According to the National Council on Alcoholism and Drug Dependence, almost 18 million Americans abuse alcohol. More than 100,000 Americans die each year from alcohol-related causes. Alcohol factors in nearly half of all US traffic deaths. Beyond these statistics, alcohol abuse can strain relationships, impact finances and cause medical and mental health problems.

Research suggests that alcohol abuse and dependence in the LGBTQ+ community occurs at about three times the rate of the general population. Independent studies suggest that an estimated 45 percent of the LGBTQ+ community abuses alcohol. Within the community, the stress and difficulty of dealing with heterosexism and discrimination, combined with a tradition of socializing in bars and nightclubs, heightens the risk of developing problematic drinking behaviors. Pride Institute has been helping LGBTQ+ people work through these dependency issues since 1986. We address these issues through a mix of medical intervention, education, individual and group therapy and social support.

Symptoms of alcohol abuse or dependence include:

• Development of a tolerance to alcohol, resulting in the need to drink more to achieve intoxication or the desired effect
• More alcohol is consumed in large quantities over a longer period than intended
• A desire to reduce the amount of drinking or efforts to reduce or quit drinking are unsuccessful
• A large amount of time is spent drinking, thinking about drinking or nursing hangovers
• Continuing to drink despite understanding the link between alcohol use and specific health problems
• Arrests or legal problems related to driving while drinking
• Important work, social or family activities are neglected or reduced as the result of drinking

Most people have experienced the physical and emotional aspects of anxiety at some point. Because symptoms are often subtle, many don’t recognize that what they are feeling is anxiety, so it’s commonly misinterpreted as a physical ailment. Sometimes anxiety can cause a panic attack, which usually develops abruptly and typically reaches a peak within ten minutes. Anxiety is also experienced as a combination of a pounding heart, sweating, shaking, shortness of breath or a sensation of choking. Excessive anxiety or worry can indicate an anxiety disorder. Anxiety disorders can be treated with medication, talk therapy, education and other methods.

Physical symptoms of anxiety include:

• Sweating
• Nausea
• Dizziness
• Lightheadedness
• Hyperventilation (uncontrollable rapid breathing)
• Pounding heart
• Muscle twitching
• Diarrhea

Emotional symptoms of anxiety include:

• Anxiety
• Fear
• Worry
• Panic
• Phobias
• A sense that things are not real
• A sense of feeling disconnected from yourself
• An urge to avoid a situation, place or person
• Depression

Unusual shifts in mood, energy, activity levels and ability to perform everyday tasks can be attributions of bipolar disorder. Symptoms are often misinterpreted as separate issues rather than being recognized as parts of a larger problem, making the diagnosis difficult. Bipolar disorders usually develop during the late teen or early adult years, with at least half of all cases beginning before age 25. Some people have their first symptoms during childhood, while others may develop symptoms later in life.

Symptoms of bipolar disorder are far different from the normal ups and downs that many people experience. They’re often more severe, resulting in damaged relationships, poor job or school performance and even suicidal thoughts and ideation. But there is hope because it can be treated.

Like diabetes or heart disease, bipolar disorder is a long-term illness that must be carefully managed throughout a person’s life. It will require some lifestyle adjustments, but people with bipolar disorder lead full and productive lives every day.

Most people struggle with body image at some point. These typical concerns become problematic when they lead to disordered eating, multiple plastic surgeries or reach levels of obsession. Body image problems can progress from going on a diet to a full-blown eating disorder or body dysmorphia in a relatively short period of time. Disordered eating or a problematic body image can co-occur with other addictions or surface as a new problem during recovery. As with a drug or other behavior problem, an unhealthy focus on body image serves as a different way to avoid the things that lead to drug abuse or other problems.

Developing a healthy body image is a process that’s not unlike treating other addictive behaviors. As with any behavioral concern, the individual must first identify the problem, not to mention the triggers for body focus, while also cultivating adaptive coping skills. Cultivating a healthy body image helps people feel more secure in themselves, their relationships and can help navigate conflicts or daily stressors more effectively.

