Health and Wellness

4 ways to overcome barriers to addiction treatment for the LGBTQ community

depressed teen, ex-gay therapy, conversion therapy, reparative therapy
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Justine is a senior in high school who can’t wait to graduate and get out of her small town, fast. For most of the 16 years she spent as Justin, she was ridiculed and bullied for being “girly,” and since coming out as trans last year, things have only gotten worse. The taunting at school has escalated, and her dad refuses to acknowledge her. She feels rejected, unwanted and ashamed.

She’d taken up smoking weed and drinking years ago to cope with the depression, but recently began buying pain pills from a dealer in town and often washes them down with vodka. She’s contemplated swallowing a whole handful of pills to put an end to her misery, but she can’t afford that many at once.

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Substance Use Disorders (SUDs) are a serious problem among the LGBTQ community, with LGBTQ adults almost twice as likely to suffer from SUD as their heterosexual peers. And just like in Justine’s case, SUDs often begin early as LGBTQ youth struggle to find their place in the world.

Many of the same stigmas LGBTQ individuals face on a daily basis are also the reasons they don’t get treatment. These barriers often lead to overdose and an increased risk of suicide. In fact, nearly half of LGBTQ youth have considered suicide in the past year and roughly 1 in 6 made an attempt, with young people ages 13-17 especially at risk.

These barriers—both internal and external—are the leading forces preventing LGBTQ individuals from getting the treatment they need.

  • Shame. Like Justine, many LGBTQ youths feel significant isolation and shame for not being “normal.” This sense of “otherness” and chronic rejection makes them feel unworthy, which is compounded by the shame of addiction. According to recent data, nearly 45% of LGBTQ youth who wanted mental health treatment said they feared not being taken seriously, and many instead self-medicate with illicit substances that have high addiction potential.
  • Internalized homophobia. Similarly, many LGBTQ  individuals suffer from internalized homophobia from living in deeply ingrained anti-gay cultures. They believe their own feelings to be “wrong,” and perceive themselves as bad people, which creates feelings of self-loathing. Many in this situation turn to substances to silence those negative thoughts and temporarily lower their inhibitions to live as their true selves. They feel uncomfortable in their own skin, and drugs or alcohol can help dull those insecurities.
  • Lack of resources. Because of discrimination and social stigma, LGBTQ individuals are often shunned and unable to fully participate in society as functioning, productive people. As a result, they may be underemployed, unemployed, uninsured, or even homeless, without the resources to seek treatment. Nationwide, over 40% of LGBTQ youth say they can’t afford mental health care with 1 in 5 lacking transportation to go and receive care.
  • General lack of treatment options. Across the country, availability of mental health treatment is low for everyone, due to a lack of providers and programs coupled with overwhelming demand. This is especially true in rural areas, and many LGBTQ individuals may think they have no choice but to travel or relocate for treatment—which they may not want or be able to afford.
  • Fear. Over the last couple of years, we’ve seen a weaponization of fear as the media has turned to “outrage-ification” to drive views and clicks. The LGBTQ community has often been the target of those fears, portrayed as deranged individuals who are “coming for your children” and dangerous to society. This mischaracterization has led to threats of violence, assault, and other risks. Nearly 30% of LGBTQ youth don’t seek treatment because they fear being outed, and as a result, can become reclusive or remain isolated within their peer group. Because of the high rate of SUD within the community, there’s often a lack of good role models for addiction recovery, which perpetuates the addiction culture.

 Overcome Barriers by Reaching Out

All of us—providers, friends, family, and even employers—can work together to overcome barriers to treatment for the LGBTQ community by becoming an ally in making it easier to access SUD and mental health programs. Here are four suggestions:

  1. Marketing materials. Treatment providers should make it very clear in their marketing materials that they’re a safe space for vulnerable groups, especially youth and teens. Emphasize the fact that your facility provides safe, non-judgmental services by well-trained, licensed therapists who are eager to help.
  2. Develop community-specific programs. Evidence shows that treatment programs for peer groups yield much better outcomes. This is true across gender, race, and professions (like first responders or medical professionals) because it creates a sense of community and acceptance where they feel understood by people who have experienced the same challenges or biases. Treatment providers need to offer groups geared toward the LGBTQ  community in order to create a welcoming atmosphere and deliver more effective therapies.
  3. Offer telehealth services. The rise of telehealth has been a game-changer for helping individuals who don’t feel comfortable in in-person settings. While the detox portion of SUD treatment isn’t compatible with telehealth, making mental health treatment available remotely could help stave off the development of a SUD in the first place. Employers and insurers can help by including telehealth in their coverage benefits.
  4. Ask the right questions. For LGBTQ individuals, asking the right questions before committing to a program is vital to success. Unfortunately, conversion therapy still exists and getting sucked into one of those programs will only make things worse. Ask specifically about the culture of the organization, empathetic treatment for vulnerable communities, and whether there are any specific group programs available. Are any facility leaders, administrators, or therapists in the LGBTQ community or consider themselves allies? Chances are if it’s an accepting and inclusive place to work, that’s reflected in the care they provide.

Enabling access to high-quality, inclusive SUD treatment for everyone must be a top priority. By working together to tear down barriers to treatment for both mental health and addiction, we can provide a safe environment for LGBTQ individuals and save lives.

Dr. Lucas Trautman is the Medical Director at Oxford Treatment Center, an American Addiction Centers facility

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