A Guide to Addiction and Recovery for LGBT Populations
Lesbian, gay, bisexual, and transgender (LGBT) individuals are more likely to use drugs and alcohol due to homophobia, rejection from families, and a history of trauma. They face a number of barriers that make it difficult for them to enter rehab, and they often have certain unique needs that must be addressed for them to recover. Research shows that LGBT individuals have better outcomes in treatment and addiction recovery when they are part of an LGBT-specific program or a program that is LGBT-friendly.
Why Does the LGBT Population Use Drugs and Alcohol?
An estimated 30% of the LGBT population struggles with addiction, and addiction is 2-4 times more prevalent in the LGBT population than the general population. There are a number of factors that contribute to high rates of substance abuse in this community, including: 1,2
- Homophobia and heterosexism. The term “homophobia” refers to the social, psychological, and political oppression of LGBT individuals. Because of deep-rooted homophobic and heterosexist views in the United States, LGBT people may experience discrimination in marriage, housing, employment, and other civil rights, leading to depression and anxiety. Lesbian, gay, and bisexual youth are 4 times more likely to make a suicide attempt than straight youth, and 40% of transgender adults have attempted suicide. 3
- Gay bars. For many within the LGBT community, gay bars are the center of social activity. They are a safe space where people can be themselves and not feel the discrimination of people outside their community. People may also attend circuit parties, raves, and gay pride parades where heavy drinking and drug use are common and expected – contributing to high rates of substance abuse.
- Rejection from families. If a young person comes out and is not accepted by their family, it places them at a higher risk for developing a substance abuse disorder. One study found that if a person experienced a moderate level of rejection, they were 1.5 times more likely to use substances than a person who experienced little or no rejection. If a young person experienced a high level of rejection, they were 3.5 times more likely to use illegal substances.4
- Trauma. Members of the LGBT community are disproportionately affected by trauma. According to the American Psychological Association, the most common types of traumas include sexual assault, intimate partner violence, and hate violence (such as discrimination or violence based on gender or sexual orientation).5 Trauma can have a major behavioral health impact. Up to two-thirds of adults in treatment for addiction are victims of child abuse and neglect, and 70% of youth in rehab have been exposed to trauma.6
Other factors that contribute to an LGBT person’s likelihood of using substances may include shame and guilt about sexuality, as well as mental health disorders including anxiety, depression, and posttraumatic stress disorder (PTSD).
Which Drugs Are Commonly Abused in This Community?
According to the Centers for Disease Control and Prevention, when compared to the general population, lesbian, gay, bisexual, and transgender individuals are more likely to use drugs and alcohol and have higher rates of substance abuse. 8
Drug misuse is associated with risky sexual behavior and unprotected sex. Some people abuse alkyl nitrites (“poppers”) and Viagra, which can have significant side effects. 9
Other commonly abused substances include:
- Alcohol: A Substance Abuse and Mental Health Services Administration survey found that people who identified as LGBT and were 18 or older were more likely to have drunk alcohol in the past month and be binge drinkers. 30 A 5-year longitudinal study of LGBT youth found that males’ drinking increased significantly over time, compared to females. Female LGBT youth who had experienced threats or physical assaults because of their sexual orientation drank more alcohol. 10
- Tobacco: Young lesbians and bisexuals are almost 10 times more likely to smoke at least weekly compared to their heterosexual peers.11 In a California survey, 33% of gay men were smokers, compared with 21% of heterosexual men.12
- Marijuana: A 2006 study did not find any difference in marijuana use between LGBT and heterosexual individuals. However, a 2005 study found that men who were attracted only to men were more likely to report past month marijuana use than men attracted only to women.13
- Methamphetamine: Meth is a commonly abused club drug in the LGBT community. Lesbian and bisexual women are more likely than heterosexual women to use methamphetamine at least once in their lives.14
- MDMA (Ecstasy): In a study of men in New York City who have sex with other men, researchers found that 13.7% of respondents used the drug in the past 6 months. MDMA users were more likely to be younger, visit the bar and club, and have more gay and bisexual friends.15
- Liquid X (GHB): Among gay men, GHB is sometimes used for its disinhibiting effects. Its muscle relaxant properties can facilitate anal sex. It is commonly mixed into alcoholic drinks. GHB is colorless and tasteless, and some people report administering it to others with the intention of having sex without that individual’s consent and without that person remembering the encounter.16
- Cocaine: A study of high school students found that LGBT youth who attended a high school without a gay-straight alliance (a club that helps create a supportive environment for all students, regardless of sexual orientation) had an increased risk for using cocaine.17 Other studies find that use of cocaine is common among LGBT people, and heterosexual women are less likely to use cocaine than lesbian or bisexual women.18
- Alkyl nitrites (poppers): Some gay and bisexual men use poppers before sexual intercourse to relax the body, enlarge blood vessels, and reduce inhibitions. Popper use is associated with unprotected sex, risky sexual behavior, and increased risk of HIV.19
What Are the Signs That Someone Is Addicted?
