Trends in Simultaneous Alcohol and Marijuana Use among US Adult Recent Drinkers: Differences by Sexual Identity, 2015-2020

Simultaneous alcohol and marijuana (SAM) use has become increasingly prevalent among young adult populations. Moreover, lesbian, gay, and bisexual populations are at increased risk for substance use initiation. To date, little research has examined trends in SAM use by sexual identity. This study aimed to investigate trends in SAM use among recent drinkers using nationally representative data. Pooled data from the 2015-2019 and 2020 National Survey on Drug Use and Health (NSDUH) were examined among 120,061 individuals (5.75% LGB) 18 years or older who reported using alcohol in the past month. Given the methodological changes in the study design, we analyzed these waves separately. Covariates included age, race, biological sex, sexual identity, rurality, and past month use of tobacco. Weighted logistic regression models and trend analyses were conducted. An estimated 11,952 of the sample reported using marijuana during their last episode of drinking. A significant linear trend (b = 0.12) of increasing SAM use among recent drinkers from 2015 to 2019. When compared to heterosexual individuals, lesbian or gay (aPR: 1.44, 95% CI 1.26, 1.63) and bisexual (aPR: 1.92, 95% CI 1.77, 2.09) individuals were more likely to report SAM use. Among the entire sample, females had a lower risk of SAM use than males (aPR: 0.68, 95% CI 0.65, 0.72). For 2020, a total of 25,679 adults 18 years or older participated in the survey, with 2,622 identifying as LGB and 54.1% reporting past month alcohol use. An estimated 1,503 individuals reported SAM use. Consistent with our findings, of those reporting past month alcohol use, LGB populations were at higher risk for SAM use, with gay individuals (aPR: 1.59, 95% CI 1.11, 2.30) at increased risk and bisexual individuals having higher risk (aPR: 2.12, 95% CI 1.73, 2.60). SAM use among individuals presents several critical health concerns, especially for at-risk populations. Findings from the present study can inform tailored interventions to reduce minority stress and stigmatized identities are needed.