It has been well documented how alcohol has traditionally been deeply embedded in all aspects of life in Ireland, both in social and celebratory events and in daily living (Doyle et al. 2024). Positive indicators of shifts in both attitudes and behaviours among Irish adults towards alcohol have recently been documented in Drinkaware’s 2024 Barometer. This is evident both in adults agreeing that they would like to drink alcohol less often (24% in 2021 versus 37% in 2024) and those already making small positive changes (31% in 2020, rising to 37% in 2024). Almost one third of adults (32%) now also agree that ‘Irish drinking culture has changed for the better since COVID-19.’ 31% of adults say that the amount of alcohol they drink has decreased in the past 12 months, while 44% of adults say that they are buying less alcohol than a year ago. Over 1 in 4 (28%) agree that they find that they are questioning when, how much and why they drink recently.
Despite this extensive research into general attitudes to alcohol there is a lack of Irish evidence to show the patterns of alcohol use across gender and sexual minorities in Ireland. For instance, the Health Research Board (HRB) (2024) states: ‘There are groups where there is limited or no information available or a lack of up-to-date information available, so we do not know the extent of alcohol use among these populations, for example, LGBTQ+ population, ethnic minorities including members of the Traveller community and those living in Ireland as asylum seekers or refugees’ (HRB, 2024,p.196).
Analysing these dynamics requires a clear understanding of the evolving and complex nature of gender and sexual identity. According to Belong To (2024), terms change over time, and even within the LGBTQ+ community, certain words that some people use to describe themselves are rejected by others. Gender identity refers to our personal sense of our own gender, while sexual orientation refers to our sexual and romantic attraction to other people. LGBTQ+ stands for lesbian, gay, bisexual, trans and queer. The plus sign includes people with other minority sexual orientations and gender identities (Belong To, 2024).
In recent years, there has been growing discussion and action in tackling health inequalities in Ireland. However, health and social care data collections do not always record social groupings that may be most affected, such as recording non-cisgender options and sexual orientation (Carroll et al. 2021). Official statistics on alcohol use amongst gender and sexual minority adults in Ireland are missing. The Institute for Alcohol Studies (IAS) in the UK provided some reasons as to why (IAS, 2021). For instance, national statistics on alcohol consumption do not routinely include breakdowns of alcohol use by orientation due to small numbers in these subgroups.
Additionally, a large portion of the limited academic literature that is available is from the United States. However, the Institute for Alcohol Studies (2022) notes that reports from charities and NGOs, as well as studies combining survey data across years, consistently finds that people in the LGBTQ+ community are more likely to drink alcohol and to drink at increasing or higher risk levels compared to the overall population. In response to this data gap, Drinkaware included an optional question on sexual orientation in our 2024 Barometer. We found that 5.6% (n=59) of the total sample1 (total n=1405 adults aged 18+) identified as gay/lesbian/bisexual and 7.6% preferred not to say/did not list their sexual orientation in the survey.
Surveys and studies should present a greater variety of intersectional data on protected characteristics (IAS 2021). Appropriate and accurate characterisation of an individual’s sexual orientation and gender identity in data fosters a sense of inclusion and may help protect the community from further undue harm by creating a sense of belonging and reducing marginalisation-related health inequities (Moreira et al., 2023). The Institute for Alcohol Studies (2022) highlights that more research is needed to represent LGBTQ+ women and trans people to prevent alcohol harm and make services feel safer and more inclusive (IAS 2021).
What do we know?
Sexual and gender minority (SGM) populations (i.e., people who identify as LGBTQ+ – lesbian, gay, bisexual, trans, queer, questioning, non-binary or otherwise gender or sexuality diverse) are more likely to experience health inequalities, including poorer physical and mental health and increased substance use, compared to heterosexual and cisgender people (Dimova et al. 2022). International research has identified that LGBTQ+ adult communities are more likely to drink excessively compared to heterosexual and cisgender people, with increased vulnerability to harm (Dimova et al. 2022; Drinkaware UK 2024; Norman et al. 2024). SGM individuals often face additional stressors related to their identity, further contributing to their heightened risk of experiencing alcohol-related harms (Drinkaware UK 2024). We found in our 2024 Barometer that SGM adults had slightly higher levels of weekly+ drinking with almost two thirds reporting doing so (64%), compared to 59% of the overall adult drinking population. In terms of frequency of recent binge drinking, SGM adults reported higher levels with 65% of drinkers in this cohort doing so in the past 30 days compared to 58% overall (Drinkaware, 2024).
