Motivations for Cannabis Use Among LGBTQ+ Youth: A Participatory Photovoice Study

Abstract

Cannabis use is prevalent among LGBTQ+ youth and is often framed within deficit-oriented models emphasizing risk and mental health vulnerability. This study moves beyond these perspectives by examining how LGBTQ+ youth understand and mobilize cannabis use in relation to mental health, gender, and sexuality. Guided by queer theory and an ethics of care, and grounded in a community-based participatory approach, this photovoice study was conducted in collaboration with three LGBTQ+ youth peer researchers who contributed to data collection, analysis, and interpretation. A total of 46 LGBTQ+ youth (aged 15–24) in Quebec, Canada, generated photographs and narratives exploring their motivations and experiences of cannabis use, which were analyzed using reflexive thematic analysis. Findings highlight cannabis use as a situated and relational practice embedded in three intersecting processes: reconfiguring thought, enacting identity, and practicing care. Cannabis was mobilized to facilitate introspection, support identity exploration, and affirmation, and foster relational and collective forms of healing, while also producing ambivalent effects, including disorientation and emotional numbing. By centering youth perspectives, these findings challenge harm-focused framings and underscore the need for more nuanced, youth-informed and strengths-based approaches to LGBTQ+ youth well-being.

1. Introduction

Cannabis use is prevalent among youth (B. Han et al., 2019; Shah et al., 2024; Wadsworth et al., 2022), with disproportionately higher rates observed among those who identify as lesbian, gay, bisexual, trans, and queer (LGBTQ+) (Boyd et al., 2020; Romm et al., 2023; Schuler et al., 2018). This pattern has raised significant concern within the literature, particularly given evidence linking cannabis use in adolescence to a range of negative mental health outcomes, including anxiety, depression, psychosis, and potential dependence (Levine et al., 2017; Scheier & Griffin, 2021; Wilson et al., 2019). These concerns are especially pronounced in relation to LGBTQ+ youth, who already experience elevated rates of mental health challenges (Lucassen et al., 2017; O’Shea et al., 2025; Plöderl & Tremblay, 2015). As such, cannabis use is often framed as both a marker of vulnerability and a potential contributor to worsening mental health outcomes (Bottorff et al., 2013; London-Nadeau et al., 2025; Reid, 2020).

Within this context, existing scholarship has largely interpreted cannabis use among LGBTQ+ youth through the lens of minority stress, positioning substance use as a response to stigma, discrimination, and structural marginalization (Hatzenbuehler & Pachankis, 2016; Hendricks & Testa, 2012; Meyer, 2003). Cannabis use, and substance use more broadly, is thus commonly conceptualized as a coping mechanism—an individual-level strategy to manage distress—while simultaneously being associated with heightened risk of harm. While this body of work has been instrumental in documenting inequities and potential risks, it has also narrowed the analytic lens by privileging deficit-oriented accounts of cannabis use (Bottorff et al., 2013; Perrin et al., 2020; Reid, 2020).

Emerging scholarship has begun to complicate these assumptions by situating cannabis use within practices of pleasure, care, and sociality (Davis et al., 2018; Ghvanidze et al., 2025; Lefebvre et al., 2026). This work suggests that cannabis use among LGBTQ+ youth intersect with processes of identity formation, belonging, and the negotiation of gendered and sexual norms (Lefebvre et al., 2026; London-Nadeau et al., 2025). Qualitative studies further show that cannabis may support introspection, facilitate identity exploration, and enable the expression and affirmation of gender and sexuality, while also fostering connection and community (Barborini et al., 2024; London-Nadeau et al., 2025). At the same time, this literature highlights the ambivalent relationship between cannabis use and mental health: cannabis may be mobilized to regulate affect, manage anxiety or trauma-related distress, or reduce harms associated with other substances, yet may also contribute to adverse experiences such as paranoia or concerns about dependence (Parent et al., 2021). Collectively, these findings suggest that cannabis use is embedded in dynamic, context-dependent practices through which LGBTQ+ youth navigate mental health, identity, and social life, underscoring the need to move beyond singular, harm-focused interpretations.

Although important advances have been made, there remains limited empirical research that foregrounds LGBTQ+ youths’ own understandings of why they use cannabis, particularly regarding the interplay between mental health, gender, and sexuality. Existing studies, with a few exceptions, largely treat motivations or outcomes in isolation, overlooking how they are produced within broader normative and structural contexts, as well as how youth themselves interpret the role of cannabis in their mental well-being (Jenkins et al., 2025). This gap is especially salient in contexts such as Canada, where the legalization of non-medical cannabis has significantly expanded access, availability, and social acceptability (Ali et al., 2022; Fischer et al., 2023; Hall et al., 2023), thereby reshaping the conditions under which young people engage with cannabis. In such contexts, understanding how LGBTQ+ youth themselves make sense of cannabis use becomes critical for moving beyond risk-based frameworks and informing more nuanced, contextually grounded public health and policy responses.

To address these gaps, the present study draws on ethics of care (Duff, 2015) and queer theory (Butler, 2004; Nash, 2010) to examine cannabis use. An ethics of care shifts attention away from individual risk and pathology toward the ways individuals engage in practices of self- and collective care in navigating mental health, particularly in contexts of constrained or inequitable access to support (Duff, 2015). Rather than treating care as a universal moral principle or simply a coping strategy, this perspective understands care as a situated, relational practice that is continually negotiated through everyday relationships and shaped by the social contexts through which people seek to live well. From this perspective, cannabis use may represent one of many practices through which LGBTQ+ youth regulate emotions, care for themselves and others, and navigate mental health in everyday life. Queer theory complements this approach by interrogating the norms through which cannabis use, mental health, gender, and sexuality are understood, regulated and negotiated (Browne & Nash, 2010; Ghaziani & Brim, 2019; Pienaar et al., 2020). It highlights how cisheteronormative (the social system in which identifying with one’s gender assigned at birth and heterosexual orientation are the only or desired identities) and biomedical frameworks often construct understandings of substance use. Indeed, these frameworks position substance use as deviant or pathological, while overlooking the ways it may be implicated in processes of identity formation, embodiment, and resistance. Together, ethics of care and queer theory provide a framework for understanding cannabis use as a situated practice through which LGBTQ+ youth negotiate mental health, identity, and social expectations, and substantiate an exploration of the diverse motivations underlying use.