For body image difficulties, any or all of the following may surface. It’s noted that although they are related and the symptoms often overlap, body image issues are different than eating disorders:

• Severely restricting caloric intake
• Eating only certain or safe foods; eating with only plastic utensils
• Hoarding food, cookbooks or recipes
• Weighing oneself multiple times per day
• Mood and behavior changes depending on their weight, inches around the waist, size of pants or positive feedback on appearance
• Self-esteem is dependent on looks or how they feel about their body on that particular day
• Pinching or measuring one’s body
• Binging, characterized as eating an excessive amount of food in a short period of time
• Purging, which can materialize with self-induced vomiting, eating then restricting calories for days, laxative abuse or excessive exercising
• Frequent comments about being ugly, fat or “not one of the beautiful people”
• Multiple plastic surgeries
• Sudden weight loss or gain, chipmunk cheeks or a callus develops on the index finger or knuckles
• Body image problems can progress from going on a diet to a full-blown eating disorder or body dysmorphia in a relatively short period of time. Cultivating a healthy body image helps people feel more secure in themselves, their relationships and can help navigate conflicts or daily stressors more effectively.

Crystal meth is a formulation of the drug methamphetamine, a stimulant that can be ingested nasally, smoked or injected. Initial effects of the drug include increased energy, a sense of euphoria and increased libido. Because these feelings are pleasurable, the stage is often set for addictive behavior as users attempt to recreate that first high by continuing to use the drug.

Crystal meth’s negative effects on brain chemistry quickly become apparent on users. Depression and anxiety often appear early, which soon becomes associated with panic attacks and paranoia. Compulsive sexual activity often accompanies crystal meth use due to its tendency to increase libido and decrease inhibitions. This deadly combination can lead to compulsive sexual behavior, impaired decision-making, unsafe sex and the contraction of sexually transmitted infections, including HIV and AIDS, Hepatitis B and C and syphilis.

Crystal meth is a growing concern in many communities, but its use in the LGBTQ community has increased dramatically in recent years. Abuse can be successfully treated with chemical addiction treatment. A few successful methods in recovery include education, therapy and social support grounded in the philosophy of 12-Steps.

Indications of a problem with crystal meth use may include:

• Increased feelings of anxiety and agitation
• Development of extreme paranoia, often accompanied by delusional beliefs
• Inability to sleep, going for days on little or no sleep
• Increasing tolerance that requires higher doses or more frequent use to achieve the desired effect
• Injecting the drug
• Noticeable increase of risky behaviors, sexual promiscuity and unsafe sexual practices
• Physical signs that include deteriorating oral health (meth mouth), high blood pressure, rapid heart rate and itchy skin or a sensation of insects crawling on the skin surface

Depression is more than simply feeling a little down or sad for a few days. It’s a condition that dramatically affects a person’s mood, body and thoughts. While experiencing feelings of sadness, hopelessness and worthlessness can be a normal part of life, clinical depression lasts longer than a few days. It can span months but you don’t have to deal with it alone. There is hope in treatment.

Symptoms of depression may include:

• A persistent sad, anxious or empty mood
• Feelings of pessimism or hopelessness
• Feelings of guilt, worthlessness or helplessness
• Loss of interest in hobbies or activities that have been previously enjoyed, including sex
• A decrease in energy, increased fatigue or feeling slowed down
• Difficulty with memory, concentration or making decisions
• A change in sleep patterns, either sleeping less or sleeping more
• A change in eating patterns resulting in weight loss or weight gain
• Irritability or restlessness
• Persistent physical symptoms that do not respond to medical treatment, including headaches, digestive disorders or chronic pain

When compared with the mainstream population, studies indicate that LGBTQ+ people are more likely to use drugs, and as a result, have higher rates of substance abuse that are more likely to continue into later life. Although LGBTQ+ people have been shown to use all types of drugs, certain drugs appear to be more popular in the LGBTQ community than in the mainstream community.

For example, gay men are significantly more likely to have used marijuana, stimulants, sedatives, cocaine and party drugs like ecstasy, ketamine and GHB than men in the general population. The use of crystal methamphetamine in gay and bisexual men has increased dramatically in recent years. Few studies have thoroughly examined drug use in the lesbian community. But what has been uncovered suggests that drug abuse in lesbians occurs at higher rates than heterosexual women and could potentially equal the rates of occurrence in gay men. Substance abuse can be successfully treated. Education, therapy and social support grounded in the tradition of 12-Step philosophy are a few of the methods shown to be successful in recovery.

Indications of a substance abuse problem may include:

• Increased feelings of anxiety, agitation or depression
• The development of extreme paranoia, often accompanied by delusional beliefs
• Sleep disturbance as evidenced by either the inability to sleep or excessive sleep
• Increased tolerance that requires higher doses or more frequent use to achieve the desired effect
• Withdrawal symptoms such as tremors, body aches, nausea and headaches when drug use stops

Commonly Abused Drugs in the LGBTQ+ Community (excludes alcohol, crystal meth):

Stimulants: includes cocaine, crack, and crystal methamphetamine. The physiological effect of cocaine is similar to crack and crystal meth, but cocaine metabolizes quickly. Its duration is approximately 20 to 80 minutes compared to the 4 to 12-hour duration of crack and crystal meth. Desired effects of stimulants include appetite loss, increased alertness, mood elevation, and increased sexual arousal.

