Addiction and Abuse in the LGBT Community
Today, there is greater awareness of gender and sexual orientation diversity than ever before in recorded history. While the LGBT community and its advocates are showing the world that one’s biological sex does not determine one’s gender identity or sexual orientation, there is still much work to be done to promote acceptance of these forms of diversity. Despite strides for greater public acceptance, marginalization of the LGBT community persist, especially for the transgender segment, and not only impacts the rate of substance abuse but may lead to a lack of research study in this area.
There is only limited research available from which to assess the rates of LGBT substance abuse as well as the specific needs of this group in treatment. However, the data available does provide insight into why this community may be at greater risk of substance abuse compared to the general population and how to best serve them in lgbt treatment centers.
Data on Drug Use in General and LGBT Populations
The National Survey on Drug Use in America provides extensive insight into different drugs of abuse and consumption patterns across the nation. The survey did not, as of the most recent survey year in 2013, provide focused information on drug use patterns in the LGBT community. However, the survey results provide greater context to LGBT statistics (provided later in this discussion).
The LGBT community is composed of lesbians, gays, bisexuals, transgender males, transgender females, and individuals who identify as queer or questioning. Within this group, research outcomes may differ along the lines of age. According to Social Work Today, national research efforts demonstrate that drug abuse is twice as common among youths in the LGBT community compared to their non-LGBT peers. This trend is also true for the LGBT population on the whole. While the Substance Abuse and Mental Health Services Administration estimates that the rate of substance abuse is 9 percent in the general population, the LGBT rates are as high as 20-30 percent.
Substance Abuse in the Transgender Community
To date, there have been few research studies focusing on the rates of substance abuse in the transgender community, and most studies have focused on the relationship between substance abuse and sexually transmitted diseases. According to the 2010 National Transgender Discrimination Survey Report on Health and Healthcare, the rate of HIV infection is four times higher in the sample population than in the general population, partly because of IV drug abuse. Much of the substance abuse that occurs in the transgender community can be attributed directly to social discrimination – 26 percent of survey respondents stated that they had used or were currently using alcohol or drugs specifically to cope with the social stigma of gender nonconformity.
Rates of substance abuse increase among transgender persons who work in the sex industry or sell drugs for a living. Out of the survey respondents who held underground or illegal jobs, 19 percent reported that they were currently using drugs or alcohol to cope with the effects of abuse or discrimination, and 36 percent reported that they had done so in the past. Job loss and job discrimination are two of the other most common reasons that transgender people abuse drugs or alcohol or attempt suicide.
Common Drugs of Abuse
A review of a sample of research available on drug use and the LGBT community demonstrates that much of the focus is on alcohol and club drugs. Regarding alcohol consumption, as mentioned earlier, members of the lesbian community tend to drink alcohol more than heterosexual females. In the case of club drugs, most studies focus on gay men. For example, one NYU study centered on gay and bisexual men; the study noted that the five most common drugs of abuse in the club scene among study participants were ecstasy, ketamine, crystal meth (“Tina”), GHB, and cocaine.
LGBT status may not be a significant factor in the specific type of drug selected for abuse. For this reason, it can be helpful to know that the most common illicit drugs of abuse in the population in general are marijuana, methamphetamine, cocaine, and opiates/opioids (including prescription pain relievers and heroin). The LGBT community is at just as much risk as the greater population for abuse of the most prevalent drugs.
Substance abuse trends in the transgender community are similar to those in the general LGBT population; however, some studies of urban populations show a preference for alcohol, marijuana, cocaine, and meth. Marijuana was one of the most common drugs of abuse among both female-to-male (FTM) and male-to-female transgender persons (MTF), with 64 percent of FTM individuals reporting use of this drug, and 43 percent of MTF individuals reporting its use. In the same study, 30 percent of female-to-male respondents said they had used speed, and 21 percent had used cocaine. Alcohol, one of the most widely available and frequently abused substances in the general population, is widely used among transgender individuals in an effort to cope with the stress of discrimination, harassment, and social exclusion experienced by this community.