Guided by this approach, and informed by a community-based participatory framework (Minkler, 2005; Minkler & Wallerstein, 2003), this study asks: What motivates cannabis use among LGBTQ+ youth, and how is it mobilized in relation to mental health and their gender and sexuality identities? Using photovoice (Wang & Burris, 1997), this question is explored in partnership with LGBTQ+ youth, positioning them as co-researchers and centering their lived experiences in the production and interpretation of knowledge.

2. Materials and Methods

The study employed photovoice, a participatory methodology grounded in community-based research traditions that seeks to democratize knowledge production by centering participants’ lived experiences (Baker & Wang, 2006; Ferlatte et al., 2022; Wang & Burris, 1997). Photovoice invites participants to represent and interpret their realities through photographs and accompanying narratives, thereby reducing reliance on exclusively verbal accounts and enabling engagement with complex, stigmatized, or difficult-to-articulate experiences (Catalani & Minkler, 2010; Ferlatte & Oliffe, 2019; Oliffe & Bottorff, 2007). This approach is particularly well-suited to research on mental health (Ferlatte et al., 2019; C. S. Han & Oliffe, 2016; Stephens et al., 2023; Tippin & Maranzan, 2022), substance use (Goodyear et al., 2023; Smith et al., 2024), and sexual and gender diversity (Capous-Desyllas & Mountz, 2019; Magyarlaki & Pipkin, 2025; Pinheiro et al., 2024), where dominant discourses often marginalize experiential knowledge and reproduce power asymmetries between researchers and participants.

Consistent with the study’s commitment to community capacity-building and epistemic justice (Nicole-Berva & Ušča, 2026), three LGBTQ+ youth researchers were recruited. They were selected based on their lived experience as LGBTQ+ young people and their interest in learning about and contributing to community-based research, rather than prior formal research training. They completed training in photovoice, qualitative interviewing, and qualitative analysis, and received ongoing mentorship from the academic team throughout the project. They were employed and financially compensated as integral members of the research team. The youth researchers actively contributed to recruitment, data collection, preliminary analysis, and interpretation. Their involvement helped anchor the research process in youth- and community-informed perspectives while enhancing analytic reflexivity and credibility.

2.1. Recruitment and Participants

Following ethics approval from the Comité d’éthique de la recherche en sciences et en santé de l’Université de Montréal (CERSES-20-156-P), participants were recruited using a multi-pronged strategy, including outreach to queer and LGBTQ+ community organizations, social media platforms (such as Facebook and Instagram), and snowball sampling. These approaches were selected to maximize reach across diverse LGBTQ+ youth communities and to facilitate the inclusion of participants with varied experiences of mental health and cannabis use. Eligibility criteria included: (1) being between 15 and 24 years of age; (2) identifying as LGBTQ+; (3) residing in the province of Quebec; (4) reporting cannabis use within the past 12 months; and (5) self-reporting diagnosed or undiagnosed mental health concerns. This broad inclusion framework was intentionally adopted to capture a wide spectrum of experiences and to avoid restricting participation to clinical or diagnostic categories.

A total of 46 queer youth participated in the study. Demographic characteristics are presented in

Table 1. Participants’ demographic characteristics.

	N = 46
Mean age (range)	21.6 (15–25)
Gender	n (%)
Trans women	1 (2.2)
Trans men	1 (2.2)
Trans non-binary	8 (17.4)
Cisgender women	17 (37)
Cisgender men	6 (13)
Genderfluid	1 (2.2)
Non-binary	11 (23.9)
Queer	1 (2.2)
Sexual orientation 1	n (%)
Lesbian	3 (6.5)
Gay	5 (10.9)
Bisexual	8 (17.4)
Queer	27 (58.7)
Pansexual	10 (21.7)
Questioning	1 (2.8)
Country of origin	n (%)
Canada	30 (65.2)
France	9 (19.6)
Lebanon	3 (6.5)
United States	2 (4.3)
Malaysia	1 (2.2)
Morocco	1 (2.2)
Frequency of cannabis consumption	n (%)
Every day	14 (30.4)
Few times a week	16 (34.8)
Once a week	3 (6.5)
Few times a month	3 (6.5)
Once a month	1 (2.2)
Occasionally	5 (10.9)
Variable	4 (8.7)
Mental health diagnosis by health professional 1	n (%)
Depression	9 (19.6)
Anxiety	17 (37.0)
Personality disorder	4 (8.7)
Other	6 (13.0)
None	19 (41.3)
Mental health management ever received 1	n (%)
Psychotherapy	22 (47.8)
Mental health medication	23 (50.0)
Social worker counselling	2 (4.3)
None	11 (23.9)

¹ Participants could identify with multiple categories; percentages do not sum to 100%.

. The mean age was 21.6 years (range: 15–25). The majority identified their sexual orientation as queer (n = 27, 58.7%), were born in Canada (n = 30, 65.2%), and reported weekly or more than weekly cannabis use (n = 33, 71.7%).

