Pot at the End of the Rainbow: Cannabis Use Among Sexual Minorities

Abstract

Introduction:

Gay, lesbian, and bisexual individuals (i.e., sexual minorities) use cannabis more frequently than heterosexuals; however, little research has directly compared sexual minorities' patterns of cannabis use (e.g., quantity, age of onset, forms of cannabis used) with heterosexuals. Some research has identified motivations for cannabis use in sexual minorities, but much of this research has been qualitative and/or narrow in scope (e.g., focused on sexual motivations). To the best of our knowledge, no previous research has used a validated measure to examine motives for cannabis use among sexual minorities. Additionally, cannabis use is known to be associated with mental health symptoms, but little research has examined relationships between cannabis use and mental health in this population.

Materials and Methods:

Data analyses were performed on archival survey data collected from 10 undergraduate psychology subject pools across the United States (N=4,669) as a part of Project ART (Addictions Research Team). Participants indicated their sexual orientation using a 5-point scale, and responses were used to classify participants into three groups: the majority of the sample (n=3,483) were classified into the heterosexual group, about one quarter were classified into the bisexual group (n=1,081), and a small number were classified into the gay group (n=105).

Results:

The bisexual group was more likely to report using cannabis. They also reported using cannabis more frequently, were more likely to report use of all product types (i.e., flower, concentrates, and edibles), and reported more severe symptoms of cannabis use disorder (CUD) than the heterosexual group. The bisexual group also reported higher levels of coping and enhancement motives for using cannabis and reported higher levels of all measured mental health symptoms (e.g., depression, suicidality, generalized anxiety, and social anxiety) compared with the heterosexual group.

Conclusions:

Increased frequency of cannabis use, use of a broad range of different products, and use of cannabis to cope with mental health concerns may be placing bisexual individuals at greater risk of CUD. Findings from this study can be used to guide future research and help target mental health interventions among bisexual individuals.

Introduction

Rates of cannabis use are especially high among sexual minorities (i.e., gay, lesbian, or bisexual individuals). These individuals use cannabis more frequently compared with their heterosexual peers in the past year,^1–4 in the past 30 days,^5–8 and daily.^2,9 However, it is unclear whether sexual minorities start using cannabis at a younger age, use different forms of cannabis (e.g., flower, concentrates, edibles), or use them in higher quantities. The current study helps to fill these gaps in the literature, thereby providing an improved understanding of cannabis use patterns in this vulnerable population.

Some specific motivations for using cannabis have been identified among sexual minorities that may help to account for their increased frequency of use. However, much of this research has been qualitative in nature and has focused on sexual motivations for cannabis use,^10,11 with a small number of quantitative studies examining expectancies that reinforce cannabis use. Mental health concerns also appear to be related to cannabis use among sexual minorities.^12–14 Specifically, past research indicates that sexual minorities may be motivated to use cannabis to enhance sex,¹¹ lower sexual inhibitions,¹¹ and self-medicate for mental health symptoms.^12,13 Additionally, one study found that higher percentages of sexual minorities have reported using cannabis on the recommendation of a doctor or other health professional (e.g., medical use) compared with heterosexuals.²

Motivations for using cannabis have been more thoroughly explored in the general population using the Marijuana Motives Measure (MMM), which is a valid and reliable measure of motivations for cannabis use in the general population.¹⁵ The MMM assesses five distinct motivations, including coping, enhancement, expansion, conformity, and social motives. Previous work has shown that coping motives are associated with negative affect, including symptoms of depression;¹⁶ however, the direction of these relationships remains somewhat unclear. Other research has shown that coping motives for cannabis use are associated with problematic cannabis use and mediate relationships between stress and problematic cannabis use.¹⁷

While most of these general cannabis use motives have not been examined in sexual minorities, previous research is consistent with the notion that these individuals use cannabis to cope with mental distress.¹³ In summary, previous research indicates that a variety of motives drive cannabis use among sexual minorities and heterosexuals. Results from those studies suggest that sexual minorities use cannabis to enhance sex and cope with mental health symptoms. However, to the best of our knowledge, no previous studies have directly compared motives for using cannabis among sexual minorities relative to heterosexuals.

