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LGBT Community and Substance Abuse

There is a growing body of evidence that suggests that members of the LGBT (lesbian, gay, bisexual, transgender) community are at higher risk of drug and alcohol abuse than their heterosexual counterparts.1 Additionally, members of the LGBT community have unique barriers to substance addiction treatment. Sexual minorities also have unique treatment needs, such as the need for compassionate, non-judgmental care and counseling concerning stigma and coming out. Fortunately, there are detox centers and drug addiction treatment programs that cater primarily to LGBT individuals.

Prevalence of Substance Abuse Amongst LGBT Population

 Research about mental health and addiction among sexual and gender minorities is relatively new. Only in the last few decades or so, when living openly as a gender or sexual minority has become more common, have researchers had access to this formerly underground community. Even still, data about this very diverse population is difficult to quantify, because there are so many different subgroups and identities. Compounding the difficulty is the fact that most large national studies about drug abuse do not ask questions about sexuality and gender identity.1

Generally, many health disparities exist in the non-heterosexual community. Amongst LGBT individuals, researchers have found a relatively higher prevalence of alcoholism, drug abuse, mental health conditions, self-harm, and suicidal ideation.1,2

One study of college students found that lesbian and bisexual women were 3 times as likely as heterosexual women to report past-year ecstasy use. Additionally, lesbian and bisexual women were twice as likely as straight women to have used marijuana in the past month and four times as likely to use at least one illegal drug other than marijuana or ecstasy in the past year. Gay and bisexual men, on the other hand, were less likely than heterosexual men to abstain completely from alcohol but drank more moderately. Binge drinking rates among gay and bisexual men were significantly lower than heterosexual male binge drinking.3

Alcohol and drug addiction are major problems for the transgender community. Some studies show that marijuana, crack cocaine, and alcohol are the substances most commonly abused by transgender people. Other studies found significantly higher rates of methamphetamine use, with up to 46% of trans people using the stimulant. Further, up to 40% of transgender individuals have reported injection drug use. 5

The gay community faces many barriers to quality substance addiction treatment. In 2008, only 6% of substance addiction treatment programs offered a specialized LGBT program. Most of the programs that did offer LGBT treatment groups were privately owned, for-profit treatment centers.6 Only 2.6% of federally-funded treatment facilities offered specialized LGBT treatment programs.6

Why Do LGBT People Have Higher Rates of Addiction?

There are several theories to explain why substance addiction is more common in the LGBT community. Most theories stem from the discrimination LGBT people face. When you are a sexual minority, whether you are gay, lesbian, bisexual, queer or transgender, your identity often defies social and religious norms. It is common for these people to feel deeply ashamed and isolated from their family members and the communities they grew up in. This type of emotional distress can lead people toward drug and alcohol abuse. Substance abuse becomes, for many people, a way to self-medicate emotional pain.1,7

Curiously, substance abuse and dependence rates are higher amongst people who self-identity as LGBT than those who have had same-gender sex partners but do not identify as LGBT. This finding suggests that sexual identity may play a bigger role in substance abuse than sexual behaviors. People who self-identify as LGBT may be exposed to more discrimination than those who engage in same-sex behaviors but don’t identify as gay, lesbian, bisexual, or transgender.1 It is important to understand that it has been well-documented that trans individuals experience more violence, marginalization, and stigma than their LGB counterparts and that this discrimination has often been underestimated by studies that examine the LGBT community as a whole.9 Transgender individuals often report experiencing genderism, transphobia, and social stigma, all which affect the person negatively. Additionally, social isolation and rejection, as well as institutionalized discrimination, such as housing or employment, can all increase substance abuse behaviors.9

Members of the LGBT community may not seek out or complete substance abuse treatment due to stigma and the discrimination they often experience from staff members in treatment programs. The quality of treatment is often sub-par, particularly from those who are not socially conscious and are inexperienced with addressing the unique needs of these individuals.8 Among LGBT people, gay men have reported the highest levels of discrimination in relation to medical care.8

LGBT Detox and Recovery Programs

 LGBT substance abuse treatment programs provide a safe space for queer and trans people to recover from alcohol and drug abuse. Specialized programs recognize the specific needs of the diverse LGBT community. Staff members at LGBT substance abuse treatment programs have experience working with sexual and gender minorities. They are trained to provide an empathetic and nonjudgmental space for people to go through detox and addiction treatment.

Individual and group counseling is a key component of alcohol and drug addiction treatment. Counselors at specialized LGBT substance abuse treatment programs are familiar with the unique challenges of living as a homosexual or transgender person. Many people find that they are more comfortable doing group work with other LGBT community members; it allows them to share more freely without fear of judgment or hate.

Detox programs vary depending on what drug you are addicted to, what dose you take, and how long you have been using. But most detox programs follow the same basic steps:7

  • Stabilization and medical monitoring.
  • Prevention of withdrawal complications, particularly amongst those who abuse benzodiazepines, alcohol, or barbiturates.
  • Administration of withdrawal medications, if necessary or applicable.
  • Transition into addiction treatment.

