In 2015, the National Survey on Drug Use and Health found that adult members of the lesbian, gay, bisexual, transgendered, and questioning (LGBTQ) community were over two times more likely to have used an illicit drug that year than heterosexual adults. The survey found that 30.7 percent of the LGBTQ individuals involved in the survey had used marijuana and 10.4 percent misused prescription pain medication. Conversely, only 12.9 percent of heterosexuals used marijuana and 4.5 percent misused prescription pain pills. Additionally, in 2013 the United States Census Bureau reported that heterosexuals began drinking alcohol later in life and tended to binge drink less frequently than non-heterosexuals.
This trend of substance use and abuse isn’t exclusive to adults, however. In fact, one analysis conducted by the National Institute on Drug Abuse found that LGBTQ adolescents were as much as 90 percent more likely to use substances than their heterosexual counterparts.
These numbers are significant, as they show that LGBTQ individuals are at a particularly high risk of substance use and abuse. Substance use disorders develop after the consistent use of potentially dangerous substances, such as alcohol, tobacco, and other drugs. A diagnosis is generally appropriate once use of the substance or substances begins to negatively impact the patient’s social life, academics, professional career, and/or health.
In order to successfully address this condition in LGBTQ patients of all ages, it’s important that counselors have a clear and thorough understanding of the issues individuals within this community often face, as well as the best methods of treatment. Working with LGBTQ clients can be challenging and success hinges on professionals learning how to:
- Recognize and understand emotional and sexual lives of their LGBTQ patients
- Educate other staff members about adopting more inclusive language and behaviors
- Appropriately address intolerance and harassment from non-LGBTQ peers receiving treatment
- Develop and establish relevant training requirements and programs for personnel
- Institute policies that specifically acknowledge the unique needs of LGBTQ patients
The information and resources provided below are meant to offer assistance for substance abuse counselors working with clients from the LGBTQ community.
Substance Use Disorder in LGBTQ+ Population
Co-Occurring Disorders in the LGBTQ+ Community
Research shows that LGBTQ community members are likely to have co-occurring disorders. They are reportedly at a higher risk for substance use and abuse, as well as many common emotional and mental disorders. As a result, it’s not uncommon for these patients to suffer from a substance use disorder and a psychiatric disorder at the same time. Common co-occurring disorders include:
Substance Use Disorders
Post-Traumatic Stress Disorders
Specifically, studies indicate that gay and bisexual men are more likely to experience mental distress, major depression, anxiety, and symptoms associated with bipolar disorder than heterosexual men. These patients may also have various health complications, such as HIV/AIDS, which can result in or further exacerbate current psychiatric disorders. This demographic has also been found to be at higher risk for suicide. Lesbians and bisexual women are also more likely to experience mental distress, major depression, phobias, post-traumatic stress syndrome, and generalized anxiety disorder than their heterosexual counterparts. This is combined with a higher likelihood of hazardous drinking habits and sexual abuse. Transgender children and young adults also demonstrate a greater predisposition for depression, eating disorders, self-harm, and suicide than peers within the sexual majority.
There is evidence that these disparities are linked to the fact that many LGBTQ individuals are exposed to various levels of harassment, life stressors, maltreatment, stigmas, discrimination, childhood adversity, family rejection, victimization, and a lack of available resources. It’s also been proven that reducing these factors, especially discrimination, can help reduce the risk of substance use and abuse in LGBTQ youth.
Because the LGBTQ community is at such high risk for substance abuse and other psychological disorders, it’s absolutely imperative that treatment providers screen patients thoroughly. If one disorder is present, it’s quite possible that other problems exist as well. In situations such as this, recovery is considerably more likely when the conditions are treated concurrently. When mental and emotional disorders are ignored, substance abuse relapse becomes significantly more probable over time.
Suicide Prevention and Resources
In addition to being susceptible to the development of mental and emotional disorders, LGBTQ individuals are also at a higher risk of suicide. This is particularly relevant for LGBT adolescents, who are reportedly two to seven times more likely to attempt suicide than heterosexuals. Suicide is the third most common cause of death for individuals between 15 and 25 years of age and LGBTQ adolescents are more likely to attempt it than their counterparts. In fact, the 2009 Youth Risk Behavior Surveillance System reported that 18.8 percent to 43.4 percent of lesbian and gay students considered attempting suicide and 15.1 percent to 34.3 percent actually attempted suicide at least once during the 12-month survey period. Conversely, only 9.9 percent to 13.2 percent of heterosexual students thought about attempting suicide and only 3.8 percent to 9.6 percent actually attempted it. Other studies show that up to one in three self-identified transgender individuals attempt suicide at least once.
It is important to realize, it is not being a part of the LGBTQ community that leads to suicide. Instead, the higher rate of suicide stems from to the bias, discrimination, family rejection, and emotional stressors often associated with being LGBTQ. Other common risk factors include substance abuse, harassment, bullying, social isolation, depression, and other mental health issues. Protective factors, on the other hand, include family acceptance, establishing positive social connections, and feeling safe.
