Substance Abuse In The LGBTQ+ Community: Risk Factors & Treatment
The LGBTQ+ community faces higher levels of substance abuse than their straight and cisgender peers. Risk factors include increased social stress and lack of healthcare. Treatment centers can provide effective care by addressing the issues that this community faces.
Substance abuse has many risk factors. People may experience addictions as a result of genetics, life circumstances, proximity to drugs, and more.
Until recent years, researchers have had little information about how substance abuse impacts the LGBTQ+ community.
Federally funded surveys about drug abuse used to omit questions about sexual orientation and gender identity, so researchers will need more data for long-term information.
Still, current studies do offer some valuable insights into drug use and the LGBTQ+ community such as the increased risk of addiction due to pervasive discrimination.
These insights can help treatment providers understand how to best address this population’s needs.
Before treatment providers can offer the best care for people in the LGBTQ+ community, they must understand relevant terminology.
Below are some basic definitions that doctors and counselors should know:
- Aromantic — a person who experiences little to no romantic attraction. An aromantic person may also be asexual, but not all aromantic people are asexual. Likewise, not all asexual people are aromantic.
- Asexual — a person who experiences little to no sexual attraction toward any gender. An asexual person may or may not enjoy the act of sex itself, but it is the lack of attraction that defines asexuality. Asexuality is not to be confused with celibacy, which is a deliberate choice and not an orientation.
- Bisexual — a person who is attracted to more than one gender.
- Cisgender (cis) — a person whose gender aligns with their assigned sex.
- Gay — this term describes anyone who is sexually and/or romantically attracted primarily to people of the same gender.
- Intersex — a person whose body does not fit into the general male/female binary categorization.
- Lesbian — often describes a woman who is sexually and/or romantically attracted primarily to other women, but a nonbinary person attracted primarily to women might also use this term.
- Nonbinary — a person whose gender does not fit neatly into the category of “man” or “woman.” Nonbinary people fall under the transgender umbrella.
- Pansexual — a person who is attracted to people regardless of gender.
- Queer — Previously a slur, this word has been reclaimed by much of the LGBTQ+ community. It’s an umbrella term that refers to anyone who is not cisgender or heterosexual.
- Transgender (trans) — a person whose gender does not align with their assigned sex at birth.
Ultimately, each individual person is the authority on their identity and sexual preference, and these definitions do have some nuances and gray areas.
For example, asexual people may use terms like “heteromantic” or “homoromantic” to describe romantic attraction without the sexual component.
Non-LGBTQ+ treatment providers may not fully grasp all of these nuances, but it’s important for them to learn basic definitions.
When doctors and counselors learn these terms, it’s a sign that they care about the community and are less likely to discriminate based on gender and sexuality.
The Scope Of Drug Use Among The LGBTQ+ Community
Some studies show that drug use is higher in the LGBTQ+ community than in cisgender heterosexual communities. The rates of drug use often depend on the drug itself.
For example, according to the National Institute on Drug Abuse (NIDA), LGBTQ+ young adults are only 2.3% more likely than cisgender heterosexuals to have an alcohol abuse disorder.
However, NIDA shows greater disparities when it comes to other types of drugs.
LGBTQ+ people are more likely than their peers to have a heroin addiction or another kind of opioid addiction.
Among surveyed adults, sexual minorities reported 9% more past opioid use than cisgender people.
Drug Use Among Sexual Minorities
According to a National Survey on Drug Use and Health (NSDUH), sexual minorities are more likely than their heterosexual peers to experience drug abuse.
Gay men and lesbians, for example, are twice as likely to deal with this issue. Bisexual people, meanwhile, are three times as likely to develop a substance use disorder.
Drug Use Among Gender Minorities
Transgender people, including nonbinary people, also have high rates of addiction and substance abuse. For many trans people, that substance use starts at a young age.
California Healthy Kids conducted a survey that compared substance abuse trends in transgender and cisgender students.
According to this survey, trans students were 2.5 times more likely than cis students to use illicit drugs.
Further Underrepresented Communities
Studies offer very little information on substance abuse in asexual, aromantic, intersex, and other queer communities. However, existing studies do reveal some insights.
For example, the aforementioned NSDUH study found that people who are not sure of their sexual identity are five times more likely than heterosexual people to have an addiction.
Many people who are unsure of their orientation may fall into one of these underrepresented communities, and they may not always have the terminology to describe themselves.
Fewer resources are available for people in these communities.
Studies also show that these communities experience minority stress and report high rates of mental health struggles as a result.
