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LGBTQIA+ Friendly Drug And Alcohol Rehab Programs

Dr. Ted Bender, Ph.D., LCDC

Medically reviewed by

Dr. Ted Bender, Ph.D., LCDC

November 27, 2018

Customizing treatment to fit the needs of the individual is an important part of drug and alcohol rehab programs. LGBT friendly programs take into consideration the needs unique to members of the LGBT/ LGBTQ community when designing treatment interventions.

The members of the LGBTQ community are abusing substances at higher rates than other groups in the United States. While only about nine percent of the population reports struggling with substance abuse, the reported rate of substance abuse in the LGBTQ population is about 20 to 30 percent overall.

It is believed that the sharp increase of substance abuse in this population is directly related to the increased amount of stress an LGBTQ person experiences simply for being a part of that community.

Prejudice, discrimination, homophobia, hate crimes, fear, and oppression are just some of the stressors that a person of the LGBTQ community experiences often, if not daily. Currently, fewer than 10% of substance use disorder treatment facilities provide custom treatment programs for sexual minorities.

Having a drug and alcohol abuse treatment facility that caters to LGBTQ members can help identify the causes behind substance abuse and addiction, treat those issues, and help maintain continued sobriety.

What Does LGBT Or LGBTQ Stand For?

People that identify as lesbian (L), gay (G), bisexual (B), transgender (T), questioning (Q) or elsewhere on the sexuality or gender spectrum are included in LGBTQ community.

Commonly referred to as LGBT, letters and symbols have been moved, added, or deleted in an attempt to recognize the inclusion of other orientations. Currently, LGBTQ is the generally accepted acronym, but this may change over time.

Although LGBTQ encompasses many sexual, gender, and romantic orientations, it is important to understand there are significant differences between them.

Orientations include, but are not limited to: lesbian, gay, bisexual, trans, pansexual, polysexual, asexual, demisexual, queer, nonbinary, and genderfluid. A LGBTQ friendly treatment program will recognize the similarities and their differences in the LGBTQ community.

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What Does LGBTQ Specific Treatment Look Like?

Like other treatment programs, LGBTQ friendly substance abuse treatment includes detox, therapy, maintaining sobriety, building a support system, and exploring aftercare options.

What makes LGBTQ friendly substance abuse treatment programs different is the attention to the specific, unique issues that members of the LGBTQ community may need addressed as part of treatment. Sexual orientation-based discrimination is one of the key factors contributing to the increased stress, which is unique to this population of individuals suffering from the disease of addiction.

LGBTQ friendly treatment programs should provide:

  • discretion
  • accommodations for all medical, hormone, and transitional needs of transgender patients
  • a safe environment that allows for exploration of topics from LGBTQ members
  • staff that is trained and knowledgeable in LGBTQ issues and supportive of LGBTQ members
  • effective and compassionate treatment
  • treatment and aftercare plans that are individualized and inclusive
  • medication management education
  • education on co-occurring disorders
  • family therapy for both family of birth and family of choice
  • connections to a network of LGBTQ resources to LGBTQ patients

Group and individualized therapy should provide a safe space for LGBTQ identifying patients to:

  • explore experiences that resulted in feelings of shame
  • build rapport with their therapist, establish trust in treatment and others
  • look at concerns related to personal sexual identity
  • talk about issues related to coming out and/or transitioning
  • discuss sexual abuse and domestic violence as it relates to LGBTQ members
  • examine parenting issues unique to the LGBTQ community
  • expand on issues related to substance abuse and LGBTQ

With all of this in mind, building and maintaining a solid support system is an important part of the therapeutic journey.

Relationships that support the changes the patient is making should be encouraged, as this type of support can increase the potential for completing treatment and maintaining sobriety.

LGBTQ Treatment Sensitivity Model

A sensitivity model for treatment of LGBTQ members was discussed by the Substance Abuse and Mental Health Services Administration, which explored different types of treatment and how each related to substance abuse treatment for LGBTQ individuals.

