# Disproportionate use of polysubstance combinations varies by sexual identity among US adults

## TL;DR

Bisexual female adults in the US disproportionately use multiple substances like alcohol and cannabis compared to other groups.

## Contribution

This study identifies specific polysubstance combinations and their variation by sexual identity and sex among US adults.

## Key findings

- Bisexual female adults most frequently used combinations involving binge alcohol, cannabis, or both.
- Substance use patterns varied by sexual identity and sex, but not among gay/lesbian adults.
- Public health strategies should consider sexual identity and specific substance combinations.

## Abstract

Polysubstance use is a major public health concern affecting lesbian, gay, and bisexual (LGB) adults, especially bisexual female adults. This study aims to identify the commonly used polysubstance combinations by LGB adults in the past 30 days and to determine whether these combinations differ by sexual identity and sex. Our analytic sample consisted of NSDUH 2021 and 2022 (n = 66,634 adults; 8.59% LGB adults). We used survey-weighted multinomial logistic regression models to assess the polysubstance combinations by sex. The most used substances were binge alcohol drinking, cannabis, cigarettes, and nicotine vape. Bisexual female adults used most of the assessed polysubstance combinations that included binge alcohol drinking, cannabis, or both, often involving three or four substances. Sex differences among the polysubstance combinations vary among heterosexual and bisexual adults but not among gay/lesbian adults. Public health strategies must consider the specific sexual identity, sex, and the types of substance combinations involved.