Heterosexism may affect gay and bisexual men, lesbian, transgender, and queer individuals (LGBTQ) people by causing internalized homophobia, shame, and a negative self-concept. It is not surprising to find that many LGBTQ individuals in therapy report feeling isolated, fearful, depressed, anxious, and angry and have difficulty trusting others. LGBTQ individuals may resort to substance abuse to cope with negative feelings. It is argued that the stigma and resulting tension of being a member of a marginalized community (i.e., LGBTQ) cause some members to manage these additional stressors by using psychoactive substances.
In comparison to the general population, studies have shown that members of the LGBTQ community are more likely to:
- Abuse alcohol, illicit and recreational drugs
- Have higher rates of substance abuse
- Have alcoholism
Studies comparing gay men and lesbians with heterosexuals have found that 20-25% of the gay men and lesbians are heavy alcohol consumers, compared with 3-10 percent of heterosexuals. Substance abuse among gay and bisexual men may be a response to homophobia, discrimination, and marginalization because of their sexual orientation. Ultimately, this impairs one’s relationships and emotional health and well-being.    Â
While LGBTQ individuals use and abuse alcohol, certain drug usage is more prevalent in their minority community than in the majority community. Gay men and men who have sex with men (MSM) are significantly more likely to have used marijuana, psychedelics, hallucinogens, stimulants, sedatives, cocaine, barbiturates, and methylenedioxymethamphetamine (MDMA) and are much more likely to have used amyl nitrates “poppers.” Party drugs, such as ecstasy, ketamine or “special-K,” and gamma-hydroxybutyrate (GHB), are increasing in popularity among some segments of the LGBTQ population. These drugs are often used during circuit parties and raves and can impair judgment and result in risky sexual behavior.
Methamphetamine abuse has substantially increased in recent years among segments of the LGBTQ community. Hepatitis C and HIV infections are associated with methamphetamine use and can lead to significant dependence and addiction. Some LGBTQ methamphetamine users inject the drug, putting them at risk for HIV, hepatitis B, and hepatitis C.
Substance abuse treatment for an LGBTQ individual is the same as that for other types of clients and primarily focuses on stopping the substance abuse that interferes with the well being of the client. Treatment differs in need to address the feeling about his or her sexual identity and orientation. Due to homophobia and discrimination against LGBTQ individuals, some may find it difficult or uncomfortable to access treatment services. Additionally, substance abuse treatment facilities are often not equipped to meet the needs of this population. Heterosexual treatment staff members may be uninformed about LGBTQ issues, and may be insensitive to or antagonistic toward LGBTQ individuals, or may falsely believe that sexual identity causes substance abuse or can be changed by therapy. These beliefs by providers become barriers to treating the LGBTQ community.
Problems arise when treating LGBTQ individuals using conventional treatment modalities for groups, couples, or families. Groups should be as inclusive as possible and encourage each member to discuss relevant treatment issues or concerns. Staff members should ensure that LGBTQ individuals are treated in a therapeutic manner and should tell others that homophobia will not be tolerated. It should be the LGBTQ individual who decides whether to discuss issues relating to his or her sexual orientation in mixed groups. Providing individual services eliminates the mixing of heterosexual and LGBTQ clients in treatment groups and decreases the likelihood that heterosexism/homophobia will become an issue.
LGBTQ substance abusers should be assessed to determine the range of medical services they require. The type and dose of drug used, the danger of a medically complicated withdrawal, the difficulty of the withdrawal, and the impact of social and psychological stressors can help a counselor determine the level of care an individual needs.
Continuity of care refers to services provided in addition to program services and services received after discharge. The types of services offered for LGBTQ individuals may differ because of the health status of the clients or their partners; their living arrangements; the nature and stability of their employment; their level of comfort about their sexual orientation; and their previous experience with a service provider.
Clinical Research Fellow at Harvard Medical School