LGBTQ+ Guide for Addiction Treatment

The LGBTQ+ community faces unique challenges in addiction recovery, but targeted treatment can help. This guide shows you how.

What Does LGBTQ+ Mean?

The LGBTQ+ community experiences substance use disorder and mental illness rates significantly higher than the general population, and most never receive treatment. No one cause creates this disparity, but most researchers agree that the unique challenges that LGBTQ+ people experience can contribute significantly to substance use.

Fortunately, there’s hope with LGBTQ+ addiction treatment centers, which can offer significantly greater chances of recovery for LGBTQ+ people compared to treatment as usual.

If you know, you know. But members outside the community often wonder, “What does LGBTQ+ stand for?” Put simply, LGBTQ+ is an umbrella term for people who don’t identify as heterosexual or identify with their assigned gender at birth.
The “alphabet” refers to specific groups, and the + is for anyone outside of gender or sexual norms.

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A Better Understanding of LGBTQ+

LGBTQ+ Meaning

The following is a brief explanation of the LGBTQ+ alphabet:
Over the last several years, the alphabet has grown significantly and will likely continue to incorporate new groups as cultural norms around gender and sexuality change.

What Are the SUD Rates for the LGBTQ+ Community?

Rates of substance use disorder in the LGBTQ+ community are significantly higher than in the general population. According to the 2019 National Survey of Drug Use and Health, 18.3% of all LGBTQ+ individuals met the criteria for substance use disorder in the United States.1 This percentage accounts for a staggering 2.6 million people.

Of those 2.6 million, 64.6% struggled with alcohol, 51.6% struggled with illicit drug use, and 16.2% struggled with both alcohol and illicit drugs. In addition, over 70% had co-occurring mental illness alongside a substance use disorder. Lastly, people in the LGBTQ+ community with substance use disorders often enter treatment with more severe problems.

What Substances Are Most Abused in the LGBTQ+ Community?

Your sexual preferences, gender identity, or gender expression don’t dictate substance use, but certain subcultures within the community can promote specific drugs over others. The most common substances of abuse in LGBTQ communities are as follows, with percentages and reported use in the last year listed from the National Survey on Drug Use and Health:1

1. Alcohol: 64.2%, 10 million
2. Marijuana: 43.6%, 6.3 million
3. Pharmaceutical drugs: 16.1%, 2.3 million
4. Hallucinogens: 8.4%, 1.2 million
5. Cocaine: 7.4%, 1.0 million
6. Inhalants: 4.3%, 623 thousand
7. Methamphetamines: 2.9%, 411 thousand
8. Heroin: 1.0%, 141 thousand

Alcohol and marijuana are clearly at the forefront of substance use, likely because of their legal status and general social acceptance. Pharmaceutical drugs, like prescription opioids or benzodiazepines, follow close behind, with stimulants and heroin use coming in near the bottom of the list.

How Do Addiction Rates Compare to Other Groups?

Looking at the statistics for the general population, LGBTQ+ rates of substance use disorder are significantly higher. The same national survey estimates the national rate of substance use disorder to be 15.4%, much lower than rates for the LGBTQ+ community.2
In addition, illicit drug use makes up only 28.5% of substance use disorders generally, compared to the 51.6% in the LGBTQ+ community.

What Factors Underlie the SUD Rates?

There’s no single, direct cause that creates the disparity in substance use disorder rates between LGBTQ+ people and the general population. Still, most researchers consider the specific challenges that members of this community face to be one of the key driving forces.

In particular, LGBTQ+ people face discrimination, stigma, abuse, and trauma at elevated levels and turn to substances to cope.

A Further Look at Addiction in the LGBTQ+ Community

LGBTQ+ Community Experiences Mental Health Issues at Higher Rates

The LGBTQ+ community also has significantly higher rates of mental illness. Depression, anxiety, suicidal ideation, and post-traumatic stress disorder are the leading causes of mental health issues for LGBTQ+ people.

What Are the Rates?