The present study was designed to examine differences in cannabis use patterns, motivations for using cannabis, and the relations between cannabis use and mental health symptoms, in groups classified as gay, bisexual, and heterosexual. We hypothesized that the groups classified as gay and bisexual would show more risky patterns of cannabis use (e.g., increased frequency of use, higher quantities of use, lower age of onset, use of broader range of products, elevated symptoms of cannabis use disorder [CUD]) compared with the group categorized as exclusively heterosexual.

With respect to motives for use, we hypothesized that the groups classified as gay and bisexual would exhibit higher levels of coping, enhancement, conformity, and social motives, as well as higher levels of medical cannabis use, compared with the heterosexual group. Finally, we predicted that both groups classified as sexual minorities would show poorer mental health outcomes compared with the exclusively heterosexual group and that associations between cannabis use status and poorer mental health would be stronger among the groups classified as sexual minorities than the exclusively heterosexual group, given sexual minorities' vulnerability to mental health concerns.¹⁸

Materials and Methods

Procedure

We conducted an analysis of data collected as a part of Project ART (Addictions Research Team), a collaborative research effort focused on addictions research in young adults.¹⁹ Data were collected via an online Qualtrics survey that was administered to 10 university psychology subject pools across the United States. The study was approved by the University of New Mexico Institutional Review Board. To reduce overall burden, the survey used a planned missing data design (e.g., matrix sampling²⁰), such that each participant received a random set of only 9 of the 18 measures that comprised the full survey, as well as a main battery of measures of substance use. A total of 7,307 students were recruited, but only cisgender young adults who completed measures relevant to this study were included in analyses, and pairwise deletion was used for missing data. Students received class credit for participation. Only the measures relevant to the present study are detailed below.

Demographics

Young adults aged 18–30 years who responded to the question about sexual orientation and indicated that they were cisgender were included in analyses (N=4,669; 70.5%), given that there were not enough transgender individuals to make meaningful comparisons. Roughly two thirds of the sample indicated that they were women (n=3,292). Demographic data are displayed in Table 1 separately for each group as well as across the entire sample. As shown in Table 1, the groups differed significantly with respect to gender, age, Hispanic identity, Asian identity, and White identity. These five variables were used as covariates in subsequent analyses comparing the groups.

Table 1.

Demographic Characteristics in Total Sample and Three Groups

Characteristic	Total sample (N=4,669)	Heterosexual group (n=3,483)	Bisexual group (n=1,081)	Gay group (n=105)	Comparisons across sexuality groups (p)
Gender					<0.001
Men	29.5%	33.0%	15.8%	55.2%
Women	70.5%	67.0%	84.2%	44.8%
Age					0.007
Mean (SD)	19.62 (2.05)	19.58 (2.00)	19.67 (2.15)	20.19 (2.73)
Race/ethnicity
White	65.5%	64.1%	69.8%	67.6%	<0.001
Hispanic	27.6%	26.4%	30.8%	36.2%	0.002
Asian	15.9%	17.0%	13.0%	9.5%	0.001
Black	11.7%	11.9%	10.6%	14.3%	0.36
American Indian	2.4%	2.2%	3.0%	1.9%	0.38
Hawaii Native or Pacific Islander	1.1%	1.2%	0.9%	0%	0.43
University Class					0.15
Freshman	49.1%	49.9%	47.1%	43.8%
Sophomore	23.6%	23.9%	23.1%	20.0%
Junior	15.2%	14.4%	17.6%	20.0%
Senior	11.4%	11.2%	11.7%	15.2%
Graduate	0.6%	1.0%	0.5%	1.0%

SD, standard deviation.