Why Are LGBT Substance Abuse Rates High?
Due to a lack of comprehensive research in this area, there may be a significant amount of conjecture around why LGBT status can dispose a person to a greater risk of drug abuse. There is a general consensus that in addition to biology, substance abuse involves environmental and social factors. There is also a general consensus that even in spite of major advancements in LGBT rights (such as the Supreme Court’s decision that lesbian and gay individuals may marry in each and every state), LGBT is not a neutral status. For instance, LGBT status remains politically charged, and LGBT individuals are vulnerable to hate crimes and other forms of abuse.
According to LGBT advocates and researchers, substance abuse may be a coping method that some LGBT individuals employ in face of the “minority stress.” LGBT status can expose individuals to a range of prejudices that can affect life basics, including relationship recognition and employment opportunities. In addition, LGBT status can create a disincentive to seek healthcare treatment due to an actual or perceived insensitivity on the part of care industry providers. Seeking treatment, whether in the form of drug recovery or other services, necessarily involves revealing personal details of one’s history, which could be challenging for a member of the LGBT community.
There is also another layer to increased risk of substance abuse. It is well established that the LGBT community has often found solace in the bar and club scene, as this scene has been traditionally more accepting. Tobacco and alcohol businesses exploit the LGBT consumer market through targeted marketing efforts in bars and clubs. This for-profit behavior seems particularly exploitative in view of the fact that LGBT-owned or LGBT-friendly bars and clubs are typically intended to be safe havens for LGBT individuals. In addition, as the National Association of Lesbian and Gay Addiction Professionals (NALGAP) notes, funding for gay community services, cultural events, and “gay pride” parades often comes from tobacco and alcohol industry sponsors.
Factors Underlying Transgender Substance Abuse
Statistics on the challenges faced by transgender people are disturbing. Transgender individuals face discrimination on a social, political, and occupational level. Statistics show that they have higher rates of poverty, homelessness, drug and alcohol addiction, incarceration, and suicide attempts than the general population. The National Transgender Discrimination Survey indicates that:
- Extreme poverty, defined as living on an income less than $10,000 per year, was four times more common in the transgender population.
- Unemployment was more common in the transgender community, with 26 percent of survey respondents reporting that they had lost a job due to their transgender identity.
- Job discrimination affected nearly half (46 percent) of the respondents, either in the form of not being hired, losing a job, or being denied a promotion.
- Homelessness was more common in the transgender population. Nearly 20 percent had experienced homelessness at some time in their lives because of their identity, while 11 percent had been evicted from a home or apartment, and 29 percent had been turned away from homeless shelters.
- Physical and sexual assault plagues the transgender community, who are often the targets of hate crimes, robbery, and harassment. Out of those who responded to the survey, 61 percent stated that they had been the victims of physical assault, while 64 percent had been the victims of sexual assault.
- Bullying occurs at higher rates in children and teens who do not conform to cultural gender norms. Seventy-six percent of respondents in kindergarten through 12th grade had been bullied or harassed at school because of their gender-nonconforming identity.
- Suicide attempts are higher among transgender individuals, with 41 percent of respondents stating that they had tried to commit suicide at some time in their lives versus 1.6 of the general population.
Not surprisingly, this degree of discrimination creates high levels of stress. People with gender-nonconforming identities often live in fear of being harassed, bullied, assaulted, or robbed. They may hide their nonconforming identity from the general public in order to hold down a job or maintain a social role, while constantly worrying about being “outed” by friends or acquaintances. Because of the frequency of job discrimination against transgender persons, many are forced into underground jobs in the sex industry or drug dealing, where substance abuse is common.
In their personal lives, many transgender people lack a strong support network. They may be cut off from their families and may have few close friends who know about their gender identity. Social isolation, depression, loneliness, and anxiety often lead to substance abuse and increase the risk of self-destructive behavior or suicide.
