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Background In 2018, an estimated 89% of individuals who needed treatment for substance use did not have their need met. Compared to heterosexuals, the disparity between needing and receiving treatment is thought to be even higher for sexual minorities. Yet, few studies have investigated sexual orientation and its relationship to unmet treatment need or the association between sexual orientation and specific reasons for the inability to enter treatment. Understanding these reasons is critical to eradicating barriers to treatment for sexua