Several surveys indicate a clear link between people who identify as LGBTQ+ and increased substance misuse risk.
People in the LGBTQ+ community are more likely to experience social stigma, discrimination, rejection, abuse and ostracism from society and even their families. People who identify as anything but heterosexual often face more challenges in their life, in addition to daily stressors, and as a result are at a higher risk of developing mental health and substance use disorders.
While great strides have been made in the LGBTQ+ community towards equality, most LGBTQ+ individuals still experience prejudice and harassment. Discriminatory laws, practices in employment, housing, relationship recognition, health care, and challenges with family and friends still exist and can cause higher levels of anxiety, fear, isolation, depression, anger and mistrust for people in the LGBTQ+ community.
Why is the LGBTQ+ Community at a Higher Risk for Addiction?
A number of surveys indicate a clear link between people who identify as LGBTQ+ and increased substance misuse risk. National studies conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA) show that patterns of drug, alcohol and tobacco use tend to be significantly higher in the LGBTQ+ community compared to the general population.
Statistics also show that LGBTQ+ drug and alcohol misuse begins at an early age. The University of Southern California’s School of Social Work found that substance misuse is twice as prevalent among LGBTQ+ youth as compared to their heterosexual peers. Almost 30 percent of gay and transgender individuals considered attempting suicide in their adolescent years. Substance abuse usually exacerbates the underlying fear, loneliness and isolation many LGBTQ+ people can feel in ever-changing political and social climates.
At a Glance: LGBTQ+ Substance Abuse
- 20–30 percent of LGBTQ+ people misuse substances, as compared to about 9 percent of the general population
- 39.1 percent of lesbian, gay and bisexual adults used illicit drugs in 2015, compared to 17.1 percent of heterosexual adults
- 25 percent of LGBTQ+ people abuse alcohol, as compared to 5–10 percent of heterosexual individuals
- Transgender and gay individuals use tobacco up to 200 percent more than their heterosexual peers
Identifying as anything other than heterosexual can mean losing relationships with family and friends, experiencing bullying in school, or experiencing underlying prejudice in the workplace and in society in general. Internally, LGBTQ+ individuals can struggle with feelings of isolation, mental illnesses like depression and anxiety, and even fear for their own safety due to permeating social stigmas. These are just a few of the major contributing factors to the high rates of LGBTQ+ substance abuse. However, there are ways to help someone dealing with these challenges and it begins with understanding. Knowing why LGBTQ+ individuals are more likely to struggle with drug and alcohol abuse can be key in supporting a friend or loved one.
LGBTQ+ Discrimination and Societal Stigma
Many LGBTQ+ individuals experience heterosexism (bigotry against the LGBTQ+ community) and discrimination from society in the form of social prejudice and exclusive laws. This often results in a great deal of stress in various areas of life, including work, in relationships and going through the healthcare system. To cope with this high level of stress and the pressure to conform, many LGBTQ+ individuals turn to drugs and alcohol.
The transgender community is one that faces a great deal of stigma, which can result in depression and anxiety. Transgender individuals are assigned a biological gender at birth that does not correspond with their gender identity. There has been some progress in recent years for the transgender community, but lack of familial and societal support still persists in most countries. In fact, according to a national study in the American Journal of Public Health, social stigma toward transgender individuals correlates with psychological distress.
This psychological distress is known as minority stress. Minority stress is defined as a theory that health disparities exist within minority communities (ethnic, cultural, sexual) as a result of the larger, more dominant culture causing stress on the smaller minority. Both mental health disorders and gender nonconformity remains stigmatized in society, leaving transgender people to struggle with both.
According to the Center for American Progress, the rates of addiction for people who identify as transgender are “disproportionately higher” compared to the rates of substance misuse among people who identify as heterosexual.
Lack of Familial Support
For LGBTQ+ individuals, embracing their true identities and coming out to family and friends can be extremely difficult and painful. More often than not, their news is met with judgment, hostility and even disownment by their own families. According to the Centers for Disease Control, LGBTQ+ young adults who experience family rejection are three times more likely to use illicit drugs than those from supportive families. Sadly, lack of acceptance among family members has led to a rise in gay and transgender men and women’s substance abuse levels, as they attempt to ease the ostracism they feel and numb the pain of rejection.