According to the same National Survey on Drug Use and Health, 47.4% of the LGBTQ+ community aged 18 or older had a mental illness.1 Of that percentage, accounting for 6.8 million people, two in five had a severe mental illness.
Suicidal ideation and suicide attempts are also much higher than for cis-gendered people. According to The Trevor Project, 39% of LGBTQ+ youth had seriously considered suicide, compared to 31% of cisgender youth.3 Transgender and non-binary youth are at particular risk; 54% have seriously considered suicide, and 29% have made a suicide attempt.

Why Are They So High?

Again, rates for mental health issues are exceptionally high for the LGBTQ+ community because of the specific challenges they face. The Trevor Project found a marked increase in suicide attempts in youth who reported that someone had tried to convince them to change their sexual orientation or gender identity and even higher rates for those subjected to conversion therapy.3
Similarly, those who experienced physical harm or discrimination due to their sexuality had a greater likelihood of attempting suicide.

Challenges the LGBTQ+ Community Faces

LGBTQ Addiction Treatment

Discrimination, stigma, and abuse are saddeningly common challenges for the LGBTQ+ community. Facing such persistent challenges can contribute to the development of mental illness, substance use disorder, or both.

Discrimination

Despite several decades of progress for the LGBTQ+ community and evolving social perceptions and attitudes, many still face discrimination for their gender identity, sexuality, or gender expression. More than a third of all community members met some type of discrimination in 2020 alone, and around half had to modify their behavior to avoid the harmful effects of discrimination.4

Discrimination can take place at work, school, or in public spaces. It can also prevent the LGBTQ+ community from receiving essential services, such as addiction treatment or the ability to buy or rent a home. This might account for the “treatment gap” outlined in the National Survey of Drug Use and Health findings that 86.4% of people in the LGBTQ+ community with substance use disorder never receive treatment.1

Stigma

Stigma is a close relative of discrimination. Whereas discrimination affects the way people treat you, stigma affects their perceptions. This can cause significant undue stress without a clear cause since people with a stigma against the LGBTQ+ community can veil their prejudice.

Abuse

The most troubling challenge for the LGBTQ+ community is outright abuse directed at them for their gender expression, identity, or sexual preferences.
The LGBTQ+ community is nearly four times more likely to be victims of violent crime than cisgender individuals.5 Violence can cause lasting trauma that can affect them for years if left untreated.

How Heterosexism Affects Substance Use

Heterosexism, or the prejudiced belief that heterosexuality is the “norm,” can cause substantial challenges for members of the LGBTQ+ community. It can lead LGBTQ+ people to internalize shame about their gender or sexuality and lead to substance use as a coping method.
Heterosexism essentially victimizes the LGBTQ+ community, leading towards self-doubt, negative self-concept, or feelings of victimhood or inadequacy.
Additionally, LGBTQ+ people may face heterosexism within treatment centers. This factor makes it more important for community members to prioritize finding treatment centers that provide affirmative LGBTQ+ addiction treatment.

Co-Occurring Disorders in LGBTQ+ Populations

The most common co-occurring disorders for LGBTQ+ people are:
There is substantial evidence that these disorders occur in the LGBTQ+ population at much higher rates, particularly among transgender and nonbinary individuals.6-7

A Discussion on Stigma in the LGBTQ+ Community

Addiction Treatment Options

People who have found themselves struggling with substance use disorder can find hope that there are several effective, evidence-based treatment options available to help them towards recovery in LGBTQ+ addiction treatment.

LGBTQ+ addiction treatment comes in various forms, from partial hospitalization programs to outpatient treatment that you only attend once or twice a week. Below, we’ve listed the most common forms of drug treatment and how they work.

Detox

Detox is a medical service provided to help people stabilize themselves during the early stages of addiction recovery. It provides a safe place to quit using drugs or alcohol under direct medical supervision and alleviates many withdrawal symptoms associated with chronic drug use.

A detox is a helpful option for any LGBTQ+ addiction treatment program, but it’s necessary for people trying to quit alcohol or benzodiazepines. The withdrawal effects from these drugs can be life-threatening without proper medical care.

