LGBTQ Substance Use: Why Treatment Starts With Self-Acceptance

As we celebrate Pride Month, there's an important but unfortunate truth that requires our attention: 20 to 30 percent of the LGBTQ community struggle with substance use, compared to 9 percent of their heterosexual, cis-gender counterparts. This applies to LGBTQ individuals across the spectrum. Use of marijuana and illicit drugs like crystal methamphetamine have become increasingly common among gay men and transgender individuals, while binge drinking and alcoholism are on the rise among lesbian women.

So, why the large disparity? As a psychiatrist and medical director specializing in substance use treatment, I believe that trauma related to lack of full societal acceptance of LGBT individuals leads to mental health problems, including a deep struggle with self-acceptance. A study from the American Journal of Public Health, showed that LGBTQ individuals who experience high rates of discrimination are four times more likely to develop a substance use disorder.

I believe the LGBTQ community requires specialized substance use treatment that includes a strong focus on mental health and self-acceptance.

Traumatic experiences as contributing factors

The experiences I often hear detailed by my LGBTQ patients are distressing and they are usually shared by many others in the group. LGBTQ patients have often been through bad experiences at the hands of homophobic or intolerant individuals: exclusion from social groups or ridicule from peers; physical or verbal abuse and violence; rejection by their families or spiritual communities; and judgment or bias at the hands of some healthcare professionals. One of the major outcomes of these experiences is poor self-esteem.

The relationship between the LGBTQ community's experiences and a higher rate of substance use can be summed up by a commonly accepted idea called the "Minority Stress Hypothesis." It states that people from marginalized groups experience more stress than those belonging to larger, more powerful, or more "accepted" groups. They come to know prejudice and exploitation all too well and continue to have their rights violated (or at least continue to see attempts made on a national and global level). The resultant stress can lead to serious physical and mental health issues and negative methods of coping.

A survey released this week found that 39 percent of LGBTQ respondents between the ages of 13 and 24 "seriously considered suicide" within the past 12 months. It also found that a significant environmental factor in determining if an LGBTQ young person had experienced suicidal ideation is whether they had experienced mistreatment based on their identity. The disease of addiction can easily become a dark part of this cycle.

Another related factor to consider is the negative experiences those who identify as LGBTQ have faced by their doctors and other treatment providers. These patients have historically been met with challenges finding the right healthcare without judgment or bias - making it much more difficult to get the treatment they need.

The importance of specialized care

My goal is to create a welcoming environment for LGBTQ patients to help undo some of the societal trauma. I believe respecting individual identity allows the process of healing to begin, and that our patients deserve to be seen as people first - not just a stereotype of a minority group. Most importantly, I want all our patients to feel their environment is safe, so they're free to be who they are openly and without fear.

For the past two years at River Oaks Treatment Center, we've been running a weekly LGBTQ-focused therapy group. It began when a handful of patients approached us asking for a separate place to meet and discuss issues which they felt uncomfortable sharing in front of their larger therapy groups. For these individuals, having a safe space to process their thoughts when it came to sexuality or gender was critical to their journey toward sobriety.

One of the many benefits of this specialized group comes in the form of peer support. For example, I treated a woman in her 50s who disclosed to me that she was a lesbian, but could hardly say the word aloud, let alone come out to her family or friends. It was a major factor in her struggle with addiction, but when she first agreed to attend the LGBTQ therapy group, it finally solidified for her that she could be comfortable with herself. She was able to come out in a supportive environment and process the fear she'd been harboring.

Getting help for yourself or a loved one

For members of this community, addressing mental health struggles early is extremely important. And for friends and family of LGBTQ individuals, showing your unwavering support is crucial. As a parent or friend, choosing to stand by someone who comes out is often the most helpful step to take. For teachers, guidance counselors, or anyone in education, resources like gay-straight alliances are proven to improve self-esteem and reduce problems with addiction. And for healthcare providers, using open and inclusive language and offering nonjudgmental care can make a measured difference.

Thankfully, specialized treatment programs are becoming more common around the country, so finding the right option is easier than ever. In addition to finding a program that provides resources for medically supported detox, rehabilitation, and ongoing therapy, specialized treatment should also have a focus on: managing responses to discrimination and peer pressure; offering support for coming out; and dealing with depression, anxiety, or guilt related to sexual orientation or gender identity. The right treatment center will address the very real issues of abuse, trauma, harassment, stigmatization, and violence that the LGBTQ community faces.

It's important to treat both body and mind when it comes to the disease of addiction, and beginning a journey to self-acceptance often mirrors progress toward overcoming substance use. Let's get the conversation - and the healing - started today.

Michael J. Murphy, MD, MPH, is Medical Director of River Oaks Treatment Center, an American Addiction Centers facility. Murphy is a proud member of the LGBTQ community.