Help Is Here: The Trevor Project is an organization dedicated to crisis intervention and preventing suicide for young LGBTQ+ adults. If you or a loved one is in crisis, you can call, text or live chat with a caring person who can help.
Mental Illness and LGBTQ+ Counseling
According to a 2015 SAMHSA report, people in the LGBTQ+ Community are more than twice as likely as heterosexual individuals to experience mental illness in their lifetime. Self-loathing, pressure to fit in and feelings of isolation can lead to struggling with a mental health disorder and even suicidal thoughts. LGBTQ+ individuals are almost three times more likely than others to experience major depression or generalized anxiety disorder. When concurrent with substance use disorders, mental health disorders are considered co-occurring disorders and should be addressed simultaneously through counseling and therapy. For people struggling with their mental health, counseling resources exist in the form of helplines, crisis lines and addiction treatment:
- The National Mental Health Association answers questions about mental health conditions and helps connect people to the care they need. Call 800-969-6642 during business hours to talk with a compassionate mental health professional.
- The National Alliance on Mental Health offers a free helpline for anyone struggling with mental health issues. Call 800-950-6264 to speak with a crisis counselor. You can also text NAMI to 741-741 to receive support via text message.
- The National Suicide Prevention Lifeline connects suicidal individuals with free and confidential emotional support. Call 800-273-TALK (8255) for 24-hour support.
Some reasons that LGBTQ+ individuals typically misuse drugs and alcohol are varied and caused by different aspects of daily life. However, it’s important to remember that it’s not simply identifying as someone in the LGBTQ+ community that makes someone more likely to abuse drugs; it’s the pressures inherent in surrounding society that marginalize people who are different from the status quo. Evening out the disproportionately high rates of substance misuse in the LGBTQ+ community will take time, effort and understanding from treatment specialists, lawmakers and society. But most importantly, decreasing LGBT substance abuse requires a greater societal shift in perspective from apathy to empathy as America strides toward equality for all.
How Does Substance Abuse Affect the LGBTQ+ Community?
Because of the added daily challenges that LGBTQ+ individuals face, the effects are often magnified and the entire LGBTQ+ population can be affected. Some ways that drug use and addiction impacts the greater LGBTQ+ community can include:
Drug abuse and addiction have the potential to interfere with relationships and jobs, potentially leading to a life of homelessness. Homelessness doesn’t just affect adults with addictions, many LGBTQ+ youth are left homeless if their families reject them. In the LGBTQ+ community, rejection and ostracization from family members leave teens out on the streets. Unfortunately, being an LGBTQ+ homeless youth opens the door to dangers including mental disorders, violent victimization, suicidal tendencies, unsafe sexual practices and HIV risk.
2. Mental Health Issues
Substance use disorders are often associated with mental health disorders, either as a cause, effect or co-occurring disorder. The LGBTQ+ population is at a greater risk for such conditions. In fact, according to the National Alliance on Mental Illness (NAMI), LGBTQ+ individuals are nearly three times more likely than heterosexuals to experience a mental condition. If these conditions exist before drug misuse begins, they can be exacerbated or lead to other disorders. Some of the common mental health disorders associated with drug abuse include:
- Paranoia: an exaggerated distrust of others, which may include delusions
- Delusions: very strong and irrational beliefs in something untrue
- Psychosis: extensive changes in personality, impaired functioning and a warped or imagined sense of objective reality
- Depression: an intense feeling of sadness and hopelessness that negatively affects day-to-day life
- Anxiety: unusual, distressing and overpowering feelings of fear and apprehension that are often characterized by physical signs
- Panic attacks: sudden incidents of intense distress or tension that may occur for no apparent reason or in response to a known trigger
3. Increased Risk for Suicide
According to SAMHSA, one of the biggest risk factors for suicide is substance abuse. There are also many studies that indicate a greater risk of suicide for LGBTQ+ individuals (including those who don’t misuse drugs), especially for youth and transgender adults. Some LGBTQ+ statistics on the link between the LGBTQ+ community and the risk for suicide are:
- Lesbian, gay and bisexual (LGB) youth:
- Suicide attempts by LGB youth and questioning youth are 4 to 6 times more likely to result in injury, poisoning or overdose that requires treatment from a physician, compared to their straight peers, according to a CDC report.
