Members of the lesbian, gay, bisexual, transgender and queer community have rates of substance abuse higher than those of the general population. Their daily battles with discrimination and stigma cause high levels of stress that may push them toward drug and alcohol use.
Substance use disorders affect 20 to 30 percent of the LGBTQ+ population, compared to 8.4 percent of the general population, according to the Substance Abuse and Mental Health Services Administration. These alarming numbers stress a need for more substance use recovery programs that cater to LGBTQ+ individuals.
A 2014 Australian study published in the Drug and Alcohol Review revealed that 57 percent of the 161 LGBTQ+ youths surveyed had reported recent use of an illegal substance, and 30 percent admitted to using two or more illicit substances. The study also found that the LGBTQ+ youths used stimulants, prescription medications, LSD and opiates.
SAMHSA reported that gay men have a higher incidence of substance use than the general population. According to a National Survey on Drug Use and Health, common substances gay men use are:
Similarly, substance abuse has been a longstanding concern among the transgender community. According to SAMHSA, some of the most common drugs used by transgender people include marijuana, crack cocaine, methamphetamine and injection drugs.
Alcohol use is ever-present in the lives of many LGBTQ+ individuals because of its prevalence in the social settings they frequent. The 2014 Australian study found that 84 percent of LGBTQ+ youths surveyed consumed alcohol, and 85 percent were candidates for hazardous alcohol use according to criteria from the AUDIT-C alcohol screening test.
According to a Substance Abuse and Mental Health Services Administration report, LGBTQ+ people are less likely to abstain from drugs and alcohol and are more likely to indulge in long-term heavy drinking.
Binge drinking is prevalent among the bisexual community, with 22.6 percent of bisexuals being binge drinkers compared to 14.3 percent of heterosexuals. Numerous studies found that lesbians were more likely to drink heavily than their heterosexual counterparts, according to SAMHSA. The report also noted that bisexual women report more hazardous drinking than lesbians or heterosexual women.
Several studies revealed that gay men used tobacco nearly 50 percent more than straight men. Similarly, studies have reported that lesbians were 1.5 to 2 times more likely to smoke than heterosexual women.
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LGBTQ+ people sometimes grapple with homophobia, discrimination and stigma that may have negative repercussions on their health. These negative feelings give rise to physical and mental health issues that sometimes push them toward substance use. In fact, the 2014 Australian study reported that 58 percent of the LGBTQ+ youths surveyed listed homophobia as one of the reasons for their drug and alcohol use.
Because of their sexual identity and orientation, LGBTQ+ people often face violent behaviors such as bullying, teasing, harassment and physical assault. The Centers for Disease Control and Prevention reported that about 40 percent of homeless youth are LGBTQ+, which shows that family rejection is indeed a problem for LGBTQ+ youth.
The CDC report also mentions a 2009 study stating that LGBTQ+ young adults who experienced family rejection were three times more likely to use illegal drugs than those from supportive families.
“One can think of three reasons for the increased rates of addiction among LGBT people – all resulting in increased stress, which is a very well-known contributor to the initiation and perpetuation of substance use,” Dr. Petros Levounis, Professor and Chair of the Department of Psychiatry at Rutgers New Jersey Medical School, told NBC News.
Levounis added that increased stress can stem from discrimination, perceived discrimination and internalized homophobia.
LGBTQ+ college students have higher rates of substance use than heterosexual students, according to a 2010 study published in the journal Addictive Behaviors. The research explained that the high rate of use might be due to stress from an unwelcome campus environment.
Despite modern society being increasingly accepting of LGBTQ+ culture and its norms, sometimes LGBTQ+ people struggle with internalized homophobia. This type of homophobia occurs when the individual accepts sexual stigma and discrimination as part of their self-concept and identity.
Internalized homophobia may result in self-loathing among LGBTQ+ people and may be a trigger for substance use. An individual might look at drugs and alcohol use as a means of acceptance of their true persona. However, when people depend on drugs to feel comfortable in their skin, it increases their addiction potential. This is due to a double-reward effect, where the substance user enjoys a chemical high from the substance and an emotional high from being his or her true self.
The ongoing marginalization contributes to the LGBTQ+ community’s struggle with anxiety, stress and depression. To cope with these issues, LGBTQ+ people often resort to self-medicating with drugs, notably marijuana, according to an NBC News article.
A 2013 study published in the Journal of HIV/AIDS & Social Services surveyed HIV-positive gay and bisexual male young adults about their marijuana use. The participants cited stress relief, social relaxation and forgetting about their diagnosis as reasons for their use of marijuana.
When asked to elaborate on why he used marijuana, a 24-year-old bisexual male participant said, “I’ve been smoking weed the whole time I’ve been having HIV and so that’s kind of like what I do to make the problem go down or just make me forget about what I was thinking.”
A 22-year-old gay male participant explained that marijuana helped him deal with his HIV problems after he’d dropped out of HIV treatment for a year. Other survey participants reported starting to smoke marijuana to cope with their HIV diagnosis.
A young gay male participant related that he smoked a large amount of weed on the first day of his diagnosis because he needed a break from his problems. Another gay male dealt with his diagnosis the same way and explained that he stayed inside and used marijuana during the first few months of his diagnosis to avoid the embarrassment of being reminded of his health condition.
