People who identify as LGBTQ+ are at a greater risk for substance abuse, addiction and mental health issues compared to those who identify as heterosexual. However, through the proper LGBTQ+ specific care that addresses and understands the unique challenges this community faces, recovery from addiction is possible as it is with any other.
The Relationship Between the LGBTQ Community and Drug Abuse/Addiction
Drug abuse and addiction has been a longstanding concern amongst the LGBTQ (Lesbian, Gay, Bisexual, Transgender, and Queer/Questioning+) community. Members of the LGBTQ community suffer from higher rates of substance abuse/addiction compared to those of the general population. In fact, according to the Substance Abuse and Mental Health Services Administration (SAMHSA), substance use disorders affect 20-30% of the LGBTQ population, compared to only 9% of the population as a whole. SAMHSA also reported that 39.1% of gay, lesbian, and bisexual adults used illicit drugs in the past year, compared to only 17.1% among heterosexual adults. These statistics can be largely contributed to the unique set of challenges this particular community faces on a daily basis.
In order to comprehend the struggles LGBTQ+ individuals endure, it’s important to understand the following terms:
Lesbian, gay, and bisexual are terms that describe sexual orientations. Lesbians are women who are sexually and romantically attracted to other women, homosexual (gay) men are sexually and romantically attracted to other men, and bisexuals are sexually and romantically attracted to both men and women.
Transgender, is a term which describes a person who identifies with a gender at odds with their sex assigned at birth. Transgender is not a sexual orientation, but a gender identification. Trans people can claim straight, lesbian, gay, or bisexual orientation.
The “+” aims to include those who identify as queer, intersex, asexual, Demisexual, non-binary, gender fluid, pansexual, polyamorous, questioning and many more besides.
Similar to all other demographics, unresolved trauma can often be the root cause of addiction for members of the LGBTQ+ community. Many LGBTQ+ individuals have histories of physical, sexual and emotional abuse which sets the stage for their need to self-medicate and blot out the pain that it causes them rather than face therapeutic resolutions instead.
Challenges Faced by the LGBTQ+ Community
People who identify as lesbian, gay, bisexual, transgender or others often face social stigma, discrimination and other challenges that people who identify as heterosexual never have to experience in their daily lives. They also face a greater risk of harassment, violence and abuse. As a result of these and several other stressors/exacerbatory issues, sexual minorities are at increased risk for abuse/addiction in various forms as well as mental health conditions.
Discrimination & Prejudice
The most common reason that LGBTQ+ individuals suffer from higher rates of mental health conditions and subsequent substance abuse/addictions of various forms are because of the discrimination and prejudice they face as a minority group. People in the LGBTQ+ community are more likely to experience social stigma, rejection, verbal abuse, ostracism from society and even from their families and friends in certain cases. These homophobic/negative experiences give rise to mental health conditions that can push them toward substance abuse, substance addiction and other forms of addiction. In fact, a 2017 study reported that 58% of the LGBTQ+ youths surveyed listed discrimination as one of the main reasons for their drug and alcohol abuse.
Additionally, LGBTQ+ people often face violence such as bullying, teasing, harassment and even physical assault. This can lead to feelings of constant fear, shame and feelings of defenselessness. The transgender community experiences this perhaps the most in today’s society and has led to rates of addiction that are “disproportionately higher” than even lesbian, gay, and bisexual individuals. In response to an outside world full of negative messages about what it means to be gender nonconforming and/or attracted to people of the same sex, many come to view themselves as deeply flawed, unlovable, unworthy and hopeless. This constant stream of homophobic abuse produced by others can then lead to internalized homophobia – the belief that being LGBTQ+ is wrong and unnatural, which is accompanied by feelings of self-loathing, insecurity and anxiety. Recent studies found that up to 55% of LGBTQ+ individuals suffer from some level of internalized homophobia.
In the United States, the LGBTQ+ community is also the only group of people that it is still legal to discriminate against. Twenty-nine states still offer no protection against workplace discrimination based on sexual identity, thirty-two states still offer no protection against discrimination on gender identity and the military only recently repealed the “don’t ask, don’t tell” policy in 2011. As a result, 52% of the LGBTQ+ population lives in states that offer them no protection against workplace or daily discrimination just because of the sex that they prefer to have a relationship/sex with, which isn’t a choice and are born that way.
Stress, Anxiety and Depression
These experiences of social prejudice and fear of rejection can lead to higher levels of stress, anxiety, isolation and depression amongst those who identify as LGBTQ+, which can all increase the risk of self-medicating with drugs and alcohol. In fact, roughly 58% of lesbians, gay men, bisexuals, and transgender individuals deal with anxiety and depression at some point in their lives. That rate is 2.5 x higher than that of their straight and gender-conforming counterparts. People of the LGBTQ+ community are also at a higher risk than the general population for suicidal ideation and attempts. The discrimination that LGBTQ+ people face and the pressure they sometimes feel from their family or communities, puts them at greater risk for poor emotional health and resulting substance abuse and addiction of various forms.
