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Why Do Gay Men Sometimes Struggle with Substance Abuse?

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.

  • The rate of alcohol abuse in gay and transgender individuals may be as high as 25 percent compared to 5–10 percent in the general population.
  • The use of tobacco products is significantly higher in gay individuals than in heterosexuals; some studies suggest 200 percent higher.
  • Gay men are far more likely to use amphetamines than heterosexual man (as much as 12 times more likely).
  • Gay men are nearly 10 times more likely to use heroin than heterosexual men.

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:

  • Heredity or genetic influences
  • Early exposure to substance use from parents or other family members
  • Being diagnosed with a mental health disorder other than a substance use disorder
  • Associating with individuals who regularly use drugs or alcohol (e.g., peer pressure)
  • Coming from a background of poverty
  • Physical, emotional, or sexual abuse.

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.

Increased Stress

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.

Issues with Cultural Competency in the Healthcare System

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:

  • Poverty and unemployment
  • Sexual and physical assaults
  • Bullying, especially among younger individuals
  • Issues with potential homelessness or feelings of insecurity when in one’s dwelling
  • Potential issues with suicidal thoughts and even suicide attempts

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:

  • Increased efforts by organizations like the Substance Abuse and Mental Health Services Administration to enact strategies to address the increased risk for substance abuse among a gay people
  • More efficient cultural competency training for medical professionals
  • The inclusion of gay and transgender cultural competence training
  • Requirements by publicly funded treatment providers to make their services more accessible to clients with diverse backgrounds
  • Targeted efforts to enroll more LGBT individuals in graduate training programs for substance abuse and in the medical profession
  • The enactment of federal legislation to ensure that discrimination does not exist with regard to employment, housing, and healthcare access for any individual

The literature suggests that the increase in substance abuse in individuals who are not heterosexual in their orientation, compared to heterosexual individuals, is primarily the result of environmental factors that can be addressed by society. There is no reason to believe that the increase in substance abuse that occurs among LGBT individuals is due to any type of specific genetic factor. Therefore, the increased risk of these individuals to develop substance abuse issues can be addressed and minimized with proper steps by federal, state, and local governments.

Treatment providers who address these issues in the LGBT community:

  • Should have specialized training in cultural competence regarding this group.
  • Should be trained in techniques and interventions that are best suited for this group.
  • Should encourage open and honest discussions regarding these issues with their clients.
  • Would be expected to be open advocates for LGBT individuals and their rights.

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.

Last Updated on October 26, 2021
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