Depressants: includes Xanax, Valium and alcohol. In low doses, depressant drugs relieve anxiety, while in moderate doses they induce sleep. In higher doses, however, they can cause anesthesia or death.

Marijuana: smoking is followed within minutes by feelings of well-being, relaxation and tranquility in most people. However, those prone to being apprehensive, depressed or angry may become more so under the influence of marijuana.

Party/Designer Drugs: includes Ecstasy, Ketamine and GHB, which were commonly used by gay and bisexual men who were participating in raves/parties. In recent years, these drugs have transitioned to weekend dance clubs and other recreational uses.

Polysubstance Abuse: when a person abuses several substances in a relatively short period. Using multiple substances is often an attempt to enhance the effect of a single drug to achieve a higher high. At other times, a drug will be used to counteract the effects of a previously taken drug, like taking sedatives when coming off of stimulants.

Properly managed medical use of opioid analgesic drugs can be effective in managing pain if taken exactly as prescribed. But long-term opioid use can lead to physical dependence and addiction. The body can adapt to the presence of the drug and withdrawal symptoms occur if use is reduced or stopped. Symptoms of withdrawal include restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes with goosebumps and involuntary leg movements. Taking a large single dose of an opioid could cause severe respiratory depression that can lead to death.

Assessing the presence of sexual avoidance, in addition to the presence of sexual compulsivity, is important. While professionals don’t agree on a term that adequately describes the state of depriving oneself of sex, sexual anorexia is the flip side of sexual compulsivity. In some cases, the time between having sexual contact and engaging in a significant relationship can be years. In a few circumstances, people often say that they haven’t had sex in a decade or more.

For some, obsessive thoughts are the problem, while other individuals engage in sexual avoidance or have a strong aversion to sexual situations The issue is not the lack of sex, but the motivating factor for why they have not had sex. Thoughts and feelings of shame, fear and hopelessness often shape why a person avoids sexual contact. Often the underlying cause for sexual avoidance is similar to the cause for sexual compulsivity.

When someone has a healthy understanding of their sexual value, preferences, attractions, history and behaviors, they can explore their sexuality in a positive manner in an affirming environment. Positive sexuality occurs when someone has the ability to receive and give sexual pleasure while setting sexual boundaries. For many in the LGBTQ+ community, forming healthy sexuality means shedding the shame and guilt associated with sexual thoughts and desired intimacy that is not heterosexual in nature. This can lead to unhealthy or even compulsive sexual behavior.

Sexual compulsivity is the inability to control one’s sexual behavior and thinking. Sexual behavior that is out of control often continues in spite of tremendous consequences including damaged relationships, loss of self-esteem, sexually transmitted diseases and financial or legal problems.

Signs of sex addiction/compulsive sexual behavior can include:

• Multiple or anonymous sexual partners or frequent one-night stands when it’s not the desired behavior
• Sexual behavior that frequently accompanies drug or alcohol abuse
• Sexual behavior that includes risk-taking, unsafe sex or potential exposure to sexually transmitted diseases
• Obsessive use of pornography, phone-sex services or pornographic websites
• An obsession with, and sexual harassment, of another person
• Severe mood changes surrounding sexual activity
• Neglect of relationships, work or other responsibilities as a result of thinking about or pursuing sex
• A sense that sexual behavior is out of control and an ongoing desire to control or limit sexual behavior

Love addiction can act in a similar pattern, although it’s often perceived to be less serious than other process addictions. In reality, it’s extremely painful and can be dangerous to the person addicted and their partners.

Signs of love addiction:

• Compartmentalization of relationships from other areas of life
• Mistaking intensity for intimacy in drama-driven relationships
• Seeking to avoid rejection and abandonment at any cost
• Fear of trusting anyone in a relationship
• Manipulative and controlling behavior
• Perceiving attraction, attachment and sex as basic human needs, on par with food and water
• Sense of worthlessness without a relationship or partner
• Feelings that a relationship makes one whole or more of a person
• Escalating tolerance for high-risk behavior
• An intense need to control self, others and circumstances
• Presence of other addictive or compulsive problems
• Insatiable appetite in area of difficulty — sex, love or attachment
• Using others, sex and relationships to alter mood or relieve emotional pain
• A tendency to trade sexual activity for love or attachment
• A tendency to leave one relationship for another or an inability to be without a relationship