Substance Use, Addiction, and Recovery in the LGBTQ Community

By Robert Castan 06/14/21

Gay and transgender youths, despite tremendous progress, are still twice as likely to suffer with a mental health disorder or a drug addiction (or both) as their heterosexual peers.

Image: 
Group of people with Pride flag

There are many dates that stick right in the mind, for one reason or another. For the LGBTQ+ community in the U.S., and, indeed, across the world, one of those dates would certainly be the anniversary of the “Stonewall Uprising,” a New York City riot resulting from the truncheon-happy local police raiding one of the city’s gay bars, way back on June 28th, 1969 - and the origin of the Pride movement.

This historic date is the reason we celebrate Pride Month every year during the month of June.

Matthew Shepard (December 1st, 1976 - October 12th, 1998)

There’s another date, too - October, 12th, 1998 - a tragic, yet pivotal date, which involved the violent gay-hate murder of 21-year-old Matthew Shepard, a Wyoming student, by other young college students, which led to a national backlash over how the LGBTQ+ community were being treated at that time, and even legislated for.

It is still regarded as one of the U.S.’s most famous gay-hate murders.

In fact, it was only after lengthy, cross-party wrangling in the U.S. congress over 10 years later that President Obama was finally able to sign the Matthew Shepard Act (2009), a law which defined certain attacks motivated by victim identity as hate crimes.

No such law existed prior to this Act. The men who dealt out the horrific beating (and it was horrific - Matthew was tied to a fence-post, and pistol-whipped so hard it crushed his brain stem) that led to the young gay man’s death were convicted of first-degree murder, and rightly each given a life sentence.

However, they were not charged with a hate crime, as, in 1998 Wyoming, no such law actually existed, regardless of how obvious the link had been in countless, previous gay-hate murders.

Fortunately, some things have changed. However, sadly, some other things have remained exactly the same.

Did you know that young gay and transgender individuals, despite tremendous progress in the past couple of decades, are still twice as likely to suffer with a mental health disorder or a drug addiction or both as their heterosexual peers?

In this article, we’ll look at why the LGBTQ+ community is at an increased risk of both mental health and substance use issues, the U.S. statistics that support this, the important questions you need to ask when finding professional and affirming treatment for your LGBTQ+ child, and what resources are available to support them in their recovery from substance addiction.

It’s 2021, but in many ways, society still has a lot of work to do to make itself as inclusive as it purports to be.

The LGBTQ+ Community and Increased Substance Abuse Risk

As the LGBTQ+ community and its allies celebrate Pride Month 2021, this year with a mix of in-person and virtual events to avidly raise awareness about the issues of being LGBTQ+ in today’s America and beyond, the fact remains that those who identify in this way have always been far more at risk of a mental health disorder, a substance use disorder (SUD), or a combination of both, known as “co-occurring disorder” or “dual diagnosis,” and, even now in 2021, they continue to be.

In this respect, nothing’s changed.

Using data from the annual National Survey on Drug Use and Health (NSDUH), an October 2016 report by the Substance Abuse and Mental Health Services Administration (SAMHSA) was actually the first to identify the extent of substance abuse and addiction among LGBTQ+ people.

The latest SAMHSA: LGBTQ+ report, published in 2020 and based on data from the 2019 NSDUH survey, has similar findings, namely:

  • Adults who identify as lesbian, gay or bisexual (LGB) have higher rates of substance use and mental health illness than heterosexual adults
  • Serious mental illness among the LGB population - ages 18-25 and 26-49 - has significantly increased compared to 2016
  • Major depressive episodes with severe impairment among all LGB men and women, aged 18-25, has significantly increased compared to previous years
  • Substance use disorder (SUD) significantly increased the probability of suicide among those within the LGB population aged 18 and older
  • The transgender community experienced an even higher risk of substance use than the rest of LGBTQ+ community

One of the biggest things I struggle with… is accepting myself, honestly. This society does not cater to me or to people like me, so I’m always in a constant battle of validating my own identity while having society tell me to throw it away.”

- Alora Lemalu, LGBTQ+ activist and artist, from Springfield, Missouri

Why Is the Substance Use Risk in the LGBTQ+ Community Significantly Higher?

The primary reason for this increased risk is “Minority Stress Theory.” This states that, as one of society’s minorities, there are intrinsic yet inescapable elements simply by being the member of a minority, such as greater discrimination and more stigma.

