Substance Abuse in the LGBTQ Community: More Than a Trend

It’s easy to make the connection between bullying, social stigma, and other social stressors and the skyrocketing rates of drug abuse and addiction in the LGBTQ community. The statistics, which are listed in this article, speak for themselves. There are other aspects of substance abuse in this community that are equally important, however, such as the causes of abuse and addiction, contributing factors, and possible treatment options.

LGBTQ Substance Abuse Facts

According to a survey carried out by the Center for American Progress, gay men and women are twice as likely to binge-drink as their heterosexual counterparts (29% to 15%). Moreover, 16% of LGBTQ (lesbian, gay, bisexual, transgender, and queer) people consumed alcohol at levels that put them in danger of addiction. In contrast, the heterosexual population was exactly four times less likely to drink at these levels.

Homosexual and bisexual men are 12 times more likely to take amphetamines and almost 10 times more likely to use heroin than heterosexual men. 30% of the LGBTQ community reports abuse of alcohol or drugs, compared to just 9% of the heterosexual population.

Drug abuse in LGBTQ by substances chart
Drug Abuse and Suicide Rates in the LGBT population

In 2015, the National Survey on Drug Use and Health found that almost 40% of gay, lesbian or bisexual adults had used an illicit drug in the past year, compared to just over 17% of straight respondents. Another study found that LGBTQ teens were 90% more likely to do drugs than their heterosexual peers.

Substance Use Disorder in the Past Year among LGBTQ and heterosexual chart

Substance Abuse and Sexuality – The Missing Link?

Studies are starting to go beyond the conventional homosexual/heterosexual divide to examine bisexual attraction, identity, and behavior. A significant finding in this regard is that bisexuality correlates more strongly with substance abuse than both exclusive homosexuality and heterosexuality. A study by McCabe and Hughes established that women who identified as bisexual or reported having sex with men and women reported greater substance use than women who were exclusively heterosexual or homosexual. Men who reported being mostly heterosexual used more drugs than exclusively heterosexual men. This finding is interesting in that it may suggest the likelihood of increased risk for individuals, whose behavior and identity are somewhat contrasting.

“Being Out” and Abusing Drugs

The terms “being out” or “outness” refer to disclosing one’s sexual orientation to social network members. A study by Theide et al. (2001) found that MSM (males who have sex with males) who were out to more than 50% of the people in their social network reported higher levels of substance use. Moreover, use of MDMA by members of this group is associated with having more bisexual or gay friends and having “come out” to more people (Klitzman, Pollack, Doleza). Recent club drug use was associated with disclosure of one’s sexual orientation to most or all of one’s relatives according to a study by Kipke et al. in 2007.

Rates of Abuse per Drug Type in LGBTQ Compared to General Population

McCabe et al. (2009) found that the connection between substance abuse and addiction and sexual identity, going beyond the scope of behavior and attraction, is stronger than that between homosexual attraction or behavior, abuse, and addiction. This is most likely due to sexual minority stressors influencing substance use in this social group. It may, however, also be possible that the members of the LGBTQ community face a higher risk for substance use as a result of peer influence, feelings or isolation, anxiety, depression, or lower self-esteem

Causes of LGBTQ Substance Abuse

There are a number of causes of the elevated substance use in this community. Sexual minority stress and the importance of the bar and club scene are outlined as the main ones, the former including homophobia and discrimination according to Hughes & Eliason.

The stress of being a member of a sexual minority contributes to higher substance use and substance abuse according to Meyer, who proposed the minority stress model as a way of grasping the experiences of the community in the context of unique stressors. In Meyer’s study, minority stressors were defined as stigma related to expectations of rejection, internalized homophobia, which involves directing society’s negative attitudes to homosexuality toward the self, and being the victim of a violent crime. All these factors contribute to this population’s increased tendency to abuse alcohol and drugs.

The Williams Institute of UCLA found that every fourth LGBT employee reported having been discriminated against in the last 5 years, and only 66% of LGBT employees disclosed their sexual orientation at work. In addition, this study established that LGBT employees who had experienced employment discrimination or fear such were more likely to abuse drugs and alcohol, had more health problems, suffered from higher levels of psychological distress, reported less job satisfaction and bigger rates of absenteeism, and were more likely to quit their jobs than LGBT employees who were not afraid of or had not experienced discrimination.

Studies show clear support of the role of partner and peer drinking and drug use in shaping individual use patterns (Homish & Leonard, McCrady). Alcohol use disorder treatment often includes close examination of drinking within one’s social network. The effects of social network drug use are not limited to partners. The majority of findings in this area are based on the social learning perspective, which is that people learn behavior by observation. This has led scientists and clinicians to predict differences between heterosexual and homosexual/bisexual substance use.

Historically, LGB communities have been centered on activities that involve drug use and drinking, meeting at gay bars or LGB circuit parties. Although this is slowly starting to change, this tendency has led to the growth of social networks of LGB individuals, who drink or do drugs more often and in higher amounts than their heterosexual counterparts. This also makes it more difficult for members of the LGBTQ community to avoid substance use triggers, such as peers who use and bars.

