What does sexual identity or orientation have to do with substance abuse, and why would seeking treatment geared specifically toward the LGBTQ+ community be beneficial? Those are important questions, but first, it helps to understand that LGBTQ+ individuals are more likely to use alcohol and drugs than the general population — and more likely to abuse alcohol and drugs, according to the Center for Substance Abuse Treatment (CSAT). In fact, CSAT studies show that 20 to 25 percent of gay men and lesbians are heavy alcohol users, compared to three to 10 percent of the heterosexual population.

Why Do the Numbers Differ?

Attitudes and assumptions regarding homosexuality and chemical abuse have evolved throughout the years. Until 1973, homosexuality was defined as a mental illness by the American Psychiatric Association, while alcoholism and chemical abuse issues were solely perceived as legal problems. At one time, it was even believed that repressed homosexual tendencies actually triggered chemical abuse and dependency. Now we know better, and this myth has been dispelled by solid research.

Today, scientists believe that societal factors affect the relationship between substance abuse and the experiences of members of the LGBTQ+ community. That means that alcohol and chemical dependencies are seen as illnesses of the mind, body and spirit. Despite recent progress, the LGBTQ+ community remains largely marginalized. In fact, the possibility of oppression in LGBTQ+ people’s lives is ever-present. Under such conditions, those who identify as LGBTQ+ experience varying degrees of heterosexism.

Negative Messages Stigmatize

Heterosexism is defined as the stigmatization of nonheterosexual forms of emotional and affectional expression, sexual behavior or community. Negative messages about the gay and lesbian lifestyle take place in the form of microaggressions such as assumptions made about the community and observing and hearing heterosexist jokes, but they can also be as severe as threats, acts of humiliation, emotional abuse or even murder. Heterosexism can contribute to internalized homophobia, shame and a negative self-concept.

Heterosexism also causes many in the LGBTQ+ community to compartmentalize their lives. On the outside, they may follow the rules of the dominant society and behave in ways that are accepted as the norm in order to fit in and succeed. This double life takes its toll, though, leading some LGBTQ+ individuals to self-medicate with drugs and alcohol as a way to cope. Others use to numb negative feelings associated with heterosexism, such as isolation, fear, depression, anxiety, anger and mistrust. Still others in the gay community turn to mind-altering substances as a way to cope with stressors caused by the tensions of living under the stigma of marginalization.

In the LGBTQ+ community, substance use is a large part of many people’s social life. The gay bar scene is regarded as a risk factor for substance abuse among the gay community, though these bars have often been the only places where LGBTQ+ folks feel free to socialize openly. Often, it’s in the gay bar that an LGBTQ+ individual finds the opportunity for identity affirmation and acceptance after experiencing rejection from biological family members or others close to them.

Sexual Identity as a Barrier to Treatment

Heterosexism plays a part in chemically dependent LGBTQ+ individuals’ ability to access effective treatment services. Substance abuse treatment facilities are often not able to meet the needs of this special population. The treatment staff of such facilities may have varying heterosexist assumptions regarding the LGBTQ+ clients who access their services. They may be uninformed about LGBTQ+ issues, insensitive to or antagonistic toward LGBTQ+ clients or hold the outdated believe that homosexuality causes substance abuse or can be changed by therapy. In addition to treatment staff, other clients may have negative attitudes toward LGBTQ+ patients, hindering the treatment process.

These issues become barriers in successful treatment experiences for the LGBTQ+ individual seeking those services.

Treatment components designed to promote successful treatment experiences for the LGBTQ+ patient include cultural sensitivity, an awareness of the impact of cultural victimization, and addressing issues of internalized shame and negative self-acceptance. The integrated biological-psychological social model of chemical addiction treatment takes into account the effects of society on the individual and his or her relation to the use of chemicals. Cognitive behavioral counseling techniques challenge internalized negative beliefs and promote emotional regulation. Such counseling helps the LGBTQ+ patient reach for internal acceptance instead of the nearest bottle or drug.

An inclusive and accepting program like Pride Institute, which addresses the unique treatment needs of the LGBTQ+ community, allows patients to transcend the inauthenticity promoted by cultural oppression through the affirming acceptance of others. Individuals don’t deal with their addiction and mental health issues in a vacuum, instead these disorders are addressed within the context of the whole person. As a result, recovery doesn’t just mean living substance-free, it means living more integrated and expressive lives.