Alcoholism is a serious problem in the LGBT community, though one often swept under the rug. It was once believed that up to a third of the LGBT community suffered from alcoholism.1 A report by the Centers for Disease Control found that LGBT people are more likely to abuse alcohol than the rest of the population and that gay men and lesbian women are more likely to do so later in life as well.2 A national survey found that LGBT people are twice as likely as their cisgender and heterosexual counterparts to binge drink and five times as likely to drive under the influence.3
Why this disparity? There are three key causes: discrimination, the LGBT social scene, and targeted advertising. Social prejudice and discrimination against gay, trans, lesbian and bisexual people cause emotional stresses and sometimes self-esteem problems which they may try to solve through alcohol abuse. The forms of abuse LGBT people experience can be as subtle as misunderstandings and micro-aggression from non-LGBT people to job, housing and healthcare discrimination to street harassment and violence.
56% of gay people report being discriminated against on the basis of their LGBT status when seeking accommodation as have a staggering 70% of transgender people. Meanwhile 43% of gay people and 90% of trans people experience discrimination and harassment at work. The legal situation remains discriminatory: in 29 states employers are able to fire or deny employment to someone on the basis of their sexual orientation or gender identity without breaking the law. In addition, gay and lesbian adults are twice as likely as the general population to lack health insurance while bisexual and trans people are even more likely to be without it. Many employer-provided health insurance programs specifically exclude transition-related healthcare for trans people4; trans people’s lack of access to treatments they may feel are essential such as hormone replacement therapy or sex reassignment surgery only exacerbates their experience of ‘gender dysphoria’- the discomfort with the sexed aspects of their body, which can be traumatic in itself and can lead some trans people to substance abuse. Sadly, transgender people can face prejudice and discrimination not only from the mainstream population but from other parts of the LGBT community too, which increases the sense of marginalization which leads to abuse. Understandably amidst this discriminatory situation many LGBT people are drawn to alcohol as a coping mechanism.
Added to this, the social scene for gay men, lesbian women and trans people has included bars and clubs since the 1950s and 1960s; indeed, the modern gay rights movement was effectively founded in a bar, as revelers at New York’s Stonewall Inn resisted police violence in a famous riot in 1969. For many LGBT people the most obvious recreational spaces to meet those similar to them are bars and clubs and thus alcohol becomes an integral part of feeling comfortable and having a good time around people of a like disposition. Alcohol companies have seized on this reality to aggressively advertise to the LGBT market, promoting their wares in gay publications and sponsoring Pride events, for example. It’s these three causes combined that lead to a situation in which 25% of LGBT people abuse alcohol compared to between 5 and 10% of the general population.5
Exacerbating these causes, and often prolonging the problem is the lack of cultural sensitivity amongst much of the medical profession and recovery programs for alcohol addiction. LGBT people who come into contact with doctors or treatment workers who are ignorant of their specific needs or downright hostile for homophobic or transphobic reasons will be put off seeking treatment and will thus find it harder than their straight and cis counterparts to get sober and stay sober. This may lead some LGBT people to disclose their sexuality and/or gender identity from staff members. Since a key part of recovery from addiction is looking at possible traumas that may be the underlying cause of the problem, concealing this vital information will make it much harder for the individual to heal. At Open Out Recovery they attempt to overcome these obstacles with an holistic program specifically centered on the needs of LGBT people.
At Open Out LGBT people are treated by professionals who understand the specific needs of this demographic and are surrounded by peers who may be struggling with similar problems for similar reasons. This helps to create a safe and supportive environment absent of the abuse sometimes experienced by LGBT people at other treatment programs. For example, in 1995 the Transgender Substance Abuse Treatment Policy Group of the San Francisco Lesbian, Gay, Bisexual, Transgender Substance Abuse Task Force reported that trans people faced physical and verbal abuse from other clients and staff and were required to dress in clothes and sleep and shower in areas assumed to be appropriate to their assigned gender at birth.6 This treatment cannot possibly help trans people recover since it jars with their lived and identified gender and thus repeats the transphobic abuse which may have led them to becoming addicted in the first place. In Open Out’s supportive environment, LGBT clients have the opportunity to access talking-based therapy as well as music and art therapy, life skills training and mindfulness-based therapy. This holistic approach means that issues which may be difficult to uncover for some clients through talking can be delved into through music and art which go directly to the emotions. Family-involvement is encouraged, with staff facilitating group counselling with the client and their family as well as sessions specifically helping the family. Long-term recovery is the goal, so help in building resumes, guidance with job seeking, and practicing skills for job interviews are part of Open Out’s Job Club. The program is cutting edge, providing every client with a digital tablet which they can use for journaling, reading and meditation materials. Open Out also guarantees that if any client has not recovered after 90 days they can remain for an additional free 30 days.7
Of course, centers like Open Out are incredibly important in the short term, but in the long term the general situation for LGBT people has to change. There must be a society-wide effort to change both cultural attitudes and legal reforms to prevent discrimination at work, in housing and healthcare. That way the underlying causes of the disproportionate levels of alcohol abuse in the LGBT community can be tackled once and for all.
6. Transgender Protocol Team. Transgender Protocol: Treatment Services Guidelines for Substance Abuse Treatment Providers. San Francisco, CA: Lesbian, Gay, Bisexual, Transgender Substance Abuse Task Force. 1995.