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When it comes to substance use, any kind of suffering or stress makes abuse of and addiction to that substance more likely. People often abuse substances to dull emotional pain or escape from the stress in their lives. Mental illness, poverty, and being subjected to prejudice and discrimination all increase life stress and suffering. LGBT (lesbian, gay, bisexual, and transgender) people experience all of this at higher rates than heterosexual and cisgender (identifying with the gender assigned at birth) people. Due to these special circumstances, addiction treatment for LGBT persons needs to be approached differently than for the rest of the population.
The LGBT community experiences higher rates of substance abuse than the general population, reaching 20-30 percent. This is compared to a 9 percent rate for the US population overall. Unfortunately, there isn’t very much information on the subject of substance abuse among this community despite it being such a severe problem. However, it’s generally theorized that the stress caused by the various effects of prejudice are responsible for the high rates of abuse.
LGBT people abuse most, if not all, legal and illegal intoxicants at a higher rate than the general population:
These are the best estimates gathered from what little data there is on the subject, but even if the data is off, there appears to be a clear trend of severely higher rates of substance use and abuse among the LGBT community.
Any marginalized societal group, whether it’s women, people of color, people with disabilities, or LGBT people, experiences a special type of stress associated with being subjected to discrimination and prejudicial attitudes. This is referred to as minority stress, and it still has a strong effect on the LGBT community today, even as laws in the US have become more egalitarian.
Despite laws prohibiting discrimination in the workplace, LGBT individuals still have more trouble finding employment than the general population and are not explicitly protected against employment and workplace discrimination in many states. Lack of employment contributes to depression and anxiety as well as, of course, poverty. They are also very likely to face housing discrimination, with 56 percent of same-sex couples and 70 percent of transgender individuals reporting this experience at least once in their lives. The additional stress of mental illness, homelessness, and poverty make substance abuse and addiction all the more likely.
A significant issue among the LGBT population is homelessness caused by total rejection by their families upon coming out as lesbian, gay, bisexual, or transgender. Youth homelessness rates among this population are excessively high due to prejudiced parents disowning and kicking their children out upon learning of their sexual orientation or gender identity, leaving them with no home, no money, and nowhere to go. This intense stress and psychological trauma create a very high risk of substance abuse and addiction.
Even if they are not rejected outright, LGBT youth still have to endure a higher rate of abuse from family members and bullying from peers. Misunderstanding and ignorance from loved ones can also be painful, especially when sexual orientation is not properly acknowledged or the family refuses to accept a transgender child’s gender identity. Being forced to remain in the closet is no better, with the fear of being discovered and the stress of living a lie a constant burden. These kind of early, repeated traumas damage the young person’s sense of safety and dramatically increase the chance of developing a mental illness.
Marginalized populations like the LGBT community also have to endure frequent small stressors and slights that psychologists refer to as microaggressions. These seemingly insignificant incidents and minor hurts add up to a significant amount of stress. For example, a same-sex couple might have to worry every time they go out together that people will give them strange looks if they hold hands, kiss, or are at all affectionate. A transgender person often has to worry about being referred to as the wrong gender or being mocked by strangers.
These small worries occur on a daily basis, often multiple times per day, on top of the looming threat of actual physical violence that these individuals still need to be wary of. Psychologists believe that microaggressions are at least partially to blame for the higher rates of stress-related illness and mental illness among this population. Studies have found that lesbian women and girls are 2-2.5 times more likely than heterosexual women and girls to experience suicidal ideation. The threat of microaggressions can also lead to more social isolation – another predictor of substance abuse.
There are safe spaces to be found for LGBT people to gather, made by and for members of the community. Unfortunately, these are often limited to bars and nightclubs, often referred to as gay bars. These became popular in the community many years ago, when being openly LGBT or pursuing relationships was much more dangerous. Along with the relative safety found among likeminded individuals came the corresponding availability of alcohol, tobacco, and drugs.
Smoking remains popular in bars, and, of course, it can be hard to go to a bar without drinking. The availability of these intoxicants combined with peer pressure and the pain and stress involved in living in a society still tainted with bigotry against LGBT individuals can create a potentially lethal combination – literally. When you consider these environments, it becomes clear why alcohol and tobacco use among the LGBT community is so high.
Gay bars and LGBT nightclubs are also commonly associated with illicit drugs like ecstasy. This may explain why the largest gap between use among LGBT individuals and the general population can be found with amphetamines.
It’s not just the existence of these establishments that are responsible for high rates of substance use in the community, however. Alcohol and tobacco companies, once becoming aware of the popularity of gay bars, began to launch aggressive marketing campaigns directly at the LGBT community. A specific marketing program called Subculture Urban Marketing or SCUM surveyed gay men in order to market to the gay male community in San Francisco in the 1990s. They also tend to target LGBT magazines for their print advertisements.
Poverty, homelessness, and mental illness always make access to healthcare more difficult to reach. In the US, medical care can be very expensive, including addiction treatment, even with insurance. Transportation costs, childcare costs, missing work to see a doctor, and other factors also cause financial issues. Depression and anxiety can make it more difficult to acknowledge a problem and get help, and many doctors do not know how to properly handle more severe mental illnesses.
With LGBT individuals, there are specific barriers that only apply to this group. The most obvious is simple discrimination among medical professionals. Doctors and others in medical fields are not immune from prejudice, whether it’s explicit or subconscious, and lack of training is still a significant problem. Nearly 20 percent of substance abuse counselors surveyed felt they were not adequately trained to treat LGBT individuals, according to a 2007 study.
This prejudice is even worse when it comes to transgender individuals. Many doctors are still uneducated on the subject of transgender individuals and what the term really means. Some are still under the impression that being transgender is indicative of a mental illness, or they may believe that many transgender people only identify as such for attention or are mistaken about their own identities. Instead of providing them with the care they really need, they may simply refer them to therapists or even refuse to treat them altogether.
LGBT-specific insurance barriers are also an issue. Until quite recently, same-sex marriage was still not legal in many states, and insurance companies lacked coverage for domestic partners or civil union partners. While nationwide legalized same-sex marriage may have solved that problem, many couples paid extra in either health insurance plans or taxes on policies that covered domestic partners for years, putting them at a disadvantage.
For transgender individuals, many insurance policies do not cover the costs associated with gender transitioning – something that is often essential to the person’s mental health. Dysphoria from being unable to transition or debt incurred from the medical costs of surgery and/or hormone therapy makes it more difficult to access treatment for other issues like substance abuse.
Ongoing support groups and 12-Step programs may not be LGBT-friendly. If other members of these groups are hostile to LGBT persons, this can easily make them feel unsafe and unable to trust their assigned sponsors. Without that feeling of being in a safe space with people who understand you, a support group is essentially worthless.
There are addiction treatment resources and programs made specifically to address the special needs of the LGBT population. However, finding these programs can be a challenge. The vast majority of substance abuse treatment agencies surveyed did not have specialized programs for LGBT individuals, but instead treated all clients the same regardless of sexual orientation or gender identity. Only 7.3 percent were prepared to handle the unique issues that LGBT persons face.
Medical professionals in any LGBT-friendly program should be trained to understand the community’s issues as a whole, and be able to use to correct terminology to address sexual orientation and gender identity in a way that makes each client feel understood and validated. There are also organizations dedicated to helping LGBT persons get access to treatment that will work for them, help them financially, and act as a go-between for them and any medical professionals they might have to deal with. These organizations include:
Once an LGBT-friendly addiction treatment resource is found, it’s much easier for individuals to get on the road to recovery. With the right kind of help, recovery is within any person’s reach.