Agency and queer solidarity: Help-seeking for alcohol and nicotine issues among lesbian, bisexual and queer women and non-binary people

<p dir="ltr">Introduction: Lesbian, bisexual, and queer (LBQ) women consume more alcohol and nicotine than their heterosexual peers but are less likely to seek healthcare support for managing their usage. This study aimed to understand the impact of queer substance use cultures on help-seeking among LBQ women and non-binary people who used alcohol and/or nicotine. </p><p dir="ltr">Methods: This was a qualitative longitudinal study using semi-structured interviews. Participants were recruited in 2023 using purposive self-selected sampling methods. Eligibility included people who: identified as a woman (cis or trans) or as non-binary with a strong affiliation with the identity of woman; identified as lesbian, bisexual, or queer; were at least 18 years old; lived in Australia; and had consumed alcohol and/or nicotine within the previous month. Sixty participants aged 18–72 were interviewed three times over 18 months. Participants included 41 cis women, 9 trans women and 10 non-binary people. Data were analysed using feminist and critical drug studies frameworks. </p><p dir="ltr">Results: Accounts of help-seeking for alcohol and nicotine use were shaped by awareness, shame, agency, and trust. Awareness of substance-related issues and solutions facilitated help-seeking, but overcoming shame was a precursor. Shame acted as both a catalyst for substance use—often as self-medication for gender or sexuality-based discrimination—and a barrier to seeking help. Agency reflected a preference for self-reliance, resistance to social norms, and the need for control in help-seeking processes. Peer support was crucial for successful help-seeking, while trust in healthcare providers was bolstered by their LBQ cultural competence. </p><p dir="ltr">Conclusions: Some LBQ participants did not seek help despite a clear need, while others only did so in crisis. LBQ peer support provided empathy but also reciprocity through a system of care that was queer-informed. Healthcare providers should cultivate an understanding of LBQ substance use and care cultures and integrate peer support frameworks. They should ask directly about substance use in clinical interactions, particularly in primary care, mental healthcare and sexual healthcare contexts to enable an integration of responses to all these intersecting issues. Demonstrating LBQ inclusivity and fostering environments that support autonomy and self-efficacy are critical for improving help-seeking behaviours.</p>