One of the biggest things I struggle with as a trans woman is accepting myself, honestly. This society does not cater to me or to people like me, so I’m always in a constant battle of validating my own identity while having society tell me to throw it away.
Even if society is moving toward the acceptance and inclusion of LGBTQ+ people, those in the community still face numerous challenges. According to a young transgender woman from Springfield, Missouri, the greatest obstacle is herself.
“One of the biggest things I struggle with as a trans woman is accepting myself, honestly,” Alora Lemalu, an artist and LGBTQ+ activist, told DrugRehab.com, “This society does not cater to me or to people like me, so I’m always in a constant battle of validating my own identity while having society tell me to throw it away.”
Although Lemalu does not know anybody who struggles with substance abuse, she said that she would not be surprised if people used it as a coping mechanism. She explained that it was very difficult for LGBTQ+ people to be proud of their identity when people are invested in bigotry and discrimination.
Hate speech hurts, and for the LGBTQ+ people without a hard shell, it can be fatal, Lemalu said.
Heterosexism, a form of bigotry against LGBTQ+ individuals, involves denying, ignoring, denigrating or stigmatizing nonheterosexual behaviors and people. Heterosexism causes LGBTQ+ individuals to perceive themselves in a negative way and develop feelings of shame and self-contempt. To cope with the negative feelings, some LGBTQ+ individuals resort to using drugs or alcohol.
Even though some states implemented laws prohibiting discrimination based on sexual orientation, LGBTQ+ people still face prejudice in terms of housing, employment and social services. In some cases, LGBTQ+ people have been denied custody of their children upon discovery of their sexual orientation.
People in same-sex relationships often find it difficult to obtain health coverage for their spouses or partners because of the lack of protection from employer discrimination. According to a SAMHSA report, 50 percent of LGBTQ+ people admitted to having difficulties seeking health coverage while 75 percent revealed that they faced discrimination in the process.
For these reasons, LGBTQ+ people may be hesitant to seek substance abuse treatment for fear that the health care provider will disclose their information.
LGBTQ+ individuals often deal with anxiety and depression from not fitting in with their family or society. This can lead to mood disorders, eating disorders or other psychiatric illnesses.
Members of the LGBTQ+ community are more vulnerable to co-occurring disorders than their heterosexual counterparts. A 2014 study at the Hazelden Betty Ford Foundation disclosed that 92 percent of LGBTQ patients suffered from co-occurring mental disorders in contrast with 78 percent of non-LGBTQ+ patients.
It can be difficult for therapists to discern whether the mental illness or the substance use disorder came first, according to Levounis. He adds that at least one out of three people with a substance use disorder suffers from a co-occurring mental disorder. Co-occurring disorders typically feed off each other.
Substance abuse can also lead to other health issues such as:
Multiple studies found that gay and bisexual men who inject methamphetamine have a high incidence of contracting HIV/AIDS. This may be due to needle sharing and unhygienic drug injection practices.
Preconceived judgment about LGBTQ+ individuals causes them to be reluctant to seek substance abuse treatment. This delay prevents doctors from offering proper treatment and diagnosing other co-occurring health issues. The late diagnosis may result in poor treatment outcomes.
Substance abuse treatment for LGBTQ+ people follows the same principles as addiction treatment for heterosexuals; however, health professionals need to account for their patients’ sexual identities and the troubles they face on a regular basis.
At times, health care providers and their patients may think these feelings stem from a person’s sexual orientation when they typically originate from prejudice toward LGBTQ+ people.
LGBTQ+ individuals who are in therapy reported feeling:
Homophobia and prejudice against LGBTQ+ people make it difficult for them to seek treatment. Often, treatment centers do not have the appropriate training to cater to LGBTQ+ people — the staff may be insensitive or hostile toward them.
Transgender people are often reluctant to enroll in health coverage plans, which may result in plan exclusions for health services such as hormone therapy and surgical procedures. They may also face limited access to preventative gender-specific services such as pap tests or mammograms.
“I’ve heard way too many stories of my transgender friends in Springfield, Missouri, being denied treatment just because of their identity. It’s horrible,” Lemalu told DrugRehab.com
In fact, a National Institute on Alcohol Abuse and Alcoholism report mentioned that stigma, intolerance and open discrimination were the most substantial barriers to substance abuse prevention and treatment among the LGBTQ+ community.
These barriers hinder exposure to healthy role models and limit access to LGBTQ+-supportive resources and substance-free outlets. They also contribute to the alienation of LGBTQ+ individuals, increasing their vulnerability to substances of abuse.
LGBTQ+ people may face several challenges in family, couples and group therapy. Some group-therapy participants may be homophobic and make derogatory comments toward LGBTQ+ clients.
Couples sometimes face a lack of sensitivity toward them, and therapists may fail to tailor their programs to include same-sex couples. On the other hand, family therapy poses its own problems if the family is in denial of the person’s sexual identity.
