Drug And Alcohol Treatment For LGBTQ+ Individuals

Drug and alcohol addiction treatment should look different for each client to help them reach their individual treatment goals, including LGBTQ+ people.

In order to best treat this group of people, rehab facilities need to have specialized programs that can address their unique backgrounds, risk factors, and challenges.

Not all treatment facilities offer specialized programs for LGBTQ+ members, but there are several that do.

LGBTQ+ Terminology

In order to speak to this community and best represent them as a group, or work in alliance with them, we need to know the correct terminology to use, and what these words mean.

Here are a few key terms to know:

• asexual: A person who is not sexually attracted to any gender.
• agender: A person who does not identify with any particular gender.
• ally: This is a person who is in active support of those who identify as LGBTQ+.
• cisgender: a person who identifies with the gender they were assigned at birth.
• gay: A person who is attracted to other members of their gender.
• gender-fluid: Someone who does not identify with a single fixed gender.
• gender identity: A person’s inner concept of being a certain gender.
• intersex: Having been born with reproductive or sexual anatomy that can’t be classified as either male or female.
• lesbian: A woman who is attracted to other women.
• LGBTQ+: Stands for lesbian, gay, bisexual, transgender, queer, plus, and includes several other sexual orientations to be inclusive to all.
• non-binary: A person who does not identify with being male or female.
• queer: This is an inclusive term that can encompass anyone who is gender-fluid, questioning, non-straight, and more.
• questioning: Someone who is in the process of exploring their gender identity or sexuality.
• transgender: A person whose gender is different from the gender they were assigned at birth.

The term LGBT has been used since the late 1980s to represent lesbian, gay, bisexual, and transgender individuals, which stemmed from the original LGB (lesbian, gay, bisexual).

Though the term “queer” used to be a slur, the LGBT community reclaimed the word around the early 1990s and updated the acronym to LGBTQ (“Q” stands for questioning and/or queer).

Since then, it’s expanded even further to include a full range of identifying members, such as intersex, asexual, agender, and others (the “I” and “A” in LGBTQIA+).

Addiction Treatment For LGBTQ+ Individuals

The Substance Abuse and Mental Health Services Administration (SAMHSA) has provided several guidelines on how to approach addiction treatment for the LGBTQ+ community.

LGBTQ+ members should have access to the same levels of care and services available to other clients.

Where treatment may differ is in the accessibility of treatment, degree of sensitivity, and their principles of care.

LGBTQ+ Issues In Addiction Treatment

The first step to providing better treatment for LGBTQ+ people is understanding the issues that this group often experiences that can affect treatment.

For example, an LGBTQ+ person may have estranged relationships with family members, so family therapy may not be a practical aspect to include in their recovery plan.

However, it can’t be assumed that all LGBTQ+ people have poor relationships with family members, as many have supportive families who accept their sexuality.

For this reason, LGBTQ+ friendly rehab programs will typically gather intel in the initial assessments and meetings to determine what issues their clients are dealing with.

This ensures that the client can get proper treatment not hindered by assumptions of a lack of information.

Accessibility Of Treatment

Simply offering the same types of treatment to LGBTQ+ individuals may not be enough in many circumstances. LGBTQ+ friendly treatment centers should make an active effort to be inclusive.

Treatment providers may be:

• ill-trained on how to treat LGBTQ+ individuals
• biased based on personal beliefs
• uninformed about LGBTQ+ issues
• insensitive to their concerns

Because of these potential drawbacks, LGBTQ+ accepting rehab centers should be aware of the issues their clients might run into (such as fear of homophobia) and respond to it.

Instead of assuming to know the issues their LGBTQ+ members have, treatment specialists should ask lots of questions and empathize with their clients.

Therapists and treatment providers should ask clients why they hold certain fears, whether they’ve felt hostility over those things, and discover where negative feelings came from.

Some changes may be seen, which include the following:

• treatment providers should ask LGBTQ+ clients what gender they prefer working with, such as urine test observers, and not assume the client identifies with one gender
• if possible, create non-gender-specific restrooms and shower facilities
• removing personal bias, such as assuming LGBTQ+ members are more likely to flirt with other members of the program
• impose the same rules regarding sexual interactions, flirting, and dating for all clients

Increased Sensitivity

SAMHSA rates the degree of sensitivity a rehab center possesses on a scale that ranges from anti-LGBT to LGBT-affirming.

