A rainbow ribbon. Recovery resources for the LGBTQIA community

Mental Health and Recovery Resources for LGBTQIA+ People

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Those in the LGBTQIA community face many unique challenges in entering recovery. This article discusses those challenges, and offers resources to help overcome them.

Those identifying as LGBTQIA+ face a number of health disparities, one of which is an increased risk of developing substance use disorders. Despite this fact, this population is largely underserved in terms of specific addiction recovery resources that are identity- and sexuality-affirming, and tailored to the types of challenges that the queer community face.

Workit Health’s supervising physician, Dr. Kevin Armington explains, “There are data showing that substance use disorder (SUD) and alcohol use disorder (AUD) are much more prevalent among these communities compared to the general public.” 

This guide provides an overview of the LGBTQIA+ community, the unique challenges and obstacles folx face, as well as extensive resources that include addiction recovery support, harm reduction tools, and how to find resources that are affirming of your identities.

What does LGBTQIA Stand for?

For those of you unfamiliar with this acronym, LGBTQIA+ represents a group of individuals who identify themselves as lesbian, gay, bisexual, transgender, queer or questioning, intersex, agender or asexual, and any combination therein. The identities within this spectrum may relate to gender identity, sexual orientation, and gender expression. For more information check out Acronyms Explained by Outright International. 

LGBTQIA Mental Health Facts

In addition to other health risks and a lack of access to resources, LGBTQIA+ individuals also face a higher risk of co-occurring mental health disorders. These include self-harm, suicidal ideation, depression, and anxiety, among others. Transgender youth experience higher levels of depression, suicidality, self-harm, and eating disorders. Gay men are three times more likely as straight men to have an eating disorder, and lesbian and bisexual women are twice as likely as straight women to suffer from binge eating.

The significance of these disparities shows that we need greater intervention. Especially as the risk of overdose is three times higher for those with depression and six times higher for those with serious mental illness. 

Key Facts About Addiction in the LGBTQIA Community

It is estimated that 30 percent of LGBTQ+ individuals suffer from some form of addiction, compared to 9 percent of the general population (Recovery Research Institute).Those who identify as LGBQIA often face a number of stressors, like stigma, discrimination, and a greater risk of violence. These can lead to an increased risk of substance use and behavioral health issues.

The Substance Abuse and Mental Health Services Administration (SAMHSA), the federal agency that regulates treatment of substance use disorders, estimates that gay and transgender people meet criteria for SUD at 2-3 times the rate of the general population. Dr. Armington says, “This is not surprising, given that for most of our history, many LGBTQIA people have been pushed to the margins of society—sometimes literally kicked out of their families and churches, excluded from important societal institutions like marriage, physically and emotionally attacked.  All these factors inflict tremendous emotional pain and make people feel isolated. Drug and alcohol use can soothe temporarily the pain of isolation.”  

LGBTQIA+ Drug Use

LGBTQ+ individuals are more likely to start drinking earlier, and they have a greater likelihood of experiencing substance use disorder in their lifetime. When combining substances use, addiction is 2 to 4 times higher in the LGBT community than that of the general population Overall, gay, lesbian, and bisexual individuals are 18 percent more likely to have alcohol use disorder, 20 percent more likely to have substance use disorder, and 5.9 percent more likely to misuse prescription medications. 

Dr. Armington believes that the lack of reliable information for many youth about sexual development is a contributing factor in this disproportionate prevalence of substance use disorders.  He explains, “Powerful elements in our society work very hard to limit and control sex education in our public schools. Withholding or strictly limiting sex education particularly affects LGBTQIA adolescents, who may not understand their natural feelings or how to express them.  When they are able to start exploring their sexuality, it seems logical to turn to drugs or alcohol to overcome the fear and ignorance they may have about exploring their natural urges. Over time, drug and alcohol use can become a habitual, or even a prerequisite for intimacy and sexuality.”

Chemsex

Chemsex is the use of drugs to enhance one’s sex life, in terms of duration and pleasure, and to reduce inhibitions. It is most commonly engaged in among gay and bi men. The main substances used during chemsex are stimulants like methamphetamine, mephedrone, and sedative-type drugs GHB and GBL. 

There are more pronounced risks associated with chemsex, such as the risk of overdose, complications from mixing substances, risks from intravenous drug use, and sexual health risks. You can read more about chemsex on Avert’s website, Chemsex & HIV.

