The Divergent Associations of LGBTQ+ Belongingness with Illicit Drug Use and Alcohol Consumption Among Adults in Kentucky

LGBTQ+ individuals face substance use disparities linked to minority stress. While community belongingness may buffer stress, its role is complex. This study examined divergent associations between belongingness within the LGBTQ+ community and lifetime illicit drug use versus past-year alcohol frequency among LGBTQ+ adults in Kentucky (n = 2953), a region with notably high rates of substance use. Methods: Cross-sectional online survey data were analyzed. We measured LGBTQ+ belongingness, lifetime use of cocaine/crack/heroin/methamphetamine, and past-year alcohol frequency. Logistic and linear regressions controlled for age, education, gender identity, and income. Results: Greater belongingness predicted significantly higher odds of lifetime illicit drug use (OR = 1.24) but lower past-year alcohol consumption frequency (B = −0.094). Transgender and gender expansive identity predicted significantly higher illicit drug use odds and higher alcohol frequency. Conclusions: In this Kentucky sample, LGBTQ+ belongingness showed divergent substance use associations: it was protective against frequent alcohol use but, unexpectedly, was associated with higher odds of lifetime illicit drug use. Findings highlight belongingness’s complex, context-dependent nature and the need for nuanced research and interventions considering substance type and specific vulnerabilities, particularly for TGE individuals.