Just over half of the sample indicated that they had used cannabis (n=2,485; 53.2%). Among this subsample, the self-reported mean age of first cannabis use was 16.24 (standard deviation [SD]=2.86), 12.2% reported using cannabis daily, 17.7% reported using cannabis weekly, and the remainder reported using cannabis a few times per month or less.

Measures

As part of the demographic's questionnaire, participants were asked to indicate their sexual orientation using the following response options: exclusively heterosexual, mostly heterosexual, equally heterosexual and homosexual, mostly homosexual, exclusively homosexual. Categories were collapsed into three main categories for analyses: (1) exclusively heterosexual (i.e., heterosexual group), (2) mostly heterosexual, equally heterosexual and homosexual, and mostly homosexual (i.e., bisexual group), and (3) exclusively homosexual (i.e., gay group). About three quarters of the sample (n=3,483; 74.6%) were classified into the heterosexual group, a quarter were classified into the bisexual group (n=1,081; 23.2%), and a small percentage were classified into the gay group (n=105; 2.2%).

The Daily Sessions, Frequency, Age of Onset, and Quantity of Cannabis Use Inventory (DFAQ-CU) was used to measure cannabis use patterns including daily sessions, frequency of use, age of onset of use, quantity of flower, quantity of concentrates, quantity of edibles, and forms of cannabis used as well as use for medical versus recreational purposes.²¹ Symptoms of CUD were assessed using the Cannabis Use Disorders Identification Test–Revised (CUDIT-R).²² The MMM was used to measure motives for using cannabis among those reporting cannabis use.¹⁵ Subscales of the DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure were used to measure depression, generalized anxiety, and suicidality.²³ Social anxiety was assessed using the Social Interaction Anxiety Scale (SIAS).²⁴

Data analysis

Variables were screened for univariate outliers, defined as scores falling more than 3.29 SDs from the mean, and a small number of outlying variables were detected (<1% of the total data set). Outlying values were replaced with scores equivalent to one unit higher or lower than the nearest non-outlying score.²⁵

Group differences in cannabis use patterns (i.e., daily sessions, frequency, quantity of cannabis flower, quantity of concentrates, quantity of edibles, and age of onset), motives for cannabis use, and mental health were assessed via a series of one-way analyses of covariance (ANCOVAs), with age, gender, Hispanic, Asian, and White identities entered as covariates. Sidak post hoc tests were used to probe significant ANCOVAs to determine specific group differences.

A series of binary logistic regression analyses were used to analyze the binary outcome data (cannabis use status; each form of use [flower, concentrates, edibles]; use for medical vs. recreational purposes). Sexual orientation (coded into binary variables) was entered as the primary predictor variables, and covariates were entered into the first block of each model. Heterosexuals were used as the reference group in the primary set of analyses. To further explore differences in the groups classified as bisexual and gay, another set of logistic regression analyses was conducted with gay used as the reference group.

A series of 2×3 factorial ANCOVAs were conducted to examine potential interactions between cannabis use status and sexual orientation group in predicting mental health symptoms (e.g., depression, anxiety, suicidality, CUD) to determine whether there are group differences in the links between cannabis use status and mental health symptoms. Age, gender, and Hispanic, Asian, and White identities were entered as covariates. Alpha was set at 0.01 for all analyses to balance power with the need to reduce inflation in type I errors due to the multiple comparisons conducted.

Results

Differences in cannabis use patterns

Logistic regression results revealed significant group differences in cannabis use status, Δχ²(2)=50.10, p<0.001, with the group classified as bisexual being 1.68 times more likely to report cannabis use than the heterosexual group, Wald χ²(1)=48.36, p<0.001, and 1.81 times more likely to report cannabis use compared with the gay group, Wald χ²(1)=7.79, p=0.005.