When you are a person who is under chronic stress, that chronic stress results in negative health outcomes. The mind and body may react in multiple ways, and substance abuse is one of those ways.”

- Jeremy Goldbach, PhD, LMSW, professor, School of Social Work, University of Southern California

Additionally, LGBTQ+ youth face fundamental and unique issues, such as:

  • Homophobia
  • Harassment (both physical and mental, in-person and online)
  • Lack of family support
  • Family ejection
  • Homelessness

Many of these young people, unsurprisingly, will use and abuse substances just like their peers do, in an attempt to deal with this hostility. Furthermore, common meeting places for the LGBT community tend to be bars and clubs - environments where it is far easier to access substances like alcohol and illicit drugs.

U.S. LGBTQ+ Community and Mental Health: Facts and Statistics

In terms of their mental health, for LGBTQ+ people, the story remains the same. For LGBTQ+ youth, the increased risk of mental health disorders mirrors their increased risk of substance use and addiction. Additionally, these young people are more likely to engage in “polydrug use” - mixing substances to magnify the resulting high and other effects.

In doing so, these youth are also magnifying their risk of a fatal drug overdose.

The most recent survey regarding mental health within the LGBTQ+ community was undertaken by The Trevor Project, with their “2021 National Survey on LGBTQ Youth Mental Health.” The Trevor Project is the world’s largest suicide prevention and crisis intervention organization for lesbian, gay, bisexual, transgender, queer & questioning (LGBTQ) young people, and the survey they conducted represents the experiences of nearly 35,000 LGBTQ youth (aged 13-24) across the U.S.

Following their detailed analysis of the collected data, their expansive report on LGBTQ youth mental health emphasizes the need for greater investment in mental health care and new policy solutions to deal with LGBTQ suicide. The survey’s various findings include:

  • 42% of LGBTQ youth, including more than half of transgender and nonbinary youth, seriously considered attempting suicide in the past year; however, nearly half of these could not access the mental health care they needed
  • An overwhelming majority of LGBTQ youth also reported recent symptoms of generalized anxiety disorder or major depressive disorder
  • More than 80% of LGBTQ youth stated that the COVID-19 pandemic had made their living situation more stressful
  • 70% stated that their mental health was “poor” either “most of the time” or “always” during the pandemic
  • Nearly 40% of LGBTQ youth who had a job reported that they lost it during the pandemic
  • 30% of LGBTQ youth reported having trouble affording enough food in the past month, including half of all Native/Indigenous LGBTQ youth, and more than 1 in 3 Black and Latinx LGBTQ youth
  • 75% of LGBTQ youth reported that they had experienced discrimination based on their sexual orientation or gender identity at least once in their lifetime, and more than half said they experienced this discrimination in the past year

The survey also discovered the immensely negative impact of LGBTQ youth being forced to undertake controversial “conversion therapy”:

  • Those who were subjected to conversion therapy reported more than twice the rate of attempting suicide in the past year compared to those who were not
  • 13% of LGBTQ youth reported being subjected to conversion therapy, including 21% of Native/Indigenous LGBTQ youth and 14% of Latinx LGBTQ youth
  • Transgender and nonbinary youth reported being subjected to conversion therapy at twice the rate of cisgender LGBQ youth (cisgender is defined as a sense of personal identity and gender that corresponds with an individual’s birth sex)
  • LGBTQ youth who reported being subjected to conversion therapy were, on average, only 15 years old at the time, with 83% reporting that it occurred when they were younger than 18

“Conversion therapy” (also known as "reparative therapy" or "gay cure therapy") is an attempt to change someone's sexual orientation or gender identity. Many U.S. states and other countries, such as Canada, Germany and Mexico, have banned (or are currently in the process of banning) the so-called “therapy,” due to its hugely negative impacts, eg. suicide, depression, and anxiety.

The past year has been incredibly difficult for so many LGBTQ young people because of multiple crises, from the COVID-19 pandemic to the hostile political climate and repeated acts of racist and transphobic violence… LGBTQ youth face unique mental health challenges and continue to experience disparities in access to affirming care, family rejection, and discrimination.”