The scale is as follows:

• anti-LGBT treatment: There is no LGBT sensitivity and antagonistic toward these program members.
• traditional treatment: There is no LGBT sensitivity and no realization that there are LGBT clients, assuming everyone is heterosexual.
• LGBT-naive treatment: There is no LGBT sensitivity, and treatment providers recognize that clients may be LGBT, but do not address LGBT-specific issues.
• LGBT-tolerant treatment: There is minimal LGBT sensitivity, as discussion of the topic of LGBT members is mentioned but not truly discussed.
• LGBT-sensitive treatment: There is a moderate level of sensitivity where clients and staff feel open to express their sexuality, and specialized groups are offered.
• LGBT-affirming treatment: There is a high level of sensitivity as the program targets LGBT people and all program components are LGBT-specific.

Ideally, all treatment programs will offer LGBT sensitive treatment; however, many treatment programs are not aware of the issues LGBT people have and do nothing to address them.

Most treatment centers that offer LGBTQ+ treatment will fall into the LGBT-sensitive treatment category, and few will offer LGBT-affirming treatment.

At an LGBTQ+ friendly rehab center, you can expect:

• to be treated with dignity and respect
• verbal affirmation that it’s ok to be LGBTQ+
• recognition and acceptance of LGBTQ+ people
• verbal affirmation that you will not be harassed by staff or other clients due to your gender identification or sexual orientation
• staff to take action if you experience homophobia at the treatment facility
• LGBTQ+ discussion groups
• workshops specifically for LGBTQ+ clients
• LGBTQ+-specific materials

Principles Of Care In LGBTQ+ Friendly Rehab Programs

To implement many of the above LGBT-sensitive measures, an LGBTQ+ friendly treatment facility will have certain principles of care that offer respect and acceptance of all clients.

SAMHSA suggests using the following principles when treating LGBTQ+ people:

• be flexible and client-centered
• be coordinated, integrated, and comprehensive
• be consistent with each client’s cultural needs and expectations
• promote self-respect and personal dignity
• promote healthier behaviors
• empower people in substance abuse treatment to make decisions in collaboration with the service provider
• reduce barriers to services for hard-to-reach populations
• develop and deliver services that are clinically informed and research-based
• work to create a treatment/recovery community

What Research Says About LGBTQ+ People And Substance Abuse

According to this national survey from 2015, people of a sexual minority are more likely to engage in substance abuse and have mental health issues than those in the sexual majority.

As compared to the sexual majority, LGBTQ+ members are more likely to:

• use illicit drugs
• smoke cigarettes
• drink alcohol
• have substance use disorders
• need substance use treatment
• have a depressive episode
• have any mental illness

Fortunately, it seems LGBTQ+ members are more willing to get treatment for addiction and their mental health.

The survey revealed that people who are sexual minorities are more likely than people in the sexual majority to receive treatment for mental health, and substance use at a specialty facility.

But encouraging proper treatment involves providing the right programs that can meet the needs of this group, which not all rehab centers offer.

Challenges Unique To The LGBTQ+ Community

Those who identify as lesbian, gay, bisexual, transgender, queer, questioning, or another gender or sexual orientation experience challenges that may increase their risk of abusing substances.

These challenges range from societal pressures to emotional and mental issues, which are detailed below.

Social Pressures

Though there are great efforts and trends toward acceptance, there’s still a long way to go for those who identify as LGBTQ+.

The pressures from society to fit in can be overwhelming for many people who don’t believe they fit those set standards.

LGBTQ+ people may face homophobia, biphobia, transphobia, and other judgments that keep them from coming out or getting help when they need it.

This creates a need to escape from negative emotions, such as depression, fear of judgment, or anxiety over telling family members about their sexual orientation.

Substances have long served as a way to dull negative feelings for people of all ages, genders, races, and sexualities.

With the pressures of bullying from classmates, judgment from coworkers, and the need to hide what they perceive to be their true identity, many LGBTQ+ members use substances to cope.

LGBTQ+ Cultural Norms

As the LGBT movement took stride, many members of the community boasted their pride in bars, clubs, and other places of social gathering centered on substances.

Starting in about the mid-1990s, club drugs (primarily cocaine, ecstasy, GHB, ketamine, and methamphetamine) gained popularity among gay and bisexual male social circles.

Researchers have found that each of these drugs are heavily linked to dance clubs, with other notable locations being bars, commercial and public sex environments, and private residences.

Many of these people engaged in polydrug use; that is, using a combination of multiple substances simultaneously.