Inpatient Addiction Treatment

Inpatient treatment usually consists of a 30-day, 60-day, or 90-day stay at a treatment facility away from home. While attending inpatient LGBTQ+ addiction treatment, you will participate in several classes and groups each day designed to help you understand and overcome your substance use disorder.

Inpatient treatment offers several distinct advantages. First, you choose to remove yourself from the situation where your addictive behaviors were strongest, granting yourself a reprieve from the stresses of everyday life.
Second, the intensive nature of therapy means you’ll be able to receive substantial support during the most challenging period of early recovery, with the constant backing from trained addiction professionals and support staff.
Lastly, inpatient treatment is often well-equipped to deal with co-occurring disorders and individualized therapy, meaning you can treat the root cause of addiction rather than the symptoms alone.
There are several treatment modalities within inpatient treatment centers, including:
Each treatment center has different options for treating addiction. Since there is no one-size-fits-all approach to recovery, experimenting with several treatment modalities and finding a treatment center that fits your needs is often the best approach.

Outpatient Addiction Treatment

Outpatient treatment is an excellent first-line treatment option, but people leaving inpatient treatment can also benefit from continuing with an outpatient program. Outpatient LGBTQ+ addiction treatment usually takes place near where you live. You don’t need to uproot your whole life to seek treatment.

Outpatient treatment offers similar therapy options to inpatient programs but can be adapted to fit your schedule. Outpatient can be intensive (five days a week for several hours) or more relaxed (a few groups each week and meeting with an individual counselor).

Medication-Assisted Treatment

Medication-assisted treatment (MAT) is provided at specialized addiction clinics or through your physician as an effective drug addiction treatment option. MAT is beneficial for people with opioid addiction treatment since medications can substantially reduce opioid withdrawal and craving. Typical medications offered at MAT clinics include Suboxone, Methadone, or Naltrexone—all medications which affect your opioid receptors to help reduce cravings for illicit drugs.

What is LGBTQ Affirming Treatment?

One of the best options for members of the LGBTQ+ community struggling with substance use disorder is to find a treatment center that provides LGBTQ+ affirming treatment.
Since the community faces such distinct challenges, many of the driving causes of substance use are related to the trauma, stigma, and abuse that many people face. LGBTQ+ affirming treatment gives people the space and understanding to address issues directly tied to their gender or sexuality.
Affirming treatment is usually provided in addition to standard addiction models. You’ll still be receiving the best evidence-based care at a facility that offers affirming treatment, meaning you can focus on your addiction as well as deal with the other issues and challenges in your life.

How is it Different than LGBTQ+ Friendly?

Many programs describe themselves as LGBTQ+ friendly but provide no specific services geared towards the LGBTQ+ community.
One study from 2007 showed that while 70.8% of treatment centers in the United States claimed themselves to be LGBTQ+ friendly, only 7.4% could identify specific services they offered for dealing with LGBTQ+ specific issues.8 Instead, they offered only the standard addiction treatment care available at other facilities.

What Does LGBTQ Affirmation Look Like?

LGBTQ+ affirmative therapy adopts a positive view of anyone’s gender or sexuality and faces the negative aspects of homophobia, transphobia, and heterosexism head on.9
Attending affirmative treatment means you’ll be able to address and process the specific challenges faced by the LGBTQ+ community in an empathetic environment with people you trust.

LGBTQ+ Addiction Treatment

It’s obvious the LGBTQ+ community continues to face disparities in rates of substance use disorders and availability of treatment. This is likely due to the unique challenges of stigma, discrimination, and abuse that plague our society despite recent progress. Drug and alcohol use in the community is relatively high, and LGBTQ+ people are more likely to experience mental illness.
Fortunately, recovery from substance use disorder is possible. LGBTQ+ members can receive help from any addiction treatment center but could benefit from attending treatment that is LGBTQ+ affirming. Most people should consider detoxification at a medical facility and engage in a level of treatment that they feel most comfortable with from there.

Addiction is not a life sentence. Evidence-based programs and medications can help reduce substance use, overcome substance use disorder, and start living your best life in recovery.