2.2. Data Collection

Data collection consisted of two individual Zoom-based meetings conducted between July and December 2021, each facilitated by a queer youth researcher. Building on their active role within the research team, youth researchers conducted the interviews to support rapport-building and facilitate open, contextually grounded discussions. Their shared lived and generational experiences with participants contributed to creating a more comfortable and affirming interview environment, which encouraged reflection and the articulation of nuanced experiences. This relational proximity also enabled the use of intuitive follow-up questions, enhancing the depth and richness of the data collected, while fostering trust in a research process positioned as attentive to queer youths’ perspectives.

During the first meeting, informed consent was obtained, demographic information was collected, and participants were introduced to the photovoice assignment. Participants were invited to take photographs that represented their experiences of cannabis use in relation to mental health and their sexual and/or gender identities. Rather than prescribing predefined themes, the assignment emphasized participant autonomy in identifying the aspects of their experiences they considered most salient. Participants were given approximately two weeks to complete the assignment. The second meeting consisted of an in-depth, participant-led interview lasting approximately 90 min. Participants presented their photographs and discussed the meanings they attributed to them, with youth researchers facilitating reflection through follow-up questions related to cannabis use, mental health, identity, and social context. This approach positioned participants as experts of their own experiences and supported the inductive development of analytic insights.

In line with best practices in photovoice ethics (Creighton et al., 2018), youth researchers received training in conducting topic-sensitive qualitative research, and a protocol was established to identify and respond to participant distress. Youth researchers, mentored throughout by the professional research team, remained attentive to signs of distress throughout data collection. Participants were provided with information on national crisis lines and mental health services. Participants received a $150 honorarium in recognition of their time and contributions.

2.3. Data Analysis

Interviews were audio-recorded, transcribed verbatim, anonymized, and verified for accuracy. Photographs were embedded within the transcripts alongside participants’ narratives to facilitate integrated analysis of visual and textual data. Data were analyzed using reflexive thematic analysis (Braun & Clarke, 2006, 2019), conducted collaboratively with the youth researchers. Transcripts were imported into NVivo, and team members engaged in an initial phase of familiarization, involving close reading of the data and regular analytic discussions to identify preliminary patterns and insights. These discussions informed the development of a provisional codebook. Youth researchers then collaboratively applied the codebook across the dataset, organizing the data into shared analytic categories. This phase foregrounded participants’ accounts of cannabis use motivations and perceived effects—both positive and negative—while situating these experiences within broader contexts of mental health, sexual and gender identity, and interactions with social and healthcare systems. As analysis progressed, a more explicitly theoretical orientation was adopted, informed by ethics of care and queer theory. This approach emphasized fluidity, relationality, and participants’ situated meaning-making processes, while resisting fixed or pathologizing interpretations. Particular attention was paid to how participants’ narratives disrupted normative assumptions about gender, sexuality, and substance use, and how meanings emerged through ongoing processes of becoming. Candidate themes were developed through iterative discussions among the research team, during which coded data were repeatedly reviewed alongside the full dataset to examine patterns of shared meaning, refine thematic boundaries, and ensure that each theme captured a distinct analytic concept rather than a collection of related topics. Theme names, definitions, and supporting data extracts were refined over multiple rounds of discussion, informed by both participants’ accounts and the study’s theoretical framework. Through this iterative and reflexive analytic process, three intersecting themes were identified and refined. Data within each theme were reviewed to enhance analytic depth and to select illustrative quotations and photographs.

3. Results

As participants discussed cannabis use motivations in relation to gender, sexuality, and mental health, cannabis use was described as an introspective and relational practice through which they engaged with their sense of self, embodiment, and emotional experiences. These accounts reflected interconnected processes through which cannabis use reconfigured ways of thinking, enabled the enactment of identity, and supported practices of care in relation to self and others. Photographs played a central role, often depicting landscapes, mirrors, fragmented scenes, or solitary moments that conveyed internal states otherwise difficult to articulate. Rather than illustrating cannabis use per se, images represented ways of thinking, feeling, and becoming, highlighting its role in self-reflection, identity negotiation, and healing. Photographs and accompanying quotes are presented using pseudonyms to protect participant’s identities.

3.1. Reconfiguring Thought

Participants described how cannabis helped them see things in a different way—the terms “hyper-focused,” “aware,” and “introspective” were recurring in their interviews. Reflecting on oneself while under the influence of cannabis allowed many to frame issues and feelings differently than when sober, as this process opened up alternative pathways of thought. Participants frequently described these experiences as shifts in cognition—where attention, perception, and interpretation were reoriented, enabling new ways of processing thoughts and experiences. In this sense, cannabis use reconfigured ways of thinking, enabling shifts in perception, non-linear meaning-making, and alternative understandings of the self, mental health, and the possibilities of being. At times, these shifts also took on what can be understood as a “queering” of thought, in that they disrupted normative and linear ways of processing experiences related to gender and sexuality, and opened space for more fluid or expansive ways of understanding the self and possibilities of being. Many participants described these moments of reflection while high as purposeful and generative, rather than escapist.

These processes were frequently articulated through photographs that visually represented altered modes of thinking. Mazia (22, queer, cisgender woman), for example, presented an image she titled Connections (Figure 1), which she described as a metaphor for the brain. The image evoked branching lines and multiple directions, illustrating how cannabis enabled non-linear and expansive thinking. These visual representations mirrored participants’ accounts of cognitive expansion, where thought processes became more associative, layered, and open-ended.

