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Drug abuse and addiction present major challenges for the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community. Already high within the general population, rates of substance abuse increase substantially within the LGBTQ community alone.

Unfortunately, little research is available to confirm actual rates of drug abuse among those who identify as LGBTQ, so it is difficult to ascertain the exact extent of the problem. However, a study conducted by Australia's Queensland Association for Healthy Communities presents a grim picture. In this 2005 survey, 44.8 percent of respondents claimed to smoke daily, with most using between 11 and 20 cigarettes per day.

Alcohol abuse was also rampant, with 41.4 percent of respondents drinking more than eight alcoholic beverages per week. Perhaps most alarming of all, half of respondents had used recreational drugs at some point or were still using them at the time of the survey. The top five recreational drugs mentioned in the survey included marijuana, ecstasy, amyl nitrite (poppers), crystal meth, and speed.

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Preliminary research suggests that rates of drug abuse are also high in the United States. A study published in the Journal of Substance Abuse Treatment found that LGBTQ youth were far more likely to develop crippling addictions than their heterosexual counterparts. Furthermore, once they did fall victim to addiction, these individuals were less likely to seek rehab and recovery treatment.

Why are LGBTQ addiction rates so high? It is clear that drug addiction is the cause of much suffering among members of the LGBTQ population, but why exactly is this community afflicted by such high rates of substance abuse? A number of factors can contribute to LGBTQ drug abuse, including the following:

--Higher rates of depression among LGBTQ individuals

--A need to escape from the constant presence of social stigma and homophobia

--Efforts to either numb or enhance sexual feelings

--Ease shame and guilt related to LGBTQ identity

--Drug use among peers leads to pressure on non-users

Unfortunately, many of the factors contributing to the development of addiction in LGBTQ individuals can also prevent these sufferers from seeking treatment. Addiction, as well as mental illness in general, carries a heavy social stigma with it, but an LGBTQ identity compounds that stigma even more. Additionally, many members of the LGBTQ community worry that they will not be able to find LGBTQ recovery centers suited to meeting their unique needs. They may be unwilling to enter traditional addiction recovery programs instead of gay drug recovery facilities, mostly due to their fear of being targeted by heterosexuals taking part in these recovery programs. These worries are not necessary, however, because a number of excellent LGBTQ rehab facilities are available.

[Source: Recovery.Org]

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Michael Boticelli: TED Talk

Michael Botticelli is a drug policy expert. He also happens to be gay. As Director of National Drug Control Policy, Michael Botticelli led the Obama Administration’s drug policy efforts to diminish the consequences of substance use through evidence-based prevention, treatment and recovery support services. His TED Talk lecture (April 2017) is worth viewing.

He says that addiction is a disease and that we should treat it that way. Only one in nine people in the United States gets the care and treatment they need for addiction and substance abuse. A former Director of National Drug Control Policy, Michael Botticelli is working to end this epidemic and treat people with addictions with kindness, compassion and fairness. In a personal, thoughtful talk, he encourages the millions of Americans in recovery today to make their voices heard and confront the stigma associated with substance use disorders.

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As Director of National Drug Control Policy, Botticelli led the Obama Administration's drug policy efforts, which are based on a balanced public health and public safety approach. The Administration advanced historic drug policy reforms and innovations in prevention, criminal justice, treatment and recovery.

In response to the national opioid epidemic, Botticelli coordinated actions across the Federal government to reduce prescription drug abuse, heroin use and related overdoses. These include supporting community-based prevention efforts; educating prescribers and the public about preventing prescription drug abuse; expanding use of the life-saving overdose-reversal drug naloxone by law enforcement and other first responders; and increasing access to medication-assisted treatment and recovery support services to help individuals sustain their recovery from opioid use disorders.

According to Pride Institute, "In the LGBTQ community, research suggests that alcohol abuse and dependence occurs at even higher rates than in the mainstream population. Independent studies collectively support the estimate that alcohol abuse occurs in the LGBTQ community as rates up to three times that in the mainstream population. Said another way, alcohol abuse is estimated to occur in up to 45% of those in the LGBTQ community."

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Ann Leible is an LPC with Pride Institute. She offers this critical information about drug and alcohol abuse among LGBTQ persons:

It is generally held among researchers that LGBTQ persons are more likely to use alcohol and drugs than the general population and more likely to abuse alcohol and drugs, as cited in the Center for Substance Abuse Treatments A Provider’s Introduction to Substance Abuse Treatment for Lesbian, Gay, Bisexual, Transgender, and Queer Individuals. Twenty to twenty-five percent of gay men and lesbians are heavy alcohol users, compared to 3-10% of the heterosexual population.