Results further revealed significant group differences in self-reported use of flower, Δχ²(2)=11.68, p=0.003, with the bisexual group being 1.41 times more likely to report use of flower than the heterosexual group, Wald χ²(1)=11.37, p<0.001. Results also revealed significant group differences in use of concentrates, Δχ²(2)=8.73, p=0.01, with the bisexual group being 1.32 times more likely to report the use of concentrates relative to the heterosexual group, Wald χ²(1)=7.98, p=0.005. There were also significant group differences in use of edibles, Δχ²(2)=10.17, p=0.006, with the bisexual group being 1.32 times more likely to report the use of edibles relative to the heterosexual group, Wald χ²(1)=8.53, p=0.004. None of the models revealed any significant differences in the forms of cannabis used by the gay versus heterosexual or gay versus bisexual groups.

The ANCOVA results also revealed significant group differences in frequency of cannabis use, F(2, 2364)=18.32, p<0.001, $η_{p}^{2}$ =0.015. Post hoc tests revealed that the bisexual group reported using cannabis more frequently than the heterosexual group (p<0.001). No significant group differences were found for daily sessions (p=0.21), age of onset (p=0.04), quantity of cannabis flower typically used (p=0.94), quantity of concentrates typically used, (p=0.07), or quantity of edibles typically used (p=0.46). The results also revealed significant group differences in symptoms of CUD, F(2, 2340)=15.03, p<0.001, $η_{p}^{2}$ =0.013. Post hoc tests revealed that the bisexual group reported experiencing more symptoms of CUD compared with the heterosexual group (p<0.001). There were no other significant group differences in symptoms of CUD.

Differences in motives for cannabis use

As shown in Table 2, ANCOVAs revealed significant group differences in the use of cannabis for coping and expansion motives. Sidak post hoc tests revealed that the bisexual group reported higher levels of coping motives (p=0.003) and expansion motives (p=0.002) compared with the heterosexual group. No other significant group differences in motives for cannabis use were detected. Additionally, contrary to our hypothesis, the logistic regression analysis indicated no significant differences between medical versus recreational cannabis use among the groups, Δχ²(2)=2.66, p=0.26, perhaps because only 2.1% of the sample (2.0% of the heterosexual group, 2.4% of the bisexual group, and 0% of the gay group) reported exclusive use for medical purposes.

Table 2.

Differences in Motives for Cannabis Use in Cannabis Users (n=2485)

Variable	Heterosexual group	Bisexual group	Gay group	F	p	η² p
Enhancement	17.64 (0.19) [17.27–18.01]	18.29 (0.27) [17.76–18.81]	17.33 (0.916) [15.54–19.14]	2.04	0.130	0.003
Conformity	7.13 (0.14) [6.87–7.40]	6.94 (0.20) [6.55–7.32]	6.50 (0.67) [5.18–7.82]	0.68	0.505	0.001
Expansion	12.15 (0.22)^a [11.72–12.59]	13.51 (0.32)^b [12.89–14.13]	12.46 (1.09)^a,b [10.33–14.59]	5.97	0.003	0.010
Coping	11.34 (0.20)^a [10.94–11.73]	12.50 (0.29)^b [11.94–13.06]	13.18 (1.00)^a,b [11.22–15.15]	6.42	0.002	0.010
Social	12.00 (0.19) [11.62–12.37]	12.56 (0.27) [12.02–13.09]	11.62 (0.97) [9.73–13.52]	1.54	0.215	0.003

The table displays the mean ratings for each motive with standard errors in parentheses. 99% Confidence intervals are given in square brackets. Means that share a superscript or contain no superscripts do not differ significantly, whereas those with different superscripts are significantly different (p<0.01).

Relationships between cannabis use and mental health

As shown in Table 3, ANCOVAs revealed small but statistically significant group differences in all mental health variables. Post hoc tests revealed that the bisexual group reported significantly higher levels of social anxiety (p<0.001), generalized anxiety (p<0.001), depression (p<0.001), and suicidality (p<0.001) compared with the heterosexual group. The bisexual group also reported significantly higher levels of suicidality compared with the gay group (p=0.03). No other significant group differences in mental health were detected.

