Addressing Stigma: Challenging misconceptions about LGBT+ individuals and addiction

Society has come a long way in recognising and accepting LGBTQ+ people since the 1960s. After several decades of significant legislative wins – albeit predominantly in the West – many believe we have arrived at a high watermark for acceptance.

However, progress is rarely linear. Despite acceptance for LGBTQ+ people generally climbing since the early 2000s, 2023 marked the first year that Gallup found a significant fall in acceptance. When asked if gay or lesbian relations were morally wrong, 8% more people than in 2022 said yes, increasing to 33% from 25%.1 This is the largest year-on-year decrease in acceptance since the polls began in 2001 and a reversal of historical trends.

As a minority group, LGBTQ+ safety and acceptance are contingent on the attitude of the majority – and this can and does change. From the relative acceptance of Weimar Germany to the brutal crackdowns of the Stonewall riots to the high point of the legalisation of gay marriage and, recently, a worrying drop in acceptance, LGBTQ+ people have historically formed their own communities for safety and mutual support, while attitudes in the larger culture swing back and forth.

For these reasons, alcohol addiction and drug addiction in LGBTQ+ communities are multifaceted, containing issues of oppression and stigma but also cultural norms arising from separate cultural spaces. LGBTQ+ history needs to be properly understood to provide a nuanced understanding of the community and how addiction plays out within it.

Addiction and the LGBTQ+ community

The LGBTQ+ community experiences higher rates of drug and alcohol addiction compared to their heterosexual counterparts.2

One model proposed for understanding why is the minority stress model. Originally created to describe the experience of sexual minorities and later expanded to include gender minorities, minority stress differs from general stress (such as the stress of losing a job) ‘by its origin in prejudice and stigma’.3. Under this model, LGBTQ+ people have an enhanced risk of developing an addiction due to the pressures of their minority status.

This phenomenon has its roots in not just social stigma but also a history of legal discrimination and exclusion. While we are at a high tide for legal acceptance of LGBTQ+ people, this is a very recent development and varies between countries. We have already seen that progress is not consistently linear. New proposed US legislation, such as a Virginia bill that would categorise trans people as ‘obscene matter,’ shows that the pendulum is capable of swinging in more than one direction.

Historical and Cultural Context of LGBTQ+ and Addiction

Understanding the historical context of LGBTQ+ history is crucial in comprehending the relationship between LGBTQ+ identity and addiction. Many individuals found and still find solace and community in bars and clubs – historically, these were some of the only places they could congregate safely. This led to increased exposure to alcohol and drugs. The Stonewall Riots of the 1960s are named for The Stonewall Inn: a bar. As a result, patterns of addiction within the LGBTQ+ community have deep historical roots that continue to affect individuals today.

Differences in addiction between different elements of the LGBTQ+ community

Often, conversations around drug use in LGBTQ+ communities suggest that all groups under this umbrella consume legal and illicit intoxicants in the same way. This is compounded by the fact that studies focusing exclusively on one group (lesbians or transgender people, for instance) are rare, and often, the whole LGBTQ+ community is studied together. Often, bisexuals are included in studies with other groups (e.g. gay and bisexual men are grouped under ‘men who have sex with men’ and lesbian and bisexual women are grouped as ‘sexual minority women’ and not treated as a separate category of their own.5)

A 2012 study found ‘lesbians and bisexual women are at greater risk for alcohol and drug use disorders and related problems, and that gay and bisexual men are at greater risk for illicit drug use and related problems’. This suggests that alcohol addiction and drug addiction present differently in different subgroups of the LGBTQ+ community, and some may be more likely to suffer from alcohol addiction and others from drug addiction.6

Studies on transgender people have, until very recently, focused on trans women exclusively – and have categorised the illegal obtaining and use of cross-sex hormones as substance misuse.7 While this may technically and legally be called ‘misuse’, it isn’t the same as drug addiction, as self-medicating with cross-sex hormones serves a different purpose than recreational drug use.

While research does suggest that LGBTQ+ people as a whole do have higher rates of drug and alcohol use, this does not mean this looks the same between groups. However, until research around this topic becomes more sophisticated and granular, we can’t say with absolute certainty what these differences look like. As a result, it’s important not to make assumptions when dealing with LGBTQ+ people in active addiction and to be as inclusive and non-judgemental as possible.

 

The need for tailored services

LGBTQ+ people face a double disadvantage when addressing their addiction and interacting with rehab. Already encountering societal stigma for their sexual orientation or gender identity, they additionally encounter prejudices related to addiction. A prevailing trend in societal attitudes toward LGBTQ+ drug use is that it’s more prevalent simply because they are LGBTQ+ when the majority of research suggests the real reason is minority stress and exclusion.

Being doubly stigmatised leads to greater levels of shame and isolation, making it more difficult and potentially decreasing the likelihood for LGBTQ+ individuals to get help. Research in the American Journal of Public Health has highlighted the need for specialised addiction recovery services that are sensitive to the unique experiences of LGBTQ+ individuals8. The study found that ‘70.8% of (allegedly specialised) “LGBT” programs were no different from services offered to the general population, and only 7.4% could identify a service specifically tailored to the needs of LGBT clients.’

LGBTQ+ people and addiction recovery – creating effective services.

While addiction rehab and detox programmes can play a crucial role in recovery for LGBTQ+ people ,programmes created with the specific needs of LGBTQ+ people in mind must exist.

Inclusivity and lack of judgement, as well as access to counsellors and therapists who are knowledgeable about LGBTQ+ history, context and challenges, greatly increase the chance of successful treatment. A 2010 study discovered that, at least for gay and bisexual men, programmes that acknowledge and address the intersectionality of LGBTQ+ identity and addiction are more likely to be effective in supporting long-term recovery9.

Withdrawal and the recovery process can be particularly challenging for LGBTQ+ individuals. LGBTQ+ people face a greater potential lack of support from family or community due to rejection of their identity. Their old peer groups may gather in places where drugs and alcohol are normalised. This means LGBTQ+ people can often face withdrawal symptoms with a smaller support network, and this can be daunting.

This means addiction recovery services must acknowledge these additional challenges by offering a supportive and empathetic approach and acknowledging these added layers of complexity.

By educating staff, healthcare providers and medical professionals on the issues specifically faced by the LGBTQ+ community, the impact of stigma, exclusion and minority stress can be more effectively mitigated, offering a better chance of recovery.

The way forward

LGBTQ+ identity and addiction interact in a complex way. This complexity means that LGBTQ+ addiction requires a nuanced understanding and approach.

Empathy, understanding, and inclusivity, along with tailored addiction recovery services, mean more effective recovery journeys. By breaking down the barriers faced by the LGBTQ+ community, the path to addiction recovery is clearer.

 

 

Talk to UKAT

If you’re struggling with addiction and unsure of where to turn, UKAT can help.

We offer non-judgemental, affirming and inclusive LGBTQ+ rehab services that are considerate and knowledgeable about the unique needs of the LGBTQ+ community.

Get in touch with us today to start your journey to recovery.