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  • Dan Escobar, LPC

Substance Use in the LGBTQ+ Population

Do you know someone who identifies in the LGBTQ+ community? Odds are that you do. If so, there is a chance this person, like others you may know, uses drugs are alcohol. While this may not surprise you, the rates among those in this population who use may. It is worth exploring why people in this community use drugs and alcohol and at higher rates.

Substance Use Rates

According to data from a 2018 study at the National Survey on Drug Use and Health (NSDUH), people in the LGBTQ+ community use drugs and alcohol at a higher rate than those who identify as straight and cisgender. Regarding alcohol use in the LGBTQ+ community, individuals were more likely to report alcohol use disorder at 12% than those not in this community at 10%. In looking at marijuana use, 37% of those who identified as LGBTQ+ reported using marijuana versus 16% in the general population.

If we go back to earlier studies, we see similar trends of use compared between those within and external to this population. Studies showed that 20-25% of gay men and lesbians reported themselves to be heavy drinkers compared to the 3-10% of the heterosexual population back in the 1980s. Studies also note that, in general, those in the LGBTQ+ population reported higher use of marijuana and cocaine than those who identify as heterosexual. Unfortunately, studies in this area are not more robust as we run into the problem with finding reliable information on the total size of the LGBTQ+ community. This may be because one’s comfort level in disclosing that they are a member of this population or if they use drugs or alcohol. Both types of self-disclosures still carry significant stigmas. Regardless of judgement, safety, or mistrust, we know there are valid reasons for not feeling comfortable answering this question.

Reasons for use

So, we know the LBTQ+ population uses at higher rates, but why? The reasons will vary just like those who use in the general population. However, there are a few consistent issues that the LGBTQ+ population consistently face, including harassment, violence, discrimination, and a tumultuous political landscape.

According to the American Addiction Centers, discrimination, internalized homophobia, stigma, and a lack of support, are all distinct reasons why a person in this community may be more likely to use than someone who identifies as straight. Co-occurring disorders such as depression and anxiety are nearly twice as likely to develop in the LGBTQ+ community when compared to those in the general population. Additionally, where someone is on their journey to navigating their gender identity, their sexual orientation, or other vulnerable parts of who they are may also be a contributing reason for using substances.

In some cases, the preliminary stages of exploring one’s identity can involve going to LGBTQ+ friendly bars and clubs to find others who may also be exploring who they are. For those who are unfamiliar, these clubs, often referred to as simply “gay bars” usually have the pride flag adorning their windows, and are known for drag queen performances, dancing, and you guessed it… drug use. In Austin, 4th street downtown has a few bars that meet these criteria. For many going to these places brings a sense of belonging, safety, and crucially, acceptance.

Gay bars have their origins in oppression. Due to historical criminalization of same-sex activity, people met in secret clubs for their own safety. These gatherings were often considered both liberating and hedonistic. Through the decades, alcohol and tobacco companies have exploited the connection between the LBGTQ+ population and the connection they have to safe space bars to increase sales through ease of availability and targeted marketing campaigns.

Bars and other businesses owned by someone in this community are what often makes up a lot of what people refer to as the “gay neighborhoods” a.k.a. “gayborhoods” and formerly referred to as the “gay ghettos.” These neighborhoods also may contain people using drugs whether for recreation or chemsex or just for meeting new people. This is consistent with trends in ‘straight bars’ where people use alcohol to loosen up, MDMA to connect and stimulants for energy. However, due to lessened acceptance of the LGBTQ+ lifestyle, the use tends to be more concentrated in gay friendly spaces.

Putting it all together

While the LGBTQ+ population share in similar struggles and stigmas, they are not a homogenous group. Reasons for their use are as complex and nuanced as any other population. Which means treatments needs and preferences will be varied as well.

Some people may prefer a formal, abstinence-based approach and fortunately more places are becoming more culturally responsive to serving all types of clients. More and more rehabilitation facilities and 12 step groups are working to meet the needs of the LGBTQ+ population.

Others may prefer to continue their use but learn about safety considerations and safer use practices. It is possible to examine one’s relationship with substances and make healthy, positive changes without treatment.

Regardless, people in this community deserve respect, validation, and the understanding that just because someone uses substances does not necessarily mean they need treatment for it. So, wherever someone is on their journey, know that there are options if they are interested.

We know that people use substances because they, in some way, work for them.

Support if you need it

If you need support in managing drugs or alcohol, Substance Use Therapy is here. Contact us for a no charge consultation. If you aren’t sure, you want counseling, but you do need more harm reduction resources, visit our Safety-First page.

Whatever you are facing, you don’t have to face it alone.


About the Author:

Dan Escobar, LPC is a therapist at Substance Use Therapy in Austin, TX. Dan works with individuals whose lives have been affected by substance use. Dan also specializes in working with LGBTQ+ issues and he is passionate about helping people to develop and hone coping skills to better manage the stresses of life. Contact today to schedule a no-charge, 30 minute consultation. In person and telehealth appointments are available.

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