At the recent annual meeting of the New York Society of Addiction Medicine, a hot topic of discussion was the state of care for the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community in addiction treatment programs across the country. For many experts, the ability of providers to understand and reach clients who identify as LGBTQ is substandard and requires greater focus in the coming months.
Penelope P. Ziegler, MD, is the medical director and CEO of Professionals Resource Network in Florida. She says:
Surveys of people in the LGBTQ community who have gone to treatment programs for alcohol or drug addiction find while some programs are very sensitive to their needs, too often they are not. Many go out of treatment and relapse. The situation is better than it was, but we still haven’t made nearly as much progress as we need to.
In recovery programs, LGBTQ clients report that their experience includes:
- Treatment that does little to address cultural issues that are specific to their community
- An atmosphere that is tolerant of homophobia in other residents
- Private rooms due to the fact that providers seem uncomfortable housing same-gender roommates together if one is gay
- Feelings of isolation due to rooming alone, being identified as the “gay” one, homophobic undertones, and other issues
- Lack of comprehensive support for same-gender partners
As a result of this sense of isolation and difference, many clients feel they are not free to focus fully on their recovery and thus lose a great deal of the value of services even when they remain actively enrolled – which many do not. Too often, feelings of discomfort cause clients to go home early and thus miss out on the opportunities provided by long-term recovery and round-the-clock support.
A better understanding of the cultural patterns prominent in many LGBTQ communities will help medical and other providers to more easily identify substance abuse, and treat the issue early and effectively.
The use of crystal meth, synthetic drugs, and other stimulant drugs at dance clubs is a popular practice among gay men. Depending on the region, the drug of choice may vary, but in general, men find it easier to meet at clubs rather than out in the world, and tend to use substances with the goal of amplifying their ability to stay awake and enjoy themselves for a longer period of time. Alcohol is also popular, as are cocaine and other “party” drugs. Because attending dance clubs, raves, and parties with electronic music is such a big part of the culture, drug use often goes hand in hand.
Alcohol and Nicotine
High levels of alcohol use and cigarette use are common among lesbians. Meeting other women in a place that is safe often means seeking out a gay bar, and with this comes frequent and often heavy alcohol use. Additionally, nicotine is a common problem in the lesbian community.
Says Dr. Ziegler:
For reasons we don’t understand, the lesbian community is much less successful than the general population in quitting smoking. In addition to being a health hazard, smoking increases the likelihood a person won’t be able to maintain sobriety for other drugs. That means if you can stop smoking, your chances of staying in recovery are much better.
Gender Transition and Fluidity
Another big issue in the LGBTQ community is gender identification. Many people consider themselves to be male in a female body or vice versa – or else do not identify as either gender, and resent the assumptions and stereotypes that often make it more difficult for them to function healthfully in the world. As a result, many turn to self-medication with alcohol and other drugs to manage their feelings of discomfort – in the world and in their own bodies – and develop a drug abuse or addiction problem as a result.
Additionally, many find the costs associated with transitioning their bodies to look more like how they feel inside to be hugely expensive and turn to black market hormones that can be dangerous if not taken correctly.
As Dr. Ziegler points out:
People shopping online for hormones are also exposed to all sorts of opportunities to shop for other drugs, such as synthetic drugs.
Increased Training, Better Understanding
Many medical schools are seeking to remedy this issue by providing training that addresses the unique needs of the LGBTQ community. However, this can be a long process and, in the meantime, older doctors may not have an understanding of what their clients are facing. Some suggest that directed training for established medical professionals would be beneficial, helping them to better serve their clients and connect those who need treatment for drug and alcohol abuse or addiction with services that will help them improve their lives.
Similarly, increased training in the substance abuse treatment community will help to ensure that those clients who identify as LGBTQ will have access to care with a level of acceptance and understanding that will empower them to remain actively engaged in recovery. The Association of LGBTQ Psychiatrists, which is connected to the American Psychiatric Association, the Gay and Lesbian Medical Association, and the Association of Lesbian, Gay, Bisexual and Transgender Addiction Professionals and Their Allies (NALGAP) all offer support and information for providers and family members who would like to better understand the needs of the LGBTQ community in addiction treatment.