Culturally sensitive peer support programs, therapy, and community services can help to reduce the risk of substance abuse and mental health problems in the LGBTQ community.

LGBTQ-identifying individuals have a heightened risk of developing substance use and mental health disorders when compared to their heterosexual counterparts. These disorders are largely found to be driven by discrimination. Further, the social stigma, homophobia, harassment, violence, and other challenges many of these individuals face make drugs and alcohol an attractive escape.

With one in five of millennials identifying as LGBTQ, as found by a recent GLAAD study, the need for LGBTQ substance abuse prevention and treatment is great. For these individuals and LGBTQ people of all ages, culturally sensitive support services and therapy are key to reducing instances of substance abuse and mental health disorders.

Preventing substance abuse in the LGBTQ community requires a multifaceted approach which focuses on the social, behavioral, and psychological causes, and impacts, of substance abuse. These individuals need access to treatment providers who possess up-to-date knowledge of the unique needs of this community, especially in regard to LGBTQ mental health issues.

Preventing Substance Abuse In The LGBTQ Community

Providing unbiased, compassionate, and individualized care which addresses physical, mental, and social health needs will help these individuals to build and maintain a foundation which better wards off substance abuse. Examples of preventative support services include 24-hour crisis support, walk-in centers, peer support groups, and community outreach programs.

Therapy and counseling sessions can greatly protect a person from the risk of developing, or experiencing a worsening of, substance use and mental health disorders. For maximum effectiveness, these sessions should be offered in an individual, group, and family setting. It’s important to recognize the personal ways that LGBTQ persons define family, including families of choice which may include close friends in addition to family members.

A significant number of LGBTQ persons face unstable living conditions and housing discrimination. In the most extreme of cases these circumstances can lead to homelessness. Programs which help to alleviate homing instability and improve living conditions can help to remove triggers for drug abuse. Individuals may also benefit from job skills training or legal support services at this time.

The Prevalence Of Substance Abuse In The LGBT Community

Research illustrates that lesbian, gay, bisexual, transgender, and queer or questioning individuals are more apt to:

  • abuse drugs and alcohol.
  • have higher rates of substance use disorders.
  • struggle with abstinence from drugs and alcohol.
  • remain heavy drinkers as they age.

The National Alliance on Mental Illness (NAMI) writes that “An estimated 20-30% of LGBTQ people abuse substances, compared to about 9% of the general population.” With these increased rates of abuse comes a greater risk for physical and mental health problems, including sexually transmitted diseases; addiction; and overdose.

The Substance Abuse and Mental Health Administration (SAMHSA) broke down the prevalence of substance use disorders in sexual minority adults compared to sexual majority adults. In these findings, sexual minority referred to people who identify as lesbian, gay, or bisexual, though transgender persons are at an increased risk for substance abuse as well.

SAMHSA determined the following rates of substance abuse (statistics represent the percentage of abuse in sexual minority adults versus abuse in sexual majority adults):

  • illicit drug or alcohol use disorder (15.1 vs. 7.8 percent)
  • alcohol use disorder (10.8 vs. 6.1 percent)
  • illicit drug use disorder (7.8 vs. 2.6 percent)
  • marijuana use disorder (3.9 vs. 1.3 percent)
  • pain reliever use disorder (2.0 vs. 0.7 percent)

Percentage of substance abuse in sexual minority adults versus abuse in sexual majority adults.

Certain experts theorize that the heightened instances of drug and alcohol abuse in the LGBT community are rooted in legal prohibitions and discrimination which prevent these individuals from having diverse social outlets. Instead, these individuals are pushed to bars, clubs, or house parties where drugs and alcohol feature prominently as the entertainment and a means of connecting to people.

Risk Factors For Substance Abuse In LGBTQ Individuals

LGBTQ individuals experience many of the same risk factors for drug and alcohol abuse as their straight counterparts, however, in addition to these they encounter many which are unique to their lifestyle.

Heterosexism, or the stigmatization of non-heterosexual forms of sexual preference, identify, emotional attachment, and behavior, causes many sexual minority individuals to turn to drugs or alcohol as a coping mechanism. Heterosexism can cause a person to develop internalized homophobia, intense feelings of shame, a poor sense of self-worth, and an uncertain self-identity.

Additional risk factors include:

  • denial of civil and human rights
  • discrimination
  • family rejection
  • fear of coming out
  • harassment
  • homophobia
  • housing instability
  • minority stress
  • prejudice
  • social exclusion
  • social stigma
  • victimization
  • violence
  • lack of social support

High levels of stress are a major risk factor for substance abuse. Physical and mental manifestations of stress often result from minority stress. Minority stress results from a hostile and stressful social environment caused and exacerbated by the above risk factors.