Many of these individuals report rejection from both inside and outside the LGBTQ+ community. This kind of minority stress, combined with a lack of resources, may contribute to addiction.
Why LGBTQ+ People Might Use Substances
People in the LGBTQ+ community may use substances for a number of reasons.
When those reasons overlap, queer individuals may become especially vulnerable to addiction and the health problems that occur alongside it.
Some people erroneously assume that the LGBTQ+ identity itself is the cause of this vulnerability.
In reality, it comes from a host of social pressures and outside circumstances, many of which are discriminatory in nature or otherwise unaccepting of this community.
Discrimination, Harassment, And Violence
LGBTQ+ individuals face more discrimination than cisgender heterosexual individuals, causing trauma and stress that puts them at a higher risk for substance abuse.
A 2020 survey of LGBTQ+ people found that more than half of this population has hidden personal relationships to avoid harassment and discrimination.
The same survey found that up to a third of these individuals have hidden other aspects of their lives for the same reason.
Transgender people are especially vulnerable to bigotry, even in places that are accepting of lesbian, gay, and bisexual people. Multiple surveys report high rates of discrimination against trans people.
Respondents have faced discrimination in multiple areas of their lives, including school, family, housing, work, and public life.
The stress of discrimination can become a constant reality without an escape, and many LGBTQ+ people may turn to drugs and alcohol to alleviate stress and dull emotional pain.
Discrimination And Internalized Homophobia
Self-directed homophobia may also lead to drug use in the LGBTQ+ community.
When queer individuals grow up in non-accepting environments, they may internalize the message that their gender and sexuality are wrong.
Internalized homophobia can lead to depression and other mental health struggles, which in turn can result in drug and alcohol abuse.
Furthermore, after years of presenting a straight and/or cisgender front for their own safety, some queer people may struggle to live as their authentic selves, even after coming out.
Because drugs and alcohol lower people’s inhibitions, some LGBTQ+ people may use drugs as a way to find temporary relief.
Discrimination And The Risk Of Homelessness
Much like the LGBTQ+ community, people experiencing homelessness have a high risk of substance abuse and addiction.
Many people in the queer community may encounter drugs while experiencing homelessness themselves.
This community is more likely than their non-LGBTQ+ peers to find themselves without a home.
They have this risk due to housing discrimination, job discrimination, and unaccepting family members.
Discrimination And The Lack Of Health Care
When LGBTQ+ people look for mental healthcare and medical care, they face more complications than non-queer individuals.
In some cases, doctors have outright refused patients due to their sexuality or gender. The transgender community especially has been forced to deal with this kind of discrimination.
Furthermore, when doctors are not educated about certain orientations, they sometimes pathologize those orientations and/or blame them for existing health problems.
The asexual community, for instance, reports a high rate of unnecessary medicalization. Due to this lack of understanding, some LGBTQ+ people may avoid seeking medical care.
Additionally, because people in the LGBTQ+ community often face job discrimination, not every LGBTQ+ person has health insurance available.
Even the Affordable Care Act (ACA) requires people to reach a certain income threshold before they’re eligible to use the health insurance marketplace. Some LGBTQ+ people may not meet that threshold.
Overall, LGBTQ+ people have fewer options for medical care, which means that they have fewer opportunities to get help for addictions and other mental health struggles.
Normalization Of Substance Abuse
Many LGBTQ+ people feel pressure to drink or use drugs at clubs, bars, and Pride events. As a result of this pressure, many vulnerable people develop drug and alcohol addictions.
Frequent exposure to drugs and alcohol is a major risk factor for addiction, and clubs and bars provide easy access to these substances.
However, places such as clubs and bars are often the only available options for people who need safe spaces to be themselves without discrimination.
Co-Occurring Disorders In The LGBTQ+ Community
Roughly half of the people with substance use disorders also deal with a co-occurring mental health condition.
Likewise, many people with mental health conditions also deal with addiction.
Researchers aren’t sure whether co-occurring disorders cause addiction or vice versa, but they do know that people with mental illness have a higher risk of substance abuse.
The LGBTQ+ community deals with more mental health struggles than the general population.
Chronic stress can disrupt brain chemistry enough to create a diagnosable illness, and the U.S. queer population certainly faces a lot of stress.
Anxiety is one of the most common mental illnesses among the general population. It is also especially prevalent in the LGBTQ+ community.
Anxiety disorders include a range of illnesses, including generalized anxiety disorder (GAD), panic disorder, and specific phobias.
