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Substance abuse is far more common among members of the LGBTQ+ community than the population as a whole. The transgender population is particularly vulnerable. One study among trans students found that they’re 90% more likely to indulge in substance abuse than heterosexual adolescents.
The five most commonly used drugs cover both legal and illegal substances. Tobacco tops the list. Although smokers rarely seek help from a rehabilitation facility to combat nicotine addiction, the fact is that gay and transgender individuals use tobacco up to 200% more than straight individuals. This may be due to the stress caused by experiencing discrimination and stigmatization, but it’s also true that there have been aggressive ad campaigns by tobacco companies targeted at the LGBTQ+ community.
LGBTQ+ smokers are vulnerable to the negative health effects associated with smoking, including cancer, stroke, and heart disease. Studies have also shown that smoking impacts other addictions. One study showed that young smokers are more likely to drink alcohol and use illicit drugs than non-smokers. It’s also been shown that smoking cigarettes increases the likelihood of relapse among people being treated for SUD.
Alcohol is another commonly used substance. It’s reported that 20-25% of the community has moderate-severe alcohol dependence, and around 44% of young lesbian, gay, and bisexual people reported binge drinking in the past month. Some have suggested that the support and sense of community found at gay bars contribute to regular drinking. People may also use marijuana for the same reason. Gay men are 3.5 times more likely to use the drug than straight men.
People in the LGBTQ+ community are also more likely to use illicit drugs. In a 2015 study, around 39% of lesbian, gay, or bisexual adults had used illicit drugs in the past 12 months, compared to 17% of heterosexual adults. Amphetamines and heroin are the most commonly used illegal substances. Gay and transgender individuals are 12.3 times more likely to use amphetamines and 9.5 times more likely to use heroin.
There are a number of common experiences among gay and transgender people that contribute to the high rate of SUDs in the community. The majority of these issues stem from social stigmas. Sexual minorities are more likely to experience discrimination, hate crimes, and rejection from family and friends than the rest of the population. Employment discrimination is also common, and 52% of U.S. gay and transgender people live in a state where there is no protection from workplace discrimination. There is also a proportion of people in the community who live a closeted or semi-closeted life, unable to tell work colleagues, friends, or family who they really are. All of these experiences add to the likelihood of substance abuse.
The LGBTQ+ community is also more likely to suffer from mental health disorders (around 42% of those in the sexual minority as opposed to 19.8% of individuals in the sexual majority). LGBTQ+ high school students are five times as likely to attempt suicide than their peers, and 48% of transgender adults in the United States have considered suicide in the past 12 months, compared to just 4% of the overall population.
Many in the LGBTQ+ community are reluctant to see health care providers. This is partly because they fear discrimination and prejudice from doctors, a not unfounded fear with studies showing many health care providers have both implicit and explicit biases against LGBTQ+ people. Financial concerns and a lack of health insurance may also lead to people delaying health care. This can mean individuals choose to self-medicate using various substances to help manage their mental health conditions and to cope with discrimination and social stigma. For example, one 2017 study found that 58% of LGBTQ youth listed discrimination as one of the main reasons they used drugs or alcohol.
There are many options for people in the LGBTQ+ community who are seeking treatment for their addiction. Most treatment programs start with detoxification, and care options can include inpatient programs, partial hospitalization, inpatient programs, and aftercare programs. Treatments are often individualized based on the substance being used. However, traditional centers may present problems for LGBTQ+ people, such as other patients who are not accepting of their sexuality.
Rehabilitation centers that offer LGBTQ-specific programs often provide the best care for gay and transgender individuals. These programs address the underlying reasons for addiction, including experiences with isolation, homophobia or transphobia, violence, and family problems. Clients in these centers can also be confident that they won’t face discrimination by health care providers or other patients. They can be open about their problems and experience acceptance and validation.
These programs are also aware of the likelihood of other mental health disorders that may contribute to the SUD. They can pinpoint other issues and provide an integrated treatment plan, which increases the likelihood of successful treatment.
Unfortunately, LGBTQ-specific centers are hard to find. A 2004 study found that even facilities advertising specialized programs did not actually have programs that were different from those offered to heterosexual clients. It’s possible that the landscape has improved since then, though specific data is difficult to find. However, gay and transgender individuals should not let perfect be the enemy of good. One study has shown that LGBTQ+ people have comparable outcomes to heterosexual individuals, even in traditional programs, so it’s possible to find recovery without specialized programs.
People in the LGBTQ+ community also benefit from strong support networks. Although many gay and transgender people find themselves ostracized from family and society at large, they often form strong bonds with other members of the community who can help them as they fight addiction. It’s also been found that LGBTQ+ people are more likely to seek treatment than straight people.
The LGBTQ+ community has often been very good at offering resources to members, and that’s true for people with SUD. Individuals, families of people with SUD, and care providers can all find many organizations that offer information and help.