The six groups of treatment included in this model are:

Anti-LGBTQ Treatment

In this treatment sensitivity model, there is no level of sensitivity toward LGBTQ members, and in fact the opposite may be true. Treatment is focused solely on heterosexuals and excludes LGBTQ members. Treatments that fit into this category typically do not openly disclose their exclusion of LGBTQ explicitly.

Traditional Treatment

This is the traditional treatment center. While there is not a lot of sensitivity toward LGBTQ clients, this type of treatment is not antagonistic toward LGBTQ members. There doesn’t appear to be any discussion regarding, or even acknowledgement that there may be LGBTQ clients in treatment.

LGBTQ Naive Treatment

In this form of treatment, the facility is aware that there may be LGBTQ patients, but there are not any specific treatment elements geared toward LGBTQ members. The needs of this specific population have not been addressed.

LGBTQ Tolerant Treatment

In a tolerant treatment program, there is limited recognition and sensitivity toward LGBTQ people. Some issues directly related to LGBTQ issues may be explored during one-on-one therapy sessions. There are not specific components that relate directly to LGBTQ individuals in treatment.

LGBTQ Sensitive Treatment

This form of treatment is more open regarding LGBTQ information, status, and treatment. There are rehab community activities that focus on LGBTQ topics, and groups are generally mixed. There is much more sensitivity toward LGBTQ issues in this category of treatment, compared to the other four types of treatment.

LGBTQ Affirming Treatment

This type of treatment is designed with LGBTQ members as the main focus. Treatment is LGBTQ specific, and activities done as a group (workshops and group therapy) are not mixed with heterosexuals. Less than 10% of substance abuse treatment facilities currently tailor specifically to this model.

Specific Issues Related To LGBTQ Members And Substance Abuse

By providing LGBTQ friendly treatment for substance abuse, issues that relate to substance abuse within this group can be specifically addressed. Although there is varying diversity within the LGBTQ community, there are some identifiable unique needs that should be approached in treatment.

Acknowledging and resolving underlying issues that influence substance abuse is extremely important for sustained recovery. The following are topics that should be considered during LGBTQ treatment:

  • acceptance/rejection
  • shame
  • coming out
  • transitioning
  • self-identity development
  • cognitive dissonance
  • family of origin and family of choice
  • housing and homelessness
  • sexual orientation
  • gender identification
  • stigmatization
  • appearance
  • religion
  • socialization problems
  • intimacy issues
  • violence
  • trauma
  • higher rates of suicide
  • mental health issues
  • parenting concern
  • isolation
  • mental health diagnoses
  • internalized homophobia
  • microaggressions

In addition to these concerns, there are unique topics that relate to specific demographics within the LGBTQ community, specifically gay, lesbian, and transgender individuals.

Unique Issues For Gay Men And Substance Abuse

Addressing substance abuse, high-risk sexual behaviors, and STD risk factors are important topics in treatment approaches for gay men. Gay men have a higher risk for Hepatitis A and B through sexual contact, and higher risk for Hepatitis C if the substance abuse includes sharing needles.

In addition, men who have sex with men (gay and bisexual) report heroin and amphetamine use at a rate at least 10 times more often than heterosexual males, and are more likely to use marijuana at a rate 3.5 times higher than the national average.

Unique Issues For Lesbians And Substance Abuse

Lesbians have been shown to consume more alcohol than the overall population of women, and younger women tend to consume more alcohol, more often. Heavy alcohol consumption can lead to addiction and negative effects on daily life.

Lesbians have additional health concerns like obesity, depression, anxiety, and other mood disorders. Because this group of women is less likely to visit a doctor regularly, this can increase the risk for addiction if the female begins self-medicating.

In addition, not having regular physician visits increases risks for developing health problems and untreated sexually transmitted infections. Providing multidimensional care, including medical care, can help alleviate some of these risk factors.

Unique Issues For Bisexual Individuals

There is an increased level of isolation that occurs for many who identify as bisexual. This demographic of the LGBTQ community often feels ostracized by both the heterosexual, as well as homosexual communities. Isolation is connected to higher rates of suicide.

Unique Issues For Transgender Individuals

There is little data that separates transgender individuals from other members of the LGBTQ community.