Mazia’s photograph illustrate how participants described cannabis as facilitating a reorganization of meaning rather than simply a distorting perception. The branching pathways illustrated resonate with other participants’ accounts of non-linear thinking, and symbolically reflects a queering of thought processes—opening space to question dominant assumptions about gender, sexuality, and the self. For Mazia and others, cannabis use enabled them to “dig deeper,” not only into personal experiences, but also into broader social structures shaping those experiences.

For Imani (21, queer, cisgender woman), cannabis was similarly mobilized as a reflective tool to understand and accept intersecting identities in relation to mental health:

“Cannabis is a very opening drug for me. It’s secured my sense of self and it helps me kind of iron out these intersections between these identities… it was almost like therapy. It was like it opened my mind to the possibility… Honestly, I stopped caring so much about like things that didn’t matter and just accepted me for the way that I am.”

Imani’s account, consistent with patterns observed across participants, suggests that cannabis use was not external to mental health, but part of how it was actively negotiated. Her description of cannabis as “almost like therapy” reflects a broader understanding among participants of cannabis as facilitating a space where emotional processing, identity work, and self-acceptance could occur simultaneously. Importantly, these processes were described as cognitively mediated, involving shifts in attention, evaluation, and interpretation of past experiences and present concerns. This was particularly evident in Imani’s reflections on family acceptance and sexuality:

“I think that most of the mental illness issues I have would be much more mitigated if it weren’t for my sexuality. Like a lot of it was a direct chain in reaction and induction to do with like my family’s acceptance of my sexuality. It has obviously impacted the way that I use cannabis because sometimes I use to work through these emotions that I have.”

Here, cannabis use is mobilized as a means of engaging with, rather than avoiding, distress. This engagement often involved reinterpreting experiences and reframing emotional responses, facilitating forms of cognitive–emotional integration. Through these processes, participants were able to work through complex and often painful emotions tied to stigma, family dynamics, and identity conflict. In this sense, motivations for cannabis use were closely linked to actively navigating mental health in relation to gendered and sexual identities, rather than merely escaping from distress.

The introspective processes enabled by cannabis were also often linked to creative and generative practices. Amaris (24, queer, non-binary) described how cannabis enhanced their imagination and sense of self: “I feel in my experiences with cannabis, I have more clarity in my imagination… I think I create myself, in the way I look and the way I am.” Participants frequently discussed these moments as involving heightened cognitive flexibility, where imagination and self-concept became more fluid and open to transformation.

For Amaris, cannabis use facilitated a form of self-production, where identity was actively constructed through imagination and expression. Participants frequently described feeling less constrained by normative expectations while high, allowing them to explore alternative ways of being and relating to themselves. This process was also reflected in Lucy’s (24, queer, trans woman) narrative:

“I think that honestly, everything in my life led up to where I am now, and I think weed definitely served a big part in that. I think weed was an introduction to a different world. And I think it was the start of the reclaiming of myself. I definitely see marijuana being a huge part in my journey to the woman that I am today. And especially the trans woman I am today.”

Lucy’s account highlights how cannabis use was embedded within longer trajectories of identity development. Rather than being a temporary state, cannabis-enabled reflection contributed to ongoing processes of becoming, particularly in relation to gender affirmation. In this context, cannabis use can be understood as a practice of self-making, through which participants reworked their relationship to their bodies, identities, and mental health. These shifts were often described as cumulative, where repeated alterations in thinking contributed to longer-term changes in self-understanding.

At the same time, participants emphasized that these experiences were not uniformly positive. Some described how the same processes of introspection afforded by cannabis could become overwhelming or destabilizing. Julian (22, bisexual, cisgender man) illustrated this through a photograph titled Disorientation (Figure 2), which visually conveyed blurred and fragmented perception.

In contrast to the expansion depicted in Mazia’s image, Julian’s photograph represents a loss of coherence and grounding. The visual instability reflects how cannabis-induced introspection and reconfiguration of thoughts can, in some cases, lead to confusion, anxiety, and a sense of losing control over one’s thoughts. Participants described these moments as disruptions to cognitive coherence, where thoughts became fragmented, difficult to organize, or overwhelming. Participants often linked these experiences to context, dosage, or mental health state, emphasizing that cannabis use required ongoing regulation. This was reflected in Nastasch’s (16, bisexual, non-binary) account: “When my mental health is good, I smoke for the right motivations… I don’t smoke to destress.”

Participants distinguished between using cannabis for introspection and using it to numb or escape, positioning the former as more intentional and beneficial. Some described taking breaks from cannabis to “reground” themselves, demonstrating awareness of its potential risks.

Overall, cannabis use for introspection was predominantly framed as a motivated practice of engaging with the self, particularly in relation to mental health and identity. More specifically, cannabis use functioned as a means of reconfiguring cognitive processes, enabling shifts in perception, interpretation, and meaning-making. At the same time, these motivations were context-dependent and ambivalent, reflecting an ongoing negotiation between reflection and disorientation. Through both visual and narrative data, cannabis use emerged as a way of queering thought processes—disrupting normative frameworks and enabling alternative understandings of self, gender, and sexuality.

3.2. Enacting Identity

For many participants, cannabis use was motivated by its capacity to facilitate the embodiment and expression of gender and sexuality, enabling a movement from internal reflection toward external enactment. Building on these shifts in thinking, participants described how insights gained while using cannabis could be translated into how they inhabited their bodies, presented themselves, and interacted with others. In this sense, cannabis use was not only about understanding identity, but about bringing it into being through action and embodied practice, particularly in ways that challenged or departed from normative expectations.

Participants frequently described cannabis as reducing anxiety, self-consciousness, and fear of judgment, thereby creating conditions in which gender expression felt more accessible. This was especially salient for trans and non-binary participants, who often navigated environments where their identities were constrained or scrutinized. Cannabis use was thus mobilized as a way to bridge internal identity and external expression, enabling participants to actively inhabit and perform aspects of themselves that might otherwise remain constrained or unexpressed, supporting moments of alignment between how participants understood themselves and how they were able to present in the world.