The symptoms of anxiety disorders may include:
- constant worry
- feelings of dread in otherwise safe situations
- excessive nervousness
- physical symptoms (increased heart rate, sweaty hands, trembling, nausea)
- trouble falling asleep
- trouble concentrating
- avoiding anxiety-inducing situations
When people experience these symptoms, especially when they don’t have access to medical care, they may use illicit drugs and alcohol to self-medicate.
Depression is another one of the most common mental illnesses, and people in the LGBTQ+ community are especially susceptible to it.
It often occurs alongside anxiety, as these two disorders are typically caused by the same brain chemical imbalances.
The symptoms of depression may include:
- excessive sadness
- feeling numb
- insomnia or sleeping too much
- loss of interest in hobbies and activities
- trouble concentrating
Much like anxiety symptoms, depression symptoms may lead a person to self-medicate if they have few other options.
Attention Deficit Hyperactivity Disorder (ADHD)
Though more research is needed, some studies show that transgender and gender non-conforming people may have a higher risk for ADHD than the general population.
ADHD symptoms include:
- lack of motivation
- trouble concentrating
- needing sensory stimulation to focus
- physical or mental restlessness
- frequently becoming distracted
- racing thoughts
- trouble planning and executing tasks
People with ADHD have a higher risk of substance abuse than their neurotypical peers. This risk comes from several factors.
For example, some ADHD traits, including impulsivity and poor planning, can lead to risk-taking behaviors such as drug abuse.
When people with ADHD receive the right treatment, their chances of addiction decrease significantly, as treatment helps their brains use dopamine for focus and motivation.
However, when a person’s ADHD remains untreated, they may self-medicate with illicit drugs and alcohol, which also increase dopamine.
People with ADHD may be especially vulnerable to illegal stimulants, which can provide temporary symptom relief. For instance, someone with ADHD may exhibit signs of cocaine addiction.
Again, transgender people, who may have a higher likelihood of developing ADHD, have less access to healthcare than cisgender people.
Without healthcare, trans people with ADHD can’t get the treatment that may protect them from substance abuse.
Treating Addiction In The LGBTQ+ Community
For the LGBTQ+ community, there are substance abuse treatment options have been proven especially effective.
Many rehab facilities, including some heroin treatment centers in Ohio, use some or all of these approaches.
In some cases, a particular therapy may be effective for the LGBTQ+ community because it is effective for most people with substance use disorders, regardless of gender or sexual orientation. Attending a drug detox center, for example, is effective for all populations.
In other cases, these treatments have been studied and proven effective for queer populations, specifically.
Unfortunately, most of the available research on effective LGBTQ+ treatment only pertains to gay and bisexual men.
More research is needed to address the needs of women, trans and nonbinary people, and other underrepresented sexual minorities.
Medical detox is a type of medication-assisted treatment program that’s highly effective as the first step in substance abuse treatment.
One of the biggest barriers to addiction recovery comes from withdrawal symptoms.
As a drug leaves a person’s body, that person will likely experience physical discomfort, strong cravings, and mental health struggles.
For example, withdrawal symptoms from alcohol may include fatigue, irritability, clouded thinking, and many similar issues. Medical detox addresses these symptoms.
When a patient gets treatment from a drug detox center, a doctor can prescribe non-addictive medications to address their withdrawal symptoms.
In some cases, medical detox is necessary for the patient’s safety. For instance, opioid withdrawal can be life-threatening if a person quits these drugs suddenly.
Withdrawal may be especially dangerous when a person uses gray death or other synthetic opioid mixtures.
Medical detox provides a gradual approach, helping the patient taper off opioids slowly.
Specialized Therapy Groups
People in the LGBTQ+ community benefit from specialized therapy options tailored specifically to sexual and gender minorities.
Some inpatient rehab facilities offer these groups. They’re also common in counseling centers and 12-step programs.
These queer-specific therapy groups accomplish two important objectives.
First, they foster trust. In many circumstances, LGBTQ+ individuals have to hide parts of themselves for their own safety.
If they must hide their authentic selves in therapy, then their therapists won’t have enough information to offer effective treatment.
In LGBTQ+ therapy groups, people can release the fear of judgment and discrimination. They can communicate honestly, which will facilitate healing.
Second, these groups address the needs of the community. For example, they can help LGBTQ+ people find ways to embrace their identities in sober spaces.
Motivational interviewing for gay and bisexual men has proven especially effective, and this approach may have similar benefits for other sexual minority groups.
