When You Can't Hold on to Society, You Hold on to Something Else: A Mixed-Methods Study on Substance Use Among LGBTQIA plus People in Türkiye

BackgroundSubstance use among LGBTQIA+ people is shaped by complex psychosocial and structural factors, particularly within contexts of social marginalization. In T & uuml;rkiye, little is known about how intersecting identities affect the substance use risks.ObjectiveThis mixed-methods study explored the prevalence and contextual dynamics of substance use among LGBTQIA+ people in T & uuml;rkiye, integrating quantitative data (n = 570) and in-depth qualitative interviews (n = 24).ResultsQuantitative findings indicated that substance use risk significantly varied across gender identity and sexual orientation. Men, trans women, and gay participants exhibited higher scores on standardized screening tools (API-RSF-Alcohol, API-RSF-Drug, and ASSIST), suggesting the elevated vulnerability. Qualitative analysis identified three main themes: the emotional roots of substance use, its associated psychosocial challenges, and strategies of resilience and solidarity. Participants described substance use not as an isolated behavior but as a coping mechanism amid emotional turmoil, identity struggles, and systemic discrimination. They also reported facing institutional barriers in accessing formal support systems, while community-based solidarity emerged as a vital resource.ConclusionsFindings highlight the urgent need for intersectional and culturally responsive substance use interventions. Addressing both individual and structural dimensions-such as stigma, identity-based rejection, and service inaccessibility-is essential for effective prevention and care. The study fills a critical gap in T & uuml;rkiye's literature by centering LGBTQIA+ voices and offers actionable insights for mental health practitioners, harm reduction services, and policymakers.