Treatment Options for the LGBT Community
Members of the lesbian, gay, bisexual and transgender (LGBT) community face unique social and emotional pressures and stressors that may increase the risk factors for substance abuse and dependence.
Studies published in Social Work Today indicate that rates of substance abuse may be between 20 and 30 percent in the LGBT community as compared to the national average of 8.2 percent that is estimated to engage in substance abuse or dependency, according to the 2013 National Survey on Drug Use and Health (NSDUH). This could be partly due to the culture and minority sexual status, and substance abuse may also be used as a form of self-medication for LGBT individuals. Rejection from family, discrimination and social stigmas can create high levels of stress that may be dulled with alcohol or drug use.
Youth prevention methods focus on reaching the general population, and LGBT youth may fall between the cracks as topics may not be as relevant to them. There may not be as many social outlets for LGBT individuals that are readily accepting of their orientation. Gay bars may provide solace for LGBT adults but can also raise the incidence of alcohol use or abuse. As society and the medical community begins to understand and appreciate the specific needs of the LGBT community, treatment options are becoming more accessible, making recovery a real and attainable goal.
Substance Abuse Treatment
LGBT individuals may use alcohol and drugs in order to integrate into and function within society. Substances may heighten the dissociative state that LGBT community members may use as a coping mechanism to keep personal feelings and true identities locked away to avoid persecution. Low self-esteem and negative self-images may also be bolstered temporarily with the use of alcohol or drugs.
Chronic use of alcohol or drugs may lead to the brain becoming dependent on the substance in order to feel normal. This is called tolerance, and more of the substance will need to be taken each time in order to maintain the desired effects. When the substance is removed, withdrawal symptoms and cravings may be present as well. Increasing the amount of substance abused over time may ultimately lead to a substance use disorder (SUD) that alters brain chemistry and includes both psychological and physical dependence.
Addiction is a brain disease defined by compulsive drug- or alcohol-seeking behavior regardless of any negative social or physical consequences. In 2013, the NSDUH estimated that as many as 20.2 million Americans over the age of 12 needed specialized treatment for an alcohol or illicit drug abuse problem but did not receive it. Warning signs that treatment should be sought include:
- Failed attempts to stop using the substance
- Withdrawal from social interactions or activities previously enjoyed
- Trouble with interpersonal relationships due to substance abuse
- Lowered work or school performance
- Financial difficulties related to substance abuse
- Deterioration of physical health
- Mood swings or personality shifts
- Prevalence of hidden stashes of alcohol or drugs
- Increased secrecy regarding drug or alcohol use
LGBT adolescents who struggle to find their place, or fit in, may be particularly drawn to substance abuse. Early onset of substance abuse increases the odds of developing a substance abuse disorder later in life. For example, of the American adults who took their first drink before age 14, 15.4 percent suffered from alcohol abuse or dependence, per the 2013 NSDUH, as compared to those who were over age 18 when they first drank – only 3.8 percent in this group suffered from alcohol abuse or dependence. Similarly, 11.5 percent of adults who abused marijuana before the age of 14 were classified with an illicit drug dependence or abuse issue, while only 2.6 percent of adults who waited until after age 18 met these criteria. Young brains are still developing, and substance abuse creates changes in the chemical pathways and interferes with the natural reward system, creating an imbalance that may encourage substance abuse as a way to regain short-term stability. This ultimately leads to further complications, however.
Members of the LGBT community may hesitate to seek treatment due to a negative interaction with a health care professional in the past. As with any minority group, certain negative associations or misconceptions may be perpetuated in the medical community the same ways they are in society. Fortunately, certain measures are being adopted in the mental health community in order to ensure all members of society receive the quality of care and compassion required to promote healing and healthy lifestyles. Traditional treatment models, including behavioral therapies in group, family, and individual settings, are all still applicable as long as cultural sensitivities are employed. Educating family members on the unique pressures and stressors their loved one may be facing as an LGBT individual can be helpful as well. Cognitive Behavioral Therapy (CBT) encourages positioning positive thoughts and behaviors in place of negative ones and can help recreate a sense of balance in everyday life. Twelve-step programs encourage honest and open communication, creating an accepting and inclusive support network as well.
Gay Affirmative Practice
In 2006, gay affirmative practice models (GAP) were created as a set of guidelines for social workers and clinicians treating members of the LGBT community. These models are intended as resource for clinicians working in this community as a type of self-assessment tool ensuring sensitivity and compassion. GAP models encourage treatment professionals to deal with personal biases and educate themselves on the unique aspects of LGBT clientele.
Assumptions on sexual orientation should not be made, and forms should be changed to represent and accept “partnerships” as an option instead of merely “marital status.” Working to help members of the LGBT community create a positive self-image and foster self-acceptance are important parts of GAP models as is education on positive tools for coming out and dispelling the unhealthy secret-keeping that creates undue stress on members of the LGBT community.
According to the National Alliance on Mental Illness (NAMI), around large-4 columns of people with any mental illness also suffer from substance abuse, while half of drug abusers and large-4 columns of alcohol abusers also suffer from mental illness. When mental illness and substance abuse disorders are present in the same person at the same time, it is considered co-occurring disorders, or a dual diagnosis. Members of the LGBT community were found to also be at an increased risk for co-occurring disorders as a study published in the Journal of Studies on Alcohol and Drugs found that those considered to be in the sexual minority were more than twice as likely to suffer from a substance use disorder and simultaneous mental health disorder than their heterosexual peers.
It is not always clear which comes first, substance abuse or mental health disorders, but each issue can exacerbate the other. Abuse of substances can lead to the earlier onset of mental health issues or symptoms, just as mental health symptoms may be grounds for substance abuse. Substance abuse is used a way to dull the senses and may be particularly compelling for those suffering from anxiety or panic disorders. Alcohol, as well as many drugs, are central nervous system depressants that can heighten depressive episodes and symptoms. No matter which comes first, health risks increase when mixing the abuse of illicit drugs and/or alcohol with mental health disorders.
Co-occurring disorders require specialized treatment methods that are most successful when perpetuated at the same time and by a team of medical professionals working together to treat both disorders. Integrated treatment models include comprehensive treatment, including therapies and medications that work in tandem to achieve positive results.
Social and legal acceptance of the LGBT population is opening doors to improved treatment and a better understanding of successful treatment models that address personal struggles unique to this community. Call us today if you’d like more information on specialized and inclusive treatment facilities.
Our admissions coordinators can help you decide on the course of action best suited to your, or your loved one’s, specific needs.