Concern within the academic literature on high rates of alcohol and other drug (AOD) use concentrated largely on gay and bisexual men, given the association with HIV risk practices; research in more recent years has since begun to focus on AOD use among lesbian, bisexual and queer women as well as trans and non-binary people (Norman et al. 2024). However, recent research has highlighted that alcohol-related harms are not experienced equally among sexual and gender minority societies, with some groups at greater risk of experiencing alcohol harm than others (Whiteley et al., 2023). A recent systematic review reported higher overall prevalence of alcohol use among bisexual people compared to either their heterosexual or lesbian/gay counterparts (Shokoohi et al., as cited by Whiteley et al., 2023).
A recent survey of LGBTQ+ adults in Australia identified different levels of alcohol use within the community, with cisgender men and those aged 40 years and over being most likely to consume alcohol at risky levels (Yuen et l. 2023). Collectively, gay, lesbian and bisexual individuals in Australia have previously been found to be one and a half times more likely to exceed lifetime risk guidelines for alcohol consumption when compared to their heterosexual counterparts (AIHW 2019, as cited in Norman et al. 2024). Various studies have identified that sexual minority women report greater levels of alcohol consumption compared to heterosexual women (Hughes et al. 2020; Drabble et al. 2005 as cited in Norman et al. 2024; SAMSHA 2023). Evidence gathered as part of a systematic review found high rates of hazardous drinking among trans populations (Connolly et al. 2020, as cited in Norman et al. 2024). Similarly, evidence gathered as part of a systematic scoping review found that harmful alcohol use is higher in LGBTQ+ people than heterosexual people in the UK. Qualitative data also reflected alcohol’s role as emotional support for LGBTQ+ people (Meads et al., 2023).
In a representative survey of UK adults – with sample of over 3,000 individuals who identified as LGBTQ+, along with more than 5,000 individuals who identified as cisgender and heterosexual, contrary to previously published studies, recent research conducted by Drinkaware UK (2024) found that gender minorities, (i.e., LGBTQ+ individuals who identify as transgender or non-binary), tend to drink less frequently and consume fewer units of alcohol when they do drink compared to LGBTQ+ adults who identify as cisgender. They are also less likely to engage in binge drinking and exceed the drinking guidelines. However, the authors found that drinkers who identify as transgender displayed a polarised pattern, with a higher proportion of ‘low risk’ drinkers on the AUDIT-C but a similar proportion of ‘higher risk’ drinkers compared to cisgender drinkers (Drinkaware UK, 2024).
A recent Irish research study undertaken in collaboration between the School of Nursing, TCD and Belong To was launched in May 2024 – Being LGBTQI+ in Ireland – an in-depth exploration of the mental health and wellbeing of lesbian, gay, bisexual, transgender, queer, intersex (LGBTQI+) people in Ireland today (Higgins et al. 2024). While 22% of the sample reported never drinking alcohol, 42% of participants who drank had AUDIT scores of 8 or more, which may indicate hazardous and harmful alcohol use, as well as possible alcohol dependence. Cisgender and gay men scored the highest on the AUDIT screening tool of all the gender and sexual minority subgroups. The prevalence of alcohol problems was very similar among participants when this study was first conducted in 2016, at 43.8%, and in 2024, at 42.0% (Higgins et al. 2024).