Jak (19, queer/lesbian, non-binary), for example, described how cannabis use enabled them to step back from immediate pressures and articulate aspects of their identity that had previously felt difficult to access: “Smoking [cannabis] has allowed me to take a step back, to talk about certain things… I was able to have top surgery.”

Jak’s account suggests that cannabis use was implicated not only in reflection, but in decision-making processes that shaped their embodied trajectory, including gender-affirming care. Here, identity is not only understood but also acted upon, with cannabis use facilitating concrete steps in the realization of embodied identity. Similarly, Nastasch (16, bisexual, non-binary) described cannabis as facilitating a sense of recognition and courage in relation to their gender identity: “I have an easier time coming to terms with being a non-binary person when I’m smoking cannabis… it seems to give me more courage.”

Across these narratives, cannabis use was motivated by its capacity to create a space where participants could acknowledge, affirm, and begin to actively inhabit and express their gender identities, particularly in contexts where such processes were otherwise difficult or constrained.

These experiences were often captured through photographs that foregrounded the body, clothing, and reflection, illustrating gender as relational, embodied, and in process. Hind (20, questioning, cisgender woman), for instance, presented a photograph titled Gender norms (Figure 3), depicting a dress laid out on the floor and photographed from above, a dress that she no longer felt represented who she was. The image captures a moment of tension between past and emerging identities, where clothing and presentation become sites of negotiation.

Hind’s photograph visually expresses a disidentification from imposed gender norms, illustrating how cannabis use enabled her to re-evaluate her identity outside of familial and cultural expectations. The depiction of a dress on the floor—and at a distance from the participant’s body—echoes her description of feeling increasingly disconnected from gendered expectations that no longer reflected who she was. In this context, cannabis use facilitated not only questioning, but also a gradual reworking of gendered self-presentation, as participants actively reconfigured and enacted new forms of embodiment, moving away from externally imposed identities toward more self-defined forms of expression.

Similarly, Amaris (24, queer, non-binary) described cannabis as supporting processes of experimentation and internal dialogue, through which different aspects of their identity could emerge:

“In the realm of gender identity, Cannabis helped me… it’s definitely been a strong influence in my gender identity as I’m rebuilding the way I identify in the world and see myself. Cannabis helped me so much through role-play, through different sexual shadow work, to understand how to allow these personalities—parts of me to come through… and dialogue with them.”

Here, cannabis use was described as enabling a form of intra-relational engagement, where identity was not singular but composed of multiple, interacting parts. This process was often linked to reduced anxiety and increased creative expression, allowing participants to explore gender in ways that felt less constrained by normative expectations. Cannabis use thus functioned as a medium through which participants could try on, perform, and enact different configurations of self in practice, rather than simply reflect on them.

Uri (24, queer/pansexual, non-binary) further illustrated these dynamics through a photograph titled Self-love (Figure 4), depicting their reflection in a mirror.

Uri’s photograph illustrate how cannabis supported moments of self-recognition and affirmation, consistent with their description of feeling greater self-love and confidence when looking at their reflection while high. Rather than emphasizing normative standards of appearance, the image reflects Uri’s account of experiencing a closer alignment between how they understood themselves and what they saw in the mirror. Similar experiences were described by participants, who frequently linked these moments to increased confidence, reduced distress, and a more affirming relationship with their bodies. In this sense, cannabis use was motivated by its capacity to support positive forms of embodiment, particularly in relation to gender and self-perception. These moments of recognition were often described as enabling participants to more fully inhabit and express their identities in lived and visible ways.

Importantly, participants emphasized that these experiences were dynamic and evolving over time, shaped by changing relationships to mental health, identity, and social context. Uri, for example, described how cannabis initially functioned as a means of numbing distress during earlier experiences of homophobia, but later became a tool for exploration and affirmation. This shift highlights how motivations for cannabis use were not fixed, but transformed alongside participants’ trajectories of identity development and mental health.

Across these accounts, cannabis use was not simply associated with gender expression, but actively mobilized as a means of embodying identity in ways that are relational, negotiated, and situated within broader social contexts. Through both visual and narrative data, participants’ accounts revealed that gender is often something that they do and become, rather than something they simply are. Cannabis use, in this sense, functioned as a practice of gendered self-expression, enabling participants to actively enact and sustain alignment between their identities, bodies, and everyday practices, while navigating—and at times resisting—the constraints of normative gender expectations.

3.3. Practicing Care

Participants frequently described cannabis use as a way of engaging with, rather than avoiding, emotional distress linked to stigma, isolation, and identity-related tensions. Extending beyond cognitive and embodied experiences in the previous themes, cannabis use was described by participants as a way of caring for themselves and others by supporting emotional regulation, healing, and relational connection with self and others. Rather than being framed as an escape from distress, cannabis use was positioned as part of broader efforts to navigate mental health through introspection, self-compassion and connection to others. In this sense, cannabis use was not only experienced as an expression of care, but also enacted as an ongoing practice of attending to and responding to emotional and relational needs. Photographs associated with this theme often conveyed stillness, emptiness, or intimacy, capturing moments of withdrawal, reflection, and emotional processing.

For some participants, cannabis use created conditions that facilitated self-reflection and personal growth, particularly in relation to difficult or unresolved experiences. Sana (21, bisexual, cisgender woman), for example, described how cannabis enabled her to sit with her thoughts in ways that supported healing: “Being alone forced me to do a lot of introspection and to be alone with my thoughts. Cannabis allowed me to move forward in my personal growth.”