There are many different types of addiction treatment. Most people benefit from a comprehensive approach that involves several different therapeutic approaches. Depending on which substance you are addicted to, there may be medications that can help facilitate long-term recovery by reducing cravings. Therapeutic services offered at many treatment programs include:

  • Individual therapy: Meeting one-on-one with a psychologist, therapist, or counselor to talk about your addiction. You may learn about the triggers that have led you to use drugs in the past and tools for dealing with them in the future.
  • Group therapy: A therapeutic discussion between a group of peers struggling with substance addiction. The discussion is led by a counselor, therapist, or psychologist who encourages people to share their experiences.
  • Support groups: Peer-to-peer discussion groups that do not involve a professional counselor. Here, people support each other’s sobriety and talk about the challenges they face.
  • Family therapy: Addiction can impact the entire family. During family therapy, you and your family will meet with a counselor to discuss the interpersonal problems caused by your addiction.

In specialized LGBT treatment programs, these treatment components will be tailored to meet your needs. Counselors are trained and experienced in leading discussions about sexuality and gender identity. They know how to work with people struggling with shame and guilt, as well as those who are afraid to come out to their family and friends. In addiction treatment, you may learn about:7

  • The importance of mental health treatment.
  • Building a strong identity and becoming part of a community.
  • Facing your internalized shame.
  • Coming out to your family and friends.
  • Handling sexual and gender identity issues at work.
  • Building strong relationships.
  • Protecting your health and your body.
  • Dealing with LGBT domestic violence.
  • Dealing with discrimination, hatred, and homophobia.
  • Learning to connect with other LGBT people in a healthy way.
  • Building a sober social life.

Detox and Treatment Options for Addiction

There are several different types of LGBT addiction treatment programs. Which specific type offers the most benefit will depend on a number of individual factors. Some facilities treat only gay men or lesbian women, while others are open to all members of the LGBT community. When deciding which program is right for you (or your loved one), you will need to consider several factors, including:

  • The cost.
  • Your insurance coverage.
  • The location of the program.
  • How long treatment lasts.
  • Whether they offer both detox and addiction treatment services.
  • What type of facilities and amenities you prefer.
  • Whether you want a single- or mixed-gender program.
  • Whether you want a program for teens and young adults.

Detox and addiction treatment is offered at varying levels of intensity. The first treatment decision to make is whether you want inpatient or outpatient treatment. In an inpatient treatment program, patients live at the facility 24/7. They receive constant supervision and medical monitoring during the detox process. During addiction treatment, inpatients follow a structured schedule of therapy and healthy activities.

Many treatment centers also offer intensive outpatient programs (IOPs), which offer a comparable array of treatment interventions and a similar level of treatment intensity as inpatient programs, but patients return home at the end of the day. People in intensive outpatient programs may attend addiction treatment 5 days per week for a specified number of hours. Outpatient programs are best suited for people with a strong sober support system at home.

Other outpatient treatment services may be relatively less intense. Examples include periodic visits to a primary care doctor, community health center, clinic, or local hospital. Some people work with a private therapist 1–2 times per week. Psychiatrists can help get people medically and mentally stable, providing medications that aid recovery. Other people benefit from peer support groups like Alcoholics Anonymous or Narcotics Anonymous, which are free to join and only require that you wish to abstain from mind-altering substances.

Sources

  1. McCabe, S. E., Hughes, T. L., Bostwick, W. B., West, B. T., & Boyd, C. J. (2009). Sexual orientation, substance use behaviors and substance dependence in the United States. Addiction (Abingdon, England), 104(8), 1333–1345.
  2. King, M., Semlyen, J., Tai, S. S., Killaspy, H., Osborn, D., Popelyuk, D., & Nazareth, I. (2008). A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay and bisexual people. BMC Psychiatry, 8, 70.
  3. Esteban, S., Boyd, C., Hughes, T. L., & d’Arcy, H. (2003). Sexual identity and substance use among undergraduate students. Substance Abuse, 24(2), 77-91.
  4. Drabble, L., Midanik, L. T., & Trocki, K. (2005). Reports of alcohol consumption and alcohol-related problems among homosexual, bisexual and heterosexual respondents: results from the 2000 National Alcohol Survey. Journal of studies on alcohol, 66(1), 111-120.
  5. Substance Abuse and Mental Health Services Administration. (2012). Top Health Issues for LGBT Populations Information & Resource Kit.
  6. Substance Abuse and Mental Health Services Administration. (2010). OAS Data Spotlight: Substance Abuse Treatment Programs for Gays and Lesbians.
  7. Center for Substance Abuse Treatment. Detoxification and Substance Abuse Treatment. Treatment Improvement Protocol (TIP) Series, No. 45. (Pg. 117-118 and Chapter 2)
  8. McCabe, S. E., West, B. T., Hughes, T. L., & Boyd, C. J. (2013). Sexual Orientation and Substance Abuse Treatment Utilization in the United States: Results from a National Survey. Journal of Substance Abuse Treatment, 44(1), 4–12.
  9. Rodman, K. (2015). Transgender People’s Experiences in Substance Abuse Treatment. California Institute of Integral Studies, ProQuest Dissertations Publishing.
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