About 10 million American adults, or around 4.1 percent of the US adult population, identify is lesbian, gay, bisexual, transgender, or queer/questioning (LGBTQ). A larger percentage of people who identify with the LGBTQ community struggle with mental health and substance abuse issues: About 9 percent of the general population suffers from substance abuse and addiction, but upwards of 30 percent of the LGBTQ population experiences these problems.
To help people in the LGBTQ community overcome addiction and substance abuse, treatment providers must understand the unique characteristics of this group – not just who they love and how they identify, but how their unique identities have shaped their lives, put them at risk, and given them a different peer group. These conditions affect approaches to healthcare in general, and substance abuse and mental health treatment in particular.
Why Do LGBTQ Individuals Need Identity-Specific Treatment?
People who identify as gay, transgender, or queer are more likely to have struggled with chronic stress for much of their lives. This likely starts at a young age, as they realize that they are different from their family and peers. If they live in an unsupportive household, they are more likely to experience domestic abuse and related post-traumatic stress disorder (PTSD). Adolescents who identify as a sexual minority are more likely to experience bullying at school and cyberbullying online. Remaining “in the closet” also causes intense psychological stress, even if it mitigates immediate, violent discrimination.
Throughout their adolescence and adult lives, people who identify as sexual minorities or who are transgender are at much greater risk of intimate partner abuse, verbal and physical aggression from strangers, and discrimination at work, school, and in their neighborhoods. They are also more likely to be assaulted or murdered. Ongoing stress from daily existence, combined with childhood stress, leads to chronic depression, anxiety, panic disorders, and suicidal ideation.
It also leads to substance abuse. In the LGBTQ community, it is likely that substance abuse is prevalent to mitigate the intense stress associated with being a social minority. While much of queer culture is associated with partying and socializing at clubs, bars, or safe spaces, substance abuse to enhance the social experience can quickly become problematic as a method of relieving psychological strain.
Additionally, safe spaces with addictive substances outnumber sober places with appropriate social support. For many adolescents, gay bars or the Pride Parade may be their first introduction to gay culture. While spaces specifically for LGBTQ individuals are extremely important, they are often in businesses that serve alcohol, or they overlook use of social drugs like GHB, ecstasy, and marijuana. Seeking treatment is difficult when the cultural association with safety is linked to drug use and drinking.
Finally, finding treatment outside major cities, or in the center of the country, is more difficult. Geographic areas associated with social liberalism, such as both the Atlantic and Pacific Coasts, will have better access to understanding, safe addiction treatment; areas more associated with conservatism, smaller populations, or fewer urban environments are less likely to have LGBTQ-specific addiction treatment or medical professionals with training to help this unique minority population.
Understanding the Unique Needs of LGBTQ-Focused Rehabilitation
Treatment programs intended to serve the majority population are not likely to consider the unique history and stressors experienced by those who are gay, transgender, or queer. While many aspects of substance abuse treatment can serve multiple populations – medication-assisted therapy and Cognitive Behavioral Therapy, for example – understanding the behaviors, histories, cultures, and psychologies of LGBTQ individuals will help medical professionals offer better treatment.
Unique considerations for LGBTQ substance abuse treatment are outlined below.
- Sexual preference affects personal behaviors.
- Less social support is likely due to discrimination.
- Less access to insurance through work or quality healthcare is prevalent.
- More members of the LGBTQ community will need treatment for co-occurring disorders.
- There is a need for explicit policies inviting LGBTQ individuals to treatment programs, the creation of safe spaces, and clear anti-discrimination policies and language in treatment programs.
For example, the history of substance abuse treatment in the Western World began with treating heterosexual white men suffering from alcohol use disorder. While treatment has expanded to include numerous other substances, more men than women typically struggle with substance abuse and more men than women enter treatment. This bias in statistics and treatment entry, however, may be due to an unintentional bias toward male-focused treatment, which would exclude lesbians, bisexual women, and transgender women, as well as largely excluding heterosexual women. Programs that wish to help LGBTQ individuals must understand their unique perspectives, experiences, and environments outside the dominant cultural narrative.
Gearing treatment facilities, or aspects of programs, to treating specific groups within the LGBTQ community will help to reduce any sense of isolation, which can make mental health problems worse and lead to a relapse of substance abuse.
What Kind of Environment Should LGBTQ-Specific Programs Offer?
Finding addiction recovery programs that help people in the LGBTQ community requires some additional searching. Look for counselors and doctors who have experience working with specific populations; for example, bisexual men will have different healthcare needs than transgender women.
Physical health, like the use of hormone therapy, antiviral medicines, and other medical interventions, will need to be understood, so they can be carefully balanced with medication-assisted therapy, if this is necessary. Doctors who understand how illicit and prescription drugs interact and how to help LGBTQ individuals safely detox while managing their overall health is very important.
Ask if the facility houses people with others who identify as the same gender. This can be especially important for transgender individuals who are too often ignored and placed with the gender they were assigned at birth – in other words, not their actual gender.
Members of the LGBTQ community who have entered other treatment programs with cis-gendered or heterosexual individuals have reported not only feeling isolated and lonely, but also being verbally or physically harassed. Transgender individuals are at particular risk in scenarios where they do not have clear support and anti-discrimination policies to back them up.
If biological family, workplace discrimination, or other personal issues are a concern, asking about confidentiality policies, including the Healthcare Insurance Portability and Accountability Act (HIPAA), will be important.
It should not be incumbent only on LGBTQ individuals to ask questions when they seek help. Rehabilitation programs that offer treatment specifically to sexual minorities and transgender individuals should be clear upfront when discussing the program and proactive in developing a safe space for this population.
Finding LGBTQ-Friendly Treatment
The National Institute on Drug Abuse (NIDA) agrees that creative safe spaces with programs specific to subsets of the LGBTQ community is the best way to help gay, transgender, and queer individuals get appropriate, supportive treatment. With LGBTQ-specific offerings, clients are more likely to remain in the program for at least 90 days, which NIDA recommends in order to change behaviors around substances.
Finding LGBTQ-focused treatment may seem as easy as using an online search engine, but many of these programs do not provide evidence-based help. Using the treatment locator offered by the Substance Abuse and Mental Health Services Administration (SAMHSA), or Psychology Today, is a great start to finding evidence-based rehabilitation programs. However, neither of these powerful treatment finders narrows down options based on sexual orientation.
A person who identifies as LGBTQ, or who is seeking help for a loved one who is gay or transgender, may find help through LGBTQ-specific community centers. Of course, both Los Angeles and New York City have two large, prominent, and helpful websites; however, many smaller cities have options nearby. Calling these community centers to track down resources can be a great way to find verified LGBTQ-friendly rehabilitation.