Lesbians have the same risk factors for alcohol abuse as other women do, including stress, anxiety, depression, genetic predisposition, and histories of childhood sexual abuse or violence. Some possible reasons for increased alcohol use among lesbians have been speculated; however, as with most research on lesbian health, these hypotheses should be considered tentative, particularly given the lack of attention to issues of social class in much of the existing research, including the following findings from Hughes and Wilsnack (1997):

• Fewer roles, responsibilities, and social norms that limit drinking . Although increasing numbers of lesbians are having children and many are in long-term committed relationships, lesbians are still less likely than heterosexual women to have children and to engage in other social and family roles that serve to limit drinking among heterosexual women. In addition, although this too is changing, there are fewer social norms against drinking in some lesbian communities and lesbians in general are likely less constrained by traditional gender role norms for women that serve to limit drinking.
• Partner's drinking. Women in general tend to drink like their intimate partners and lesbians are likely no exception. In addition, because lesbian relationships may tend to be characterized by greater intimacy and shared activities than heterosexual relationships, problem drinking of partners may have an even greater impact on lesbians' drinking.

Large-scale studies using probability sampling methods and appropriate non-lesbian comparison groups are needed to better assess and understand the patterns of alcohol use among lesbians.

Use of Illegal Drugs. Very few data are available to document the use of illegal drugs by lesbians. Skinner and Otis (1996) compared data on substance use from a multiple-recruitment source convenience sample of lesbians from two southern metropolitan areas with population-based survey data from similar geographical areas. They found that lesbians reported greater use of cigarettes, marijuana, inhalants, and cocaine than did women in general (Skinner and Otis, 1996). In the NLHCS, 47% of those surveyed reported some marijuana use (14% reporting at least weekly use),