Key Messages 

• Substance use includes alcohol, tobacco, nicotine and vapes, illegal drugs, and the non-medical use of prescription medicines 

• Some experimentation is common in adolescence, but frequent or harmful use can lead to serious risks 

• Research suggests trans young people are more likely to use some substances than their cisgender peers1 2 3  

• Stress from discrimination, family rejection, trauma, and barriers to gender-affirming care can increase risk1 2 4 

• A calm, affirming, non-shaming approach can make a real difference 

What is Substance Use? 

Substance use includes alcohol, tobacco, nicotine and vaping products, illegal drugs, and the non-medical use of prescription medicines. Some young people experiment, such as trying alcohol or a cigarette once. This is often described as experimental use. Use becomes more concerning when it is frequent, heavy, or starts causing problems in daily life. A substance use disorder (SUD) usually means a young person keeps using despite harm, and may involve craving, tolerance, or withdrawal.1 Intoxication means being under the influence of a substance, for example, feeling drunk or high. Withdrawal refers to unpleasant symptoms that can happen when someone stops using a substance their body has become dependent on. 

 
Young people may use substances for many reasons. These can include curiosity, wanting to fit in, coping with stress, easing anxiety, managing painful emotions, or trying to get relief from gender dysphoria. Some may also use substances to self-medicate when they feel overwhelmed. Substance use and mental health difficulties often overlap, and each can make the other worse.5 

How common is substance use in young people? 

In Australia, many younger teenagers don’t use alcohol or other drugs at all. About 70% of 14 to 17-year-olds report never drinking alcohol, and around 23% of 18 to 24-year-olds abstain. In 2022 to 2023, around 44% of 12 to 17-year-olds had consumed alcohol in the past year, and 22% had done so in the past month.6 Cigarette smoking among young people has dropped substantially. However, vaping has increased. In 2022 to 2023, about 9.7% of 14 to 17-year-olds and 21% of 18 to 24-year-olds reported current e-cigarette use.6 

 
Illicit drug use is less common in younger teens and becomes more common with age. About 35% of 18 to 24-year-olds reported using an illicit drug in the past year, compared with about 13% of 14 to 17-year-olds. Cannabis is the most commonly used illicit drug in young people.6  

 
Many young people who experiment don’t go on to develop serious problems. Risk is higher when use is frequent, heavy, involves multiple substances, or is clearly being used to cope with distress. Warning signs can include blackouts, declining school performance, worsening mental health, conflict at home, risky behaviour, or using substances to manage painful emotions. 

How common is substance use in trans young people? 

Research suggests trans young people are more likely than cisgender peers to use some substances.1 2 3 In an Australian survey of 859 trans young people, with an average age of 19.4 years, 72.4% had ever consumed alcohol, 31.1% had ever smoked tobacco, and 30.6% had ever used cannabis. In that same study, 13.5% met criteria for a lifetime substance use disorder.1 2 3 

International evidence shows a similar pattern. One United States study found trans youth had substance use rates around 2.5 to 4 times higher than cisgender youth.3 A meta-analysis also found that transgender people were more likely to use tobacco and other drugs than cisgender people, although overall alcohol use and diagnosed substance use disorder were not clearly different overall.7 

Why are trans young people at higher risk? 

There is no single cause. Substance use is usually shaped by a mix of emotional, social, environmental, and structural factors. Trans young people may face extra stressors and barriers that increase risk or make harms more likely.1 2 

Minority stress and discrimination 

Trans young people may experience bullying, rejection, discrimination, invalidation, and barriers to healthcare. These ongoing stressors can increase distress and make substances feel like a way to cope or escape. Research links victimisation and discrimination with higher substance use risk in trans youth.2 3 

Family rejection and lack of support 

Family support is a major protective factor. When young people feel accepted and supported at home, they are less likely to experience severe distress and substance-related harm. Family rejection, conflict, or invalidation can increase the risk of depression, self-harm, and substance use.3 4 

Gender dysphoria and barriers to care 

Some trans young people report using substances to cope with dysphoria, body distress, or the stress of waiting for gender-affirming care. Long wait times, lack of knowledgeable clinicians, and barriers to support can worsen distress.1 

Mental health and trauma 

Substance use often overlaps with anxiety, depression, trauma, and suicidal distress. These difficulties can reduce coping capacity and increase the appeal of substances as a short-term escape. For some young people, this can become a cycle where distress increases substance use, and substance use then worsens distress.2 5 

Neurodivergence 

Some trans young people are also Autistic or have ADHD. Young people with ADHD are at particularly high risk of substance-related difficulties. Traits such as impulsivity, novelty- seeking, and emotion regulation difficulties may contribute. Some Autistic young people may use substances to cope with sensory overload, anxiety, or social stress. Although this evidence is not always trans-specific, it suggests sensory needs and emotional regulation are important to consider.2 

Social and marketing influences 

Young people may also be influenced by peers, social media, or environments where substance use is normalised. Tobacco and vaping companies have historically targeted LGBTQ+ communities, which may contribute to higher rates of nicotine and vaping use in some groups.8 

What helps? 