- Amit Paley, CEO & Executive Director, The Trevor Project

LGBTQ+ Teenage Addiction Treatment: 9 Important Questions

When your child is suffering with a substance use disorder, or a co-occurring disorder, it can make your child and you extremely stressed, and even fearful. The natural temptation would be to grab the first offer of help that comes along. Please, don’t do that. It’s vital you take the time to ask the right kind of questions first.

It’s important for you, as their parent or guardian, to understand that not all addiction treatment programs are the same. Unfortunately, LGBTQ patients, and especially transgender patients, have high than average rates of walking out of their treatment, and causes for this can range from a lack of support, therapists who don’t understand, inadequate facilities, disrespectful staff, to unresolved bullying by other patients.

So before you sign on the dotted line of the first addiction treatment patient form place in front of you, ensure you ask these important questions of the addiction treatment facility:

  1. Do you have any LGBTQ-identified clinicians, counselors, or other support staff?

Discussing personal issues and experiences with a counselor can be difficult for most people. However, these discussions are critical in successful addiction recovery. Obviously, a counselor who has experienced similar attitudes and issues will be able to earn the trust of their LGBTQ+ patient far quicker. Be sure to find out if rehab staff are LGBTQ+ themselves, or at least have stated they’re happy to work with members of the community.

  1. What LGBTQ certifications / training does your staff have to treat my child’s needs?

LGBTQ+-related certifications and training are no guarantee of a perfect program of treatment, but it shows these staff are knowledgeable about identity and gender experience.

  1. How will your program make my child feel welcome and included?

It’s vital that your child feels welcome, safe and content within an addiction treatment setting. Additionally, it is important that confidentiality is given a high priority, especially with information about sexual orientation or gender identity.

  1. Does your program offer specialized groups for LGBTQ people?

Research has consistently highlighted that addiction treatment programs with groups specifically for LGBTQ+ patients have far better outcomes and success rates. Effective therapies for LGBTQ+ individuals include motivational interviewing, social support therapy, contingency management, and cognitive behavioral therapy (CBT). Ask if these are available as standard within the program.

  1. How does the treatment program address trauma, self-harm, depression or other mental health issues?

It is well known that many LGBTQ people who enter addiction treatment suffer with a co-occurring disorder, meaning they have also been diagnosed with a mental health disorder. If this type of disorder applies to your child, make sure that any treatment program you are considering offers co-occurring treatment, and will treat both conditions simultaneously.

  1. How will you address the special needs my child has due to their identity?

Asking questions about the LGBTQ-specific needs of your child is to ensure as best as you can that they have the best possible chance of success in their recovery. Is the vocabulary prospective counselors are using respectful, up-to-date and informed?

Furthermore, will hormonal therapy be adequately managed if your trans child is in residential treatment? How does the treatment facility address HIV, STDs, hepatitis and other health issues if they need to? Obviously, stay away from any programs offering “Conversion Therapy.”

  1. What has the provider’s experience been with treating LGBTQ people like my child?

Treatment providers should be able to tell you about how they have served your child’s population previously. For example, you can ask how the recovery program has helped other LGBTQ patients in the past. Did those patients complete the program? How successful were those programs?

  1. What are the bathroom and sleeping arrangements?

If your child is transgender, ask if the treatment facility has co-ed bathrooms, showers and sleeping areas. Will they share a room with people who share their gender expression? Asking for a private room and bathroom can be an option, where possible.

  1. How familiar is the program with LGBTQ resources in your community for your child’s continuing care plan?

On completion of the program, your child may move to a lower level of care. Understanding your child’s needs from this point on is important. Be confident that any “Relapse Prevention Plan” provided by the treatment facility addresses all of your child’s needs from this point onwards.

LGBTQ+ Addiction Recovery Support & Resources

The LGBTQ community has many addiction recovery support organizations, programs and groups that can access to help your child, other family members and yourself, such as:

Please read our comment policy. - The Fix
Robert Castan.jpg

Robert Castan is the CEO of SpringBoard Recovery in Scottsdale, Arizona. Robert started his professional career as a house manager and has become an industry leader and trusted voice in the treatment world. He brings extensive knowledge of organizational growth, industry-leading outcomes, and comprehensive marketing to SpringBoard Recovery.
 
Robert has been walking his own path of recovery for over 10 years.  This path has truly driven his ambition to help make treatment available to others who are struggling with addiction.  Robert finds great joy in traveling and keeping physically active, with an emphasis on biking. Robert resides in Arizona with his husband and two four-legged children.