Rehab treatment for the LGBTQ+ community

LGBTQ+ people who are struggling with addiction are doubly stigmatised – both based on their addiction and their sexual identity or gender minority status. This dual discrimination can present a significant barrier to LGBTQ+ people seeking treatment. They may also have estranged relationships with their families, and the process of entering rehab without this external support may be daunting. Additionally, rates of trauma are significantly higher in the LGBTQ+ community, which may mean that they avoid seeking out rehab, particularly if it isn’t inclusive and runs the risk of re-traumatising them.

For these reasons, tailored rehab for LGBTQ+ people is crucial to remove as many barriers as possible for people seeking treatment and to ensure the care they receive when engaging in addiction recovery is as effective as possible.

LGBTQ+ and addiction

Rates of addiction are higher in the LGBTQ+ community than in the general population.

Amongst sexual minority adults (people who describe themselves as lesbian, gay or bisexual), the 2020 US National Survey on Drug Use and Health found that:

• 41.3% of sexual minority adults reported marijuana use in the past year, compared to 18.7% of the general adult population
• 6.7% of sexual minority adults misused opioids in the past year, compared to 3.6% of the general population
• 21.8% of sexual minority adults had an alcohol use disorder in the past year, compared to 11% of the population.
• These statistics suggest that substance misuse and addiction occur at about twice the rate in the LGB population.

There aren’t as many studies on addiction in the trans community, but a study in the International Journal of Environmental Research and Public Health states that:

• Trans people, particularly trans men, are at higher risk for alcoholism than the general population
• Cannabis misuse is higher in the trans population, particularly among trans men
• Illicit drug use is higher in the trans population overall
• Trans women, in particular, are at higher risk for methamphetamine and injection drug use.

What makes LGBTQ+ individuals susceptible to addiction?

One reason why LGBTQ+ people might struggle more with addiction is minority stress.

Minority stress theorises that struggles with health and addiction in minority populations have their roots in discrimination. This discrimination can be external (discriminatory laws and policies, street harassment) or internal (shame, rejection, identity concealment). The emotional dysregulation, shame and isolation from minority stress can increase the risk for addiction.

Earlier in the 20th century, anti-sodomy and public morality laws made it difficult for LGBTQ+ people to associate in public. These laws reflected and condoned anti-gay sentiment in the general population, and being visibly LGBTQ+ could result in street harassment, violence, and targeting by the police. LGBTQ+ people often found community and solace in bars – historically, these were some of the only places that LGBTQ+ people had available to meet others safely. These venues were still often targeted by the police.

Bars and clubs remain as part of LGBTQ+ culture, where alcohol and drug exposure will be higher.

Why might LGBTQ+ individuals avoid rehab treatment?

The identity of LGBTQ+ and addiction are both stigmatised, and this may cause LGBTQ+ people to avoid seeking treatment. Fear of judgement and isolation can cause LGBTQ+ people to avoid services that could help them overcome their addiction, so tailored, non-judgemental services are critical to ensure LGBTQ+ people are more likely to seek help.

Why is LGBTQ+ inclusive rehab important?

A US study in the American Journal of Public Health found that 70.8% of LGBTQ+ addiction treatment programmes were functionally no different than standard programmes.
Addiction can present differently between populations, and even within the LGBTQ+ population, certain types of addiction are more or less common among gay people, trans people, lesbians, etc. Understanding this and why this might be the case does not just mean more effective treatment – it helps the person undergoing treatment feel more seen and supported.

In addition, an LGBTQ+ person may worry that they could face homophobia or transphobia during detox, withdrawals, and the recovery process, which are all vulnerable times. If they’re concerned about this, they may delay or avoid reaching out for help with their addiction.

Rehab Treatment for the LGBTQ+ Community

Programmes that acknowledge how LGBTQ+ identities and addiction intersect are more likely to be effective. A good LGBTQ+ rehab needs to be knowledgeable and inclusive.
At the most basic level, the LGBTQ+ person entering rehab must know that they are physically safe, will not encounter homophobia, transphobia or judgement, and will be able to focus on their recovery without additional stressors from others reacting negatively to their identity.

LGBTQ+ rehab needs to be affirmative and non-judgemental – this means understanding the identity of the person in treatment, creating a supportive environment, exploring identity-related internal stigmas and traumas and validating the person’s identity.

Key therapies in rehab treatment for LGBTQ+ individuals

Many therapies and approaches could be beneficial for LGBTQ+ people in rehab.

Trauma-informed care

Rates of PTSD are higher among the LGBTQ+ population. Studies indicate that as many as 48% of LGB individuals and 42% of trans people meet the criteria for PTSD. Emphasising safety, trust, peer support, and empowerment is crucial for creating a trauma-informed environment.

Cognitive Behavioural Therapy

CBT focuses on addressing, interrogating and countering inaccurate negative thoughts and self-beliefs. This can be used to tackle self-stigmatisation and reframe and challenge negative beliefs around self-worth and identity.

Group therapy

Group therapy is an excellent way to reduce isolation, form bonds and share experiences. Group therapy with other LGBTQ+ individuals can provide a safe place to be open about prior experiences, build connections and provide mutual support.

Family therapy

Family therapy can be offered as part of an LGBTQ+ treatment programme but must only be done so with careful consideration of the individual’s circumstances.

A barrier to entering rehab for LGBTQ+ people may be a lack of support from family when undergoing rehab, as family relationships may be distant or fraught. Family therapy treats addiction as part of an embedded network and can be extremely useful for treating the circumstances that addiction has arisen from and healing the relationships that were present before and during a person’s development of an addiction. However, family therapy should never be forced and only be pursued with the full consent of the LGBTQ+ person and their family.