Support is usually most effective when it addresses the whole picture: safety, mental health, coping, relationships, environment, and access to affirming care. 

Harm minimisation 

The first priority is safety. Harm minimisation can include storing alcohol, medicines, and other substances securely at home, planning ahead for social situations, discussing safer transport options, and helping young people think through how to reduce immediate risk. This approach is not about approving of substance use. It is about reducing the chance of serious harm. 

Supportive and non-shaming conversations 

Young people are more likely to talk honestly when they feel safe and respected. A calm, non-judgmental approach is usually more effective than punishment, lectures, or heavy surveillance. It helps to focus on what the substance use is doing for the young person, rather than only focusing on the behaviour itself. 

Gender-affirming and trauma-informed care 

For trans young people, affirming care matters. Reducing dysphoria, improving safety, and supporting access to appropriate care may reduce some of the stress that contributes to substance use.1 4 Trauma-informed care is also important, especially when a young person has experienced bullying, rejection, assault, or chronic stress. 

Psychological support 

Psychological support can help trans young people explore their substance use and find healthier ways to cope with distress.9 When finding the right service, look for one that is gender-affirming and understand the reasons a trans young person might be using substances minority stress and discrimination. 

Co-occurring support 

If a young person is also dealing with anxiety, depression, trauma, eating difficulties, or gender related distress, these issues should be addressed alongside substance use. Integrated care usually leads to better outcomes than treating each issue in isolation. 

What parents and carers can do 

You don’t need to solve everything at once. Small, steady supports matter. 

• Take substance use seriously without reacting with panic: Let your child know you care about their safety and well-being. Try to respond calmly, even if you are frightened. 

• Focus on what might be underneath the use: Ask what the substance is helping with. It may be linked to social pressure, dysphoria, stress, trauma, loneliness, or sensory overwhelm. 

• Reduce stress where you can: Look for stressors that are keeping your child on edge, such as bullying, family conflict, misgendering, unsafe environments, or barriers to healthcare.1 4 

• Keep communication open: Ask open questions, listen more than you lecture, and avoid labels like “addict” or “druggie”. Shame usually makes secrecy worse. 

• Support safer routines: Regular sleep, meals, supportive activities, and time with safe people can strengthen coping and reduce risk. 

• Seek affirming professional help early: If concerns are ongoing, try to find a GP, youth service, or mental health professional who is both youth-informed and trans affirming. 

References

1. Bailey, S., Lin, A., Cook, A., Winter, S., Watson, V., Wright-Toussaint, D., Barrett, E. L., Newton, N., Perry, Y., Grummitt, L., & Strauss, P. (2024). Substance use among trans and gender diverse young people in Australia: Patterns, correlates and motivations. Drug and Alcohol Review, 43(7), 1940–1953. https://doi.org/10.1111/dar.13915  
2. Fahey, K. M. L., Kovacek, K., Abramovich, A., & Dermody, S. S. (2023). Substance use prevalence, patterns, and correlates in transgender and gender diverse youth: A scoping review. Drug and Alcohol Dependence, 250, 110880. https://doi.org/10.1016/j.drugalcdep.2023.110880  
3. Gower, A. L., Rider, G. N., Brown, C., McMorris, B. J., Coleman, E., Taliaferro, L. A., & Eisenberg, M. E. (2018). Supporting transgender and gender diverse youth: Protection against emotional distress and substance use. American Journal of Preventive Medicine, 55(6), 787–794. https://doi.org/10.1016/j.amepre.2018.06.030  
4. Kennedy, K. S., Harper, C. R., Li, J., Suarez, N. A., & Johns, M. M. (2022). Protective environments, health, and substance use among transgender and gender expansive youth. LGBT Health, 9(6), 393–400. https://doi.org/10.1089/lgbt.2021.0258  
5. Hansen, E. R., Kruckow, S., Ewing, S. W. F., Nordentoft, M., Thomsen, K. R., & Tolstrup, J. S. (2025). Adolescent substance use patterns and subsequent risk of mental and behavioural disorders, substance use, and suicidal behaviour: A cohort study. The Lancet Public Health, 10(7), e578–e587. https://doi.org/10.1016/S2468-2667(25)00115-X
6. Australian Institute of Health and Welfare. (2026). Alcohol, tobacco & other drugs in Australia: children and young people’s experiences of alcohol and other drugs. Canberra: AIHW. https://www.aihw.gov.au/reports/alcohol/alcohol-drugs-young-people  
7. Cotaina, M., Peraire, M., Boscá, M., Echeverria, I., Benito, A., & Haro, G. (2022). Substance use in the transgender population: A meta-analysis. Brain Sciences, 12(3), 366. https://doi.org/10.3390/brainsci12030366  
8. Truth Initiative. (2025, May 21). Tobacco use in the LGBTQ+ community Fact sheet. https://truthinitiative.org/research-resources/targeted-communities/tobacco-use-lgbtq-community
9. Glynn, T. R., & van den Berg, J. J. (2017). A systematic review of interventions to reduce problematic substance use among transgender individuals: A call to action. Transgender Health, 2(1), 45–59. https://doi.org/10.1089/trgh.2016.0037