Professionals working with LGBTQ individuals of all ages can help decrease the potential of suicide by creating an environment that is safe and inclusive. The following preventative strategies may also be helpful:
Train all staff to effectively interact with and serve LGBTQ patients, as well as identify potential suicidal risk factors and behaviors
Address new clients with the understanding that they may be any sexual orientation or gender identity
Provide up-to-date and accurate information regarding LGBTQ issues
Ensure all services and providers are inclusive and affirming
Provide peer-based programs that cover stress management, life skills, and discrimination
Establish appropriate protocols to be administered once a client is identified as at-risk
Understanding the Concerns of LGBTQ Clients
While LGBTQ substance abuse clients often share many similarities with heterosexuals who have the same diagnosis, they must often learn to cope with additional issues throughout the treatment process. It’s not uncommon for these patients to simultaneously be dealing with coming out, social stigmas, medical issues, and discrimination. LGBTQ community members also tend to associate with friend groups that actively participate in social drinking, drug use and partying that make it difficult to avoid potential substance abuse triggers. These factors can negatively impact recovery and must be taken into consideration during treatment
Additionally, LGBTQ individuals are at a higher risk of contracting HIV and AIDS, especially in the case of gay and bisexual men. While substance abuse treatment can help patients avoid spreading these diseases, the resulting physical, mental, and emotional effects must be taken into consideration at all times.
Other common concerns for lesbians, gay men, and bisexuals include:
Heart disease due to inactivity, obesity, and smoking
Harassment and/or physical violence
Suicidal ideation and/or attempts
Emotional stress that may develop into depression
Other sexually transmitted diseases
Recommendations and Policies for Developing Affirmative Therapeutic Environments
Unfortunately, many substance abuse treatment centers insufficiently meet the needs of their LGBTQ patients. Recovery programs are often ill-equipped to address the unique situations often associated with individuals within this community and, as a result, the treatment becomes less effective. Group therapy, for example, may not be the best solution if other patients demonstrate bias or homophobia. If the group is not inclusive, it can result in a sense of alienation and counteract progress.
Studies show that specialized programs which address factors like homophobia, discrimination, harassment, violence, family unacceptance, and social isolation, resulted in better recovery outcomes. Substance abuse counselors should incorporate a variety of modalities, including social support therapy, cognitive-behavioral therapy, motivational interviewing, and contingency management. Patients have also proven to respond well to social skills training.
When developing a treatment environment that is welcoming and affirming for LGBTQ patients, consider the following important guidelines. Staff must:
Work to understand how social stigmas, discrimination, and violence impact LGBTQ patients
Acknowledge that having a different sexual orientation doesn’t mean the patient is mentally ill
Understand that same-sex relationships are normal and that attempting to change a person’s sexual orientation is ineffective and unsafe
Identify, address, and strive to understand the unique experiences of LGBTQ community members, as well as their potential problems and risks
Accept that LGBTQ patient families may not be legally or biologically related
Recognize that an LGBTQ client’s sexual orientation may impact family and occupational relationships
Realize there may be additional challenges outside of sexual orientation, such as racial, ethnic, and religious values and beliefs
Understand how health factors, such as HIV/AIDS, will impact an LGBTQ client
Program Models for LGBTQ Clients
While there are definite ways to tailor substance abuse treatment programs for LGBTQ patients, it’s relatively rare to find recovery centers that do. Despite evidence that these programs produce better results, many LGBTQ patients ultimately receive services from facilities that cater to the majority population. There are, however, some organizations that can serve as successful models for future improvement.
While everyone has their own individual reasons for substance use, research does indicate that these trends may be a result of several important factors. LGBTQ individuals experience a substantial amount of social stigma and discrimination, so much so, in fact, that their civil and human rights are often questioned and/or blatantly denied. They are also frequently the targets of violent acts and face many emotional hardships resulting from family and friends refusing to accept their sexual orientations and gender identities. Feelings of shame and self-doubt are prevalent as well. Exposure to this kind of emotional and physical stress and victimization, even limitedly, can have long-lasting, negative effects that may leave the individual more susceptible to the development of substance use and abuse, psychiatric disorders, and even suicide.
Research has also found that some orientations may be prone to overuse of certain substances. While it’s possible for LGBTQ patients to abuse any substance, lesbians and bisexual women, for example, have proven to be at higher risk for alcohol use disorders. Gay and bisexual men, on the other hand, seem to be at a higher risk for illicit drug use disorders; these individuals are significantly more likely to use marijuana, psychedelics, hallucinogens, stimulants, sedatives, cocaine, and barbiturates.
It’s also important to realize that some patients will keep their sexual orientations and gender identities private while receiving treatment for their substance use disorder(s). This means that it’s completely possible that the staff will never know whether individual clients are part of the LGBTQ community or not, which can slow down the recovery process. While a person should never feel pressured to disclose this type of information, maintaining an approachable and accepting atmosphere will make is much easier.
General Resources on Serious Mental Illness
Studies show that tens of millions of people suffer from mental illness in the United States alone. According to the 2015 National Survey on Drug Use and Health, there were significantly more LGBTQ adults suffering from mental illness than sexual majority adults. Approximately 3.9 million (37.4 percent) of LGBTQ adults over 18 years of age had a mental illness. About 1.4 million (13.1 percent) of those individuals had what is considered a series mental illness. These numbers vary drastically from those reported for sexual majority adults. Only 17.1 percent of sexual majority adults had a mental illness, 3.6 percent of which was classified as serious.
Because many LGBTQ substance abuse disorder patients are also diagnosed with mental illnesses, it’s important that counselors become familiar with conditions that are prevalent among this demographic. It’s also vital that professionals have a clear understanding of how serious mental conditions should be treated. While anxiety disorders, eating disorders, and post-traumatic stress disorders are all common, the most serious mental illnesses include:
Severe, Major Depression
Severe Bipolar Disorder