- LGB youth who come from highly rejecting families are 8.4 times as likely to have attempted suicide as LGB peers who reported no or low levels of family rejection.
- Transgender adults:
- Based on the results of a national study in The Report of the 2015 U.S. Transgender Survey, 40 percent of transgender adults admit to having attempted suicide. Ninety-two percent of these individuals reported having attempted suicide before the age of 25.
- The prevalence of suicide attempts among respondents to the National Transgender Discrimination Survey (NTDS) is 41 percent. This exceeds the 4.6 percent of the overall U.S. population who report a lifetime suicide attempt.
Which Substances Do LGBTQ+ Individuals Struggle With?
Members of the LGBTQ+ community are significantly more likely to use tobacco products than the rest of the population. According to a 2015 report by the CDC, nearly 1 in 4 individuals who are gay, bisexual or transgender smoke cigarettes, compared to approximately 1 in 6 heterosexual individuals.
While this widespread tobacco use is often attributed to the stress and anguish caused by LGBTQ+ stigmatization, there are other, more sinister factors at play. In the last 25 years, several major tobacco companies have launched aggressive ad campaigns targeting the LGBTQ+ community. The most famous example of this emerged in 2000, when a document labeled “Project SCUM” from Camel and Pall Mall was leaked to the press. This document outlined plans for a campaign that targeted young gay men and the homeless in the city of San Francisco. Ironically, while many of these companies position themselves as allies to the queer community, they donate money to support politicians opposed to gay rights.
High tobacco use among members of the LGBTQ+ community leaves them vulnerable to addiction and the countless negative health effects associated with smoking. This includes the development of cancers, diseases and other health complications. Sadly, these consequences can sometimes be fatal, and more than 30,000 LGBTQ+ people die each year of tobacco-related diseases.
Between 20 and 25 percent of gay and transgender individuals abuse alcohol, compared to 5 to 10 percent of the general population. This is likely due to a combination of factors. The safety, support and sense of community that gay bars offer can make heavy drinking among gay and transgender individuals more likely. Many in the LGBTQ+ community also use alcohol to cope with the high stress levels that societal stigma can cause.
Whatever the reason, alcohol dependence can quickly become dangerous or even deadly if left unaddressed. Regular, excessive use may even lead to alcoholism, a condition in which a person is psychologically and physically dependent on alcohol. Side effects of long-term alcohol use and alcoholism include:
- Liver damage
- Decreased immune system function
- Reduced sexual performance
If you suspect that you or someone you love may be dependent on alcohol, it’s important to seek help if you observe any of the following signs:
- Drinking that interferes with work, school or other activities
- Frequent blackouts
- Inability to control the amount of alcohol consumed
- Spending a great deal of time drinking or recovering from drinking
- Drinking early in the day, staying drunk for long periods of time or drinking alone
- Experiencing withdrawal symptoms when alcohol consumption stops, like feeling shaky sweaty, sick and anxious
Amphetamines belong to a class of drugs called stimulants that produce intense feelings of euphoria. Amphetamines can be medically manufactured or occur in dangerous street forms like meth. While these substances bring short-term, good feelings, regular use can quickly lead to dependence and addiction. Amphetamines are another type of drug widely abused by the LGBTQ+ community. Recent studies show that gay men are 12.2 times more likely to use these drugs than their heterosexual peers.
This high frequency of misuse likely occurs for a variety of reasons. LGBTQ+ Individuals may use the stimulating, energizing effects of the drug to perform well at work or participate in the late-night gay club scene. But while amphetamines might seem like harmless party or productivity drugs, they can cause psychosis, malnutrition, cardiac problems or even convulsions if used frequently. Because of this, it’s important to be honest with yourself if you are misusing amphetamines, or talk to friends or family members who you suspect may be addicted to them.
