The LGBTQ+ Community and Substance Use Disorder
It is impossible to deny the fact that access to treatment and stigma play a huge role in the lives of anyone living with a substance use disorder (SUD). For the LGBTQ+ community, these barriers are often more challenging and they encounter a more complex system that cisgender heterosexual people do not. Historically, research efforts have not focused or attempted to study SUD health indicators by sexual orientation. In fact, 2013 was the first time in the 57-year history of the NHIS (National Health Interview Survey) that included a measure of sexual orientation. Since then, more studies have examined the prevalence of SUD amongst members of the LGBTQ+ community. These studies are the first step in having data that represents the unique health needs of the population.
Statistics
Research studies looking at substance use in the LGBTQ+ community have found similar results to the 2013 NHIS and 2015 National Survey on Drug Use and Health. A 2013 study reported that sexual minorities had a greater likelihood of lifetime substance use disorders and earlier age of drinking onset. The same study found that LGBTQ+ individuals had more extensive family histories of substance use disorders. Another study indicated that the disparities identified among adults were also affecting adolescents. One analysis found that lesbian, gay, or bisexual adolescents were 90 percent more likely to use substances. The increased rates of substance use were more pronounced among lesbain or bisexual females who were 4 times more likely than their heterosexual counterparts to partake in substance use.
Treatment
Unfortunately, literature has also found that openly LGBTQ+ individuals enter treatment with more severe SUDs, greater psychopathology, and greater medical service utilization than heterosexual patients. For this reason, it is important to examine access to treatment, quality of care and treatment outcomes among members of the LGBTQ+ community.
A 2005 randomized control trial evaluated the efficacy of four behavioral substance use treatments (standard cognitive behaviroral therapy, contingency management, combined CBT and CM, and a culturally-tailored gay-specific cognitive behavioral therapy) for gay and bisexual men who were dependent on methamphetamine. The results of the trial showed that all of the treatments reduced substance use, but the treatments that addressed more unique personal factors showed better results in terms of retention. Another randomized controlled trial sought to examine the effects of four motivational interviewing sessions on reducing club drug use. The trial showed that for individuals with lower severity drug use, the motivational interviewing sessions correlated with decreased club drug use.
These studies and many more have shown the benefits that come with having treatment that is tailored to each person’s unique experiences. Considering the evidence showing that addiction treatments that offer specialized programs for LGB individuals yield better outcomes, it is shocking that studies report fewer than 10% of programs offer such specialized services.
Stigma
The consequences of stigma and discrimination towards the LGBTQ+ community are complex. Craig Sloane, a psychotherapist and self-identified gay man in recovery states, “The trauma associated with the social stigma of being LGBTQ, of living in a culture that, for the most part, is homophobic and heterosexist, is traumatic. From the experiences of being bullied and being rejected by friends and family, those traumas unfortunately still are true in 2019.” Sloane goes on to explain the shortage of safe spaces for LGBTQ+ people, which contributes to their feelings of isolation and loneliness. The high levels of social stress leaves many LGBTQ+ individuals susceptible to substance use disorders and mental illness.
On top of the rejection they may experience from friends, family and peers, LGBTQ+ people have a hard time finding an inclusive healthcare environment. According to Dr. Alex S. Keuroghlian at The Fenway Institute, the treatment landscape needs to be more aware of the ties between minority stress and substance use disorders: “Addiction treatment needs to be tailored for LGBTQ people. We have to infuse minority stress treatment principles into evidence-based approaches. Providers have to tailor and address treatment to things like opioid use disorders among LGBTQ people for instance.”
While our country has made progress in protecting the rights of LGBTQ+ people, the community continues to face barriers. In fact, a study found that same-sex couples who live in a state with a constitutional amendment banning same-sex marriage experience increased mood disorders, generalized anxiety disorders, alcohol use disorders, and psychiatric comorbidities. Research has shown that transgender individuals report inability to pay for treatment, negative experiences with treatment in the past, and fear of mistreatment at much higher rates than cisgender individuals. Additionally, a survey found that one in five transgender individuals reported that health care providers blamed them for their own health status. Too often, treatment for substance use disorders fails to properly address the trauma LGBTQ+ people have faced and thus contributes to the barriers the community faces when seeking treatment.
Takeaway
The health needs of the LGBTQ+ community are large and are negatively impacted by the discrimination and intense social pressures surrounding their identities. Being openly LGBT has even been correlated with high substance use. While capturing every unique aspect of LGBTQ+ substance use may be incredibly difficult, individualization of treatment is essential. Clinicians and providers need to do more to decrease stigma and understand their unique needs and substance use patterns in order to deliver culturally-competent care. Additionally, the treatment landscape needs to be changed to better match the goals of LGBTQ+ individuals. Reports have found that abstinence is not the goal for a large number of lesbian, gay and bisexual people, but many programs remain abstinence based and do not offer medication assisted treatment (MAT) as a viable treatment option.
Acknowledgement of disparities based on sexual orientation has been steadily increasing over the years. The demand for information on such disparities is a promising sign that more will be done in the future to tackle these broad-ranging inequities. Motivational interviewing, social support therapy, cognitive-behavioral therapy, and contingency management have all been shown to yield positive outcomes in LGBTQ+ individuals with SUDs. While there are still many gaps in research, there is a growing consensus that providers need greater awareness regarding sexuality and sexual orientation in order to deliver the most effective treatment. Treatment programs can no longer ignore the unique needs of the LGBTQ+ community. For future studies or reports, a recommendation would be to focus on improving treatment outcomes for the LGBTQ+ community. The community represents a large spectrum of people and to fully help each individual, treatment options must be on a spectrum as well.
Sources:
Sexual Orientation and Health Among U.S. Adults: National Health Interview Survey, 2013
Sexual Orientation and Adolescent Substance Use: A Meta-Analysis and Methodological Review
Substance Use and SUDs in LGBTQ* Populations
Why the Risk of Substance Use Disorders Is Higher for LGBTQ People
Protections for LGBTQ People with Behavioral Health Needs
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