Sana’s account, echoed across multiple participants, suggests that cannabis use was not external to mental health, but actively implicated in how it was worked through. Participants described using cannabis to disentangle complex emotions, revisit past experiences, and develop a deeper understanding of themselves. These practices were often described as deliberate forms of self-care, where participants used cannabis to regulate emotional intensity, create space for reflection, and support processes of healing. In this sense, cannabis use was motivated by its capacity to create a space for intentional engagement with distress, rather than its avoidance.

Several participants drew parallels between cannabis use and therapeutic processes. Sarah (15, bisexual, cisgender woman), for instance, compared her experiences using cannabis to interactions with a psychologist:

“I went to the psychologist a lot and she would rephrase my thoughts or like repeat back to me what I had just told her, and then she would analyze my stuff out loud. It’s like the same situation [when consuming cannabis], but you know in a different way. It just makes you realize a lot of things.”

Here, cannabis use is positioned as facilitating a form of reflexive dialogue, where participants could process thoughts and emotions in ways that resembled therapeutic reflection. Similarly, Callie (22, queer, cisgender woman) described how cannabis supported both introspection and relational communication:

“I think what my favorite thing about weed is that while consuming weed, I have the patience to work on myself, I have the patience to sit down and do nothing, or go on a walk, and really be with myself and try to understand myself and putting the time and effort. And then, when I’m sober, the connections and maybe the realizations that I came to, or the language I was able to use to articulate my emotions, I still retained them when I was sober. And it was really helpful, not just internally, but the way I communicated to my friends, about the way I was feeling or the way I communicated to my partner about what I needed in that time.”

Callie’s account highlights how cannabis use was not limited to momentary effects but could have enduring impacts on emotional awareness and interpersonal relationships, suggesting that its motivations extended beyond immediate relief to longer-term processes of growth and connection. Importantly, these accounts illustrate how care was practiced both inwardly and relationally, shaping how participants engaged with themselves and others over time.

While many participants described these experiences as occurring individually, others emphasized the importance of collective contexts of use, particularly within queer social spaces. Selma (20, queer, cisgender woman) described how using cannabis with other queer individuals fostered a sense of safety and shared healing: “When I go to queer events, we smoke a lot, we feel safe together… I feel safer when I am smoking with fellow queers, to just vibe. We are all on a healing journey.”

Similarly, Sharon (23, pansexual, trans woman) described how cannabis use facilitated connection and mutual understanding among peers navigating similar identity-related experiences:

“I was smoking with a lot of queer people who were also coming to terms with their identity and their queerness, and I think that marijuana allowed for spaces for us to congregate together but also share with each other. I’ve met a lot of queer people through smoking weed and I’ve been able to learn a lot from these people, and a lot about myself too through that. And we found our connection through smoking weed together.”

These accounts suggest that cannabis use was embedded in relational practices of care, with participants describing healing as extending beyond the individual to include shared processes of connection and support among people navigating similar experiences of marginalization and identity exploration. In these contexts, cannabis were described as creating opportunities for intimacy, enabling conversations and relationships that participants felt otherwise difficult to initiate and access.

At the same time, participants were attentive to the limits and ambivalences of cannabis use as a healing practice. These tensions were particularly visible in photographs that depicted emotional withdrawal or disconnection. Mo (23, pansexual, non-binary), for example, presented a photograph titled Numbing (Figure 5), showing a frozen and expressionless face.

Mo’s photograph can be interpreted as a visual representation of the ambivalent effects of cannabis use, where the intention to alleviate distress may lead to emotional flattening or disconnection. The stillness and absence of expression contrast with earlier images of reflection and connection, highlighting a rupture in engagement with the self and others. Participants often described oscillating between these experiences, where cannabis could support introspection and healing in some contexts, while contributing to avoidance or numbing in others. This highlights how practices of care were not fixed or uniformly beneficial, but required ongoing adjustment and negotiation.

This ambivalence was further reflected in participants’ discussions of dependence and regulation. Some described becoming reliant on cannabis for emotional processing, while others emphasized the importance of moderating use or taking breaks to “reground” themselves. Together, these accounts highlight care as an ongoing practice of regulation, in which participants actively calibrated their use in response to their emotional states, needs, and contexts. Cannabis use was thus continually reassessed through a process of negotiation, balancing its perceived benefits and harms.

Across these narratives, cannabis use emerged as part of broader efforts to navigate what participants described as emotional or “queer wounds”, shaped by experiences of stigma, exclusion, and identity struggle. Through both visual and narrative data, cannabis use was positioned as a practice of care that is situated, relational, and contingent, rather than inherently therapeutic or harmful. Rather than a fixed strategy, cannabis use functioned as an evolving practice of care through which participants responded to their needs, relationships, and social environments. Motivations for use were thus embedded in participants’ attempts to engage with their mental health in ways that were meaningful within their social and structural contexts, even as these practices remained marked by tension and uncertainty.

4. Discussion

This study sought to examine the motivations underlying cannabis use among LGBTQ+ youth, and how these motivations relate to mental health and gender and sexual identities. By centering youth perspectives through a participatory, arts-based approach grounded in participant-generated photographs, our findings extend existing literature by demonstrating that cannabis use is not solely a response to distress or risk, but is actively mobilized as a situated and relational practice through which young people engage in reconfiguring thought, enacting identity, and practicing care. Grounded in an ethics of care and queer theoretical framework, these findings shift attention away from individual pathology toward the relational, affective, and normative contexts that shape how cannabis use is experienced and enacted.

