Substance use in queer and trans communities
Reprinted from the "LGBT" issue of Visions Journal, 2009, 6 (2), pp. 12-13
Health professionals who work with lesbian, gay, bisexual and transgender (LGBT) clients suggest that LGBT people use more of all substances than the general population.1-2 And, current research suggests that about 30% of the LGBT population abuse substances, while only about 12% of the rest of the population does.1-2
There is, however, no solid agreement on these statistics and trends. Very little research has been done on LGBT people and substance use. The existing research is full of problems with methods: notably, problems with definitions, study locations, community representation and assumptions made. Terms like “homosexual” and “substance abuse” are not easy to define in a standard way.1,3 For example, women tend to report more changes in their sexual orientation over their lifetimes.4 Black-or-white definitions (“gay” or “straight”) of sexual orientation do not fit for many people.
Some earlier studies on alcohol and drug use took place in gay bars, so only gay men were included. This represents a very small slice of the LGBT community. However, findings from studies of gay men have been assumed to apply to everyone else in the community. As a result, there has been very little research about lesbian women.
There is even less research about bisexual and transgender people, even though there are notable differences between these groups.1,3
Basically, more research is needed to help us clearly understand substance use in the LGBT community.
Alcohol and drug services specificto LGBT clients
Other alcohol and drug services
What are some differences? (Service providers take note)
Despite a lack of research, there are some things we do know about working with LGBT clients. We know that being queer (LGB) or transgender does not cause someone to have problems with substances.5-6 In fact, people who are queer or trans use alcohol and drugs for the same reasons that other people do.
There are, however, some special issues to consider when working with this community. The stresses that LGBT people experience in society just due to homophobia and heterosexism may cause them to turn to substance to cope.1,2,7
In addition to being more at risk for substance use problems because they have to deal with more stress, LGBT people are targeted by tobacco and alcohol advertisers.8 For example, as early as the 1950s, Smirnoff vodka slyly advertised their product as “mixed or straight.”9 The president of an LGBT marketing firm stated that clever and subtle targeting of gays and lesbians is growing because sexual minorities are an attractive market.He calls them “attention-starved and very loyal,” and noted that gay men in particular tend to have high disposable incomes.9
There are fewer specialized services to help LGBT people. Although these clients can access general services, there may be barriers that prevent them from getting help.10 LGBT clients may have had bad experiences with health care in the past. They may also fear facing prejudice. And service providers may not be equipped to reduce common barriers or to address special issues.
Research tells us that many alcohol and drug treatment programs aren’t doing a good enough job of dealing with issues of sexuality and gender.2 While LGBT clients may come into alcohol and drug treatment with the same issues as other people, they may also have some unique concerns.
They may need to explore their feelings about their sexuality or gender, explore the effects of stigma, or deal with “coming out” issues (i.e., issues around disclosing their sexual orientation and/or gender identity).
LGBT clients may prefer to work with LGBT staff. At the very least, they should have access to competent and supportive “allies.” However, competent and trained allies or openly queer and transgender staff are not always available to these clients. Many treatment programs do not address issues around sexual or gender orientation in their programming.
At the same time, it’s important to be aware that not all queer or trans clients will want or need to focus on issues related to their sexuality or gender.7,10 Staff must look to the clients to decide when these issues are key.
Another thing to be aware of is that queer and trans people may use substances differently than others. Club drugs may be part of the party scene for both sexual minority men and women. Gay men may mix Viagra with “uppers” or stimulants like cocaine or methamphetamine. This can lead to very risky sexual behaviour because their sex drive is heightened and inhibitions are lowered. It’s important to be aware of any links between sex and drug use as there’s a potential relapse risk for clients.1 Sex may trigger urges to use substances.
Finally, LGBT people may have different family types or circles of support.1-2 Their families may be “families of choice,” made up of close friends and ex-partners.
Services providers should be open when asking about or including people the client identifies as a family member or support.
Wanted: more specialized services
At this point, most of British Columbia’s substance use treatment resources for LGBT people are located in Metro Vancouver (see sidebar). Hopefully, more addiction and other services just for LGBT people will be offered across the province in the future.
About the authorStacey is an alcohol and drug counsellor for Addiction Services, Vancouver Coastal Health, actively involved with Prism Alcohol and Drug Services. She provides group and one-to-one counselling, trains staff to work with sexual minority clients and participates on Prisms’s program planning and evaluation committees.
Guss, J. & Drescher, J. (Eds.) (2000). Addictions in the gay and lesbian community. New York: Haworth Medical Press.
Ritter, K. & Terndrup, A. (2002). Handbook of affirmative psychotherapy with lesbians and gay men. New York: Guilford Press.
Cochran, S., Keenan, C., Schober, C. et al. (2000). Estimates of alcohol use and clinical treatment needs among homosexually active men and women in the US population. Journal of Consulting and Clinical Psychology, 68(6), 1062-1071.
Charbonneau, C., & Lander, P.S. (1991). Redefining sexuality: Women becoming lesbian in midlife. In B. Sang, J. Warshow & A.J. Smith (Eds.), Lesbians at midlife: The creative transition (pp. 35-43). San Francisco, CA: Spinsters.
American Psychological Association. (2000). Guidelines for psychotherapy with lesbian, gay, and bisexual clients. Washington, DC: Author. http://www.apa.org/practice/guidelines/glbt.pdf.
Garnet L., Hancock, K., Cochran, S. et al. (1991). Issues in psychotherapy with lesbians and gay men: A survey with psychologists. American Psychologist, 46(9), 964-972. http://www.apa.org/pi/lgbt/resources/issues.aspx.
Finnegan, D. & McNally, E. (2002). Counseling Lesbian, gay, bisexual, and transgender substance abusers: Dual identities. Binghampton, NY: Haworth Press.
Drabble, L. (2000). Alcohol, tobacco, and pharmaceutical industry funding: Considerations for organizations serving lesbian, gay, bisexual, and transgender communities. Journal of Gay & Lesbian Social Services, 11(1), 1-26.
Washington, H. (2002). Burning love: Big tobacco takes aim at LGBT youths. American Journal of Public Health, 92(7), 1086-1095.
Substance Abuse and Mental Health Services Administration. (2001). A provider’s introduction to substance abuse treatment for lesbian, gay, bisexual, and transgender individuals. Rockville, MD: US Department of Health and Human Services. http://kap.samhsa.gov/products/manuals/pdfs/lgbt.pdf.