, gay, bisexual, transgender, intersex or queer people who use alcohol and other drugs?

There is a lack of data available on alcohol and other drug-related health and harms among LGBTIQ+ people in Australia. 

Detailed information about alcohol and other drug-related health and harms among the general population is presented in Health and harms.

How many lesbian, gay, bisexual, transgender, intersex or queer people receive treatment for alcohol and other drug use?

The majority (66%) of participants in the Private Lives 3 survey who sought professional support for their drug use did so from a mainstream service. Four in ten (40%) sought support from a mainstream service known to be LGBTIQ-inclusive and 8% from a service that caters only to lesbian, gay, bisexual, transgender and/or intersex people (Hill et al. 2020).

Where do I go for more information?

• LGBT people’s use of alcohol, tobacco, e-cigarettes and other drugs
• Private Lives survey