When Joan was an adolescent, she knew that she did not want a heterosexual relationship. From a very early age she felt that she was a lesbian, although at the time she did not have a word for it. Despite having a loving relationship with her mother, she was scared to reveal that she was a lesbian woman: she feared that she would encounter homophobia within her family. Her fears turned out to be well grounded: even though they lived in San Francisco, which has always been known to be very LGBTQ friendly, her mom refused to accept it when she revealed that she was a lesbian. Begrudgingly, Joan dated heterosexual men throughout her teenage years, and she used alcohol to drown her true identity.
Mickie was raised in a loving, two parent family who always accepted that he identified as a transgender person. Born as a female, Mickie says he always knew that he was a male and wanted to be treated as such. Despite living in the deep South of the United States, he found a loving welcome in a small, close-knit transgender community. However, as he grew into an adult and attempted to have a dating life, he realized that not everyone was accepting of him being a transgender person. The pain of that rejection led him to want to numb his overwhelming sadness, and he ended up turning to prescription opioids.
As a child, Rick knew two things to be true: that he was not heterosexual, and that he suffered from severe depression. Neither of those things was of any concern to his family. They were extremely religious and, in their words, their son was not queer. All he needed to do, in their opinion, was to be more active in church and he would be fine. As Rick’s co-occuring disorders stacked up, he began to consider suicide. He could not imagine hiding his sexual orientation for the rest of his life. The more his parents denied who he was, the more his mental health deteriorated. Until the night he discovered that methamphetamines could give him the ability to feel good.
Compared to the population as a whole, the LGBTQ (lesbian, gay, bisexual, transgender, queer) community has a much higher rate of substance abuse. Studies have shown that an estimated 20 to 30 percent of the LGBTQ community abuses drugs and/or alcohol. This can be attributed to the obstacles they face daily, that those who are heterosexual men and heterosexual woman do not encounter.
Some of the challenges include:
These challenges can lead LGBTQ individuals to seek a way to numb their pain and often, that will mean drugs or alcohol to self-medicate. The prejudice that the gay and transgender population faces in society can be so overwhelming and isolating that alcohol or drugs can help the individuals deal with their feelings. They may feel anxiety, anger, depression, or fear, and escaping those feelings becomes a top priority.
One segment of the LGBTQ population that is especially vulnerable to becoming addicted is transgender individuals. One recent study found that transgender youth are 2.5 times more likely than the general population to use cocaine or crystal meth, and they are twice as likely to abuse prescription medications such as opioids.
A high percentage of the LGBTQ population has co-occurring disorders arising from discrimination against the sexual orientation of its members. Co-occurring disorders can be attributed to the stress experienced by members of the LGBTQ community. These stressors can arise from childhood trauma, or from not having one’s sexual identity validated, meaning individuals are forced to live “in the closet”. Having to keep one’s sexuality a secret is a burden that has an enormous psychological toll on an LGBTQ individual.
Studies have shown that compared to their heterosexual counterparts, members of the LGBTQ community have more co-occuring disorders, especially during adolescence. A staggering percentage, up to 52%, of LGBTQ youth attempt self-harm, 44% consider suicide, and 42% report feeling mental distress.
Common co-occuring disorders and effects can include:
Due to the unique challenges, such as discrimination and hate crimes, some LGBTQ individuals turn to alcohol to handle their trauma. This has caused alcoholism to be an extremely serious problem among LGBTQ individuals. The rates of binge drinking, alcoholism, and alcohol abuse are all higher when compared to heterosexuals. In the LGBTQ community, 20 to 25% are reported to have a moderate to severe drinking problem, compared to 12.7% of the general population.
The risk factors associated with alcohol abuse include stress, co-occuring disorders, and victimization. The victimization occurs when specific social groups, LGBTQ in this case, face distress and hostile harassment. The targeted aggression causes deep wounds and may alter the way that members of the LGBTQ community see and respond to the world around them.
Members of the transgender community are more likely than their LGBTQ peers to be subjected to prejudice in many forms, including discrimination, loss of family, and physical and sexual abuse. This makes them especially likely to turn to alcohol to cope.
Another common theory about the high frequency of alcoholism and substance abuse is the importance of gay bars and clubs to the community. Historically, gay bars and clubs have been a safe place where gay and transgender people can be open about their sexuality and socialize with people who accept who they are. However, this has led to a higher rate of drinking, and sometimes, drug use.
Both men and women in the LGBTQ community consume alcohol for different reasons and in different amounts. Woman may be subjected to unique challenges due to gender-based homophobia, including sexual violence. The CDC, Center for Disease Control, released their National Intimate Partner and Sexual Violence Survey which stated that 44% of lesbians and 61% of bisexual women experience rape or physical violence, compared to 35% of heterosexual women. They noted that in the 2015 United States Transgender Survey, 47% of transgender people are sexually assaulted in their lifetime.
Sadly, the survey goes on to state that 85% of victim advocates who worked with an LGBTQ survivor of violence reported that the victims were denied services and treatment because of their sexual orientation or gender. This can be a very common reason why alcoholism rates are much higher in gay women and transgender individuals than they are in gay men.
