Date of Award

May 2024

Degree Type


Degree Name

Doctor of Philosophy


Health Sciences

First Advisor

Virginia Stoffel

Committee Members

Lisa Berger, Antoinette Spector, Lucy Mkandawire-Valhmu, Fiona Maclean


Phenomenological Interviews, Photovoice, Reflexive Thematic Analysis, Sexual Identity, Substance Use


Substance use disorders are growing in prevalence globally, including in the United States. Sexual minority women (SMW) (women who are lesbian, bisexual, asexual, pansexual, queer, questioning, etc.) have increased rates of harmful substance use and disparities differing from heterosexual females. Additionally, substance use in emerging adulthood (between ages 18-29), is often high, with SMs having an increased risk for harmful substance use. This is a critical period in which to evaluate substance use for SMW. While occupational science and therapy have important roles in addressing substance misuse, practitioners report challenges with working with persons with harmful substance use and varying sexual identities related to a lack of education, comfort, and competency. This results in the need for research informing practitioners of populations’ substance use-related needs (including SMW) and expanding our professional conceptualizations of substance use.

This study explored the lived experiences of student SMW in emerging adulthood who are using substances and explored women’s recommendations regarding their preferred approaches to healthcare interactions. This was accomplished through the implementation of Photovoice methodologies and phenomenological interview methods. Twelve women explored their substance use experiences and service needs, with reflexive thematic analysis used to generate resulting themes. Women who participated served as co-researchers across the study. Member checking was conducted to assess the acceptability and trustworthiness of the study themes and recommendations. Co-researchers who engaged in the study explored their personal substance use patterns, defined misuse, and detailed personal coping strategies for addressing misuse. Women also discussed the impact of familial, religious, and discriminatory factors on their substance use, including the role of substance use in the queer community, their experiences with healthcare providers, and the mutable relationship of substance use as a stand-alone occupation and influencer of others.

Co-researcher recommendations for healthcare providers included creating safe, intentional spaces to discuss substance use/sexual identity, practicing with love, and providing women with beneficial resources. These findings must be directly applied within our occupational science and therapy practices in improving the lives of SMW, with initial steps for this implementation outlined in this work.

Available for download on Wednesday, May 21, 2025