Why is this? What factors contribute to the prevalence of chemical abuse among gays and lesbians, bisexual, transgender, and queer individuals? And, finally, what can be done about it? Attitudes and assumptions regarding homosexuality and chemical abuse have evolved throughout the years. Until 1973, homosexuality was defined as a mental illness by the American Psychiatric Association.

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Alcoholism, drug abuse, and chemical dependency issues, once treated solely as legal problems, now are seen as illnesses of the mind, body, and spirit. At one time it was believed that there was a causal relationship between homosexuality and alcoholism with the idea that suppressed homosexual tendencies actually triggered chemical abuse and dependency.

Today this myth has been dispelled by research. Instead, scientists believe that societal factors affect the relationship between chemical abuse and the experiences of members of the LGBTQ community. The society in which we live marginalizes the LGBTQ community. In fact, there is an ever-presentness of possible oppression in LGBTQ people’s lives. Under such conditions, LGBTQ folk can experience varying degrees of heterosexism.

[Source: Pride Institute]

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Why Are There More LGBTQ Addicts?

Ann Leible (Counselor with Pride Institute) offers an explanation as to why substance abuse may be higher among LGBTQ people. She sites these factors:

Heterosexism - Heterosexism is defined as the stigmatization of non-heterosexual forms of emotional and affectional expression, sexual behavior or community. Negative covert and overt messages about the gay and lesbian lifestyle as well as incidents of hate in the form of threats, acts of humiliation, emotional abuse, and even murder occur frequently. Other common examples of heterosexism include: rejection by family, friends, and peers; loss of employment or lack of promotion; and observing/hearing people make heterosexist jokes. Heterosexism can contribute to internalized homophobia, shame, and a negative self-concept.

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Self-Medication - Some LGBTQ individuals self-medicate with drugs and alcohol as a way to cope with or numb negative feelings associated with heterosexism, such as isolation, fear, depression, anxiety, anger, and mistrust. Others in the gay community may use mind altering substances as a way to cope with stressors caused by the tensions of living under the stigma of marginalization. In fact, substance use is a large part of the social life of many in the LGBTQ community. The gay bar scene is regarded as a risk factor for substance abuse among the gay community. But these bars have often been the only places where LGBTQ folks can socialize and feel free from the prevailing oppression that is experienced every day in a strongly heterosexist society. The LGBTQ individual who has experienced rejection from his or her biological family may find in the gay bar that one opportunity for identity affirmation and acceptance.

Heterosexism also causes many LGBTQ folks to compartmentalize their lives. On the outside, they may follow the rules of the dominant society and behave in ways that are accepted as the norm in order to fit in and succeed. Kimeron N. Hardin, in The Gay and Lesbian Self-Esteem Book: A Guide to Loving Ourselves (1999), defines this identity as the public self. The secret self, on the other hand, is that part of self that is honest and consistent with how one truly feels and what one desires. It remains hidden and is often perceived by the LGBTQ identified individual as shameful, evil, or unworthy. Engaging in such actions of secret keeping, compartmentalizing, and self-degradation can take a huge emotional toll on an individual. As every 12 Step member knows, secrets keep us sick.

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Substance use can provide an avenue of relief that is easily accessible and immediate in its effects. It can also mirror the coping mechanisms of self-compartmentalizing. The user can experience a chemically promoted dissociation, which the LGBTQ individual may find both familiar and comforting. Therefore, the compelling allure of alcohol and drugs manifest, and the user becomes vulnerable to the cycle of chemical addiction.

Barriers in Treatment Services - Heterosexism plays a part in the chemically dependent LGBTQ individual’s inability to access effective treatment services. Substance abuse treatment facilities are often not able to meet the needs of this special population. The treatment staff of such facilities may have varying heterosexist assumptions regarding the LGBTQ clients who access their services. They may be uninformed about LGBTQ issues, insensitive to or antagonistic toward LGBTQ clients or believe that homosexuality causes substance abuse or can be changed by therapy. Other clients may have negative attitudes toward the LGBTQ client.

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These issues become barriers in successful treatment experiences for the LGBTQ individual seeking those services. Treatment components designed to promote successful treatment experiences for the LGBTQ client include cultural sensitivity, an awareness of the impact of cultural victimization, and addressing issues of internalized shame and negative self-acceptance. The integrated biological-psychological social model of chemical addiction treatment takes into account the effects of society on the individual and his or her relation to the use of chemicals.