Limited Treatment Services
Addiction treatment facilities are often unable to meet the unique needs of LGBTQ+ people struggling with both substance misuse and mental health. In order to provide a full-spectrum of care, health professionals need to account for their patients’ sexual identities and the troubles they face on a regular basis. A national study found that of the 854 treatment programs that reported to have specialized treatment services for LGBTQ+ individuals, only 62 confirmed these services actually existed during a telephone follow-up. This means that about 70% of treatment facilities that boasted specialized LGBTQ+ services were lacking and the options offered are actually no different than those provided to non-LGBTQ+ people. More programs that are designed specifically for this community need to be developed as more options make it easier for them to seek the treatment they need for co-occurring disorders.
In addition to the limited LGBTQ+ specific treatment services available, LGBTQ+ individuals may be reluctant to seek treatment or disclose their sexual orientation during treatment out of concern that health providers might be homophobic or prejudiced against them. In fact, a National Institute on Alcohol Abuse and Alcoholism report mentioned that stigma, intolerance and open discrimination were the most substantial barriers to substance abuse/addiction prevention and treatment among the LGBTQ+ community.
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“Chemsex” In LGBTQ+ Community
What Is Chemsex?
Chemsex is the practice of taking drugs, often GHB, mephedrone and/or methamphetamine, for the specific purpose of facilitating sexual activity between gay men. The term chemsex also refers to the parties, often hosted by dealers of chemsex drugs, where men meet up to take drugs and have sex.
Chemsex is distinct to sex that takes place after gay men have used recreational drugs coincidentally. Instead, chemsex is the intentional use of drugs to fuel, enhance or prolong sexual activity.
The drugs that are typically used for chemsex have a range of mood-altering effects, as well as significant risks to the user. They include:
GHB or GBL: GHB (gammahydroxybutrate) and GBL (gammabutyrolactone) have sedative and anaesthetic effects. They are used at chemsex parties to reduce sexual inhibitions and bring about euphoria and drowsiness. Accidental death is a growing risk because people can “go under” when using the drug – experiencing fits, slipping into a coma or suffering respiratory arrest. Accidental overdose is a serious risk because the drug comes in liquid or powder form; sometimes potency is very unclear and it’s easy to make errors or take risks with dosage when new, rushing at a party or peer pressure with others makes using more than needed a risk.
It’s also easy to get addicted if people use GHB or GHL frequently. If physical addiction develops, then withdrawal symptoms can include anxiety, shaking, sweating and insomnia. In extreme cases, people need to dose every hour in order to prevent the onset of severe withdrawal symptoms. With GHB or GBL addiction, it’s strongly advised to seek medical support or addiction treatment, to manage detoxification safely and rehabilitate effectively.
Mephedrone (meph): mephedrone is a synthetic stimulant that brings about feelings of euphoria and causes a speedy sensation. Side effects can include hallucinations, insomnia, inflammation, heart palpitations and anxiety. It can be psychologically addictive. Many of the longer term effects of mephedrone are not known however, as there isn’t much evidence available.
Methamphetamine (crystal meth): this drug is highly addictive and can be very potent. It releases dopamine, serotonin and norepinephrine in the brain. Crystal meth can make people feel extremely high, charged, alert and sexually aroused with decreased sexual inhibitions. Using and withdrawing from crystal meth is often extremely distressing, both physically and mentally – in some cases inducing heart problems, paranoia, aggression and even suicidal ideation.
Associated risks of chemsex: Apart from the risks of drug poisoning or fatal drug overdose, chemsex has also been connected in some cases to violence, rape and even murder of gay men. Chemsex also carries a risk of contracting STIs including HIV, due to the effect of reducing sexual inhibitions or safe sex practices. There’s also a risk of transmitting blood-borne viruses (BBV’s) including hepatitis and HIV/AID’s through injecting drugs with shared needles. People have also been victims of theft at chemsex parties, where money and/or drugs have been stolen from them while they are under the influence of drugs.
If There Are So Many Risks to Chemsex, Why Do It?
For many people, gay and straight, hedonistic sex-fuelled with drugs starts off as experimentation. It’s about fun, thrill seeking and pleasure. It’s a heady mix of risk and reward, which taps directly into human motivational processes. For some gay men, chemsex is a form of self-expression and liberation, in a world that has felt isolating or prejudiced at times. For tourists in big cities, chemsex can be a way of connecting very quickly with the gay community and enjoying sexual experiences.