This counseling approach is designed to help patients overcome conflicting feelings.
It focuses on identifying goals and values, and then it prompts clients to make changes based on those goals and values.
While some forms of therapy focus primarily on changing behaviors, motivational interviewing combines behavioral change with finding reasons to make that change.
Contingency management has been studied as a substance abuse treatment option for gay and bisexual men.
It has also been studied as an option for all people who deal with substance abuse.
Contingency management offers rewards in exchange for sobriety, attending therapy sessions, obeying drunk driving laws, and other aspects of addiction recovery.
Rewards may include cash, movie vouchers, raffle tickets, and similar prizes.
Contingency management works because it offers external motivation at times when a person may not have much internal motivation available, a skill that must be strengthened over time.
It’s an especially difficult skill for people with depression, ADHD, and other mental health conditions that are prominent in segments of the LGBTQ+ community.
External rewards provide a stepping-stone. They can help people build on their sobriety as they strengthen their internal motivation.
Cognitive Behavioral Therapy
Cognitive behavioral therapy (CBT) has been proven to be effective in treating LGBTQ+ people, as well as the general population.
This evidence-based treatment maintains that thoughts, feelings, and behaviors are closely connected and can influence one another.
This form of therapy helps patients identify their core beliefs, including “cognitive distortions” such as overgeneralizing.
Patients learn how to respond to these thoughts with more helpful thoughts. Then, they learn healthy coping skills to address their thoughts, feelings, and behaviors.
CBT may be particularly beneficial to the LGBTQ+ community for two reasons.
First, it has been proven effective for depression and other mental health issues that are common in the community.
For people with co-occurring conditions, the most successful addiction treatment addresses both the substance use disorder and the condition(s) that may contribute to it.
Second, CBT helps clients confront false beliefs about themselves, and many LGBTQ+ people have these false beliefs.
For example, if a gay person grew up hearing homophobic messages, they may have internalized that negativity.
The resulting shame may have caused them to drink excessively or abuse drugs. CBT may help this person confront those unhelpful beliefs and find healthier ways to deal with them.
Resources For LGBTQ+ People Overcoming Addiction
If you are a part of the LGBTQ+ community and have an addiction, you don’t have to deal with it alone. Several resources and programs are available.
Explore the following organizations and resources to get started:
- Gay and Sober Meetings Directory — Search for support groups and 12-step programs for LGBTQ+ individuals.
- LGBT Foundation — Find advice and support for LGBTQ+ people, including advice about mental health and addiction.
- National Institute on Drug Abuse — Learn about addictive substances and how they impact the brain and body.
- Parents, Families, and Friends of Lesbians and Gays — Find support for LGBTQ+ people and their loved ones.
- Substance Abuse and Mental Health Services Administration (SAMHSA) Behavioral Health Treatment Services Locator — Search for addiction treatment in your area, including addiction treatment for LGBTQ+ individuals.
- The Trevor Project — Explore mental health resources for young LGBTQ+ people.
- American Progress - The State of the LGBTQ Community in 2020 https://www.americanprogress.org/article/state-lgbtq-community-2020/
- California Healthy Kids Survey - 15th Biennial Statewide Survey https://calschls.org/docs/biennial_state_1315.pdf
- Journal of Consulting and Clinical Psychology (Published by ResearchGate) - A Randomized Controlled Trial Utilizing Motivational Interviewing to Reduce HIV Risk and Drug Use in Young Gay and Bisexual Men https://www.researchgate.net/publication/259454688_A_Randomized_Controlled_Trial_Utilizing_Motivational_Interviewing_to_Reduce_HIV_Risk_and_Drug_Use_in_Young_Gay_and_Bisexual_Men
- National Institute on Drug Abuse - Substance Use and SUDs in LGBTQ Populations https://nida.nih.gov/research-topics/substance-use-suds-in-lgbtq-populations
- National Library of Medicine - Relationship Between Discrimination and Substance Use Disorders among Lesbian, Gay, and Bisexual Adults in the United States https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2937001/
- Psychiatry and Clinical Pharmacology (Published by Taylor & Francis Online) - Gender Dysphoria and Attention Problems: Possible Clue for Biological Underpinnings https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions/co-occurring-disorders
- Substance Abuse and Mental Health Services Administration - Co-Occurring Disorders and Other Mental Health Conditions https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions/co-occurring-disorders
- Substance Abuse and Mental Health Services Administration - The National Survey on Drug Use and Health: 2017 https://calschls.org/docs/biennial_state_1315.pdf