Pride Month is held every June, which makes it as good a time as any to take a look at addiction in the LGBTQ community.
This year, COVID-19 and public unrest have put a damper on many Pride Month observances. In April, organizers of Knox Pride — the metropolitan area that’s home to Cornerstone of Recovery — announced that its slate of activities would be postponed until 2021 , and around the country, Pride event organizers have scrambled to find an alternative. The result, according to a May article in The Washington Post : Global Pride, scheduled for June 27:
“The organization behind the event, InterPride, likens its concept to New Year’s Eve broadcasts, which cycle through time zones with fireworks and fanfare. So far, about 350 Prides have indicated their desire to participate, allowing organizers to spotlight queer hot spots like Sydney, Tel Aviv and Rio de Janeiro, as well as less-covered events in Africa, Latin America and Asia. Along the way, the event will feature political speakers, musical performances, celebrity cameos, stories from locals and possibly, to encourage engagement, at-home videos shared by participants.”
While Pride is a celebration that also works to advance the recognition of LGBTQ rights, its spirit of unity and joy often overshadows a much darker problem: the struggles of those who suffer from addiction in the LGBTQ community to find treatment that helps them overcome a problem with substances while also affirming their sexual orientation.
Addiction in the LGBTQ community: A double-edged sword
Addiction and alcoholism don’t discriminate — they are diseases that plague individuals across lines of age, race, sexual identity, religion and socio-economic status, and they continue to claim thousands of lives annually. More than 67,300 Americans died of a drug overdose in 2018 , and it’s estimated that there are 88,000 deaths every year related to alcohol use .
However, the LGBTQ community is especially vulnerable: According to the Centers for Disease Control and Prevention (CDC) , “Studies have shown that, when compared with the general population, gay and bisexual men, lesbian, and transgender individuals are more likely to:
- Use alcohol and drugs,
- Have higher rates of substance abuse,
- Not withhold from alcohol and drug use, and
- Continue heavy drinking into later life.”
On the surface, why those rates are higher might seem obvious, and lack of acceptance is still a very real driver of young members of the LGBTQ community who turn to drugs and alcohol. According to Brooklyn-based clinical social worker and psychotherapist Heather Zayde, who spoke to Healthline about the topic in 2019 : “She pointed out these young people are often afraid of not being accepted by those closest to them, from their families to their peers. For these kids, there is ‘no escape from that fear’ of rejection, and oftentimes substances can become an easy ‘go-to’ for them to help regulate their emotions.”
However, older members of that community pointed out, the fear of rejection isn’t limited to younger LGBTQ individuals. If anything, says Brian O’Hearn — associate director of the Aviation Program at the drug and alcohol treatment center Cornerstone of Recovery — there’s been a slow but encouraging move toward greater acceptance in society at large.
“I think it is generational,” he says. “It was completely different for us, because we were always looking over our shoulders. We were the ones who were taunted and called names in school, but the generation before this one, they sort of became the in-crowd. Everyone wanted a gay friend.”
Acceptance, of course, isn’t the only driver of addiction in the LGBTQ community. According to the National Institute on Drug Abuse (NIDA) , “People who identify as lesbian, gay, bisexual, transgender, or questioning (LGBTQ) often face social stigma, discrimination, and other challenges not encountered by people who identify as heterosexual. They also face a greater risk of harassment and violence. As a result of these and other stressors, sexual minorities are at increased risk for various behavioral health issues.”
And on top of that, experts in the field point out, members of the LGBTQ community face pressure from another source: within.
“The emotional stress that lesbian, gay, bisexual and transgender individuals often feel — including rejection, isolation and low self-esteem — as well as the threats of physical violence, prejudice and discrimination, make them vulnerable to addiction,” writes Dr. Jonathan Horey, chief medical officer at Sunspire Health, for the Huffington Post . “At the same time, these factors decrease the likelihood that they will receive effective treatment. Too often, members of the LGBT community face internalized stigma and homophobia. These internal struggles with themselves can make it more difficult to seek out or achieve long-term recovery.”
Drugs and alcohol as social aids
It’s ironic, in a sense, that the first “research on substance use and addiction in the queer community was conducted in places like gay bars,” in the 1970s, according to Tom Hill  — writing for the journal Scholar and Feminist Online, associated with the Barnard Center for Research on Women — “as these were the logical, and oftentimes only, places to find queers who self-identified, if only within the context of the specific space.”
It was, according to Cornerstone of Recovery Extended Care Counselor Susan Mullaly, the only safe space that members of the LGBTQ community found, especially during the 1970s and ’80s.