The data available seems to indicate a significant amount of substance abuse, and an equally concerning set of risk factors that contribute to increased substance abuse, such as high levels of victimization, suicide, mental health issues, and STD’s including HIV. Individuals who identify as transgender are also unlikely to have health insurance.

When a person who identifies as transgender enters a treatment facility, it is important that they feel safe and comfortable. Being able to utilize gender-correct facilities is necessary. It is also important to adhere to any hormone therapy that they are taking. If these needs cannot be met, it is unlikely that the person will feel safe or accepted enough to finish treatment.

Minority Stress Theory

Many of the issues faced by LGBTQ members can be included as stressors under the term minority stress. This is a unique type of stress that marginalized or minority groups face.

This type of stress is a direct result of being repeatedly exposed to discrimination and prejudice. Individuals who identify as LGBTQ experience this stress regularly, and there seems to be a connection between this constant increased stress level and increased rates of substance abuse.

Overall, more than 25 states do not have clear laws to protect LGBTQ members from discrimination that may keep them from obtaining employment, maintaining employment, housing, and public accommodations. This is especially troubling considering that perceived discrimination in the LGBTQ community has been shown to lead to significant emotional stress, and an increased risk for self-harm and suicidal thoughts.

This lack of protection creates an uncertainty that alters daily living for the majority of members of the LGBTQ community, and all too often, substance abuse offers an escape.

Barriers To Addiction Treatment Faced By LGBT Members

There are several barriers to treatment faced by the LGBTQ community. Treatment is expensive, especially if the individual does not have insurance, or the insurance they have does not cover these services.

Until recently, many LGBTQ couples were unable to put their partners on their insurance policies, which caused additional issues in regard to lack of care.

Another concern of this demographic is the lack of accurate and appropriate treatment methods. Treating an individual who identifies as LGBTQ with standard substance abuse approaches may be less effective than a treatment program that includes adequately trained staff that use culturally appropriate, successful treatment approaches.

In addition, there are horror stories of treating homosexuality as a disorder and attempting conversion therapy in inpatient settings, which makes many LGBTQ individuals apprehensive about treatment.

Many socializing situations include drugs and alcohol in the LGBTQ community. Often, a person who is aware they need drug or alcohol treatment does not pursue it because they are reluctant to limit their social circle.

They have spent a significant amount of time building the social support network, which in some cases is the only support they have, and they fear that sobriety may remove that support system.

Understanding Confidentiality In LGBTQ Treatment

An LGBTQ friendly treatment facility is bound by confidentiality for each individual, regardless of sexual orientation or gender identity. During the admission process, the individual signs a confidentiality form that outlines the confidentiality policy of the rehab center.

As a general rule, personal information is not to be shared without an individual’s permission. This includes disclosure of sexual orientation and identity.

Even if an individual signs a release of information, this does not mean that all personal information will be shared with this entity, medical office, insurance provider, or even family members. Release of information forms usually read that only applicable information relevant to the treatment is shared with this party.

In addition, an individual can request that specific information is not shared, like sexual orientation and gender identity.

Goals In LGBTQ Addiction Treatment

Sobriety is not the only goal of an addiction treatment center. Providing a framework of understanding and self-realization to help abstain from substance abuse in the future is another key element of the recovery process.

Members of the LGBTQ community may have an additional unique set of circumstances that have led to their substance abuse.

When a person goes through substance abuse treatment that is LGBTQ friendly, they should typically have a good understanding of the following:

  • Understanding the connection between identifying as LGBTQ, the stigma society holds towards them, the internalized homophobia they have, addiction, and recovery.
  • Defining LGBTQ specific elements of diversity and identification, including sexual identification, gender identity, feelings and emotions, appearance, and self-identity.
  • Realizing how the discrimination towards members of the LGBTQ community affects the coping strategies used in both recovery and active addiction.
  • How to handle peer pressure and future social events that may include substance abuse.

Connect with us today, so we can help you find an LGBTQ friendly drug or alcohol treatment program that meets the needs of you or your loved one.

Movement Advancement Project - Non-Discrimination Laws

Substance Abuse and Mental Health Services Administration - Sexual Orientation and Estimates of Adult Substance Use and Mental Health

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