Addiction is characterized by compulsive behavior and uncontrollable drug use despite negative health and social consequences.20 Symptoms of addiction will vary depending on the individual, their drug/s of choice, and their mental health status. But below are some general signs and symptoms:21
- Secretive behavior
- Neglecting one’s physical appearance (i.e., not showering or brushing teeth)
- Weight loss or weight gain
- Financial problems
- Mood swings
- Poor performance at work or school
- Bloodshot eyes
- Smells on body, breath, or clothing
- Change in friends
- Drug use despite relationship problems
- Tremors, slurred speech, or lack of coordination
- Change in appetite or sleep habits
- Legal problems
Addiction is a chronic condition. If it is left untreated, it can result in a number of negative social and health consequences including damaged relationships, financial problems, accidents, overdose, and death.
Why Do LGBT People Have a Hard Time Getting Treatment?
Homophobia, discrimination, and insensitivity can make it extremely difficult for LGBT people to feel comfortable getting treatment. If a lesbian, gay, bisexual, or transgender individual is denied medical or social services, they will often turn to social workers, rape crisis counselors, and emergency shelter providers for support.
- One report found that 85% of advocates said they worked with a member of the LGBT community who had been denied services based on their sexual orientation or gender identity.
- In 2011, a study found that 21% of transgender black respondents and 23% of transgender Latina/o respondents were refused medical care because of their identity.
- Another study found that 70% of transgender participants were discriminated against by medical providers.22
In addition, very few substance abuse treatment programs are equipped with trained staff and culturally competent programming to meet the needs of this population.
Other barriers to treatment may include but are not limited to:23,24,25,26
- Fear of being stigmatized.
- Cost of services.
- Hearing about bad experiences.
- Not wanting to talk about their personal life.
- Not wanting to talk in groups.
- Not wanting to take medications.
- Inadequate insurance.
- Past negative experiences in treatment.
- Lack of culturally competent providers.
- Experiencing physical or verbal abuse by other clients and/or staff.
- Being required to wear clothes based on sex instead of their identified gender.
- Being required to shower or sleep in areas based on sex instead of their identified gender.
What Are the Special Needs of These People in Treatment?
Providers should have a solid understanding of the stressors and traumatic events that lesbian, gay, bisexual, and transgender individuals face, including: 29,30
- Sexual abuse in childhood.
- Family abandonment or disconnect.
- Inadequate access to healthcare resources.
- Shortage of healthcare providers who are trained in treating LGBT issues.
- Historical trauma (such as the Orlando Nightclub shooting, Matthew Shepard murder, and Harvey Milk assassination).
- Bullying in schools.
- Discrimination in access to marriage rights.
- Being rejected from religion for their sexual orientation.
- HIV/AIDS diagnosis.
Given the high rate of substance use and substance use disorders, psychiatric disorders, and suicide among LGBT people, it is important that they feel safe to share experiences related to sexuality while in treatment. Treatment centers that provide appropriate services for co-occurring issues such as HIV and STDs, anxiety, depression, and PTSD, are frequently in a better position to meet the treatment needs of LGBT youth, adults, and elders.