Frequently, individuals develop mental health disorders in response to this extreme social and emotional strain, including addiction. A significant number of LGBTQ persons use drugs or alcohol as a way to relieve stress and cope with the emotions they experience in response to these circumstances.

These behaviors can quickly accelerate to addiction unless an individual is taught good coping and stress-management techniques which are embedded in LGBT culturally-sensitive support services. This support should also be accompanied by crisis support services, as needed, therapy, and counseling.

Alcohol Abuse In LGBTQ Individuals

LGBT individuals seeking treatment for an alcohol use disorder frequently started drinking at younger ages than their heterosexual persons. Alcohol has been shown to be the drug of choice for LGBTQ college students. Many who begin drinking at young ages or in college develop patterns of alcohol abuse which continue throughout their adult years.

The National Alliance on Mental Illness cautions that “25% of LGBT people abuse alcohol, compared to 5-10% of the general population.” Alcohol abuse includes intermittent or frequent patterns of binge drinking, heavy drinking, and the chronic drinking patterns of alcoholism.

The Substance Abuse and Mental Health Services Administration (SAMHSA) details that:

  • roughly 30 percent of lesbians have an alcohol use disorder
  • 20 to 25 percent of gay men and lesbians are heavy drinkers

Binge drinking is especially problematic in these groups, with LGBTQ individuals engaging in this harmful behavior more often than heterosexual persons. SAMHSA found that 36.1 percent of lesbian, gay, and bisexual persons were binge drinkers, whereas 26.7 percent of heterosexuals were.

Past Month Alcohol Use among Sexual Minority and Sexual Majority Adults Aged 18 or Older, by Age Group and Sex: Percentages, 2015

Illicit Drug Abuse In The LGBTQ Community

Sexual minority adults have been found to be two times more likely than heterosexuals to engage in illicit drug abuse.

The Substance Abuse and Mental Health Services Administration reported that in 2015 “Among sexual minority adults, 39.1 percent used illicit drugs in the past year, or nearly 2 out of 5.” Only about 17 percent of sexual majority adults used illicit drugs in this same time period.

As reported by SAMHSA, the following forms of illicit drug abuse are most prevalent in sexual minority adults. Statistics represent the percentage of abuse in sexual minority adults versus abuse in sexual majority adults.

Young adults are at an acute risk for these forms of abuse. Patterns of abuse which develop at younger ages more frequently progress to substance abuse disorders down the road. The Partnership for Drug-Free Kids writes that in comparison to heterosexuals, LGBTQ young adults have:

  • 1.6 times the odds of marijuana use
  • 2.9 times the odds of injection drug use
  • 3.3 times the odds of cocaine use

Overall, certain groups of the LGBTQ community have increasingly shown favor to “party drugs” like such as MDMA (ecstasy), ketamine (“Special K”), and GHB. Lesbians have been shown to abuse cocaine and marijuana more frequently than heterosexual women. According to SAMHSA, research shows that gay men and men who have sex with men (MSM) frequently use amyl nitrates (poppers), and have a higher risk of using:

The CDC cautions that illicit drug use, particularly methamphetamine and poppers, increases the risk of HIV and other STDS in gay and bisexual men.

Prescription Drug Abuse And The LGBTQ Population

As with Americans from all walks of life, prescription drug abuse is a rising concern in the LGBTQ population. The following statistics represent the percentage of prescription drug abuse in sexual minority adults compared to abuse in sexual majority adults, as reported by SAMHSA:

  • prescription pain relievers (10.4 vs. 4.5)
  • prescription tranquilizers (5.9 vs. 2.2 percent)
  • stimulants (4.2 vs. 1.9 percent)
  • prescription sedatives (1.2 vs. 0.6 percent)

In general, frequently abused prescription painkillers include hydrocodone (Vicodin) and Oxycodone (OxyContin and Percocet). Prescription tranquilizers include benzodiazepines such as Ativan, Valium, and Xanax and muscle relaxers such as Soma. Stimulants include ADHD medications like Adderall or Ritalin. An example of commonly abused prescription sedatives include zolpidem (Ambien).

Prescription drug abuse includes misusing a personal prescription in a way other than prescribed (e.g. using a drug more frequently; in greater quantities; or altering the way the drug is administered, such as snorting, smoking, or injecting the drug).

Co-Occurring Disorders Run High In The LGBTQ Community

Substance abuse occurs frequently with mental illness, but in the LGBTQ population this correlation is even stronger. These individuals are nearly three times more likely to develop a mental health disorder than their heterosexual persons. They also have a significantly higher risk of severe mental illnesses.

