Gender and sexuality considerations in substance use and addictive behaviours

Gender and sexuality affect a person’s level of risk of harm, types of harms and their needs for a particular approach to their health care.

In populations of diverse gender, stigma, discrimination and trauma related to sexuality or gender are common contributors to a high prevalence of substance use. Populations of diverse sexuality or gender may engage in ‘chemsex’ (using substances such as gamma-hydroxybutyrate (GHB), stimulants [eg ecstasy or metamfetamine] or amyl nitrite [a volatile inhalant] to enhance sexual experience). Consider seeking advice from or referral to a sexual health expert for help with harm reduction measures for sexual health. For links to information on trans health for individuals and healthcare providers, see Trans and gender diverse health. For links to alcohol and other drug services with a specific focus on diverse gender or sexuality, see Substance use in populations of diverse sexuality or gender: additional resources for clinicians.

Females develop disorders of substance useGreenfield, 2007 or addictive behaviours earlier than males and experience harms at lower levels of substance use. Females are more likely to be introduced to substance use by their intimate partner or peer groups, and to engage in sex work to support their use. Although the prevalence of gambling disorder is lower in females than males generally, females who play poker machines are at higher risk of harm than malesHing, 2014. Females benefit from services that consider gender-specific needs such as the opportunity for single-gender peer supportGreenfield, 2013 as well as support of pregnancy, breastfeeding and family needs (eg supporting childcare and development of parenting skills)Greenfield, 2009.

Males have higher prevalence of substance use and drug-related death (including overdose and chronic illness) than femalesAlcohol and Drug Foundation (ADF), 2019Australian Institute of Health and Welfare (AIHW), 2018. Disorders of gambling and gaming are also more prevalent in males than femalesHing, 2014Loton, 2016.