This type of drug use spurred a number of issues, including:

• risks of developing addictions and chemical dependencies
• an increased risk of overdose
• decreased cognitive function and inhibition
• risky behavior, including unprotected sex
• the spread of HIV and other bacterial and viral illnesses

For many members of this demographic, drug and alcohol use wasn’t really a choice, it was a way of life.

Not all LGBTQ+ people engage in drug use, but this cultural acceptance of drinking and doing drugs began a strong wave of substance use, leading many down a path of addiction.

Mental And Emotional Stress

LGBTQ+ people carry heavy burdens that their sexual majority peers do not face. Many of the issues mentioned previously (fear, depression, rejection, and more) cause serious mental effects.

Lesbian, gay, and bisexual adults are more than twice as likely as heterosexual adults to experience a mental health condition.

Transgender adults are more than four times as likely to have a mental health condition than heterosexual adults.

And according to a study published by the Journal of Adolescent Health, transgender and nonbinary youth:

are physically threatened or harmed at twice the rate of cisgender LGBTQ youth
report the highest rates of depressive moods, suicidal thoughts, and attempted suicides

One 2020 study showed that gay men, bisexual men, and bisexual women showed higher reports of co-occurring conditions, such as substance abuse and mental illness.

The study revealed that middle-aged and older LGB adults are at high risk for experiencing co-occurring drug use and mental illness.

The 2015 U.S. Transgender Survey found that 40% of transgender people have attempted suicide in their lifetime — that’s almost nine times the rate of the general population (4.6%).

Resources For LGBTQ+ Individuals

The resources included below may help you or a loved one to find assistance getting mental health treatment, addiction treatment, or other support.

LGBTQ+ activist organizations:

• Bisexual Resource Center: Here, you can find information on what it means to be bisexual, mental health and the bisexual+ community, and more.
• GLAAD: This resource addresses issues pertinent to the LGBTQ+ community, starting important conversations and cultural change.
• It Gets Better Project: This is a non-profit organization that uses media programming, educational resources, and more to reach young members of the LGBTQ+ community.
• National LGBTQ Task Force: This organization fights for freedom, justice, equality and equity for LGBTQ people.
• True Colors United: True Colors United fights LGBTQ+ youth homelessness.

Organizations that promote awareness of mental health and substance abuse for the LGBTQ+ community:

• The Association of Lesbian, Gay, Bisexual, Transgender Addiction Professionals and Their Allies: Promotes the prevention and treatment of addiction in LGBTQ+ people.
• Recovery Research Institute, LGBTQ+ & Recovery: Learn about what addiction treatment involves for LGBTQ+ people.
• The Trevor Project: This is a suicide prevention and crisis intervention organization for young LGBTQ+ people.
• The Triangle Club: This is a non-profit organization serving LGBTQ+ individuals recovering from addiction in the Washington D.C. area.

Hotlines you can call:

• Crisis Text Line: Text HOME to 741741, get 24/7 support from a trained crisis counselor.
• ​LGBT National Hotline: Call this hotline to speak about issues such as coming out, relationship concerns, bullying, and more.
• LGBT National Youth Talkline: This helpline offers free, confidential support for LGBTQ+ people 25 and younger.
• National Suicide Prevention Lifeline: This lifeline is available to anyone in emotional distress or a suicidal crisis.
• Rape, Abuse & Incest National Network (RAINN) National Sexual Assault Hotline: Call (800) 656-HOPE or reach out to their chat line.
• Trans Lifeline: Call this peer support phone service and talk with someone who identifies as trans and can help you through a crisis.

Information for further reading on LGBTQ+ individuals and substance use/mental health:

• Human Rights Campaign Foundation (HRC), Preventing Substance Abuse Among LGBTQ Teens: Find risk factors for addiction and action steps to help LGBTQ+ teens.
• LGBT National Help Center: The Help Center provides programs and resources for LGBTQ+ individuals, such as online peer support chats and a resource locator tool.
• National Alliance on Mental Illness (NAMI), LGBTQI: This page discusses the risk factors associated with mental health and how to find a mental health professional.

Substance abuse and mental health self-screening tools:

• Mental Health America, Take a Mental Health Test: Take this free test to screen yourself on mental health conditions, such as depression, PTSD, or anxiety.
• MindWise Innovations behavioral health screening: Take this free test to screen for issues related to substance abuse and mental health.
• Talk Space, Take a free mental health test: Several online tests are available to test for symptoms of mental illness.

Written by the Addiction Resource Editorial Staff