Expectancies about drug use and drinking, including the fact that they are perceived as normal among this population could increase the probability of LGB individuals making the decision to do drugs or drink heavily.

A quarter of respondents in a national transgender health survey cited by Reuters stated they had abused alcohol and drugs in response to rejection by family members. Researchers established a direct link between feeling rejected after disclosing one’s orientation and drug and alcohol abuse, suicide attempts, and depression.

Studies conducted by Green and Feinstein have found that there exists a bidirectional relationship between substance use and being diagnosed with HIV. Substance use is a major risk factor for HIV-to-AIDS conversion as well as sexual behavior that heightens the probability of contracting HIV in the first place. However, evidence suggests that the relationship goes both ways – testing positive for HIV may affect substance use patterns. A study by Greenwood and colleagues found that HIV status was the strongest correlate of use of multiple drugs in MSM. More specifically, men in this group who were HIV positive and men who did not know their status reported higher drug use than men in the same group who knew they did not have HIV.

The connection between HIV-positive or unknown status, depression, anxiety, and elevated substance use is a fairly obvious one to infer. Likewise, a study by Stall and colleagues found that MSM who reported either a low or high number of HIV-positive individuals in their social network were less likely to abuse alcohol than those who reported moderate numbers of HIV-positive relatives or peers.

A possible reason for this tendency in those with higher numbers of HIV-positive persons in their social network could be that they have found constructive ways to deal with the negative emotions rather than resorting to drug or alcohol use or are simply more health-conscious. LGB individuals with few HIV-positive peers, on the other hand, are not as affected by negative emotions that could underlie substance abuse.

Being LGBTQ and Substance Abuse Risk

After disclosing their sexuality, members of the LGBTQ community face excessive social stigma, criticism, even violence. This impacts teens, college students, and adults in a variety of ways.

Past Year Illicit Drug Use among Sexual Minority by sex and age chart

LGBT Teens and Substance Abuse

Apart from being ostracized at school, LGBT youth also face challenges at home. Parents can respond to their LGBT teens in a negative way, which can have a tremendous impact on their physical and mental state. Many parents even proceed to throw these teens out, while other LGBT teens choose to run away from home to escape the emotional turmoil and stress. They frequently turn to alcohol and drugs as a way to cope.

According to the CDC, LGBT teens are at risks of behaviors that contribute to violence, risky sexual behavior, behavior that contribute to unintentional injuries, depression, and suicide attempts.

College Students and Substance Abuse

The experience of violence, discrimination, and hate leads to problems in mental and physical health of college students as well. Victimization can deplete an LGBTQ person of their sense of safety, trust, and security in the world. Effects on them include sleeping problems, digestive problems, headaches, substance abuse, agitation, post traumatic stress disorder, expectations of future discrimination, and hypervigilance. LGBTQ individuals are also at risk of developing poor self-esteem after internalizing these pressures even if they don’t experience hate, violence, or discrimination first-hand.

Although it is felt most strongly in the stages after coming out, internalized pressure doesn’t disappear even if the individual has accepted their sexuality or gender identity. Internalized oppression is an aspect of an LGBTQ student’s adjustment throughout university because of continued exposure to anti-LGBTQ attitudes and the strength of early socialization.

The Consequences of Oppression

Regardless of whether they choose to come out or not, having to deal with oppression can add excessive stress to an LGBTQ student’s already hectic college life. The social stigma of homosexuality, experiences of discrimination, ways that LGBTQ lives differ from heterosexuals’ lives, and lack of social support contribute to a higher risk of drug abuse.

Decades of studies have consistently documented a link between suicidal thoughts and attempts and LGBTQ students. Students who identified as being gay, lesbian, or bisexual were over five times more likely to have attempted suicide in the past year according to a number of recent studies. What is more, they were almost nine times more likely to have required medical care after attempting suicide. One Gender expression and/or identity is a factor in higher suicide rates and drug abuse rates in LGBTQ youth. In one study, students who reported having gender expressions or traits more often associated with the opposite sex faced a higher risk of suicide, irrespective of their sexual orientation.

Up to 88% of self-identified transgender youth are estimated to have seriously contemplated or attempted suicide.

Adults

Members of the LGBT community are exposed to chronically high levels of stress. Many LGBT adults continue to endure social prejudice, which can cause their emotions to spiral out of control. This includes discrimination in housing and relationship recognition as well as challenges and stigma with their friends and relatives. This type of stress can lead to higher levels of fear, anxiety, isolation, anger, depression, and mistrust, which can increase the risk of self-medicating with drugs and alcohol.

LGBTQ Drug Addiction and Comorbid Disorders

adult LGBTQ and heterosexual patients with comorbid disorders chart

LGBTQ members face a higher risk not only of excessive drug and alcohol use, but also other mental health problems. The little evidence that is available regarding mental health issues in the LGBTQ community is quite disconcerting. According to data of the National Alliance on Mental Illness, the overall mental illness rate of LGBTQ adults and teens of both sexes is almost 200% higher than the rate of the heterosexual population. SAMHSA reports that LGBT individuals face an increased risk of developing anxiety disorders and depressive disorders.