Cognitive behavioral counseling techniques challenge internalized negative beliefs and promote emotional regulation. Such counseling helps the LGBTQ client reach for internal acceptance instead of the nearest bottle or drug.

The inclusive and accepting spirit promoted by Alcoholics Anonymous and other support groups provides an appropriate alternative to the gay bar. LGBTQ folks can find a way to transcend the in-authenticity promoted by cultural oppression through the affirming acceptance of others. As a result, they may find themselves living more integrated and expressive lives. Who needs alcohol or drugs when one’s life is so full?

[Source: Pride Institute]

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Language of Substance Abuse

In the context of addiction and recovery, "substances" should understood to include alcohol and a wide range of prescription and non-prescription drugs. The "chemicals" in the term "chemical dependency" refer to alcohol and drugs. The term "self-medicating" refers to the act of "using, abusing, or misusing" alcohol or drugs for purposes of coping that ultimately leads to "addiction, dependence, disorder, disease, or illness."

Contemporary approaches view the field of addiction and recovery in terms of "disease management" and "recovery management" and "treatment interventions." As an example of language that reflects a more supportive approach, and seeks to minimize stigmatization, modern verbiage may include newer terms, such as Alcohol Use Disorder (AUD) or Substance Use Disorder (SUD). Elevating the concept of "recovery" is important because it reflects a shift from a "pathology" paradigm to a "resiliency" paradigm. It is a way of declaring that it is time for "addiction treatment" agencies to become "recovery agencies."

Addiction - This widely understood term describes “uncontrollable, compulsive drug seeking and use, even in the face of negative health and social consequences.” There is a distinction between addiction and dependence, although many use the words interchangeably. Addiction conveys both social and health problems, whereas dependence only encompasses health problems.

Addictive Disorder, Addictive Disease - By incorporating disorders or disease, these terms reinforce the medical nature of the condition.

Alcohol and Drug Disease - This term works because it is precise. Alcohol and drugs is more specific than substance, which could include any substance to which one can become addicted, including nicotine and caffeine. In addition, the word disease clearly denotes the condition as a health issue.

Alcohol and DrugRelated Problems - This term is useful as a general descriptor because it refers to the range of difficulties that may accompany alcohol and drug disease.

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Chemical Dependency - Term used more in clinical settings than by the public at large, chemical dependency accurately alludes to the changes in brain chemistry in alcohol and drug disease.

Dependence - The term is useful because it represents a distinct clinical diagnosis and it does not include stigmatizing terminology. Physical dependence is a state of adaptation that often includes tolerance and is manifested by a drug class specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of specific medication.

Intervention - Broadly used term to describe the interruption of the progress of an illness or potential illness. Intervention is widely used in clinical settings to describe the process in which a group of formally prepared, concerned parties intervene to encourage a person to get help for a substance use disorder.

Patient - As with other illnesses, the word accurately refers to a person who is under care for a substance use disorder. It reinforces the fact that substance use disorders constitute a health issue.

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Person With - Using language such as "person with alcohol and drug disease" or "people with with addictions" or "persons with substance use disorders" identifies the individuals as people, rather than labeling them by their illness. This is referred to calling someone an "addict" or "alcoholic."

Recovery Management - Straightforward description of what the recovery process entails. As with other chronic illnesses such as diabetes and hypertension, a substance use disorder is an illness that can be treated and managed, and from which people recover.

Recovery Movement - Term elevates the notion that the voices and faces of recovery are becoming stronger, more visible, and more unified. The recovery movement seeks to make recovery a reality for all who may seek it, free from stigma, discrimination, and other barriers.

Remission - Term is aligned with medical terminology that describes a period of time in which the signs and symptoms of the illness have disappeared.

Roads/Paths to Recovery - Useful term because it recognizes that there is no single means to achieve recovery, but rather that people find recovery via multiple paths such as clinical treatment, 12step programs, or medicationassisted recovery.

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Misuse - Same intended meaning as what has traditionally been termed as "abuse," but without the stigma and judgmental overtones that "abuse" carries. Also, "risky use" or "problem use."

Substance Use Disorder - Includes misuse, dependence, and addiction to alcohol and/or legal or illegal drugs. The term is helpful because it encompasses a range of severity levels, from problem use to dependence and addiction.

Treatment - Use of any planned, intentional intervention in the health, behavior, personal and/or family life of an individual suffering from alcoholism or from another drug dependency designed to enable the affected individual to achieve and maintain sobriety, physical and mental health, and a maximum functional ability. It effectively connotes a health intervention.

