One of the most common reasons that people use drugs and alcohol is to cope with stress. Lesbian, gay, bisexual, and transgendered (LGBT) people are likely to experience more stress than their heterosexual counterparts. Stressful circumstances might include:
- The decision of whether to come out, and if so, how
- Rejection or punishment from family members
- Bullying and harassment growing up
- Fears of discrimination in social and work situations
- Fears of physical violence
- Feeling alone and different
- Shame or negative self-view
The Center for American Progress reports that 20 to 30 percent of LGBT people use drugs and alcohol, compared to about nine percent of people in the general population. In addition, stress also aggravates mental illness (which in turn can drive people to use substances to self-medicate). As such, LGBT individuals are more likely to experience depression, anxiety, PTSD, and other mental health disorders, reports the Substance Abuse and Mental Health Services Administration (SAMHSA). They are also more likely to experience suicidal thoughts and to attempt suicide.
However, stress isn’t the only reason people use drugs and alcohol. Substance use can have a strong social component, giving people a reason to meet in clubs and bars. Party subcultures among LGBT communities can also encourage substance use and abuse. A study in the UK reported in the Independent found that the drugs most widely used by LGBT individuals were party drugs – cannabis , poppers, cocaine, Ecstasy, ketamine, and amphetamines.
A more specific breakdown by SAMHSA found:
- Lesbian women are more likely to drink alcohol heavily and 1.5 to two times more likely smoke tobacco and marijuana than heterosexual women. These differences were linked to emotional distress, especially that caused by gay-related stressful experiences like homophobia. Lesbian women are also more likely to experience depression, phobia, and PTSD. Lesbian and bisexual women who are out are two to 2.5 times more likely to experience suicidal thoughts than heterosexual women, and lesbian and bisexual women who are not out are more likely to have attempted suicide than heterosexual women.
- Gay men smoke cigarettes as much as 50 percent more than heterosexual men, and also use illicit drugs at higher rates. They experience depression and anxiety at higher rates than in the general population, especially among men who are still in the closet. Suicide rates are also higher, triggered by factors including harassment, family rejection, and isolation.
- Bisexual people smoke tobacco at higher rates than heterosexual or homosexual people, with rates as high as 30 or 40 percent. Bisexual women are also eight percent more prone to binge drink than straight women. Depression and anxiety are more common among bisexual people than the general population, with depression twice as prevalent as among heterosexuals (37 percent versus 17 percent). The risk of self-harm and suicide is higher among bisexuals than among either heterosexuals or homosexuals.
- Transgender people smoke tobacco at high rates (45 to 74 percent). For transgender women taking estrogen, this can greatly increase the risk of blood clots. Other drugs of concern include marijuana, cocaine, alcohol, methamphetamine, and injected drugs. Few studies have examined the mental health status of transgender individuals, save for one area – 38 to 65 percent of transgender people have experienced suicidal thoughts, and 16 to 32 percent have attempted suicide.
These circumstances make it crucial for LGBT individuals to have access to mental health and substance abuse treatment. However, the issues that LGBT individuals face may present additional difficulties when finding the right treatment program.
- Coming out is often a difficult process, and it doesn’t happen just once, but over and over. When people feel that they have to hide their sexual orientation or gender identity from their therapist, this weakens the client-therapist relationship and makes treatment more difficult. SAMHSA found that lesbian and bisexual women are more likely to consult their doctor for emotional reasons if their doctor is already aware of their sexual orientation.
- Many treatment centers have gender-specific residential facilities and programs. Transgender, genderqueer, and other non-binary-conforming individuals may experience distress if required to use the facilities designated for their biological sex or to conform to other requirements, such as a gender-specific dress code.
- In non-LGBT-friendly settings, LGBT individuals might experience verbal or physical abuse from other clients or even staff.
A study of LGBT-specific treatment programs in Substance Use & Misuse found that about 12 percent of treatment facilities reported that they offered LGBT-specific services. However, follow-up found that only 7.4 percent of them could identify a specific service tailored to LGBT clients – the rest simply reported that they accepted or did not discriminate against LGBT clients.
Tailored services really do make the difference. Another study in Substance Use & Misuse found that people who received services specific to LGBT groups had much higher rates of abstinence from substance use after completing treatment.
When it comes to co-occurring issues of substance abuse and mental health, dual diagnosis treatment can be the best way to help you start a new healthy life in recovery.
Call us today to learn more about how dual diagnosis care can help.
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David W. Newton is a board certified pharmacist and also has been a board member for boards of examiners for the National Association of Boards of Pharmacy since 1983. His areas of expertise are primarily pharmaceuticals as well as cannabinoids. You can read an article about his expertise in CBD on the National Library of Medicine.