What fuels addiction in the LGBTQ+ Community?

According to Jeff Zacharias LCSW, CSAT, CAADC there are a few factors that fuel addiction within the LGBTQIA+ community, including:

  • Socialization: Substance use is a common part of queer culture, as many social events happen in bars. Pride parades may also be alcohol- and drug-fueled, as they are often seen as a big party. And last, alcohol advertisers specifically target this market, thus normalizing higher than average drinking consumption.
  • Deficiencies in the health care system: Only 77 percent of lesbian, gay, and bisexual people have access to healthcare. That number is significantly reduced for trans folx, with as few as 57 percent having access, and many states not covering services for their identities.
  • Stress: Some stressors in the LGBTQIA community include: Social prejudice; employment stress and discrimination (being fired or denied a job due to LGBT identification); housing stress, such as higher levels of homelessness and unsafe/discriminatory housing due to sexuality; and limited access to medical care.  
  • Homophobia/heterosexism: External and internalized homophobia and heterosexism can lead to depression, anxiety, guilt/shame, isolation, and low self-esteem/self worth.

LGBTQIA Health Disparities

We asked Dr. Armington why LGBTQIA face the greatest health disparities. He explains, “For young homeless LGBTQIA people, lack of access to healthcare is obviously one of the reasons.  Also, internalized shame can be an impediment to clear communication between LGBTQIA people and their healthcare providers.”

Dr. Armington says that fearing that revealing one’s sexuality to a medical professional will lead to judgement or discrimination is still common. However, he believes that keeping LQBTQIA identity and/or behaviors from healthcare providers can present individual risks. “Withholding this information may result in the person missing out on very important information such as availability of pre- and post- exposure prophylaxis for HIV infection. Trans folks may opt not to reveal a symptom they associate with their assigned sex, leading to delayed diagnosis of certain illnesses.”

Another issue is the political climate within the US, Armington says. “A recent very disturbing political trend is passage of bills in some states making it illegal to treat young trans individuals with hormones. If there is not enough opposition to misguided and dangerous initiatives like this, I believe we will see politics interfering more and more in healthcare provided to the LGBTQIA and other vulnerable communities.”

LGBTQIA Recovery Resources

Addiction treatment is often largely heteronormative and tailored to cis-gendered individuals, especially within mutual-aid meetings. Therefore, a critical part of recovery from SUD for LGBTQIA individuals is finding a community of people with their identities, affirming information from specific treatment programs tailored to their unique needs, and physicians and medical staff that are aware of the characteristics of LGBTQIA SUDs. 

LGBTQIA Peer Support

“Interaction with strangers and developing new support communities is a key element to recovery,” says Dr. Armington. “For a lot of LGBTQIA people, this means coming out again—which may feel too stressful for someone who is about to let go of their drug of choice, something they think they can’t live without.”

Tailored LGBTQIA Addiction Treatment Facilities

From a formal treatment perspective, it is critical that in-patient and residential programs should be up front on their websites, literature, written philosophies, and any public statements about whom they serve. “Leaders in these programs should not shy away from using terms like gay, transgender, or queer, or otherwise acknowledging the presence of LGBTQIA in the community,” Dr. Armington says.

In some treatment settings, it may be desirable to create a group specifically for LGBTQIA people so that members can have a space where they feel less self conscious when discussing their identities. But they should also participate fully in all aspects of the program with all other members. “I am an advocate for programs that include all communities, but I recognize that some LGBTQIA individuals will only be comfortable entering treatment if the program specifically caters to their community. And that is a valid choice as well,” explains Dr. Armington.

Medical Training

Schools and training programs for future treatment providers for substance use and alcohol use disorders need to include LGBTQIA issues and individuals in their curriculum. “When I was in medical school, LGBTQIA issues were discussed only when I or one of the few other vocal students stood up and insisted that they be addressed,” says Dr. Armington.

Harm Reduction in the LGBTQIA community

Harm reduction as a movement originated in the LGBTQIA community, with HIV activists seeking to reduce harm among the transmission of HIV/AIDS. Since then it has expanded considerably to include needle exchanges, safe consumption sites, free overdose prevention training and resources, moderation management, medication-assisted treatment, and much more. You can learn more about harm reduction for the LGBTQIA community in this interview with Shauntelle Hammonds and in our recent webinar, Changing Perspectives on Harm Reduction.