“My 12-Step group has been my life support system,” says a woman who asked to be called Kristina. A singer and crossdresser, Kristina performs in one of San Francisco’s transgender clubs under the stage name Kriss Kross. She used to work as a prostitute while selling drugs to support her habit; now she is able to stay sober with the help of her recovery group. “No one in my family has spoken to me for over 15 years, since I came out as queer,” Kristina says. “The members of my group are my family, my friends, my lifeline. Going to meetings isn’t just how I stay sober, it’s how I stay connected to people who care. Straight folks, even gay folks, don’t really understand how cut off we are in the trans community.”
As the National Association of Lesbian and Gay Addiction Professionals (NALCAP) discusses, public education is a main key to improvements in the relationship between the LGBT community and substance abuse. NALCAP advises that the following actions can be taken to increase public awareness and sensitivity to the LGBT community, which would in turn positively impact substance abuse trends:
LGBT-Focused Recovery Groups
The availability of recovery groups largely depends on the local community, but at least two national organizations feature LGBT meetings: Special Interest Meetings through Narcotics Anonymous (NA) and Gays and Lesbians in Alcoholics Anonymous (GAL-AA). GAL-AA maintains a searchable website for meetings, whereas the best practice to find an NA-LGBT meeting is to search postings and offerings for local NA meetings (and numerous locales list ongoing LGBT-based meetings). Ongoing attendance at 12-Step or other group recovery meetings is a staple of an effective aftercare program.
For transgender individuals, fitting in at LGBT 12-Step meetings may be more challenging. Even in groups that are dedicated to supporting the gay, lesbian, and bisexual communities, transgender people may encounter mixed messages about whether they are welcome. The AA saying “the women with the women and the men with the men” refers to the group’s traditional separation of the sexes at meetings. This mindset leaves transgender members in the position of having to justify their presence at a meeting when the sex on their birth certificate does not match their gender orientation.
Sara, a genderqueer person, overcame an initial resistance at 12-Step meetings by focusing on the spiritual aspect of recovery. “AA taught me discipline and connected me to my spiritual life,” she told The Fix. “My sexuality is connected to my human life, and my spiritual life connects me to my higher power, which gives me the feeling that it’s all gonna be okay. I have access to that spiritual life and no one can take that access from me.”
Challenges to Treatment for Transgender Individuals
In healthcare, as in other areas of their lives, most transgender individuals have had at least one experience being discriminated against or inadequately treated; as a result, many do not trust the medical community and may reluctant to seek out care for mental health concerns or substance abuse issues. They may be worried about confidentiality or having their identity inadvertently revealed by a care provider or therapist. Professionals who work with transgender individuals need a high level of compassion, sensitivity, and respect for this community.
Another barrier to treatment is the lack of education about transgender issues in the recovery community. Even in rehab programs that are supposedly specialized for transgender individuals, medical needs like hormone therapy are not always met. Clinical staff and therapists often do not understand the medical needs or risks of this community, and they may hold cultural misconceptions about transgender people that interfere with personalized care. According to the National Transgender Discrimination Survey, over half of transgender individuals have had to educate their medical providers about transgender care.
Faced with isolation, rejection, or harassment, many transgender clients isolate themselves and eventually leave treatment before completing a rehab program. In an article published in Substance Abuse, Prevention and Policy, a transgender woman known as Julia stated that although the staff members at her treatment center were generally supportive and treated her fairly, many of the counselors did not understand her gender identity. In spite of these misunderstandings, Julia had a positive experience with her treatment team; however, other clients abused her verbally and ostracized her.
“I had a lot of support from the staff,” Julia was quoted as saying, “but with the other clients, it was really difficult. I mean, everybody in the whole unit is talking about me … ‘cause I’m the only transgender. I ended up isolating myself, locked in my room 24 hours a day … it’s like this isn’t dealing with your addiction.” Julia ended up leaving her treatment program, not as a result of the staff’s lack of support, but because of the harassment and rejection she faced from her colleagues. Other transgender clients in the same qualitative study reported leaving their treatment program because counselors had tried to pressure them to conform to conventional gender standards, or because they had faced physical or verbal violence from other clients.