What Are the Common Types of Recovery Programs?
Treatment for a substance use disorder can be given in a number of ways. Depending on your location, drug abused, and severity of addiction, you may be referred to any of the following types of recovery programs:
- Detox: You may begin treatment with detox, especially if it is medically necessary (e.g., with cases of alcohol and sedative addiction and, often, with opioid dependence). During this time, your body will slowly wean itself off of any substances. Following detox, you will be referred to the most appropriate next step in treatment, which could be an inpatient or outpatient facility.
- Inpatient: Inpatient treatment is often the treatment of choice for people with more severe addictions. These programs offer 24/7 monitoring by medical staff to ensure that your withdrawal signs are monitored and taken care of. These centers also offer comprehensive treatment programs that include counseling, group therapy, 12-step meetings, recreational activities, and medical care. Many inpatient facilities can simultaneously treat any co-occurring mental health disorders.
- Outpatient: Outpatient programs rely heavily on group therapy sessions. If you have stable housing and your addiction is not severe, this may be a good option for you. During outpatient treatment, you will visit the facility throughout the week to work with a therapist and engage in group therapy.
- Partial hospitalization (PHP): PHP programs are outpatient services that allow you to visit the facility during the day but do not require an overnight stay. Treatment lasts several hours each day and includes many of the same services found in inpatient programs.
- Intensive outpatient (IOP): IOPs usually require more of a time commitment than standard outpatient programs, but they still allow you to live at home. Group sessions are at the crux of most IOP programs.
- 12-Step programs: Twelve-step support groups such as Narcotics Anonymous are based on the 12 Steps of Alcoholics Anonymous. Many people in recovery attend groups for support and to stay involved in the recovery community. Groups meet monthly or weekly and provide a space for you to reach out to others who struggle with substance abuse. Most LGBT nonprofit programs and resource centers will host 12-step groups at their facilities.
Given the high rates of mental health issues in the LGBT community, therapy can play a vital role in treating addiction. LGBT individuals who are in therapy often report feeling anxious, fearful, isolated, depressed, and have trouble trusting other people. All of these feelings can fuel substance abuse, so it’s especially important to address mental health concerns during treatment.
Numerous studies have found that both individual counseling and 12-step program participation are beneficial components of substance abuse treatment. Depending on your situation, you may engage in any or all of the following during rehab:
- Individual therapy: During one-on-one sessions with a licensed therapist or counselor, you will work through underlying issues related to addiction. You may talk about significant personal experiences that happened in childhood, past trauma, or how you are coping with addiction treatment. All conversations with a therapist are 100% confidential, and you can feel free to open up and share anything that’s on your mind and receive professional feedback and/or support.
- Group therapy: In group sessions, you will gather with others and share feelings, thoughts, and reflections about what you are going through. Sessions may be facilitated by a counselor and cover a wide variety of topics related to substance abuse and mental health.
- Culturally tailored, gay-specific cognitive behavioral therapy: Gay-specific cognitive therapy helps to address sexually risky behaviors such as unprotected sex while also targeting addiction. This therapy has been shown to be effective in LGBT populations.31
- Family therapy: If your family is willing to go to family therapy, it can be an incredibly healthy step in your recovery. You may have never opened up to your family about issues underlying your addiction, and in family therapy you can feel free to express yourself with the help of a professional therapist or counselor. It may be hard at first, but talking through issues can help family members understand each other more and practice more compassion toward one another.
- Couples therapy: By working together in couples therapy, your partner may learn how to better communicate, create healthy boundaries, and support you. It is likely that your addiction has affected their life, and you both can learn skills that will strengthen the relationship and repair past damage.
How Do You Find an LGBT Rehab Center?
