Substance Use Disorder Treatment for Queer Identities: Considerations for Best Practices
In the United States, substance use does not discriminate. Substance use and abuse can happen to anyone with any income, for any length of time, at any age, and can be found in any community. Whether you are a stockbroker on Wall Street, a substitute teacher in Oklahoma, a marine biologist in Florida, or a personal trainer in Oregon - you are not immune to the possibility of developing a substance use disorder and are just as susceptible as everyone else due to the substance’s availability, appeal, and notoriety. Or just sheer curiosity. However, while this is true, there are communities and populations that possess a more severe risk of developing more serious substance use disorders. One of these populations are the LGBTQIA+ populations.
Within this community, you have individuals that do not fit into societies check boxes and therefore are not only finding their true selves but also attempting to tackle something as serious as a substance use disorder on their own because they do not find traditional treatment to be sufficient because they, themselves, are not traditional.
For example, when a person goes to a residential treatment facility for substance use treatment, one would normally will find unit bathrooms, client rooms, and the possibility of having gender specific psycho-education groups. That's all well and good, but not for everyone...
Sexual minorities with SUDs are more likely to have additional (comorbid or co-occurring) psychiatric disorders.
What happens if you identify as a homosexual male? Typically, units are separated for safety and an attempt at deterring relationships amongst the patients. Would there be any differences in your room assignment because the facility is separated with the intentions of preventing relationships? Or, what happens if your assigned gender is male yet you identify as female. What group of people will you be housed with? Would you be accepted or even allowed to join the female psychoeducation group due to your genitalia?
These, and other questions do not have definite answers because the answer lies within facility itself and their protocols. That realization begs the questions: does LGBTQIA+ specific treatment help those who identify as part of that community, and if so, is it necessary to change the procedures and protocols in facilities to adhere to those specifications?
According to the research from the 2018 National Survey on Drug Use and Health (NSDUH) it is suggested that substance use patterns reported by sexual minority adults (in this survey, sexual minority adults includes individuals who describe themselves as lesbian, gay, or bisexual) are higher compared to those reported by heterosexual adults.” As stated before, there is no discrimination when it comes to substance use and substance use disorders, so why are numbers higher in some areas and some populations?
In the same research from the NSDUH study, it explains that “sexual minorities with SUDs are more likely to have additional (comorbid or co-occurring) psychiatric disorders. For example, gay and bisexual men and lesbian and bisexual women report greater odds of frequent mental distress and depression than their heterosexual counterparts.” It goes on to say that those who are a part of the children or adolescents identifying as a part of the transgender community also have a higher risk than heterosexual children and adolescents. Specifically stating “transgender children and adolescents have higher levels of depression, suicidality, self-harm, and eating disorders than their non-transgender counterparts.” So to answer the question of whether or not it is necessary to have specific treatment for those in this community, I believe so, but it is very important, as the research in the NSDUH study states, that “LGBT people in SUD treatment [need to] be screened for other psychiatric problems (as well as vice versa), and all identifiable conditions should be treated concurrently.”
If someone is coming to a facility for a substance use disorder... be kind.
It isn’t a new idea, in the United States, to be outwardly straight, gay, lesbian, bisexual, or any other orientation or identities, so why the fuss over specific treatment? It is because this topic is something that has been brought to the attention in the more recent years that maybe it is necessary to dive deeper into the effectiveness of individualized treatment, in hospital or facility settings. Therefore those facilities or hospitals are more readily able to effectively treat people with substance use disorders, instead of a general, cookie-cutter treatment plan. Basically, if one is to look at the person as an individual, they must also treat that person individually. But how?
Some may suggest renovating the facilities to have things such as gender neutral bathrooms to be more all-incorporating. Inclusive does not mean erasing identities, it means to be for every single person. Include cultural competency training for the staff to be able to professionally, and thoughtfully, treat individuals as individuals. And going as far as changing the intake forms and paperwork to include options for pronouns, genders, and orientations.
Lastly, go back even further, to the early years of school, and to the Golden Rule: Treat others how you would like to be treated. If someone is coming to a facility for a substance use disorder, whether it be by choice or court order, be kind. No one knows what is happening in their mind when they walk through those doors, and most likely it is scary or upsetting in some way. Be kind. Let them be them/they/her/him and let's make sure that the individual is seen and heard. It helps the focus be on the presenting problem, which is substance use. Although we are treating the individual, we want them to feel like they belong with everyone else, and simply addressing the person as they would like to be addressed, can go a long way.