Research investigating prevalence rates for substance abuse in the LGBT community is not extensive; however, the bulk of it indicates that the rate of substance abuse is estimated to be between 20 percent and 30 percent, or higher, in gay and transgender people compared to about 9 percent in the general population.
There are most likely numerous reasons that account for the increased risk for gay men to abuse substances compared to heterosexual men. The American Psychiatric Association (APA) and the National Institute on Drug Abuse (NIDA) list numerous risk factors associated with an increased probability to abuse drugs or alcohol. These include:
These general risk factors certainly apply to gay men as well as to heterosexual men. However, gay men may experience some additional risk factors that can increase the probability that they may turn to drugs or alcohol. These factors include high-level stress that is associated with social discrimination targeted at gay man, problems with the healthcare system that discourage gay men from seeking treatment for substance abuse, and marketing efforts by alcohol and tobacco companies that may exploit the connection between substance use and sexual preference.
The increased stress that gay men may experience would be defined as a type of minority stress. – the negative effects of stressful experiences on individuals who are members of marginalized social groups. This type of stress is associated with the prevailing notion that individuals who are not heterosexual are somehow immoral or undesirable as a result of their choice of sexual partner.
Minority stress can be quite open or quite subtle. It may take numerous forms.
Workplace discrimination based on sexual preference is still an issue in the United States, and perceived discrimination in the workplace is reported by a large percentage of gay men. This poses a real threat to the economic security of the person and then affects their ability to function on a daily basis. Such stress can lead to one turning to alcohol or drugs.
Discrimination in housing is also high, according to the self-reports of gay individuals. This can lead to living quarters that may be unstable, unsafe, and can disrupt the family structure of the people involved.
Issues with the acceptance and recognition of same-sex relationships and of gay marriage continue to be an issue that can lead to stress for gay men. Moreover, in areas where individuals are denied the right to marry, this can lead to problems with benefits and health insurance.
Discrimination in healthcare aimed at gay men can be subtle, or it can be quite forthright. Gay men are nearly twice as likely as heterosexual men to be without healthcare coverage. Moreover, discrimination against gay marriage or issues with providing healthcare benefits to the partners of gay men exacerbate the situation.
Gay men may be hesitant to utilize healthcare services that can assist them in identifying and treating issues with substance abuse because they have significant experience with healthcare professionals who are unaware of the specific needs of this group, or there may be outright hostility and/or discrimination directed at them.
The discrimination associated with being gay may lead to overall negative expectations of the healthcare system. As a result, gay men may delay getting treatment for substance abuse, or they may not disclose their sexual preferences or relationship issues with treatment providers.
Specific types of clubs or bars have been traditional meeting places for gay men to feel safe while socializing with others. In these locations, drinking and smoking remain acceptable and often popular. As a result, gay men will often associate socializing with others who share their sexual preference with drinking, smoking, and using other drugs.
According to the American Cancer Society, tobacco companies traditionally advertise in magazines aimed at gay and transgender individuals. The use of advertising in other venues that are frequented by gay men for alcohol and tobacco has also been an issue of concern for this group.
The experience of stress, perceived abuse, stereotyping, and targeted efforts at marketing directed at gay men may be exacerbated by potential issues with:
There is no simple solution for these issues. The National Association of Lesbian and Gay Addiction Professionals suggests that the use of public education, public awareness, and legislation are the keys to preventing the increased risk of substance abuse in gay individuals. This would include:
Treatment providers who address these issues in the LGBT community:
Although no amount of legislation will change the attitudes of some individuals regarding those with different lifestyles, legislation can ensure that public discrimination that can lead to an increase in stress in gay men and others in the LGBT community is minimized. This could significantly decrease the risk of substance abuse issues in this demographic.