The lesbian, gay, bisexual, transgender, and queer (LGBTQ) Community has received a lot of cultural attention since the AIDS epidemic swept the nation and killed thousands of young gay men in the 1980s. Since then, members of this community have fought for civil rights and won many victories for improved access to healthcare, better treatment on the job, and the right to marry.

However, people who identify as gay, lesbian, bisexual, transgender, queer, and even asexual struggle with higher rates of substance abuse than the general population, often develop these struggles at an earlier age, and continue harmful patterns later in life. This is, in part, due to some aspects of the community itself; however, most of it is tied into struggles with mental health that are associated with depression and anxiety.

Addiction in the LGBTQ Community

Substance Abuse Problems among Those Identifying as a Sexual Minority

The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that around 20-30 percent of sexual minorities, which include members of the LGBTQ community, struggle with substance abuse. While exact numbers are not known, these rates are significantly higher when compared to the rate of substance abuse in the general population, which is 9 percent. LGBTQ adolescents are twice as likely as their peers to try substances and abuse them regularly. Addiction is 2-4 times higher in the LGBTQ community compared to the general population.

A large part of being in the LGBTQ community involves socializing, which too often involves social drug use. Bars, clubs, and circuit parties all involve substance use of at least alcohol and often marijuana, club drugs, poppers, and other substances.

People who identify as gay, bisexual, or transgender are less likely to have access to healthcare – twice as likely as the general population to not have insurance or adequate access to treatment – so substance abuse that turns into addiction is much less likely to get attention as needed. Additionally, daily stress on mental health from social pressure and threats of violence puts people in the LGBTQ community at a greater risk of developing a substance abuse problem to cope with poor mental health.

The Substances Abused by Those in the LGBTQ Community

SAMHSA found that the LGBTQ community was much more likely to abuse any substance compared to the general population. In a 2015 survey, 39.1 percent of any sexual minority abused illicit substances compared to 17.1 percent of the nation as a whole. The substances most widely used in the LGBTQ community are outlined below.

  • Alcohol: About one-quarter of the LGBTQ population abuses alcohol. This rate is dramatically higher than in the heterosexual population, of which 5-10 percent abuse alcohol. Eighty percent of gay men have used alcohol in the past month while 73 percent of lesbians have consumed alcohol in the past month.
  • Tobacco: People who identify as LGBTQ are 200 times more likely to smoke than the general population; the average is 11-20 cigarettes per day. Lesbians smoke more than gay men: 43 percent are daily smokers compared to 35 percent. About 34 percent of bisexuals smoke.
  • Marijuana: About 7 percent of the community abuses marijuana. Gay men are 3.5 times more likely to struggle with marijuana abuse compared to straight men. Overall, 63 percent of the LGBTQ community has experimented at least casually with the intoxicating drug.
  • Cocaine and crack cocaine: Per the survey, both 2 percent of lesbians and 2 percent of gay men had abused cocaine in the past month. Percentages are lower in the heterosexual population, although there seems to be a greater stigma against meth in the LGBTQ community than the nation at large, so meth is much less abused.
  • Amphetamines: Gay men are 13 times more likely to abuse amphetamines compared to heterosexual men. This puts them at elevated risk for contracting sexually transmitted infections due to risky sexual behaviors.
  • Ecstasy: Sixty-three percent of the LGBTQ community has experimented with ecstasy.
  • Opioids: Much of the opioid epidemic involves addiction to prescription painkillers, and 10.4 percent of the LGBTQ community abused painkillers in 2015 compared to 4.5 percent of the general population. Although the nation is in the grip of an opioid abuse epidemic, gay men are at greater risk of trying and becoming addicted to heroin. Compared to straight men, gay men are 10 times more likely to struggle with heroin.
  • Club drugs: Poppers are one of the most popular club drugs among gay men, as 48 percent of the LGBTQ community in general has tried poppers. About 5 percent of the community tried hallucinogens.
  • Other prescription drugs: Although there is little data to understand this trend, lesbians are more likely to struggle with benzodiazepines, especially Xanax and Valium. In general, 5.9 percent abused prescription tranquilizers, 1.2 percent abused prescription sedatives, and 4.2 abused prescription stimulants.

LGBTQ young adults were the most likely to abuse drugs, with 54 percent abusing any substance in 2015. These patterns carried on for 32.5 percent of the population after age 26. Women are more likely than men to abuse substances if they identified as a sexual minority, which is a reverse of the US in general: 41 percent of women and 36.3 percent of men who identified as a sexual minority abused substances.

A meta-analysis published in 2008, which compared substance abuse rates among LGBTQ adolescents and their heterosexual peers, found that gay, bisexual, and transgender youth were 190 percent more likely than straight peers to struggle with substance abuse. Bisexuals specifically were 340 percent more likely to abuse substances, and adolescent female members of the LGBTQ community were 400 percent more likely to struggle with substance abuse.

Among older adults in the LGBTQ community, 10 percent participated in binge drinking, and 12 percent abused drugs that were not prescribed to them. This can lead to serious problems with long-term health, including increasing the risk for cancer, dementia, heart disease, and liver disease.

Treatment Specifically Geared to the LGBTQ Community

When seeking substance abuse treatment, members of the LGBTQ community need special attention from facilities, counselors, medical professionals, and case managers to understand the specific discrimination faced by this minority group. Many families still reject children who come out as gay, bisexual, or transgender, and in some cases, these adolescents or young adults are physically and emotionally abused, forced into conversion therapy, or worse. People who are identifiable as members of the LGBTQ community are more likely than the general population to suffer domestic abuse, intimate partner abuse, sexual assault, physical assault, murder, and harassment. To understand the drastically different outlook on life that a person who is gay, bisexual, or transgender may have, a treatment program should specialize in helping these individuals in order to get a complete picture of their mental health, community support, and underlying causes of substance abuse or addiction.

Effects on mental health start in school. The website NoBullying.com found that 82 percent of LGBTQ youth experienced bullying in the prior year specifically targeting their sexual orientation; 64 percent felt unsafe at school because of their sexuality, and 44 percent felt unsafe because of their gender identification. About 44 percent experienced physical harassment, and 22 percent experienced “stronger violence.” Around 32 percent of these students did not attend school at least one day in the year due to feeling unsafe, and 31 percent said their school made no effort to protect them. These statistics are closely linked to rates of substance abuse among LGBTQ adolescents.

Treatment Specifically Geared to the LGBTQ Community

In 2010, SAMHSA surveyed treatment options for LGBTQ community members and found that 7 percent of private-for-profit substance abuse programs, 5.8 percent of nonprofit programs, 5.5 percent of state programs, 2.6 percent of federal government programs, 4 percent of tribal council programs, and 2.9 percent of other government programs had specific options geared to helping the LGBTQ community. Overall, this represented 777 options out of 13,688 facilities surveyed. With many more people in this community struggling with substance abuse compared to the average American population, the need for better services is clear.