Use - Term commonly refers to experimental or occasional consumption of alcohol and drugs. This is preferred to "abuse."

Wellbriety - Term that combines wellness with sobriety, conveys the notion that recovery is more than the cessation of alcohol and drug misuse.

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LGBTQ Rehab: Inclusive Addiction Treatment and Recovery for LGBTQ Community

As anyone who works in addiction treatment can attest, addiction doesn’t discriminate. For those who already face ongoing discrimination due to their sexual orientation or gender identity, seeking addiction treatment can be particularly daunting. If you are LGBTQ and are ready to reclaim your life, you’re probably unsure about where to turn for help. One thing’s for sure: You have options. Increasingly, rehab facilities around the country are going to great lengths to be inclusive to members of the LGBTQ community.

Staggering Rates of Addiction Among the LGBTQ Community

According to the Substance Abuse and Mental Health Services Administration, approximately 20 to 30 percent of LGBTQ individuals suffer from a substance use disorder. Among the general population, the rate is around 8.4 percent. In a survey, 39.1 percent of LGBTQ admitted to using illicit drugs in the past year versus just 17.1 percent of the general population. Per these statistics, then, rates of addiction are anywhere from two to three times higher among the LGBTQ population than the regular population—but why?

Why are members of the LGBTQ community at higher risk for addiction? Given that members of the LGBTQ community already suffer unfairly from bias, homophobia, prejudice and even violence, it seems especially unfair that they are also more susceptible to developing substance use disorders. However, many factors contribute to this increased risk. By understanding these factors, it is easier to see why choosing an addiction treatment center can be so overwhelming.

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Stress

Sure, all of us have to deal with stress from time to time. However, LGBTQ individuals often carry around a lot more of it due to rampant stigma and prejudice in today’s society. Although the community has made impressive strides toward equality, it is still perfectly okay in many places to be openly discriminatory and prejudiced toward lesbian, gay, bisexual, transgender and queer people. LGBTQ individuals with addictions often cite the stress that they endure from discrimination as a major trigger for turning to drugs or alcohol.

Internalized Homophobia

Facing discrimination for being LGBTQ is bad enough. What’s worse is that many gay and lesbian individuals absorb society’s cruel messages and internalize them. Without even realizing it consciously, they may loathe themselves for being who they are. Self-loathing is a very common trigger for wanting to escape through the use of mind-altering substances. Such individuals may even convince themselves that they deserve to be miserable and addicted. This is especially likely when the very people who are supposed to love and care about them reject them.

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Rejection

Indeed, members of the LGBTQ community often face the rejection of their closest friends and relatives. According to the Centers for Disease Control, approximately 40 percent of today’s homeless youth identify as LGBTQ. Sadly, many of them end up on the streets after being rejected by their families. Whether a person is snubbed and treated poorly by loved ones or is actually kicked out of their home, feelings of rejection are difficult to cope with. For many, drugs and alcohol offer a tempting escape from those difficult feelings—and from the overall lack of support that they receive from the people who are supposed to love them unconditionally.

Self-Medication

Finally, as we will discuss below, a significant percentage of LGBTQ individuals suffer from mood disorders, eating disorders and other forms of mental illness. Regardless of their sexual orientation or gender identity, someone who suffers from such illnesses often looks for relief wherever they can. All too often, this takes the form of substance abuse. When compounded by the stress of being discriminated against for being LGBTQ, it is easy to see why members of this population are so much likelier to develop addictions.

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Co-Occurring Conditions and Substance Abuse Among LGBTQ Individuals

Co-occurring conditions, or dual diagnoses, are common among those who suffer from substance use disorders. They are even more common still among members of the LGBTQ community. According to the Hazeldon Betty Ford Foundation, in fact, 92 percent of LGBTQ patients in treatment had co-occurring conditions versus just 78 percent of non-LGBTQ patients. For these individuals, it is especially crucial to find treatment that addresses not just their addiction but their co-occurring conditions as well.

Benefits of Inclusive Addiction Treatment for LGBTQ

You should select a facility that explicitly states its inclusivity to members of the LGBTQ community. As always, words aren’t enough, so look for evidence that the facility takes extra steps to address the special needs of LGBTQ individuals. For example, such a facility will offer traditional group therapy as well as group therapy that is specific to LGBTQ people. A facility that goes out of its way to make LGBTQ patients feel welcome is likelier to have caring, understanding personnel who have even been trained to more effectively address the needs of gay, lesbian, bisexual, transgender and queer individuals.

[Source: Dr. Nicole Folmar-Doss, Ocean Hills Recovery, August 2018]

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