With the right to same-sex marriage passed by the Supreme Court earlier this year the media is awash with triumphal narratives of progress when it comes to the LGBT community, but the many hardships LGBT people continue to face are leaving their mark in the problem of addiction. We cannot expect this problem to disappear on its own. Rather, as a community we must expose it and demand better care.
Available studies indicate substance problems are disproportionately high among the gay and lesbian community. Less is known about transgender and bisexual people, but their situation may be even worse, given that they can face discrimination not only from the straight and cisgender majority but from the gay and lesbian community too, discrimination which increase stress and can lead to alcohol and drug-related problems. LGBT people face rejection by family and friends which can cause emotional difficulties that some seek to heal with alcohol, tobacco or other drugs.
Gay, trans and bisexual people grow up in a world where everyone is assumed to be straight and cisgender and they thus may harbor relatively greater obstacles to self-esteem and self-acceptance which they may try to medicate with drugs, tobacco and alcohol. And for trans people who have difficulty accessing transition-related medical care, they may seek drugs and alcohol as ways to cope with the pain of “gender dysphoria”- the feeling of discomfort with the sexual aspects of one’s body. Staff members working on treatment programs must be aware of this psychological difficulty faced by trans people and hiring members of staff who are themselves transgender could be a great help in this regard.
For young LGBT people, furthermore, family rejection can cause homelessness, making the young person much more vulnerable to addiction. The risk of LGBT youth exchanging sex for money, drugs or shelter and thus engaging in unsafe sex and potentially contracting HIV is significantly greater if they are homeless.
A lack of opportunities for LGBT people to socialize among their peers other than in bars and clubs where they will be exposed to alcohol as well as illegal drugs fuels this problem of addiction. There is a need for LGBT organisations to provide alcohol-free spaces for socializing as well as to include addiction-related education and support as part of their work. The process of ‘coming out’ often involves this kind of socializing and it is therefore vital that for LGBT and questioning youth especially there are alternative spaces free of alcohol, drugs and tobacco. Many LGBT spaces and events rely on the tobacco and alcohol industries for funding, including Pride events which are often sponsored by them.
One of the further dangers attendant with the use of illicit drugs is the contraction of sexually transmitted diseases. A study by Klitzman and colleagues suggested that there is a link between use of MDMA and high-risk sexual behavior which increases the danger of contracting an STD. The most common way HIV is transmitted is through unsafe sex. Drug use can not only lead to contracting HIV but can worsen the illness once it is contracted; thus treatment for addiction and treatment for HIV are intertwined processes.
A paper published in 1995 suggests three strategies for preventing drug and alcohol abuse among LGBT people:
– Public education and policy advocacy aimed at eliminating heterosexual and homophobia.
– LGBT cultural competency training for community-based agencies, programs and services, including those focused on substance abuse (e.g., police, health and social services, education, faith community, families, and foster care).
– Safer, alternative venues for LGBT youth and those in the process of forming their sexual identities to “come out.”
Campaigning for more affordable and accessible transition-related healthcare for trans people would also be an aid in combating addiction. In terms of treatment, transgender people can face specific difficulties distinct from those faced by gay, lesbian and bisexual people. 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. This treatment cannot possibly help trans people recover since it jars with their lived and identified gender and thus repeats the trans-phobic abuse which may have led them to becoming addicted in the first place. Staff members must be trained in sensitivity towards trans people with a fundamental requirement being that they support the individual in their self-identified gender. Though there is sadly little research done on the question, a 1997 study by the San Francisco Department of Public Health found that for trans people taking part in focus group discussions, drug and alcohol abuse were often caused by low self-esteem and a lack of job and educational opportunities partly due to discrimination- yet more evidence of the need for a society-wide transformation in attitudes and proper legal protections against discrimination to tackle the problem of addiction at its roots.
So the solutions are broad and involve engaging with LGBT culture as it stands. Treatment workers must be aware of the specific problems LGBT people face or their work will have limited efficacy and could even worsen problems by increasing the sense of rejection and alienation among LGBT people. Studies from the early 1990s and in 1997 show that when gay men and lesbian women are treated by mental healthcare providers trained in understanding the issues that specifically effect them they are more willing to be involved in treatment programs and are conversely more likely to refuse treatment if offered by homophobic staff. Therefore, to deal with addiction among LGBT people, treatment workers must understand the stressful effects of homophobia and trans-phobia on the lives of LGBT individuals.
The solutions can thus be found in both the general fight against cultural bigotries, struggling for broader societal reforms, and changes in the way LGBT organisations and addiction treatment programs work so that they are better tailored to the specific needs of this demographic. As the scant evidence referred to in this article makes clear, there is also much need for further research to be done on the causes and character of the problem, which cannot be solved unless it is understood.
Open Out is designed to help members of the LGBT community overcome their problems with substance addiction with the help of a program exclusive to their needs. Often, members of the LGBT community can feel uncomfortable openly discussing their sexuality, gender identity and how they relate to their problems with addiction. At Open Out, when our clients look around the room, they feel at ease in discussing their problems because we have created a judgement-free community of their peers. If you or a loved one need help or would like more information about our program call us at 855-525-4357 .
2. Klitzman, R.L.; Pope, H.G., Jr.; and Hudson, J.I. MDMA (“ecstasy”) abuse and high-risk sexual behaviors among 169 gay and bisexual men. American Journal of Psychiatry 157(7):1162-1164, 2000. and Research World 15(2):151-157, 1991.
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.
7. San Francisco Department Of Public Health, AIDS Office. HIV Prevention and Health Service Needs of the Transgender Community in San Francisco: Results From Eleven Focus Groups. San Francisco, CA: San Francisco Department of Public Health, 1997. 8. O’Hanlan, K.; Cabaj, R.B.; Schatz, B.; Lock, J.; and Nemrow, P.A review of the medical consequences of homophobia with suggestions for resolution. Journal of the Gay and Lesbian Medical Association 1(1):25-40, 1997.