“That was our only touchstone for people like us, and what do you do when you go to a bar?” Mullaly says. “That’s where we met, and it really was the only touchstone we had for our ‘people.’ You’d go to bars, and you’d drink, and if you have any sort of propensity for addiction or alcoholism, it can turn into a problem quickly.”
“As a gay man in his ’50s, I didn’t know how to socialize outside of a bar when I got sober,” O’Hearn adds. “And it wasn’t just drinking — it was cocaine, it was molly, it was all of that.”
Drugs and alcohol, Mullaly points out, serve as social lubricants in both the gay and straight worlds — but for those individuals already self-conscious about their sexuality, and perhaps carrying residual shame over it from family-of-origin issues, it quickly becomes a crutch as well.
“That’s what’s going to make you feel like you fit in,” she says.
It can also serve as a trap — a siren song of acceptance that convinces members of the LGBTQ community that only through alcohol and drugs will they truly find freedom to be themselves. It’s a cruel reinforcement, in some ways, of the oppression that LGBTQ individuals feel from mainstream society. That’s one reason it’s critical, Mullaly and O’Hearn agree, that drug and alcohol treatment centers accept and affirm the sexual orientation of their patients.
That’s not an easy task, given that anti-discrimination laws prohibit outright bias. But there’s a big difference between not discriminating and not affirming, writes Manny Rodriguez for The Advocate : “Mental and Behavioral Health professionals working with the LGBT population receive more than their share of phone calls from distraught parents and colleagues, each reporting their alarm at the lack of concern (and the general absence of compassion) involving treatment programs that do not accommodate the needs of this group.”
“There’s a huge fear of acceptance around getting into treatment,” says O’Hearn, who went through Cornerstone as a patient in 2016. “I was fearful to acknowledge who I was until I felt a certain comfort level there. I’m a gay man in the South, and I’ve worked in sales before, so I know how to change my behavior to gain more acceptance. Today, I feel more free to be who I am.
“At the time, though, some of my co-patients in the Adult Residential Program at the time were surprised when I did tell them. But by then, I was also pleasantly surprised — because it was like, ‘Oh, you have black hair? Okay.’ It wasn’t a big deal, and I think part of that has to do with the culture of the treatment program.”
Addiction in the LGBTQ community: Acknowledgement and acceptance
Even after on-site research began to reveal higher rates of alcoholism and addiction in the LGBTQ community, the role of recovery was slow to adjust. Alcoholics Anonymous and other 12 Step programs have taken great pains from their beginnings to ensure that “the only requirement for membership is the desire” to stop drinking or using drugs, and while that’s certainly inclusive, it also can create a rigidity that dismisses sexuality as an integral part of a recovering person’s identity.
“When I started going to (12 Step programs) in 1979, you didn’t talk about that, and when I finally got sober in 1982, you still didn’t,” Mullaly says. “I remember one young lady who came to a meeting and accidentally mixed up her pronouns, and some of the people in that meeting started grumbling, and it upset her. She left, and I went out after her, but he was already gone.
“And that’s what happened all the time — you didn’t talk about that, because it was not accepted at all.”
In the years since, especially after the turn of the century, the recognition of individual recovery needs in the LGBTQ community has become more commonplace. There are online organizations like Gay and Sober, and in East Tennessee, Sober Pride meetings take place twice a week — and before the COVID-19 lockdown, they were some of the most popular meetings to attend by the robust LGBTQ members of the Cornerstone patient population, O’Hearn points out.
In many ways, he adds, while the fear of acceptance is still prevalent, meetings like Sober Pride are vital, because they help to unravel an individual’s sexuality from the disease that has caused them so much pain.
“When I was thinking about coming to treatment and was getting to the end of my rope, I had resigned myself to things,” he says. “When it comes to being gay, we’re told for so long that it’s just who we are, and it can lead you to believe the same thing about drugs and alcohol — ‘an alcoholic is just who I am,’ or, ‘an addict is what I’m going to be.’ Recovery helps you to see what the future looks like without believing those lies.”
For victims of addiction in the LGBTQ community, Mullaly adds, it’s important to understand that there is help out there. Recovery isn’t a one-size-fits-all blanket, and quality drug and alcohol treatment will meet individuals where they are, affirm their identities and help them recover in a safe, therapeutic environment that identifies and meets their needs in all areas of their lives.
“One thing I think they need to understand about treatment is that we share our soul stuff,” Mullaly says. “Five years from now, the people with you in treatment aren’t going to remember that about you. They’re going to remember the things you said to help them, or the way you were able to laugh together for the first time, or how you got better together. And that’s what’s most important.”