Why There May Be a Link to ADHD and Substance Use Among Young Sexual Minority Men

Rutgers Health researchers reveal how attention difficulties and impulsivity may heighten vulnerability to early and frequent substance use among young sexual minority men

Young sexual minority men - a term used to describe gay, bisexual, and other men who have sex with men - with attention-deficit/hyperactivity disorder (ADHD) symptoms are more likely to begin using substances such as cigarettes, alcohol, cannabis, stimulants and illicit drugs at an earlier age, according to Rutgers Health researchers.

The study, published in the Journal of Gay & Lesbian Mental Health and led by the Center for Health, Identity, Behavior & Prevention Studies (CHIBPS) at the Rutgers School of Public Health, analyzed data from 597 young sexual minority men to assess ADHD symptoms and their associations with substance use.

The researchers found clinically significant ADHD symptoms were both common and strongly associated with heightened risk and earlier initiation of substance use. Inattentive symptoms were closely tied to cigarette use, while both inattentive and hyperactive/impulsive symptoms predicted earlier use across all substances assessed.

Given that young sexual minority men are disproportionately impacted by several other mental and physical health problems, this phenomenon warrants further attention from healthcare providers, researchers, and policymakers alike.

Kristen Krause

Assistant Professor, Rutgers School of Public Health

"Given that young sexual minority men are disproportionately impacted by several other mental and physical health problems, this phenomenon warrants further attention from healthcare providers, researchers, and policymakers alike," said Kristen Krause, an assistant professor at the School of Public Health and co-author of the study.

Findings also suggested key differences across subgroups. The connection between ADHD and early-onset substance use was stronger among bisexual men than among gay men, suggesting that tailored prevention strategies may be needed to address distinct vulnerabilities within the sexual minority population.

Krause, who also is the deputy director of the center, said the findings underscore the importance of integrating mental health and substance use screening and prevention efforts for sexual minority youth, particularly young men. Early identification of ADHD and intervention strategies could help reduce long-term health disparities in this group.

"At CHIBPS, we have long understood that health risks do not occur in a vacuum but that they are the result of the complex interplay of person, social conditions, and physical and mental health," said Perry N. Halkitis, dean of the School of Public Health and senior author of the study. "Modern and relevant public health approaches recognize that simply telling people to become vaccinated, wear a condom every time, and/or of banning menthol cigarettes is simply not enough."

"The focus must be on the person not the drug or the pathogen," said Halkitis, whose forthcoming book, Humanizing Public Health: How Pathogen-Centered Approaches Have Failed Us, will be published by Johns Hopkins University Press in the winter.

Halkitis, who is the director of the center, and the researchers said future studies should use different measurement tools to better estimate ADHD prevalence and severity in sexual minority men. Longitudinal approaches that account for factors such as resilience, mental health comorbidities and social support could offer deeper insights and inform more effective interventions.

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