Addiction in LGBTQIA Communities: Minority Stress

It’s not surprising that stress plays a part in addiction. The minority stress theory explains that health disparities faced by minorities could be the result of prolonged stress from experiencing discrimination over a lifetime. People may turn to substances to cope with this buildup of stress. Among other groups, people from the LGBTQIA (lesbian, gay, bisexual, transgender, queer/questioning, intersex, asexual) community may experience minority stress.

Stress and Substance Abuse

Brain regions such as the amygdala, hippocampus, insula, medial prefrontal cortex and more are involved in perceiving stress. The brain stem, hypothalamus, thalamus, striatal, and limbic regions are involved in emotional responses. These areas working in tandem are what create a physical stress response. Many of these parts of the brain also comprise the brain’s reward circuit, meaning they are responsible for motivation and associative learning. In short, brain areas involved in modulating stress and those involved in reward-seeking behavior have a lot of overlap. Multiple studies have found that when people are exposed to increased stress, they show an increase in impulsivity and maladaptive behaviors. In addition to these neurological reasons, people experiencing high levels of stress may use substances to try to numb the suffering. “Fight or flight” is usually a response to an immediate threat. However, humans are capable of prolonged activation of this response if exposed to repeated stressors. Additionally, consistent substance abuse alters these brain pathways in ways specific to the substance. For instance, chronic alcohol abuse is associated with changes in heart rate.

Minority Stress

Minority stress is defined as stress that is: -Unique. Specific to the minority group -Chronic. Recurring over the course of years or a lifetime, rather than a one-time event -Socially-based. Founded in social or political ideology, rather than on rational grounds The minority stress theory is often broken down into distal and proximal stressors, which are separate but related. Distal stressors are external forces like discrimination or bullying. Proximal stressors are internal and occur in response to distal stressors, such as internalized homophobia or concealment of identity. While people in marginalized communities are commonly targets for harassment, they don’t have to be targeted directly to experience distal stressors. For instance, if a gay teenaged boy noticed anti-gay slurs used against his peers, he might feel unsafe. His perception of a hostile environment might make him stay in the closet. This would still be considered a distal stressor.   Many people in the LGBTQIA community face harassment, bullying and discrimination throughout their lifetime. On top of these stressors, they may internalize messages from family, friends or society that there is something wrong with them. This could contribute to low self-worth, and the stress that accompanies it. According to an article in the journal Drug and Alcohol Dependence, LGBTQIA adults who experienced more than one form of discrimination (for example, race, sexual orientation and gender) were about four times more likely to report a past-year substance use disorder. Experiencing discrimination across an intersection of identities produces a significant amount of stress. Additionally, myriad studies have shown a link between harassment and increased substance use in lesbian, gay, bisexual and transgender youth.

General Rates of Substance Abuse

Results from a 2015 national survey suggest that LGBTQIA adults were twice as likely to have used illicit drugs. 10.4% had misused prescription pain relievers, compared to 4.5% of heterosexual adults.  LGBT individuals on average start using substances earlier than non-LGBTQIA people. One study found that LGBTQIA adolescents were 90% more likely to use substances than adolescents not part of the LGBTQIA community.  

Sub-Category Addiction Statistics

While LGBTQIA people as a whole face particular problems, there are differences within each sub-category of identity. People also often face discrimination across an intersection of identities. For instance, a white gay person will have a different experience than a Black transgender person. In the general population, men have higher rates of substance use disorders. However, LGBTQIA men and women have about the same rates of abuse. Lesbian adolescents are almost 30% more likely than heterosexual female youth to meet the criteria for alcohol abuse. Multiple studies have also shown that lesbian and bisexual women are more likely to have received treatment for a substance use disorder. Still, there aren’t many resources for recovery for queer people.  According to a review by the Substance Abuse and Mental Health Services Administration, gay men are more likely than straight men to use cocaine, hallucinogens, and methamphetamine. The same review also found that gay men are almost 11% more likely to use marijuana. Myriad studies have found that bisexual people are more likely to report substance use than both heterosexual and homosexual people. A study published in the Journal of School Health found that transgender adolescents were twice as likely to misuse prescription medication as cisgender students. Another report found that transgender populations were three times more likely to abuse opioids.

Addiction Treatment for Members of the LGBTQIA Community

Substance abuse is a major public health issue in America. However, only 11.2% of Americans in need of substance abuse treatment receive it. The unmet treatment needs of LGBTQIA substance users is believed to be particularly high, even though LGBTQIA clients on average enter treatment with more severe substance abuse problems than non-LGBTQIA clients. In addition to potentially not receiving care, LGBT people experiencing substance abuse may face discrimination in treatment. People who do not feel safe to be who they are will not get much out of a healthcare program. In fact, their substance abuse problem may even get worse. There has been debate about how to provide better treatment to LGBTQIA people. Some believe the focus should be on creating specialized programs for LGBTQIA substance use treatment. Others think all substance abuse counselors should be trained to meet the needs of LGBTQIA clients in a mixed setting. What is agreed upon, however, is that members of the LGBT community face particular issues. These issues should be considered when providing care. 

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