A meta-analysis and methodological review of studies on sexual orientation and adolescent substance use found that lesbian, gay, and bisexual (LGB) adolescents reported significantly higher rates of substance use compared to heterosexual youth, with overall odds ratios of 2.89 and Cohen's d of 0.59. The effect sizes varied by gender, bisexuality status, sexual orientation definition, and recruitment source. Most studies did not test mediation or moderation, and few controlled for confounding variables. LGB youth had 190% higher odds of substance use than heterosexual youth, with bisexual youth showing 340% higher rates and female LGB youth 400% higher. The study highlights the need for further research on causal mechanisms, protective factors, and long-term outcomes. Methodological limitations include lack of standardized measurement of sexual orientation, limited examination of bisexuality as a moderator, and variability in recruitment sources. The review also notes that findings may not be generalizable beyond the U.S. due to limited international research. The minority stress model is proposed as a framework for understanding the risks faced by LGB youth, including discrimination, harassment, and stigma. The study underscores the importance of addressing substance use in LGB youth through targeted interventions and highlights the need for more research on the role of sexual orientation in adolescent substance use. Clinicians are encouraged to routinely assess sexual orientation and substance use in adolescents. The results suggest that LGB youth are at significantly higher risk for substance use and abuse than heterosexual youth, but further research is needed to understand the underlying mechanisms and develop effective prevention strategies.A meta-analysis and methodological review of studies on sexual orientation and adolescent substance use found that lesbian, gay, and bisexual (LGB) adolescents reported significantly higher rates of substance use compared to heterosexual youth, with overall odds ratios of 2.89 and Cohen's d of 0.59. The effect sizes varied by gender, bisexuality status, sexual orientation definition, and recruitment source. Most studies did not test mediation or moderation, and few controlled for confounding variables. LGB youth had 190% higher odds of substance use than heterosexual youth, with bisexual youth showing 340% higher rates and female LGB youth 400% higher. The study highlights the need for further research on causal mechanisms, protective factors, and long-term outcomes. Methodological limitations include lack of standardized measurement of sexual orientation, limited examination of bisexuality as a moderator, and variability in recruitment sources. The review also notes that findings may not be generalizable beyond the U.S. due to limited international research. The minority stress model is proposed as a framework for understanding the risks faced by LGB youth, including discrimination, harassment, and stigma. The study underscores the importance of addressing substance use in LGB youth through targeted interventions and highlights the need for more research on the role of sexual orientation in adolescent substance use. Clinicians are encouraged to routinely assess sexual orientation and substance use in adolescents. The results suggest that LGB youth are at significantly higher risk for substance use and abuse than heterosexual youth, but further research is needed to understand the underlying mechanisms and develop effective prevention strategies.