The statistics for substance abuse and substance use disorders among LGBTQ+-identified people are harrowing, but there are a plethora of resources that people within the community — and their families — can use to seek help and treatment.
How do Substance Abuse and Addiction Affect LGBTQ+ People?
Substance abuse is a threat across the spectrum of U.S. demographics, and mental/emotional wellness issues know no boundaries. These are public health issues. However, there’s a statistically higher rate of mental illness, mental health struggles, and substance abuse in the LGBTQ+ community when compared to others.
These struggles don’t take place in isolation. They occur in the context of stress created by isolation, discrimination, and a lack of support systems for LGBTQ+ individuals in society at large.
How Common is Substance Abuse in the LGBTQ+ Community?
There was significant overlap between substance use disorders, or SUD, and mental illness in the 2019 National Survey on Drug Use and Health (NSDUH). Of the 6.8 million lesbian, gay, and bisexual individuals 18 and older who exhibited mental illness, 1.9 million (28%) also had a substance abuse disorder.
The 2.6 million persons with a substance abuse disorder who also had a mental illness accounted for 38% of the total number of individuals with an SUD.
The trend in these categories was concerning as well. The number of lesbian, gay, and bisexual adults who had either a mental illness or a substance abuse disorder (or both) also increased, rising by 20.5% from 2018 to 2019, to a total of 7.6 million.
The higher incidence of LGBTQ+ adults dealing with substance abuse disorder should come as no surprise. Stress has long been identified as a risk factor in developing (and potentially relapsing into) addiction. “Stress,” in this context, refers to processes “involving perception, appraisal, and response to harmful, threatening, or challenging events or stimuli.”
Such stress is, unfortunately, a common experience among LGBTQ+ individuals, 1 in 4 of whom reported experiencing discrimination in a 2016 survey. And of those, 68.5% said the discrimination affected their psychological well-being.
This discrimination can take the form of harassment in the workplace or public places such as stores or restaurants. This was a particular area of concern among transgender people who took part in the survey: 25.7% said they’d avoided such public places, compared with 9.9% of cisgender LGB respondents.
Discrimination can manifest as bullying, taunting, physical abuse, discriminatory ordinances, and hate crimes. The fear of such discrimination leads to repression of self-expression and, in some cases, living “in the closet,” fear of being “outed,” and self-blame or internalized homophobia. These coping mechanisms, in turn, create further stress that can open the door to substance abuse.
The lack of community support and acceptance among family, friends, and peers leads to a feeling of isolation and can produce a desire to numb or distract from emotional hurt by turning to substance abuse.
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What Percentage of LGBTQ+ People Abuse Substances?
Given these challenges, it should come as no surprise that statistics show higher rates of substance abuse among people who identify as LGBTQ+ than in the general population.
For example, the National Survey on Drug Use and Health found in 2018 that 37.6% of those identified as “sexual minority adults” (defined as lesbian, gay, or bisexual) reported having used marijuana in the past year, compared with 16.2% of the adult population overall.
A similar trend was noted in 2018 when it came to the use of opioids: 9% compared to 3.8% overall. The 2019 survey found mixed results concerning opioid use. It was found to have increased significantly among LGBTQ+ adults 26 and older between 2017 and 2019, while having fallen among those aged 18-25.
Methamphetamine use has been trending upward, as has marijuana use. The former is a particular concern. Although relatively stable among those aged 18-25, it rose markedly over the three-year period of 2017 to 2019 among adults who are 26 and older from 122,000 to 348,000. LSD use was rising as well, nearly doubling from 103,000 adults to 201,000 over the same period among adults 26 and older.
The increase in marijuana use, however, may not be too surprising in light of the trend toward legalization. As of June 2021, recreational marijuana was legal in 19 states, plus the District of Columbia and Guam. Marijuana is legal for medical use in other states, which has encouraged some doctors to prescribe it as an alternative to opioids.
Alcohol use, on the other hand, has remained relatively stable, percentage-wise, among lesbian, gay, and bisexual adults.
Focusing on individual substances, though, tells just part of the story. The NSDUH also found that struggles often aren’t limited to a single substance, and that those who were having problems with one were likely to have trouble with others, too.
What is Substance Use Disorder (SUD)?
The NIH defines substance use disorder (SUD) as “a mental disorder that affects a person’s brain and behavior, leading to a person’s inability to control their use of substances such as legal or illegal drugs, alcohol, or medications. Symptoms can range from moderate to severe, with addiction being the most severe form of SUDs.”
The abuse may involve prescription or illicit drugs, and it’s important to note that some prescription drugs (such as opioid painkillers) carry a high risk for addiction.
Signs of Substance Abuse
Substance abuse is a behavioral health issue. It can alter a person’s life in a variety of ways, including physical, mental, and emotional. It can lead to changes in priorities and create further isolation, while damaging the body and heightening the risk of potentially catastrophic events such as an overdose.
Physical Signs of SUD
Those dealing with SUD may have intense urges for the drug that make it difficult to focus or function effectively when performing tasks.
As time passes, it becomes increasingly difficult to obtain the same level of enjoyment from the drug use, which may lead to experimenting with higher doses. Attempts to discontinue use can lead to physically unpleasant side-effects known as withdrawal symptoms.
Physical signs of substance use disorder include:
Physical cravings for the substance.
The need to use the substance daily or more often.
Developing a tolerance for the drug, which results in a reduced level of pleasure from the same amount of use and the need for larger doses to achieve the desired result.
Withdrawal symptoms when the drug is not available for regular use.