Table 3.

Differences in Mental Health in Full Sample

Variable	Heterosexual group	Bisexual group	Gay group	F	p	η² p
Social anxiety	1.49 (0.02)^a [1.46–1.53]	1.72 (0.04)^b [1.65–1.79]	1.84 (0.12)^a,b [1.60–2.09]	17.73	<0.001	0.016
Generalized anxiety	3.52 (0.08)^a [3.37–3.67]	4.77 (0.14)^b [4.50–5.04]	4.04 (0.45)^a,b [3.16–4.91]	31.48	<0.001	0.027
Depression	2.55 (0.05)^a [2.44–2.66]	3.45 (0.10)^b [3.27–3.64]	2.64 (0.31)^a,b [2.03–3.26]	33.55	<0.001	0.029
Suicidality	0.37 (0.02)^a [0.32–0.41]	0.67 (0.04)^b [0.60–0.75]	0.32 (0.13)^a [0.07–0.57]	23.46	<0.001	0.021

The table displays the mean ratings for each mental health concern with standard errors in parentheses. 99% Confidence intervals are included in square brackets. Means that share a superscript or contain no superscripts do not differ significantly, whereas those with different superscripts are significantly different (p<0.01).

The interactions between cannabis use status and sexual orientation were not statistically significant in the ANCOVAs predicting generalized anxiety (p=0.62), social anxiety (p=0.014), depression (p=0.84), or suicidality (p=0.63).

Discussion

The current study was conducted to examine differences in cannabis use patterns, motives for using cannabis, and relations between cannabis use status and mental health among groups classified as bisexual, gay, and heterosexual. Findings generally supported our hypotheses in that the bisexual group (but not the group classified as gay) reported elevated cannabis use patterns, coping and expansion motives for cannabis use, and worse mental health. Contrary to our hypothesis, associations between cannabis use and mental health were not stronger in the sexual minority groups than in the heterosexual group.

People classified into the bisexual group indicated that they used cannabis more frequently compared with the heterosexual group, which is in line with previous research.^1–4 Additionally, people in the bisexual group were more likely to endorse use of all three forms of cannabis (flower, concentrate, and edibles) compared with the heterosexual group. The finding that the bisexual group uses concentrates more than the heterosexual group is concerning, as these products have a higher potency and may increase tolerance to cannabis.²⁶ Nevertheless, there were no significant group differences in self-reported quantity of flower, quantity of concentrates, or quantity of edibles typically used. The bisexual group also reported higher levels of CUD than the gay group. These findings suggest increased health risks related to cannabis use in bisexuals and indicate an area for intervention among this population.

In addition to reporting more frequent cannabis use and use of a wider variety of types of cannabis products, the bisexual group also reported higher levels of coping and expansion motives compared with the heterosexual group. In other words, they reported higher motivation to use cannabis to cope with negative mental states, which makes sense given the elevated mental health concerns (including anxiety, depression, and suicidality) detected in this subsample. This finding is concerning given known associations between coping motives and problematic cannabis use and cannabis dependence.^15,17,27

When intervening on problematic cannabis use in clinical settings, it may be prudent to discuss whether bisexual individuals are using cannabis to cope with their distress and to help them find alternative coping strategies that might be more effective and carry less risk for additional mental health concerns. The finding that the bisexual group reported higher levels of expansion motives compared with the heterosexual group is contrary to our hypothesis. To the best of our knowledge, there is little research on positive or negative outcomes related to expansion motives for cannabis use, although expansion motives have been found to be unrelated to problems with cannabis use in two previous studies.^15,27 Future research should explore the reasons why bisexuals differ in expansion motives and perhaps the situations in which these motives might be more salient in this group.