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While the LGBTQ+ community has a higher incidence of substance use than heterosexuals, they also tend to seek treatment at a significantly higher rate, according to a 2012 University of Michigan study. Because of the LGBTQ+ community’s willingness to seek help, treatment providers should equip themselves with the necessary tools to address the unique challenges faced by LGBTQ+ people.
“With advancement of societal acceptance of LGBT orientations and the new generations internalizing less homophobic beliefs, we should see a decrease in the rates of substance use.” – Dr. Petros Levounis, professor and chair of the Department of Psychiatry at Rutgers New Jersey Medical School
LGBTQ+ individuals struggle with issues stemming from societal rejection and continuous discrimination. Addressing these issues is sometimes paramount to a successful recovery from substance abuse; therefore, it is important that the individual receive the proper care. According to a SAMHSA guide on LGBTQ+ substance abuse treatment, LGBTQ+ individuals respond the best to treatment programs that are sensitive to their unique needs.
– Dr. Petros Levounis, professor and chair of the Department of Psychiatry at Rutgers New Jersey Medical School
In its treatment guide, SAMHSA included a list of nine principles of care to ensure that substance abuse treatment providers are well equipped to cater to LGBTQ+ individuals.
Addiction specialists should be understanding of the special circumstances surrounding LGBTQ+ substance abuse and tailor their treatment to meet the person’s need. However, treatment should remain consistent and thorough.
It is ideal to gather resources from different providers and specialists to tackle the different aspects of LGBTQ+ substance abuse. The variety of addiction services and a team approach may be beneficial to the individuals.
Addiction treatment programs should ensure that their staff is well acquainted to LGBTQ+ cultural needs and expectations. Staff members who are not familiar with LGBTQ+ issues may require sensitivity training.
LGBTQ+ people may have faced stigma prior to entering treatment, so it is important that specialists and staff members treat them with respect and dignity. LGBTQ+ people should always feel that they are important to their community.
Physicians and staff should educate LGBTQ+ patients about safe health practices and promote healthy sexual behaviors, strong relationships and compliance with medication and treatment.
Health professionals should consult with their patients and service providers to come to a consensus on the treatment plan. It is best to include everybody involved in the recovery process to make it easier for the patient.
Treatment providers and recovery services should work toward eliminating any barriers to substance abuse treatment for hard-to-reach populations. They need to focus on expanding their reach and developing retention mechanisms.
Physicians should not assume that conventional treatment will work for LGBTQ people. Given the differences in issues and co-occurring disorders, treatment providers should base their treatment plan on clinically informed and research-based services.
A recovery community provides a safe space for LGBTQ+ individuals to share their experiences about substance use disorders and recovery. Substance abuse agencies and organizations should work together to create treatment or recovery communities that cater to LGBTQ+ people and their needs.
When asked about what society can do to help LGBTQ+ people, Lemalu replied, “The best thing to do is to educate yourself. Do some research on what being LGBTQ+ means. Get to know an LGBTQ+ person; understand and really listen to their experiences.”
“All we want is to be able to exist peacefully and equally,” she added. To help LGBTQ+ people with their substance use disorders, society needs to equip itself with the tools to understand the struggles that LGBTQ+ people face. Many organizations, notably SAMHSA, have implemented programs that cater to and include LGBTQ+ people.
SAMHSA has established several initiatives to support LGBTQ+ individuals. It urged states to account for LGBTQ+ needs while distributing SAMHSA grants that aim to fund substance abuse and mental services, among other initiatives.
The LGBTQ+ community faces several barriers to obtaining health coverage. Many struggle to make ends meet and are also not aware that they can receive financial help to treat their substance use disorder under the Affordable Care Act.
In an effort to increase LGBTQ+ health care coverage, SAMHSA designed a comprehensive guide to walk LGBTQ+ people through the Affordable Care Act. The guide provides detailed descriptions of the ACA options and explains the legal rights of LGBTQ+ people to receive health benefits from their employers.
The guide also supplies information on choosing a plan and a provider, including a list of LGBTQ+-friendly health centers along with resources to help with health coverage questions.
The LGBTQ+ community faces many substance abuse treatment challenges because health care providers often overlook their specific needs.
SAMHSA created a comprehensive guide for physicians and administrators, designed to help them understand the treatment needs of LGBTQ+ patients. The guide thoroughly explains the need for cultural sensitivity and explains the numerous challenges faced by LGBTQ+ people as they seek substance abuse treatment.
The Family Acceptance Project, a research initiative by San Francisco State University, works to prevent health and mental health risks for LGBTQ children and youths. It uses a research-based approach to assist ethnically, socially and religiously diverse families in supporting their LGBTQ+ children.
The Association of Lesbian, Gay, Bisexual, Transgender Addiction Professionals and Their Allies (NALGAP) is dedicated to the prevention and treatment of alcohol use disorders, substance abuse and other dependencies in LGBTQ+ communities. NALGAP is committed to providing unbiased support and assistance to LGBTQ+ people suffering from substance use disorders.
Alcoholics Anonymous hosts special meetings for LGBTQ+ people to help them through recovery. In addition to providing a platform where LGBTQ+ people can express themselves and share their experiences with people in similar situations, AA provides a guide specifically designed for gay and lesbian alcoholics.