In other Irish research that used CAGE-4, problematic alcohol use was found to be shared among gay and bisexual men, with 27% of those who had drank in the preceding 12 months screening positive for alcohol use disorder (Witzel et al. 2022 as cited by Higgins et al. 2024). However, only a significant minority (17%) reported being concerned about their alcohol and/or drug use (Witzel et al., 2022). Another Irish study found that 31% of men who had sex with men (MSM) screened positive for alcohol use disorder, with bisexual men more likely to screen positive compared to gay men (Daly et al. 2021, as cited by Higgins et al. 2024). However, only a significant minority (17%) reported being concerned about their alcohol and/or drug use (Witzel et al., 2022). Another Irish study found that 31% of men who had sex with men (MSM) screened positive for alcohol use disorder, with bisexual men more likely to screen positive compared to gay men (Daly et al. 2021, as cited by Higgins et al. 2024).
In terms of the negative impact of COVID-19, research suggests in some cases LGBTQ+ people used alcohol (and other drugs) to cope with the fear, isolation and boredom of the pandemic, with health inequalities further exacerbated (Bochicchio et al. 2021; Drabble & Eliason 2021; Leven 2020; Phillips et al. 2021 Riggle et al. 2021 as cited by Dimova et al. 2022). From an Irish context, Higgins and colleagues (2024) found that a significant number of LGBTQI+ people in their study reported that their mental health deteriorated or relapsed during COVID-19 with increased stress, anxiety, and depression all highlighted, with some reporting an increased reliance on alcohol.
Why?
The reasons for harmful alcohol use being more prevalent among sexual and gender minorities (SGMs) than their cisgender/heterosexual counterparts are complex (). Whiteley (et al. 2023) point to several factors, including alcohol’s normalisation and availability in social settings, its importance to identity construction, and drinking to cope with stigma and discrimination. We recently found that adults who identified as gay/lesbian/bi-sexual in our 2024 Barometer were more likely to report drinking to cope with 50% reporting doing so in the past 30 days because it helps when feel depressed or anxious, to cheer up when in bad mood and/or to forget about problems (vs 34% adult drinkers overall). Alcohol has been found to be used to manage the loneliness created by the transition into an LGBTQ+ identity, with finding drinking companions and friends to help overcome such feelings (Nelson et al., 2023). Perceived barriers to accessing alcohol services may further increase the potential for alcohol-related harm for LGBTQ+ people (Dimova et al., 2022). For instance, qualitative research conducted in Scotland found that many service users perceived their drinking to be connected with their LGBTQ+ identity, as a response to experiences of shame, stigma, or negative reactions from their family, while also reporting connected mental health problems (Dimova et al. 2022).
Less is known about motives for drinking specifically among the transgender (trans) and non-binary community (Davis et al., 2023). Indeed, understanding the causes of drinking among transgender people is often overlooked in research (IAS 2021). A recent UK cross-sectional survey among 462 people co-produced with community stakeholders and administered to a purposive sample of trans and non-binary people found that coping motives, enhancement motives, and drinking to manage dysphoria were also associated with higher AUDIT scores (Davies et al., 2023).
What needs to happen?
A recent scoping review found that significant gaps remain in research on inequities in the area of LGBTQ- communities with AUD (alcohol use disorder), with the authors pointing to the need for community-based participatory methodologies (Ward et al. 2024). The voices and experiences of LGBTQ+ communities must, therefore, be central to all stages of the process.
Research has also documented that there is a need and a want for the provision of alcohol-free spaces for members of the LGBTQ+ community (Dimova et al., 2022; Higgins et al., 2024). Increased public acceptance and understanding of LGBTQ+ issues to reduce alcohol-related harm in this community is also required (Dimova et al., 2022).
At the same time, there is little evidence about how people’s experience of being LGBTQ+ and their alcohol use intersects with other characteristics such as ethnicity, religion, disability, or socio-economic status. (IAS 2021).
At Drinkaware we speak to all adults who consume alcohol. However, we understand that there may be increased alcohol-related harm within some adult populations and hence it is important that our research and campaigns capture such discrepancies. We will continue to build on the evidence gathered in our 2024 Barometer during 2025 in helping to address the unique challenges that these communities face.