Signs of amphetamine abuse or addiction can include:
- Withdrawing from friends and family
- Emotional disturbances, including depression and psychosis
- Physical health problems
- Withdrawal symptoms when consumption stops, including intense cravings, anxiety, depression, fatigue and hunger
Heroin is one of the most dangerous street drugs available. Produced from morphine, heroin produces an intense rush of euphoria when ingested, injected or snorted. Lifelong experiences with homophobia, discrimination or abuse can leave members of the LGBTQ+ community more likely to try this dangerous drug as a way to numb the pain of their experiences. Because of this, gay men are 9.5 times more likely to use heroin than heterosexual men.
Frequent heroin use can lead to a broad range of dangerous health effects, including:
- Collapsed veins (from intravenous use)
- Constipation and stomach cramping
- Infection of cardiac tissue
- Kidney or liver disease
- Lung complications
But the most dangerous potential health effects of heroin use are addiction and death. Misusung this drug regularly causes a tolerance to develop, meaning that someone with a heroin addiction need more of the drug to produce similar effects. Once a person develops a tolerance, the possibility of a fatal overdose becomes increasingly likely. Signs of heroin addiction include:
- Withdrawing from friends or family
- Visible needle marks or bruises
- Emotional disturbances, like sudden bursts of anger or depression
- Withdrawal symptoms when consumption stops, including vomiting, nausea, diarrhea and paranoia
How Loved Ones Can Help
Whether you’re a friend, family member, ally or member of the LGBTQ+ community, there are a number of ways to help support those affected by drug or alcohol abuse. Instead of perpetuating an environment (whether it be at home, school, work or public) that is hostile or exclusive, creating a judgement-free and inclusive space is critical.
For parents, this could mean having open conversations about unconditional love. At work and school, it means presenting equal opportunities, amenities and rights and in public, it means providing equal services without discrimination.
Preventing substance use disorder and mental illness in the LGBTQ+ community starts at home, in the classroom and in the street. Society can help change the narrative on addiction and mental health for people who identify as LGBTQ+ by:
- Bolstering the self-esteem of LGBTQ+ individuals, especially youth
- Offering counseling and open discussion in schools
- Providing inclusive services and programs at school, work and business
- Supporting open conversation and acceptance at home
- Discussing alternative coping strategies for stress like exercise, art and healthy sleep patterns
- Encouraging regular health screenings and evaluations
Reinforcing self-worth is an important, if not the most important factor in preventing substance use in the LGBTQ+ community. It is equally important that individuals who suffer from addiction or mental health conditions are not ostracized further. Despite the fact that addiction affects people of all races, genders, incomes and sexual orientations, there is still a negative stigma associated with it.
People who struggle with substance use are human beings, just like anyone else, who need help and encouragement to overcome their struggles. Addiction, like sexuality, does not need to be kept a secret. As society slowly accepts this concept, more LGBTQ+ people may seek the help they need.
Encourage LGBTQ+ Substance Abuse Treatment
For those affected by addiction, it can be difficult to realize when outside resources and help should be sought. For the LGBTQ+ community, it can be even harder; addiction and sexuality can both seem like isolating, enveloping issues. Neither of these is something to be ashamed of. Friends and family members play a vital role in encouraging others to better themselves by accepting their sexuality and seeking treatment for addiction and mental illness.
How Can a Rehab Center Treat LGBTQ+ Substance Abuse Disorders?
There are hundreds of rehabilitation facilities in the country that offer substance abuse treatment options and are welcoming to the LGBTQ+ community. Recovery centers help individuals with substance addiction and co-occurring disorders and can help transform lives.
Traditional Rehabilitation Centers
Although the LGBTQ+ community can be affected by substance use disorders more than the general population, they are more likely than heterosexuals to seek treatment. Based on the results of a national survey recorded in the Journal of Substance Abuse Treatment. In addition, 15.3 percent of LGBTQ+ adults who needed substance misuse treatment received it at a specialty facility in 2015, according to a report from SAMHSA report. Only 10.6 percent of heterosexual adults received treatment.