The minority stress model posits that both internalized stigma and discrimination from others (including physical and emotional abuse) cause increased stress among sexual and gender minorities, which results in a greater likelihood for mental health problems, such as substance use, anxiety, and depression.¹⁸ Consistent with the minority stress model, the bisexual group reported higher levels of all mental health disorder symptoms than the heterosexual group. However, contrary to our hypothesis, cannabis use did not moderate the relations between sexual orientation group and mental health concerns, revealing that sexual minorities are generally no more vulnerable to mental health disorder symptoms associated with cannabis use compared with heterosexuals.

Nevertheless, clinicians working with sexual minorities, especially bisexual individuals, should be aware of their higher levels of mental health disorder symptoms and increased tendency to use cannabis to cope with their distress. It is likely that many of these mental health disorder symptoms work in concert with one another. For example, an individual who copes with negative affect by regularly using cannabis may become reliant on cannabis since the effects of cannabis in reducing negative affect are only temporary,²⁸ thereby increasing their risk for developing CUD symptoms^15.27 and exacerbating mental health symptoms such as depression,²⁸ which may prompt the individual to use more cannabis to mitigate this increased negative affect, creating a vicious cycle.

Limitations and future directions

Limitations of the study include the use of a cross-sectional design, which precludes the ability to make conclusions about the direction of the relationships or causation. The focus on young adults limits generalizability to other age cohorts, especially older adults. Nevertheless, young adults use cannabis more than any other age group²⁹ and as such are an important group to target. An additional possible limitation is the measure used to categorize individuals' sexual orientation, which may not correspond to common labels individuals use to identify themselves, such as “gay,” “straight,” or “bisexual.” Indeed, some individuals who would typically have identified themselves as “gay” or “lesbian” might have been categorized as “bisexual” using the classification strategy in the current study.

Additionally, given the relatively small number of individuals who identified themselves as “exclusively homosexual” and the elevated variability observed in this group, the current study may lack power to elucidate significant differences in this group. Finally, we focused exclusively on cisgender respondents as there was too small a sample of gender minorities to examine in a meaningful way and we did not want to conflate sexual orientation with gender identity. Future research should examine cannabis use patterns, motives, and mental health symptoms among transgender and gender-diverse individuals.

Conclusions

These findings represent a step forward in understanding cannabis use among this high-risk population by providing detailed quantitative analysis of not only cannabis use patterns but also differences in motivations for using cannabis among sexual minorities in comparison to heterosexual individuals. Findings indicate that individuals classified as bisexual use cannabis more frequently, use a broader range of products, use cannabis to cope with negative affect and for expansion motives, and are at greater risk for CUD and other mental health concerns. These results can be used to enhance mental health interventions, targeted toward bisexuals, and who represent a high-need and understudied group.

Footnotes

Acknowledgments

This project was completed by the Addictions Research Team (ART), which includes the following investigators: Matthew R. Pearson, University of New Mexico (Coordinating principal investigator [PI]); Adrian J. Bravo, William and Mary (site PI); Bradley T. Conner, Colorado State University—Fort Collins (site PI); Carrie Cuttler, Washington State University (site PI); Craig A. Field, University of Texas at El Paso (site PI); Vivian Gonzalez, University of Alaska—Anchorage (site PI); James M. Henson, Old Dominion University (site PI); Jon M. Houck, Mind Research Network; Kevin M. King, University of Washington (site PI); Benjamin O. Ladd, Washington State University (site PI); Kevin S. Montes, California State University—Dominguez Hills (site PI); Mark A. Prince, Colorado State University—Fort Collins (site PI); Maria M. Wong, Idaho State University (site PI).

Authors' Contributions

K.S. helped conceive of the ideas, conducted the statistical analyses, and wrote the article. C.C. helped design the study and conceive of the ideas, contributed to data collection and statistical analyses, and assisted with writing and editing. B.T.C. and M.A.P. helped design the study, contributed to data collection, and edited the article. ART established the measures and collected the data.

Author Disclosure Statement

The authors have no conflicts of interest.

Funding Information

No funding was received for this article.

Abbreviations Used

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