Gay, lesbian, bisexual, and transgender individuals frequently experience higher rates of depression that the heterosexual population. Examples of other mental health problems experienced in the LGBTQ population include:

  • anxiety
  • personality disorders
  • post-traumatic stress disorder (PTSD)
  • self-harm
  • suicidal ideation (thoughts of suicide)

Due to the prevalence of mental health problems in this community, it’s imperative that LGBTQ individuals be screened for mental illness as part of treatment for their substance use disorder.

Treating Mental Health Disorders To Prevent Substance Abuse

Reducing mental and emotional duress and treating mental illnesses are some of the most significant preventive measures for preventing substance abuse.

Many LGBTQ individuals have deeply held traumatic experiences and acts of discrimination which continue to erode at their mental and emotional health. Identifying and treating these issues is key to preventing initiation into substance abuse for the first time, in addition to relapse.

Behavioral therapies and counseling sessions promote healing by uprooting any existing negative thoughts, emotions, and behaviors a person may struggle with. These sessions also help a person to confront and overcome painful memories or circumstances which may be triggering symptoms of their mental illness. For an individual in recovery, balancing stress and treating latent trauma can reduce the opportunity for relapse triggers in individuals in recovery.

Treatment providers should undergo LGBTQ cultural competency training, so they can recognize and respect the unique issues these persons face. Providers should not make assumptions, nor should they label their clients. When treating LGBTQ persons it’s important that providers allow each individual to offer their own labels, especially in regard to expressing their preferred gender identity.

Substance Abuse In LGBTQ Adolescents And Teens

Similar to adults in this community, LGBTQ young people have unique risk factors for substance abuse and mental health disorders, including:

  • bullying
  • childhood abuse
  • family conflict and rejection
  • gender stereotypes
  • housing instability or homelessness
  • lack of parental support or guidance
  • mental illnesses
  • minority stress
  • victimization in school

Rates of drug and alcohol abuse have been shown to climb when LGBTQ students are victimized in school or when they suffer large amounts of minority stress. Many of these youths feel disconnected from their schoolmates, communities, and families. This sense of isolation and lack of social and family support can greatly contribute to the risk for substance abuse.

An Addictive Behaviors study found that students at high schools without a gay-straight alliance (GSA) had increased risks for certain forms of drug abuse and misuse, including:

  • cocaine
  • hallucinogens
  • marijuana
  • ADHD medications
  • prescription pain medications

Like LGBTQ adults, mental health problems are more prevalent for LGBTQ youth, and with this, a heightened risk of suicide. According to NAMI, “For LGBTQ people aged 10–24, suicide is one of the leading causes of death.” Mental health problems and suicidal ideation are two major risk factors for substance abuse. To make matters worse, drug and alcohol abuse can worsen both mental illness, self harm, and thoughts of suicide.

Preventing Drug And Alcohol Abuse In LGBTQ Youth

Preventing substance abuse requires teachers, parents, and treatment providers to be aware of risk factors for substance abuse. Intervening to eliminate bullying and victimization can help to protect youths from these risks, however, supportive services and community outreach programs also play a critical role in prevention, especially for youths who have already experienced these traumatic experiences.

Youth and teens benefit from counseling services which effectively identify and treat any issues related to minority stress. Instances of childhood abuse, trauma, bullying, and family turmoil should be addressed in therapy and counseling to minimize the risk for current or future substance abuse.

Support groups, either in the school or a community setting, can be a vital resource to help adolescents improve morale, build peer support, develop coping skills, and build a positive self-image. Students who are enrolled in a school with an active gay-straight alliance may also witness greater protection from drug abuse.

Family support is perhaps one of the biggest preventive factors for LGBTQ youth, but sadly, almost 40 percent of these adolescents don’t have an adult in their family who they can reach out to. Family education and therapy sessions help families to heal, reconnect, and build a healthier dynamic. They also foster a healthier dialogue which improves the mental and emotional well-being of LGBTQ young persons.

LGBTQ-Friendly Treatment Programs

For an addicted LGBTQ person, a significant barrier to treatment can be the lack of an LGBTQ-friendly treatment program. These individuals may fear that discrimination will continue within treatment or that a program and treatment providers will be insensitive to their needs.

Many LGBTQ individuals feel more comfortable either pursuing treatment which is LGBTQ friendly or programs which exclusively serve members of these communities. Treatment providers should always communicate acceptance and articulate that they’re offering a safe and welcoming space or personal growth and healing.

Programs and providers should be aware of:

  • a person’s community, heritage, and traditions
  • a person’s family structure
  • where a person is in the coming out process
  • a person’s family problems
  • any co-occurring disorders (like depression and anxiety)
  • the importance of maintaining confidentiality

Treatment providers should strive to promote healing as their patients work on overcoming the negative impacts and shame of homophobia and heterosexism. Any acts of violence, discrimination, and prejudice should be fully addressed. Trauma-centric care should be made available to individuals who have experienced serious and life-altering circumstances.

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