As with any drug use or reward-seeking behaviour, no-one ever starts out with the intention of doing themselves or other people harm or getting addicted. Many people who attend chemsex parties won’t get addicted or “play” so much that it damages other areas of their life. For some, however, experimentation becomes riskier as they chase guaranteed highs or specific sensations. As drugs are used more frequently and in greater quantities, the risks of physical and psychological addiction increases too.
When addiction sets in, the choice about engaging in chemsex – including how often, how long and what people do – is diminished or non-existent. As with any other addiction, people can find themselves doing things they did not intend to do, bringing about guilt, shame or disassociation with self, leading to further shame and guilt which is then self-medicate and so the vicious cycle continues, ever worsening.
LGBTQ Community and Self-Medication
Marijuana (weed) and Amphetamines. In fact, research indicates that LGBTQ+ people use these drugs at a rate 2-4 x greater than that of the broader population. LGBTQ+ substance abuse must be understood within the context of the stigma, prejudice, and discrimination to which LGBTQ+ people are constantly exposed to. The Center for Addiction and Mental Health notes that “isolation, alienation and discrimination from a homophobic society is stressful,” and escaping those feelings is one of the main reasons that LGBTQ+ individuals use drugs, alcohol, other substances and addictive behaviours to cope.
Rather than seeking professional help (either at a residential rehab or community based) to treat any underlying mental health disorders (due to fear of further discrimination or not having the financial means to do so), many LGBTQ+ individuals turn to their own solution – drugs. The high that drugs produce allows for distraction from the negative thoughts and experiences that the LGBTQ+ community endure daily. Substance abuse then becomes a means to mitigate emotional pain and reduce stress. This can seem like the perfect fix – but it’s only temporary and actually makes mental health conditions worse in the long run. Self-medication with drugs and/or alcohol can increase negative emotions and does very little to treat the underlying condition. However, many LGBTQ+ individuals continue this destructive cycle as they believe it’s their only option.
Drugs of Choice Within the LGBTQ Community
Aside from those listed above in the “Chemsex” section, those who identify as LGBTQ+ can experiment with and use many different drugs, there are five that are most commonly abused within the LGBTQ+ community.
LGBTQ+ individuals use tobacco more than those who identify as heterosexual in the UK. About 1 in 5 LGBTQ+ adults smoke cigarettes compared to 1 in 6 straight heterosexual adults. This statistic increases when adolescents are factored in. A 2016 survey reported that past-month cigarette use was higher among bisexual, gay, and lesbian teen and adult populations than heterosexuals. This group has a past-month smoking rate of 32.2%, compared to 20.6% among heterosexual people.
Amphetamines are also popular drugs of choice amongst the LGBTQ+ community. Amphetamines include stimulants that produce intense feelings of euphoria, such as cocaine, crack cocaine and meth. Recent studies show that gay men are 12.2 x as likely to use these drugs than their heterosexual peers. In particular, gay and bisexual men are more likely to use Meth, which is troubling as it has been linked to increased risk of HIV and STI transmutation and infection. While these substances can bring periods of increased happiness and sociability, regular use can quickly lead to dependence and addiction.
Many LGBTQ+ individuals also use Marijuana (weed) to help reduce anxiety and other mental health problems. Nearly a third of LGBTQ+ adults (30.7%) used Marijuana in the past year, compared to only 12.9% of heterosexual adults.
Heroin is one of the most dangerous opioid drugs available and carries a high risk for overdose, specifically if injected. Lifelong experiences with homophobia, discrimination or abuse can leave members of the LGBTQ+ community more likely to try this dangerous drug as a way to numb the pain of their experiences. In fact, lesbian, gay, and bisexual adults are 3 x more likely to develop an opioid use disorder compared to heterosexual adults. Additionally, gay men are 9.5 x more likely to use Heroin than straight men.
A 2016 report by SAMHA found that past-month alcohol drinking rates were higher among gay, lesbian, and bisexual adults (63.6%) than among heterosexual adults (56.2%). The survey also found that a higher percentage of LGBTQ+ individuals reported past-year binge drinking, five or more drinks on a single occasion) than heterosexual adults. By some estimates, between 20-25% of the LGBTQ+ community has moderate to severe alcohol dependency. Of the LGBTQ+ people in treatment for substance use disorders, the majority of them cited engaging in alcohol consumption earlier than their heterosexual counterparts.
I Want Help To Stop This Lifestyle, What Can I Do?
You can find links to relevant organisations and charities on our help and support page. You can also visit the UK Drug Policy Commission report on drug & alcohol addiction here: