Substance Abuse in the LGBTQ Community

Compared to the general population, members of the LGBTQ community are more likely to use alcohol and drugs, have higher rates of substance abuse, not abstain from alcohol and drug use, and drink heavily later in their life.¹

Gay and bisexual men may use alcohol and drugs to cope with the homophobia, discrimination, or violence they experience because of their sexual orientation. This kind of treatment can also lead to additional mental health and physical problems, affect relationships, disrupt employment, and create financial instability.¹

Alcohol and illegal drug use in gay men, especially methamphetamines, amyl nitrates, and drugs for erectile dysfunction, can also lead to a higher chance of contracting HIV and other STDs. Risky sexual behaviors that result from drug and alcohol use and sharing needles or other injection equipment can increase the risk of getting HIV or giving it to others ¹.

Statistics for Substance Abuse in the Older LGBTQ Population

Older members of the LGBTQ community are also more likely to engage in drug use. MIddle-aged and older adults who identify as lesbian, gay, or bisexual use various substances at a higher rate than heterosexual adults.²

13.9% of older sexual minority adults and 5.5% of older heterosexual adults use cannabis nonmedically
3.6% of older sexual minority adults and 1.1% of older heterosexual adults use prescription tranquilizers nonmedically
4.7% of older sexual minority adults and 2.3% of older heterosexual adults use prescription opioids nonmedically

Statistics for Substance Abuse in LGBTQ Youth

Younger LGBTQ members are also more likely to use drugs and alcohol than heterosexual youth. LGBTQ youth use drugs and alcohol at a 2-4 times higher rate than the rate at which their heterosexual peers use drugs and alcohol. These drugs include cigarettes, alcohol, marijuana, and street drugs such as cocaine, methamphetamine, and injection drugs.³

Rates of Substance Abuse in the LGBTQ Community

The LGBTQ community, in general, is more likely to engage in drug and alcohol use than their heterosexual counterparts. These drugs include vaping and tobacco, alcohol, and hard drugs. While the data is limited, there are some statistics for each. ⁴

Among LGBTQ individuals, bisexual women have tried e-cigarettes at a higher rate than heterosexual women. They are also more likely to use tobacco cigarettes and e-cigarettes when compared to both lesbian and heterosexual women. ⁵
Bisexual men are also more likely to have ever used or currently use e-cigarettes than heterosexual men. ⁵
Gay and transgender individuals, in general, are 200% more likely than their heterosexual and transgender peers to smoke tobacco. ⁴

Men who have sex with men are 3.5 times more likely than men who do not have sex with men to use marijuana recreationally. ⁵
They are also 12.2 times more likely than men who do not have sex with men to use amphetamines. ⁵
These men are also 9.5 times more likely than men who do not have sex with men to use heroin. ⁵

Risk Factors

There are three main factors as to why members of the LGBTQ community use drugs at a higher rate than the rest of the population. These include high levels of stress, a lack of cultural competency in the healthcare system, and targeted marketing efforts from alcohol and tobacco companies.⁴

High stress levels in the LGBTQ community are often due to social prejudice and discrimination laws that affect employment, relationship recognition, and healthcare.⁴

A lack of cultural competence in health care can discourage LGBTQ members from seeking substance abuse treatment. The healthcare system also typically offers inappropriate or irrelevant services to individuals within the LGBTQ community when they do seek treatment.⁴

Alcohol and tobacco companies use targeted marketing efforts that create a sense of connection for many gay and transgender individuals within bars and clubs. These bars and clubs are marketed as safe spaces for socializing and provide easy access to alcohol and tobacco.⁴

Gay and transgender individuals deal with minority stress daily. Minority stress is the negative effect that occurs as a result of the adverse social conditions that individuals within a marginalized social group experience.⁴

There is a general social prejudice against the gay and transgender population. Some laws and policies are also discriminatory to this population, which triggers minority stress. Social discrimination towards the LGBTQ community comes from the belief that it is immoral to be gay and transgender. Social prejudice can manifest in subtle ways or verbal and physical violence.⁴

Members of the LGBTQ may avoid social settings or neighborhoods where they believe they might encounter this kind of treatment. They might also feel more anxious in general when engaging in daily activities due to the fear of being judged or attacked. This anxiety and fear can, in turn, lead to substance use as a way to cope.⁴

LGBTQ individuals may also feel stress due to discriminatory laws and practices, which can lead to drug and alcohol use. More specifically, they may encounter discrimination in employment, housing, relationship recognition, and the healthcare system.⁴

In 29 US states, it is legal for a business to deny employment to, fire, and discriminate against LGBTQ individuals based on their sexual orientation or gender identity. A total of 43% of gay people and 90% of transgender people have been discriminated against or harassed while at work.⁴

Discrimination in the workplace can lead to job instability for gay and transgender individuals, making it difficult for these people to earn a steady income and access health insurance through employment. This kind of treatment and instability can threaten the economic security of LGBTQ individuals as well as their partner, spouse, children, or anyone else who is financially dependent upon them.⁴

The majority of gay individuals, 56%, and transgender individuals, 70%, say that they have experienced discrimination in housing based on their sexual identity or gender identity. Safe and stable housing is an essential part of someone’s well-being. When someone is denied this kind of shelter, they may have increased difficulty maintaining employment, accessing healthcare, and having a safe and stable family life.⁴

Within the United States, there has been significant debate regarding marriage in gay couples. The perpetuation of this narrative has increased the visibility of antigay sentiments, which has increased social prejudice towards gay individuals.⁴

Additionally, only eight states allow gay couples to marry. In the rest of the states, families headed by gay partners are unable to access public policies and programs that increase economic security. These programs include child care tax credits, Social Security benefits, employer-provided health insurance, and citizenship for a partner.⁴

The inability to access affordable and competent healthcare can contribute to LGBTQ minority stress and subsequent issues with substance use. LGBTQ adults are much more likely than the rest of the population to go without health insurance. Uninsurance rates for lesbian and gay individuals are twice as high as that of the general population, and rates are even higher for transgender and bisexual people.⁴

Members of the LGBTQ community may have issues accessing affordable healthcare, as most affordable insurance plans are offered through employers. Discrimination in the workplace makes it difficult for LGBTQ individuals to have consistent access to health insurance. Additionally, many employers do not provide benefits to same-sex domestic partners.⁴

Health insurance plans that are most accessible outside of employment, such as Medicare, Medicaid, and plans through the Federal Employees Health Benefits Program, often deny coverage for transition-related care. In some cases, doctors may use these exclusions to refuse any basic service to transgender individuals.⁴

Additionally, many providers are not adequately trained to serve patients in the LGBTQ community, which significantly affects their quality of care. This lack of quality care can create additional expenses for LGBTQ individuals and diminish their quality of life, increasing the likelihood of using or abusing substances as a coping mechanism.⁴

In some cases, LGBTQ individuals are hesitant to utilize health care services to recover from substance abuse because they fear discrimination and are not confident that health care providers will adequately understand how to meet their needs. Many LGBTQ people who seek substance abuse treatment may prolong the process and choose not to disclose their sexual or gender identity, which can create challenges for their recovery.⁴

Many bars, clubs, and restaurants have been seen as safe places for members of the LGBTQ community to socialize. Drinking, smoking, and drug use can be prevalent activities within these environments. The more time LGBTQ individuals spend within environments like this, the more likely they are to engage in drug and alcohol use and the more often they will do so.⁴

Tobacco and alcohol companies have also aggressively marketed their products to the LGBTQ community for decades. In the 1990s, some tobacco companies surveyed gay men regarding their branding choices and created a marketing program that targeted gay men in San Francisco.⁴

Tobacco companies continue to target the LGBTQ community through advertising in gay and transgender magazines, advertising in magazines with many gay and transgender readers, same-sex undertones, and sponsoring events that support LGBTQ issues. They also tout themes important to the LGBTW community, such as liberation, individualism, social success, and acceptance. This kind of marketing can lead to increased rates of substance abuse in LGBTQ individuals.⁴

Substance Abuse and Comorbidities

LGBTQ individuals who engage in substance abuse are more likely to have comorbid or co-occurring psychiatric disorders. Gay and bisexual men and lesbian and bisexual women experience mental distress and depression more often than heterosexual counterparts. Additionally, transgender youth are more likely to experience depression, suicidality, self-harm, and eating disorders than their non-transgender peers.⁵

In instances where someone experiences substance abuse and co-occurring mental health disorders, psychiatrists may find it challenging to determine which came first. The two also interact with each other, and both need to be treated together. Many antidepressant medications are affected by other drugs. ⁶

Members of the LGBTQ community also have a higher risk of contracting the human immunodeficiency virus (HIV) because of intravenous drug use and risk sexual behaviors. HIV is most prevalent in gay and bisexual men who have sex with other men and transgender women who have sex with men. Treatment for substance abuse can help prevent HIV transmission due to reduced drug use and less risky sexual behavior.⁵

LGBTQ Substance Abuse During COVID-19

The COVID-19 pandemic has created even more challenges for the LGBTQ community with increased stress due to social prejudice, discriminatory laws, and family rejection. During the pandemic, they face a greater risk of harassment and violence and job loss, and increased financial difficulty, which increases the likelihood of drug and alcohol abuse. Substance abuse can also increase vulnerability to contracting COVID-19.⁷

Among the LGBTQ community, one-third of men who have sex with men reported increased substance abuse or binge drinking during the COVID-19 lockdown. Additionally, 32% of LGBTQ students drink more, and 22% use recreational cannabis more since the onset of the pandemic. Among LGBTQ individuals, 65% felt moderate or severe psychological distress, 40% felt isolated from others, and 26% had no social or emotional support. ⁷

Treatment

Members of the LGBTQ community with substance abuse issues often enter treatment with more severe substance abuse problems than their heterosexual counterparts. Also, lesbian and bisexual women seek treatment for alcohol use disorders at a higher rate than heterosexual women. Treatment centers need to be aware of the unique experiences of the LGBTQ community to provide the most effective treatment. ⁸

Modes of treatment such as motivational interviewing, social support therapy, cognitive management, and cognitive-behavioral therapy (CBT) are effective for gay and bisexual men who seek treatment for substance abuse.⁵

Additionally, treatment programs that offer specialized groups for gay and bisexual men showed better outcomes than those that do not provide specialized groups. Treatment methods for members of the LGBTQ community need to address things like homophobia/transphobia, family problems, violence, and social isolation. ⁵

Mental health professionals may improve their effectiveness and role in treatment by utilizing gay affirmative practice (GAP). The six principles of GAP are: ⁹

Don’t assume that a client is heterosexual.
Understand that homophobia in a client or society is the problem rather than sexual orientation.
Accept that identifying as gay, lesbian, or bisexual is a positive outcome.
Help clients to decrease internalized homophobia they might experience so they can achieve a positive identity.
Learn about different theories of the coming out process.
Overcome one’s own homophobia and heterosexual bias.

Video: "LGBTQ+ Populations and addiction Rehab"

References & Resources