Comorbid disorders in the LGBTQ population are particularly problematic for a number of reasons. It is harder for doctors to diagnose overlapping mental health and substance-related issues than to diagnose isolated conditions. What is more, they need to devise a treatment plan that addresses the effects of each separate issue after making a diagnosis, not just the effects of a single issue.

A team of researchers analyzed the impact of sexuality on the odds of experiencing comorbid substance and mental health issues in a study published in the Journal of Studies on Alcohol and Drugs in 2012. Results showed that the LGBTQ community is affected by comorbid disorders more than 100% more often than the general population of the United States. These results mean that LGBTQ drug abuse or addiction treatment should include a separate mental health aspect to address all existing problems in participants in the rehab program.

Getting Help: Challenges before the LGBT Community

The most frequent challenge the LGBT community faces when trying to get help for substance abuse or addiction treatment is discrimination in health care. Other factors include specific social and cultural issues, such as pressure from being a sexual minority member.

  • Discrimination in Health Care

    A report by Reuters found that 42% of transgendered people were verbally or physically abused in a doctor’s office, or denied equal treatment. While this statistic is not directly connected to substance abuse, it signifies the extent, to which barriers to treatment exist for the community. What is more, the majority of respondents were Caucasian and young, with jobs, university degrees, and private health insurance. We can make quite a few inferences regarding the “treatment” economically marginalized persons or persons of color who are also members of the LGBTQ community are receiving.

  • Access to Treatment

    Members of the LGBTQ community are equally likely to face poor treatment and lack of access to such. A recent academic study by Southern Illinois University Carbondale showed that only 7.3% of rehab centers in the US offer programs tailored to the unique needs of LGBTQ clients. What is more, just 1.5% of all rehab centers nationwide target members of the LGBTQ community. More than 50% of these are located in either New York or California.

  • Cultural and Social Pressure

    As noted earlier, LGBTQ individuals face a great deal of social pressure due to their status of a sexual minority, such as being ostracized by peers, alienated from their families, and condemned by religious organizations after coming out. This separation can lead to feelings of isolation and limited social support, both of which cause mental health and/or substance use problems.
    In this case, an LGBTQ individual will experience double pressure, being both an addict and a sexual minority, two groups that suffer from intense social stigma. This compounded stigmatization keeps these people from getting help for substance abuse. For lesbian and bisexual women, the pressure is threefold. This is a major contributing factor to the high rates of substance use, and this tendency extends into older adulthood.
    Another major stressor is internalized heterosexism. A study on the relationship between substance abuse and internalized heterosexism in LGB populations revealed a positive association between drug and alcohol use and internalized homophobia. These findings have been corroborated by a series of other studies conducted by Cochran, Ackerman, Mays, and Ross.

How Important Is LGBTQ-Friendly Treatment?

It’s important that clinicians be aware of the unique challenges the LGBTQ population faces in terms of substance abuse in order to address the increased risk, in particular for drug problems in men and alcohol problems in women. Improving the understanding of treatment outcomes for substance abusers in this community is crucial, as research has shown LGBTQ abusers and addicts enter treatment with more severe substance abuse problems than their heterosexual counterparts.

Sexual Minority Adults who received and did not receive substance abuse treatment diagram

Differing Goals and Expectations

With respect to expected treatment outcomes, evidence suggests that abstaining from alcohol use completely is not the goal of choice for many bisexual and gay men who seek treatment for alcohol abuse. Further studies have found that this applies to lesbian and bisexual women as well.

A study by Green reported that 53% of LGBT respondents who abused alcohol reported a controlled or moderate drinking goal. Just 9% stated abstinence from alcohol as their goal.

Since studies have shown that treatments that don’t allow personal goal choice are less effective at reducing problematic drug and alcohol use, clinicians should take this into account when discussing treatment goals with members of this community, who in turn should be able to have access to the respective rehab programs.  

A study by Bux, published in the online library of the National Institutes of Health, showed that rehab programs tend to ignore the unique needs of problem drinkers or alcoholics in this population. More specifically, treatment providers have only limited awareness of issues related to sexuality, sexual orientation, and the unique features of gay and lesbian social and developmental experiences, which deters them from offering effective rehab programs.

  • Poor academic performance.
  • Missing school and/or extracurricular activities.
  • Getting into conflicts or trouble at school.
  • Becoming defiant, uncooperative, or hostile (e.g., violating curfew, ignoring rules, lashing out).
  • Increased illegal activity or behavior.
  • Decreased interest in activities and hobbies.
  • Changing friends or social circles.

A Rehab Center with LGBT Treatment Experience

Most importantly, LGBTQ individuals should ask if their rehab of choice has experience in treating members of their community. These persons are often also dealing with depression, anxiety, or suicidal thoughts related to aspects of their sexuality. A rehab facility with some experience is much better than one with little or none. A large number of prestigious rehabs often achieve mixed outcomes with their LGBT patients just because they don’t have enough experience counseling them. It’s crucial to do research. Asking a health care professional or another trusted individual is also recommended.