How to make recovery spaces inclusive

While heterosexual individuals in recovery may feel like they are welcoming to LGBTQIA individuals, there may still be room for improvement. There are many assumptions made and micro-aggressions committed that people outside the community are simply not aware of but are participating in. The following list of recommendations could be applied to any mutual-aid meeting, recovery encounter, and medical professionals involved in the addiction treatment industry. This is an excerpt from a blog I wrote for Faces & Voices of Recovery:

  1. Don’t assume an individual’s sexuality or their gender. State your own pronouns when you introduce yourself and encourage other group members to do the same, especially if they are cisgendered. For example: “I’m Liv. My pronouns are she, her, hers.”
  2. Don’t use heteronormative cliches like “men stick with the men and women with women.”
  3. Consider reviewing literature and changing gendered pronouns to neutral “they/them/theirs.”
  4. Be conscious of your privilege around access to healthcare, housing, and other facilities and resources. Don’t assume that everyone has the same opportunities.
  5. Advertise your group on the meeting schedule as LGBTQ+-affirming and don’t share images that are heteronormative or clearly gendered. Try to represent equity and inclusion in choosing images.
  6. Consider renaming bathrooms to be gender neutral.
  7. Don’t silence an individual’s experience relating to their sexuality. Be mindful that they may have experienced prejudice and other harms as a result. These types of stressors are just as valid as any other. 
  8. Educate yourself about trauma, and practice holding a trauma-informed space.
    • When holding meditations, give people the option of keeping their eyes open and moving around. 
    • Announce at the beginning of the meeting where the exits are, and make it clear that if anyone feels uncomfortable at any time they are free to take a time-out and leave the room.
    • Ask members to be conscious about sharing traumatic events, as they may be triggering for others. 
    • Consider holding a specific time during the meeting for people who find it hard to share.

LGBTQIA Recovery Resources

This section of the guide is dedicated to specific resources for LGBTQIA individuals, including how to find a queer, trans, or other identity therapist, safe spaces for queer individuals, and a list of peer-based mutual-aid support. 

How to find a queer, trans, and/or other identity therapist

The following directories provide nationwide lists of therapists that should be welcoming and affirming of your identities. 

  • LGBTQ Psychotherapists of Color (website)
  • QTPOC Mental Health (website)
  • QTIBIPOC Healing Space (website)
  • National Queer and Trans Therapists of Color Network (website)

Chem sex resources

Chemsex and HIV information, harm reduction tips, syringe exchange programs, PrEP, and resources can be found on the following organizations websites:

Recovery Groups

The following list is of mutual-aid groups, run by individuals in recovery: 

LGBTQIA Recovery Resources

  • Gay & Sober (website)
  • Gay and Lesbians in AA (website)
  • LGBTQIA+ Queer Sangha (website)
  • LGBTQ Psychotherapists of Color (website)
  • QTPOC Mental Health (website)
  • QTIBIPOC Healing Space (website)
  • National Queer and Trans Therapists of Color Network (website)

While the following groups may not specifically be for LGBTQIA-only individuals, many groups have LGBTQIA meetings available. Check out their websites to find a specific LGBTQIA affirming group.

12-Step Support Groups

Non-12-Step Groups

BIPOC Resources

Similarly, while these are BIPOC-specific peer groups, some are not LGBTQIA specific. However, as with other mutual-aid meetings, many have LGBTQIA groups available. 

Other Recovery Groups

  • The Recovery Gym: A project of the Alano Club of Portland that runs classes for people in recovery.
  • The Phoenix: Offers group fitness for people in recovery

Sober spaces

There are many alcohol-free safe spaces for the LGBTQIA+ community. This is often considered revolutionary for this community, which is often centered around substance consumption. You can find a detailed directory of alcohol- and drug-free spaces in this article by Them: Sober Queer Spaces Are Giving LGBTQ+ People a Place to Just Be

Publications

There are a couple of recovery publications and blogs that are written by many writers identifying as LGBTQIA, including Workit Health Guides and The Temper

Mental Health and Recovery Resources for LGBTQIA+ people

Olivia Pennelle is a writer, journalist, and recovery activist. Her work has appeared in STAT News, Insider, Filter Magazine, Ravishly, The Temper, and Shondaland. She is the founder of popular site Liv’s Recovery Kitchen. She lives near Portland, Oregon. Follow her on FacebookInstagram, and Twitter

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