Studies have shown adults with a minoritized sexual identity are between 1.6 and 3.1 times more likely to have a substance use disorder (SUD) compared to their heterosexual counterparts. SAMHSA data reports that one-third of gay males, bisexual males and females had an SUD in the past year. Additionally, LGBTQ+ addiction treatment can be complex, with LGBTQ+ adults more than twice as likely to experience a complicating mental health condition.
There are a number of reasons why this might be the case. The minority stress theory suggests that increased stigma, prejudice, discrimination, and harassment suffered by minoritized individuals, including LGBTQ+ individuals, can lead to depression, anxiety and suicidal ideation, and that struggling with these issues increases risk for SUDs. Trans people often experience especially intense stigma, including violence, discrimination, prejudice, and bullying along with social exclusion and marginalization, meaning that they face a further raised risk of substance misuse. Transgender people are four times more likely to have experienced violence in their lives and this can lead to emotional regulation strategies or coping mechanisms and can make them more likely to engage in risky behaviors.
With this well-documented need, the care and treatment available for LGBTQ+ individuals is vastly inadequate. One study into the availability of specific LGBTQ+ addiction treatment in the United States found that only 17.6 percent of substance abuse facilities reported having LGBTQ+-sensitive recovery programs.
There are a variety of possible reasons behind the alarmingly low rates of LGBTQ+‐specific mental health and substance abuse treatment programs. Some of these reasons are due to flagrantly poor practice, including discrimination, reported by a significant number of LGBTQ+ people in healthcare settings. Some clinics are affiliated with non-affirmatory religious organizations. Others may not intend to discriminate but have implicit negative bias towards LGBTQ+ individuals.
For many LGBTQ+ individuals, simply attending a general treatment center is not an option. Some facilities are single-sex, which can affect trans patients. Other individuals have reported name-calling or harassment from other patients, and experienced social rejection or even violence. They have also reported that there are often no repercussions for those aggressive patients.
Some patients reported healthcare professionals not understanding their gender identity or making judgements or assumptions. Some patients can also struggle with felt stigma, based on a belief that their presence will disturb others undergoing treatment, and self-censor, which can affect the success of their own recovery.
Ensuring that a clinic is inclusive and affirming involves recognizing families, including same-sex partners, as well as implementing trans-inclusive policies and practices. These may include providing access to bathrooms and using correct pronouns and names for trans patients, which can prevent them from feeling marginalized. However, inclusivity also extends to the actual treatment provided.
It has been theorized that internalized stigma is one of the psychodynamic factors responsible for a predisposition towards substance use. Research has shown that this internalized stigma is associated with increased relationship problems and a lack of connection with their local communities. It is just one of the many LGBTQ+-specific sensitivities that may need to be addressed while in treatment for SUDs.
Providing identity-affirming treatment
Providing SUD treatment that is designed to meet the complex care needs of underrepresented populations is not just a responsibility and good practice, it can also expand your patient base and help improve recovery rates.
One study on transgender patients found that treatment that was perceived as non-inclusive was associated with failure to complete the program. But trans individuals who felt respected reported positive treatment experiences.
You may be committed to providing treatment free of discrimination, but it is always worth conducting a thorough inclusivity audit of your facilities to identify areas where your clinic or program may be falling short and suggest some practical measures to take.
For example, consider designing trauma-informed programs that are especially aimed at LGBTQ+ people and their families, and introducing reach-out programs for LGBTQ+ communities at risk. Connecting with communities promotes inclusivity in treatment and offers a pathway to individuals likely to need sensitive help. Create a safe and inclusive environment by using inclusive language, ensuring staff receive cultural competency and sensitivity training to respect the diversity of the LGBTQ+ community.
To ensure you are delivering LGBTQ+-sensitive services, you can consider the following specific strategies:
- Make sure your workplace is diverse and inclusive. A safe space for clients is also a safe space for colleagues.
- Ensure your colleagues feel they truly belong and are able to bring their whole self to work. A visibly diverse workforce is encouraging to minoritized clients.
- Educate your colleagues. Consider bringing a consultant on board to conduct training around implicit bias, as many well-meaning people can inadvertently marginalize minoritized groups without intending to.
- Conduct specialized training to address a lack of knowledge about any LGBTQ+-related issues patients may be struggling with and the specific treatment needs they have.
- Collaborate with other healthcare providers who may be treating your patient to ensure continuity and inclusivity of care.
- Implement trans-inclusive policies and practices as the norm, including providing access to bathrooms and using correct pronouns and names. This can help transgender patients feel more included and avoid feeling marginalized.
- Ensure that you and your staff are well-informed about inclusive language, including sexual orientation and gender-affirming terms, use of correct pronouns and names, etc.
- Consider designing trauma-informed programs that are especially aimed at LGBTQ+ people and their families and their unique challenges, such as minority stress and internalized stigma.
- Consider LGBTQ+-specific group therapy sessions, led by diverse counselors to create safe spaces where people can share without fear of judgement.
- Create open dialogue and encourage LGBTQ+ patients to share their thoughts and feedback – anonymously if necessary – so that you can continue to improve your services.
- Partner with LGBTQ+ organizations to better understand the complex challenges faced by this vulnerable community.
- Introduce reach-out programs for LGBTQ+ communities at risk. Connecting with communities promotes inclusivity in treatment and offers a pathway to individuals likely to need sensitive help.
It’s clear that, with an increased risk of SUDs and a lack of specialized addiction treatment for LGBTQ+ people, there’s an imbalance that needs to be addressed. There are many challenges that treatment centers may face when it comes to addressing this imbalance. However, with strategic focus and a deeper understanding of the needs of an underserved population, we can reshape the treatment experience for millions of LGBTQ+ people across the United States.