Many of these problems stem from ignorance of the needs of transgender individuals, as well as from social prejudices. Educating substance abuse treatment professionals about the nature of transgender identities can help to create a safer, more positive environment for these clients, many of whom are currently living with the effects of substance abuse rather than risking the negativity and hostility that they may find in treatment.
By contrast, clients who feel accepted by staff and peers in treatment reported having good experiences and were more likely to complete the rehab program. A participant, Rielle, described her treatment in positive terms: “Their staff was knowledgeable around trans people, the terminology … I was put in on a women’s side as I requested, and when it came time to doing the groups I was obviously put with the women versus with the men. I did everything that the women did. I wasn’t excluded from anything. I shared a room with another female and it was good.”
Transgender Treatment Needs
The recovery needs of transgender persons are often combined with those of the LGBT community; however, the needs of transgender individuals are unique. Transgender individuals may need medical services, such as hormone therapy or gender reassignment surgery, to make the transition to their chosen gender. However, providers cannot assume that all gender-nonconforming individuals are in search of medical or surgical interventions. Some members of this community do not feel the need to take these steps.
Substance abuse treatment for transgender people begins with the admission phase. In order to provide sensitive, compassionate, and effective recovery services, the needs of transgender clients must be assessed and clearly identified in the beginning. This goal can be accomplished through the use of screening instruments — questionnaires, tests, or interview questions — designed specifically for the transgender community. Clinicians and therapists working in rehab must have specialized training in working with the transgender community. With these tools, the treatment team can develop culturally sensitive care plans that reflect the client’s chosen identity, rather than requiring the person to conform to the gender assigned at birth.
Resources on Substance Abuse in the LGBT Community
- Center of Excellence for Transgender Health: Housed at the University of California, San Francisco, this center is dedicated to providing innovative programs that meet the health needs of transgender individuals throughout the country. Education, research, preventive health care, and public policy are among its chief concerns. The Center’s website offers many educational and legal resources for transgender individuals and for health providers seeking education or information about transgender issues.
- GLBT National Help Center: This national hotline provides free, confidential support to gay, lesbian, bisexual, and transgender individuals and their supporters. Peer volunteers across the country are available 24 hours a day to answer questions about substance abuse, mental health, safe sex, sexual identity, and other concerns. In addition, the GLBT National Help Center maintains a large database of resources, including information on support groups, social connections, student groups, gay-friendly professional organizations, therapists, and counselors.
- NALGP (The Association of Lesbian, Gay, Bisexual, Transgender Addiction Professionals and their Allies): Founded in 1979, this membership organization is dedicated to the prevention and treatment of addiction within the LGBT community, with an emphasis on overcoming social and political barriers to recovery. Its website provides access to articles, resources, and contact information for addiction professionals and for individuals seeking help for substance abuse.
- National Center for Transgender Equality: Based in Washington, DC, this social advocacy organization supports the rights of transgender individuals at the state, local, and federal levels. Its goal is to promote justice for transgender persons and public awareness of their needs by actively seeking policy change. The Center’s website includes valuable information about transgender issues, as well as access to social and legal resources for the community.
- Parents, Families and Friends of Lesbians and Gays (PFLAG): Founded in 1972, PFLAG has grown into one of the largest national support organizations for the families, friends, and allies of the LGBT community. This group encompasses many local chapters that promote education, advocacy, and support for the gender nonconforming community.
- Substance Abuse and Mental Health Services Administration (SAMHSA): Lesbian, Gay, Bisexual, and Transgender: SAMHSA, a government agency that promotes education and treatment for substance abuse and mental illness, provides a list of resources on substance abuse in the LGBT community, including behavioral health resources, national survey reports, information on federal initiatives, and more.
- org: Staffed by transgender people supporting transgender people, this free telephone hotline offers help to individuals experiencing a gender identity crisis. The primary goal of the Translifeline is to prevent self-harm and suicide; however, volunteers are available to help anyone seeking support or answers about gender identity issues: “If you are not sure whether to call us or not, then please call us.”
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