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The Connection Between Sexual Orientation and Substance Abuse

“(Researchers) have repeatedly called for studies of substance use to include all dimensions of sexuality…and as an apt example, their 2009 study found that prevalence rates for substance use in the past year and substance dependence varied among sexual minorities across the three dimensions of sexual orientation.” ~ Michael Shelton, Fundamentals of LGBT Substance Use Disorders: Multiple Identities, Multiple Challenges Researchers have long been of the opinion that people who identify as other than heterosexual are at a higher risk for double health and substance abuse issues, compared with the sexual majority. In 2015, the National Survey on Drug Use and Health began asking two questions about respondents’ sexual orientation – one about sexual attraction, and one about sexual identity. This makes the 2015 NSDUH the first time the federal government has collected information about mental health and substance abuse issues among LGBTQ? adults in a nationally-representative sample. There were over 51,000 interviews, and approximately 3000 self-identified as LGBTQ?.

Overview of the Findings of the 2015 NSDUH – Sexual Orientation, Substance Abuse, and Mental Health

According to the Substance Abuse and Mental Health Services Administration,  a comparison between sexual minorities and the sexual majority uncovers several patterns:

  • Higher use of ANY illicit drug, 39% versus 17%
  • Marijuana use, 31% versus 13%
  • Misuse of prescription opioids, more than double, 10.4% versus 4.5%
  • Misuse of prescription tranquilizers, 268% higher rate
  • Cocaine use, nearly triple
  • Use of hallucinogens more than triple
  • Heroin use, triple
  • Meth use, almost quadruple
  • Misuse of prescription stimulants, more than double
  • Misuse of prescription sedatives, double

Respondents in a sexual minority also had higher rates of past-month alcohol use or binge-drinking than those in the sexual majority. Tellingly, these higher rates of use were consistent across boundaries of age or sex. This pattern continued when the substance use increased to the point of meeting the criteria for an actual disorder:

  • ANY Substance Use Disorder – 15.1% versus 7.8%
  • Alcohol Use Disorder – 10.8% versus 6.1%
  • Illicit Drug Use Disorder – 7.8% versus 2.6%
  • Marijuana Use Disorder – 3.9% versus 1.3%
  • Prescription Opioid Use Disorder – 2% versus .7%

The greater prevalence of substance use and SUDs among sexual minorities also led to a greater need for treatment – 15.9% versus 8.1% among heterosexuals. That equates to 1.7 MILLION sexual minority adults in need of professional drug or alcohol treatment.

Why Does the LGBTQ? Population Has Higher Rates of Substance Use and Abuse?

According to the Center for American Progress, there are a number of factors that contribute to the problem of substance abuse within the gay and transgender communities –

  • Higher stress due to social prejudice, lack of acceptance from their family/friends, and discrimination – especially in terms of housing and employment. 43% of gay and 90% of transgender people say they have been discriminated against or harassed at work, while 56% of gay and 70% of transgender people say they’ve been the victim of some form of prejudice and their housing situation.
  • Difficulties in finding treatment programs that are sensitive to the unique needs of the LGBTQ? community. Even something as simple as the “M/F” question on an intake form can be off-putting to someone who self-identifies as neither.
  • Subculture marketing aimed specifically at the gay/transgender demographic depicts a bar or club scene as the perfect environment where LGBTQ? people can socialize and feel safe.

How Can the Problem of Substance Abuse within the Gay and Transgender Communities be Addressed?

Sexual minorities with substance abuse problems need the same kind of drug rehab as the sexual majority, with some accommodations and adjustments:

  • The staff at the chosen rehab facility or program should retain and ongoing cultural competency training.
  • Any drug or alcohol rehab program that accepts LGBTQ? patients should adhere to the National Standards on Culturally and Linguistically Appropriate Services (CLAS).
  • The program should endeavor to have a culturally-diverse staff.
  • Modify intake forms and treatment literature.
  • Insert boilerplate non-discrimination statements into handbooks and workbooks, covering guidelines about acceptable behavior from both the staff and other clients.
  • Treatment facilities should internally evaluate individual providers’ strengths and weaknesses in dealing with gay and transgender patients by using the Gay Affirmative Practice Scale.

Finally, the best drug and alcohol treatment programs will be adept at using a trauma-focused approach. Many LGBTQ? substance abusers have experienced or witnessed traumatic events as a direct or indirect consequence of their sexual orientation or identification. A gay or transgender client in substance abuse treatment may not fully realize the effect that traumatic experiences have had on their life, but it is almost certainly there. For example, since early childhood, the individual may have been subjected to bring messages that gender non-conformance or same-sex attraction was somehow sinful, dirty, or disgusting. Obviously, that kind of emotional bombardment can have a serious impact on a person’s psyche and self-esteem. Therefore, any LGBTQ? person needing treatment for a substance abuse disorder should look for a facility that specializes in addressing co-occurring disorders such as PTSD, anxiety, or depression.