Studies have shown that 25% of lesbian women were heavy drinkers compared to other LGBTQ identifying individuals. The studies defined heavy drinking as four drinks or more in a span of two hours. In addition, the studies show that older lesbian women consume higher amounts of alcohol compared to younger lesbian and bisexual women. This type of heavy drinking can easily transition to binge drinking, which can lead to the individual becoming dependent on alcohol.
When drinking becomes a crutch to deal with the stress and challenges of life, this signals a dependency on alcohol that needs attention and proper treatment.
In Canada, several research entities are attempting to quantify the problem of LGBTQ youth who end up on the streets. It is difficult to put an exact number on this because many youth will not disclose their LGBTQ status out of concerns for their safety. They fear reprisal not only from their own families, but from a shelter system that is ill-equipped to deal with homophobia and transphobia.
This fear of violence appears to be justified: according to a book entitled Where Am I Going To Go? by the Canadian Observatory on Homelessness, 34% of homeless LGBTQ2S (lesbian, gay, bisexual, transgender, queer and 2-spirit) youth left home because of violence or abuse, compared with 16% among homeless heterosexual cisgender youth.
These young people are at a significant risk of developing substance abuse issues: many of them feel safer on the streets than they do in shelters, and the combination of street life and the everyday discrimination experienced by the LGBTQ2S population may well increase the likelihood of dealing with mental health issues through self-medication.
There have been great strides made in the gay rights movement in the last few decades, but that has not erased the social prejudice that LGBTQ individuals encounter daily.
These prejudices include discriminatory laws, both written and unwritten, in employment, housing, and health care, and oft-insurmountable obstacles in having same-sex marriages and relationships legally and socially recognized.
Additionally, the stigma and lack of acceptance by family and friends can lead to extremely high stress levels, which in turn can led to the tendency to self-medicate with alcohol and other drugs.
According to a national study by the National Institute of Health, a search of SAMHSA (Substance Abuse and Mental Health Services Administration) treatment listings found “854 treatment programs that reported to have specialized treatment services for LGBT people”. However, during a telephone follow-up, only 62 treatment centres confirmed that these services actually existed. In fact, it was discovered that 70% of the programs were no different to those that were offered to heterosexuals. Only “7% could easily identify a service specifically tailored to the needs of LGBT clients”.
LGBTQ individuals may be reluctant to disclose their sexual orientation or seek treatment for a few reasons. In addition to specialized services being limited, they may fear that they will receive hostile treatment, or that the treatment centre may not be aware of their specific needs. Three of the most substantial barriers to substance use treatment and prevention in the LGBTQ population are: open discrimination, intolerance, and fear of stigma.
According to NIDA, the National Institute of Drug Abuse, addiction treatment centres that offer specialized groups and programs for members of the LGBTQ community show better outcomes for those clients, compared to non-specialized programs. Their research suggests that treatment should address homophobia and transphobia, family problems, violence, and social rejection and isolation.
In 2015, a study was conducted among the LGBTQ community regarding addiction and treatment. Alumni from various LGBTQ treatment centres identified the need to improve treatment by offering separate units that are welcoming to them. They also noted that treatment should be provided by LGBTQ identifying staff or LGBTQ-affirming staff. Addiction treatment has been tailored towards heterosexual men and women and based on age, race, and cultural background, but more needs to be done to tailor it to the LGBTQ community.
Due to higher rates of addiction and alcoholism, along with the unique sets of challenges, stressors, and discrimination that the LGBTQ population faces, more needs to be done so that they can receive the care that is much needed and very much deserved.
Cochran, Bryan N., et al. “Do Specialized Services Exist for LGBT Individuals Seeking Treatment for Substance Misuse? A Study of Available Treatment Programs.” Substance Use & Misuse, vol. 42, no. 1, 2007, pp. 161–176., doi:10.1080/10826080601094207.
Homeless Hub. “LGBTQ2 Youth Homelessness.” Homeless Hub, www.homelesshub.ca/about-homelessness/population-specific/lesbian-gay-bisexual-transgender-transsexual-queer.
Human Rights Campaign. “Sexual Assault and the LGBTQ Community.” Human Rights Campaign, www.hrc.org/resources/sexual-assault-and-the-lgbt-community.
Moazen-Zadeh, Ehsan, et al. “A Call for Action on Overdose among LGBTQ People in North America.” The Lancet Psychiatry, vol. 6, no. 9, 2019, pp. 725–726., doi:10.1016/s2215-0366(19)30279-2.
Thompson, and Sienna. “The Effects of Substance Abuse on the LGBTQ Partner of the Substance Abuser: A Support Group for Couples in Recovery.” Electronic Theses & Dissertations (ETDs) (2011-), California State University, Northridge, 10 Jan. 2019, scholarworks.csun.edu/handle/10211.3/207648.
Photo credit: Pete. This picture has a Creative Commons attribution license.— Addiction Problem, Alcohol Abuse, Drug Abuse & Drug Addiction, LGBT, LGBTQ, LGBTQ2S, Substance Abuse