Behavioral Signs of SUD
SUD can lead to uncharacteristic behaviors such as stealing to support the addiction, and a loss of interest in normal activities, including those that have typically been enjoyable like social and recreational events.
Those dealing with SUD may find themselves spending more money on the drug than they can afford, even if it’s in order to have a reliable supply so they don’t run out.
Behavioral signs of SUD include:
Increased risk-taking, such as drunken driving, binge drinking, unsafe sex, becoming confrontational, etc.
Spending money you can’t afford on the drug, or in lieu of necessities.
Prioritizing the substance ahead of work and other obligations, or recreational/social activities.
Stealing to finance the use of the substance.
Repeated failed attempts to stop using the drug.
Thinking about the drug more than anything else.
Spending a lot of time and effort obtaining the drug, and ensuring there’s enough on hand.
Substance Abuse and Mental Health Statistics
How important are the issues of drug abuse and mental health among the nation’s LGBTQ+ community to the nation as a whole?
Consider that 4.5% of U.S. adults identified as LGBT or as gay, lesbian, or bisexual in a 2017 Gallup poll, and that more than 39% of those reported having a mental illness. That’s more than the population of Kentucky.
Four years later, in 2021, the overall percentage of U.S. adults who self-identify as LGBTQ+ had grown to 5.6% of adults, with 7.6% declining to answer Gallup’s question about their sexual orientation.
Younger Americans were by far the most likely to self-identify within the LGBTQ+ community. Among Generation Z respondents (born 1997-2002), the figure was 15.9%, and among Millennials (born 1981-1996), it was 9.1%.
Statistics regarding young people bear out their continuing struggles. It is estimated that LGBTQ+ youth and young adults have a 120% higher risk of experiencing homelessness, which is often the result of family rejection or discrimination based on their gender identity or sexual orientation. This risk is especially high among Black LGBTQ+ youth.
Approximately 48% of LGBTQ+ youth whose parents are aware of their gender identity or sexuality say their families make them feel bad about themselves. For most people, home is the ultimate safe space, but when home itself is no longer safe, that can lead to a continual sense of stress and vulnerability.
Stressors such as these can translate into anxiety, depression, and other mental health issues. Indeed, 60% of LGBTQ+ youth reported being so sad or hopeless that they stopped doing some of their usual activities (Kann 2016). As well, according to one study, transgender youth are nearly four times as likely as their cisgender peers to experience depression (Reiser 2015).
This, not surprisingly, correlates with statistics that show higher rates of substance use among LGB-identified high school students and young adults. One study from The Trevor Project found that alcohol use was 25% higher among LGBT high school students and 18% higher among individuals 18-25 than among their peers.
The disparity in marijuana use was even greater, at 62% among high school students and 59% in the 18-25 age group. Additionally, LGBT high school students used ecstasy, methamphetamine, and heroin at three times the prevalence of their peers.
Among adults, stress and depression take a similar toll. In 2015, the Substance Abuse and Mental Health Services Administration’s National Survey on Drug Use and Health found that one in three LGBQ adults experienced mental illness in 2015, compared with only one in five of their heterosexual counterparts (Medley 2016).
The CDC reports on its website that gay and bisexual men are at greater risk for major depression, bipolar disorder, and generalized anxiety disorder than other men. Also, severe trauma, such as that caused by the 2016 mass shooting at the Pulse nightclub in Orlando that left 49 dead, can trigger post-traumatic stress disorder (PTSD).
LGB-identified adults are also nearly twice as likely as heterosexual adults to experience a substance use disorder. Among transgender individuals, the figure is even higher: almost four times as high as that reported for cisgender individuals.
A total of 1.4 million LGB adults in the 2019 NSDUH reported opioid misuse, or 9.6% of that population, while 1.3 million in the same survey misused prescription pain relievers that year.
High rates of suicide were reported in the transgender population, where 40% of adults have attempted suicide during their lifetime, compared with less than 5% of the U.S. population at large (James 2016). In addition, transgender college students who were denied access to gender-appropriate facilities on campus were 45% more likely to try to take their own lives (Seelman 2016).
Get Help and Support for Mental Health or Substance Abuse
Fortunately, a variety of support resources are available for people dealing with substance abuse, some of which are geared specifically toward LGBTQ+ youths and adults.
Confidential phone support and referrals to addiction treatment services, health care providers, and substance abuse treatment facilities are available, in some cases 24 hours a day. The following are some resources that can be accessed.
People within the LGBTQ+ community face challenges ranging from workplace harassment to institutionalized discrimination to bullying and social isolation. These challenges often lead to mental health issues such as depression and anxiety that put them at an increased risk of substance abuse.
At Alternative to Meds Center we recognize each individual is a divine expression of life, and aim to provide the very best in alternative medication and recovery services to all of our clients.
This content has been reviewed and approved by a licensed physician.
Dr. Michael Loes, M.D.
Dr. Michael Loes is board-certified in Internal Medicine, Pain Management and Addiction Medicine. He holds a dual license in Homeopathic and Integrative Medicine. He obtained his medical doctorate at the University of Minnesota, Minneapolis, MN, 1978. Dr. Loes performed an externship at the National Institute of Health for Psychopharmacology. Additionally, he is a well-published author including Arthritis: The Doctor’s Cure, The Aspirin Alternative, The Healing Response, and Spirit Driven Health: The Psalmist’s Guide for Recovery. He has been awarded the Minnesota Medical Foundation’s “Excellence in Research” Award.
Lyle Murphy is the founder of the Alternative to Meds Center, a licensed residential program that helps people overcome dependence on psychiatric medication and addiction issues using holistic and psychotherapeutic methods.
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