According to the National Survey of Substance Abuse Treatment Services (N-SSATS), only 6% of rehab centers offer specialized programs for the LGBT population. The survey found that private, for-profit treatment centers, as well as facilities that treat both substance abuse and mental health, were more likely to offer LGBT programming.32
Although the percentage of centers offering treatment tailored to the LGBT community is small, many centers offer LGBT tracks as part of a larger program. Also keep in mind that even if a recovery program does not offer exclusive LGBT treatment, it may still offer an accepting and supportive environment.
If you are looking for a center that specializes in LGBT treatment, you can begin by searching online and reading reviews. Other ways to find an LGBT program include:
- Researching the staff and their experience: When you call rehab centers, you can ask about how the staff were trained and educated on LGBT issues. Most treatment websites will feature the staff, their bios, and credentials. Try to get an understanding of the providers’ experience and competence in treating LGBT substance abuse issues. Some centers even have public data available on treatment outcomes for past LGBT clients.
- Asking about accommodations for transgender patients: Unfortunately, transgender patients may face issues with restrooms and sleeping arrangements. The treatment center you choose should be sensitive to these issues and ensure that you feel safe in the facility.
- Asking about culturally sensitive treatment and therapies: When providers have an in-depth understanding about the population they’re treating, they are able to deliver better care.
- Talking to people in 12-step programs, therapists, and other members of the LGBT community: Often, you can get great advice from people who have been through treatment about what centers provide LGBT-specific programs.
- Looking for terms in a treatment center’s description: Keep an eye out for phrases such as “LGBT tolerant,” “LGBT sensitive,” and “LGBT affirming.”
- Using SAMSHA’s behavioral health treatment locator: You can search for facilities by entering your zip code, clicking the substance abuse (SA) checkbox, then checking “lesbian, gay, bisexual, or transgender (LGBT) clients.”
What Happens After Rehab?
Rehab is the beginning of recovery, not the end. As you transition out of treatment, set up an aftercare plan of ongoing support and recovery services to keep you on track. Work with treatment staff to create a plan that includes any combination of the following:
- Support groups: LGBT community centers around the country hold 12-step meetings. Attending a group can help you feel respected and supported. You can find a 12-step group that focuses on your drug of choice (i.e. Alcoholics Anonymous, Crystal Meth Anonymous, Cocaine Anonymous). You can also seek support through a secular support group such as LifeRing or Smart Recovery.
- Therapy/counseling: Finding a therapist or counselor who is trained in providing treatment to LGBT clients can make you feel more comfortable. Many providers are aware of issues specific to the LGBT community, and they will understand how orientation, identity, and other factors interact with addiction.
- Employment assistance: If you stopped working during treatment or you are re-entering the workforce, your discharge plan may include resources for getting help with your resume, conducting a thorough job search, gathering references, and preparing for interviews. If you are going back to your original place of employment, you may work with a counselor on creating work-life balance, using stress-reduction techniques, and avoiding triggers.
- Sober living: You may be referred to a sober living home (halfway house) after completing inpatient treatment. In a halfway house, you will continue to attend 12-step groups or see a therapist, learn life skills, and look for work, school, or volunteer opportunities. Sober living homes give you extra time to stabilize before fully transitioning out of treatment.
- LGBT National Help Center: This help center operates 3 hotlines specifically for the LGBT community – the LGBT National Hotline (1-888-843-4564), the LGBT National Youth Talkline (1-800-246-7743), and the SAGE LGBT Elder Hotline (1-888-234-7243). They also offer one-on-one online chats for adults and youth.
- The Trevor Project: If you need to talk to someone, trained counselors are available 24/7 to chat over the phone. If you are having suicidal thoughts or you want to talk and vent to someone who will listen without judgment, call the Trevor Lifeline at (1-866-488-7386). If you feel more comfortable texting, you can use TrevorText by texting “Trevor” to (1-202-304-1200).
- The Movement Advancement Project: This PDF contains information on how to talk about suicide with LGBT youth.
- Faith-Based Addiction Treatment
- Couples’ Addiction Treatment
- Holistic Addiction Treatment