A central contribution of this study is the identification of reconfiguring thought as a key process through which cannabis use becomes meaningful in relation to mental health and identity. Participants described cannabis as enabling shifts in cognition, through which they reinterpreted experiences, reconfigured narratives of self, and explored alternative possibilities of being. These findings echo emerging research showing that cannabis can facilitate introspection and identity exploration among LGBTQ+ youth (Barborini et al., 2024; Lefebvre et al., 2026; London-Nadeau et al., 2025; Paul et al., 2026; Pienaar et al., 2020), where use is often mobilized to support self-discovery and affirmation. However, our study extends this literature by demonstrating how introspection operates as a reorientation of thought processes, characterized by shifts in perception, multiplicity, and non-linear ways of making sense of experience. Rather than conceptualizing introspection as a by-product of use, our findings highlight it as an intentional and situated practice through which youth engage in critical, expansive, and at times generative modes of reflection that disrupt normative logics of selfhood. From a queer theoretical perspective (Race et al., 2026), these processes open space for alternative ways of thinking about gender, sexuality, and mental health, enabling participants to question dominant frameworks and rework meanings shaped by stigma, family dynamics, and social expectations. Importantly, these processes were not solely oriented toward identity exploration, but were also mobilized in relation to mental health, as participants used cannabis to actively process emotional experiences and reframe distress. At the same time, these forms of introspection were described as ambivalent and context-dependent, at times facilitating clarity and insight, and at others producing disorientation or emotional overwhelm, requiring ongoing regulation.

Importantly, these cognitive reconfigurations were not confined to thought but extended into the enactment of identity, as participants translated shifts in perception into embodied and social practices. As illustrated in the second theme, cannabis use supported the translation of internal insights into lived and enacted forms of gendered and sexual expression, enabling participants to more closely align their bodies, identities, and modes of presentation. Through a queer theoretical lens, these practices can be understood as processes of gender negotiation and reconfiguration, where participants actively worked with and against normative expectations to inhabit more affirming and self-defined ways of being. This finding corresponds with emerging scholarship showing that cannabis can be purposefully mobilized by LGBTQ+ youth to facilitate embodied identity expression, support the experience of an “authentic” self, and enable moments of gender affirmation and euphoria (Barborini et al., 2024; London-Nadeau et al., 2025). Consistent with participants’ accounts, research further suggests that cannabis may reduce anxiety and self-consciousness while enhancing sensory and affective awareness, thereby creating conditions that support experimentation with identity, confidence in self-presentation, and relational engagement with others (Bilgrei et al., 2022; Felner et al., 2020; Lefebvre et al., 2026; Rukus et al., 2017). In this sense, cannabis use was not merely reflective but actively implicated in the doing of identity—shaping how participants inhabited their bodies, expressed themselves, and navigated social interactions in everyday life.

At the same time, our findings highlight that cannabis use was deeply embedded in ongoing practices of care, as reflected in the third theme. Participants described using cannabis to engage with emotional distress, process trauma, and foster connection with others, particularly within queer social contexts. This aligns with a substantial body of literature documenting that, for young adults—and particularly sexual and gender minority populations—cannabis may function as a form of relief or reprieve from mental health challenges, including anxiety, depression, and minority stress-related distress (London-Nadeau et al., 2026; Parent et al., 2021; Paul et al., 2026; Rup et al., 2022). At the same time, emerging research emphasizes that cannabis use may also feature in young people’s efforts to survive and thrive, including fostering connection, navigating adversity, and supporting well-being within contexts of structural marginalization (London-Nadeau et al., 2025). From an ethics of care perspective (Duff, 2015), these practices can be understood as forms of situated and relational care, where individuals actively respond to their own and others’ needs within conditions of constraint and limited access to affirming resources (Ortiz-Paredes et al., 2024). Consistent with research highlighting the evolving and socially negotiated meanings of cannabis use among youth (Bilgrei et al., 2022), participants in this study actively calibrated their use in relation to their emotional states, relationships, and environments. Rather than framing cannabis use as inherently harmful or protective, our findings underscore its ambivalent and context-dependent role, where care may involve both relief and disconnection, healing and risk. Participants navigated these tensions reflexively, adjusting their use as part of ongoing efforts to manage well-being. This underscores the importance of understanding cannabis use not as a fixed behaviour, but as an ongoing, relational negotiation of care within constrained and unequal conditions.

Taken together, these findings point to the need for a “more-than-harm-reduction” approach to cannabis use among LGBTQ+ youth. While harm reduction has been essential in mitigating adverse outcomes, its dominant application often centers risk and narrows attention to harm, overlooking the broader meanings and functions that substance use holds in young people’s lives (Jenkins et al., 2017; Souleymanov & Pino, 2023). As Race et al. (2026) argue, prevailing public health frameworks tend to totalize substance use as inherently problematic, obscuring its social and relational dimensions. A more-than-harm-reduction perspective shifts the focus from what substance use is to what it does in practice—how it is embedded in everyday forms of care, identity work, and social connection (Dennis et al., 2020). Our findings extend this perspective by showing that cannabis use operates as a set of situated practices through which youth engage in introspection, enact identity, and navigate relational care, while also producing ambivalent effects.

These insights have important implications for public health and healthcare practice. Moving beyond binary distinctions between “healthy” and “unhealthy” use requires engaging with the lived realities of LGBTQ+ youth and recognizing cannabis use as part of broader, context-dependent strategies for managing mental health and navigating identity. Rather than framing use solely in terms of risk, this approach foregrounds youth agency, including how young people actively calibrate their use in response to shifting needs and environments. As Race et al. (2026) caution, risk-based framings can obscure both the meanings of use and the structural conditions shaping it. Supporting well-being therefore requires not only minimizing harm, but also expanding access to inclusive, affirming, and relational forms of care that resonate with young people’s everyday experiences, including those that extend beyond conventional harm reduction frameworks (Dennis et al., 2020).