Many traditional rehab centers include LGBTQ+ addiction treatment and LGBTQ+ substance abuse treatment programs, with drug or alcohol detox as the first phase. Other care options may include:
- Residential (inpatient) treatment: Around-the-clock care, including therapy.
- Partial hospitalization programs: Around-the-clock care, but with less monitoring than residential care.
- Intensive outpatient programs: Can take place at the patient’s home or at one of the center’s housing locations.
- Outpatient programs: Intended to help patients move from treatment to recovery, while providing access to recovery specialists.
- Aftercare services: Ongoing care that may include LGBTQ+ counseling or therapy to prevent relapse.
Many of these programs are individualized to meet the specific needs of each patient, with regard to the specific substance being used. However, not all rehabilitation centers operate equally when it comes to the needs of the LGBTQ+ community. Some facilities have a significantly larger population of heterosexual patients, some of whom may not be accepting of LGBTQ+ patients. Some centers may also not offer any gender-specific programs.
To help combat this problem and make more traditional rehab centers LGBTQ+ friendly, SAMHSA established nine principles of care for treatment providers. These principles are intended to enable substance abuse treatment providers to better accommodate LGBTQ+ individuals, helping them to:
- Be understanding and flexible
- Provide a comprehensive approach
- Be consistent with cultural needs
- Promote self-respect
- Promote healthy behaviors
- Support collective decision making
- Reduce barriers to treatment
- Provide evidence-based treatment
- Create a recovery community
LGBTQ+ Rehab Centers
Fortunately, LGBTQ+ individuals have more options beyond traditional drug rehab facilities, including those that are designed specifically for the lesbian, gay, bisexual, transgender and queer community. Just knowing that these options exist may be all it takes to remove barriers for those who would otherwise be hesitant to seek treatment.
Many of these centers offer the same substance misuse treatment programs as traditional facilities while also focusing on issues that are specific to the LGBTQ+ population. An emphasis on research-based therapy as well as individual and group meetings are common aspects of many of these programs. Similar to standard rehab centers, the primary phase in treatment at a LGBTQ+ rehab center is detoxification. This first step is critical to recovery for any patient at a rehab facility.
One of the other benefits of various LGBTQ-oriented rehab centers is that staff members are specially trained to meet the needs of the LGBTQ+ community. In many cases, some of the staff members are part of the queer community themselves. Some centers were even founded by LGBTQ+ professionals. The same is true of the creation of the various gender-specific programs.
However, just as with standard drug rehab facilities, no two LGBTQ+ rehab facilities are exactly alike. Treatment programs may be different, in terms of the approach, length and intensity. Some are categorized by sexual orientation while others have a wider range of gender identities. The following are some of the treatment options that you can expect at various LGBTQ+ rehab centers:
- Residential treatment
- Intensive outpatient programs
- Partial hospitalization programs
- Sexual health programs
Many centers may also help patients cope with various stressors that are associated with substance misuse. These include discrimination, rejection, depression, coming out and homophobia.
Depending on the specific needs of the LGBTQ+ individual, a traditional rehab center like The Recovery Village may be best, while for other individuals, they may feel more comfortable at a LGBTQ+ specific rehab center. Fortunately, there are resources available to help everyone in the queer community make the right decision for their unique needs.
At The Recovery Village, we welcome our LGBTQ+ friends and family. If you or someone you love is struggling with substance use and co-occurring disorder, you’re not alone. Whether you are lesbian, gay, bisexual, transgender or questioning, you are worthy of the highest level of care in overcoming a substance use disorder.
The Recovery Village offers a continuum of care for all types of substance use and co-occurring disorders from medical professionals who have years of experience in the field. In our judgment-free environment, you’ll be surrounded by people who care about your unique situation and want to help you overcome addiction for good. At The Recovery Village, you can find relief from addiction and pursue healing — no matter who you love. Call and speak with a representative to learn more about what treatment program can work for you.
The Recovery Village aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare providers.