4.1. Methodological Reflection

This study contributes to calls for youth-centered and participatory approaches that foreground youth agency in knowledge production (Augsberger et al., 2023; Bailey et al., 2024; Mawn et al., 2015; Pillainayagam et al., 2025), particularly within cannabis and substance use research (Jenkins et al., 2025; Ortiz-Paredes et al., 2026), where youth perspectives are often marginalized or framed through risk-based paradigms. By combining photovoice with the involvement of queer youth researchers, the study moves beyond extractive models to position youth as active co-producers of knowledge. Consistent with prior work on photovoice with youth (Fountain et al., 2021; Stephens et al., 2023), this approach enabled the generation of contextualized and affective knowledge, with participant-generated images anchoring narratives in everyday experiences and emotional contexts. The visual dimension also facilitated the expression of experiences that may be difficult to articulate verbally, particularly in relation to stigma, ambivalence, and care.

The involvement of LGBTQ+ youth researchers further supported relational and affirming research spaces, helping to reduce power differentials and foster more open discussions. This responds to critiques of tokenistic youth participation (Mawn et al., 2015; Nwaozuru et al., 2025; Smith-Carrier & Tuyl, 2024), as well as to calls within substance use research to better integrate lived experience and peer-led approaches, enabling more meaningful and situated engagement (Jenkins et al., 2025; Ortiz-Paredes et al., 2026). Photovoice also functioned as a reflexive process, prompting participants to critically engage with their own experiences and, in some cases, develop new insights into their cannabis use and well-being. At the same time, the co-constructed and visual nature of the method raises important ethical considerations related to representation, consent, and the potential risks of visibility (Creighton et al., 2018; Hannes & Parylo, 2014; Stephens et al., 2023). Overall, this study highlights the value of participatory, arts-informed, and youth-led methodologies for advancing more nuanced, equitable, and contextually grounded understandings of cannabis use and mental health among youth, while supporting youth agency in the research process.

4.2. Limitations

Several limitations should be noted. First, while this study was designed within a participatory framework and involved three LGBTQ+ youth researchers across key stages of the research process, the extent to which it achieved the broader emancipatory aims often associated with photovoice warrants reflection. Empowerment cannot be assumed as an automatic outcome of participation in a photovoice project, but depends on sustained access to decision-making and opportunities beyond data collection (Jenkins et al., 2025; Liebenberg, 2022). In this study, youth researchers contributed meaningfully to recruitment, data collection, and interpretation, strengthening the relational and analytic dimensions of the research. However, participation evolved across different phases of the project, and opportunities for shared decision-making were more limited during later stages of the research process. As is common in longer-term participatory research, practical constraints—including project timelines and changes in youth availabilities—made it challenging to sustain the same level of engagement throughout all phases of the study. For example, only one LGBTQ+ youth researcher was involved in drafting this manuscript, as the other youth researchers’ work and educational commitments limited their availability during manuscript preparation. Accordingly, co-production was strongest during participant recruitment, data collection, and interpretation, and more limited during manuscript preparation and knowledge mobilization.

Second, while photovoice enabled the generation of rich, affective, and situated accounts, its implementation aligns more closely with a photo-elicitation approach (Oliffe & Bottorff, 2007; Shaw, 2021) than with a fully realized participatory action research process. The absence of sustained collective analysis and structured engagement with community or policy audiences may limit its transformative potential, despite a successful in-person exhibition that generated media interest and attracted over 300 attendees and a virtual exhibit (Qollab, n.d.). At the same time, key participatory elements—including the involvement of LGBTQ+ youth researchers throughout the research process and participants’ leadership in generating photographs and narrating their meanings during interviews—enhanced the depth, relevance, and contextual richness of the findings.

Third, interviews were conducted online, which may have limited opportunities to capture embodied and contextual cues central to participatory and visual methodologies. However, this approach was necessary in the context of the COVID-19 pandemic and is supported by research demonstrating that online interviews can enhance accessibility, flexibility, and participant comfort when discussing sensitive topics (Oliffe et al., 2021). Future research would benefit from expanding participatory components, including greater youth involvement in dissemination and action-oriented processes, as well as exploring more diverse contexts.

Finally, although participants’ experiences with cannabis were likely shaped by broader structural conditions—including socioeconomic inequality, racialization, migration, and differential access to affirming resources—these intersecting dimensions were not the primary focus of the present analysis. Future research should examine how these structural factors shape cannabis use motivations, meanings, and practices among LGBTQ+ youth.

5. Conclusions

This study contributes to emerging efforts to move beyond deficit-oriented and harm-focused frameworks by reconceptualizing cannabis use among LGBTQ+ youth as embedded within broader practices of meaning-making, identity negotiation, and care. Drawing on an ethics of care and queer theoretical lens, it offers a reframing that attends to what cannabis use does in young people’s lives, rather than what it represents in terms of risk, thereby aligning with calls for more nuanced, relational, and context-sensitive approaches to substance use. In doing so, it challenges paternalistic narratives and underscores the importance of recognizing LGBTQ+ youth as knowledgeable actors in shaping their own well-being. Methodologically, the study further illustrates the value of participatory, arts-based, and youth-led approaches to generate richer and more situated forms of knowledge, while supporting youth agency in the research process. In a context of expanding cannabis availability, such approaches are critical for informing more equitable, non-stigmatizing, and youth-responsive public health and policy responses, and point to the need for future research and practice to create sustained spaces for meaningful youth participation in shaping knowledge and interventions that affect their lives.