Alcohol and drug abuse is a significant problem in the LGBT community — our community. It affects LGBT individuals in higher rates than it does their heterosexual counterparts. In a 2016 SAMHSA study, it was estimated that illicit drug use among members of the LGB community was twice as high as it is for their heterosexual peers (39.1 percent versus 17.1). Alcohol use was also alarming, if not as much of a disparity, at 63.6 percent for LGB individuals vs. 56.2 percent for their heterosexual counterparts. This study did not include the transgender community; however, in a 2012 study that did, it was found that 20-30 percent of LGBT individuals abused substances compared to 9 percent of their heterosexual peers.
While looking at the disparity in these figures, it is important to consider why they are so disparate and examine the many factors that play into this. Mazzoni Center’s behavioral health-treatment team often works with folks who have experienced many traumas over their lifetime. These traumas include alienating coming-out processes, bullying, shame-based external and — perhaps more damaging — internal narratives, and physical, emotional and sexual abuse, among others.
Let’s look at the confluence of substance abuse and mental health. SAMHSA’s study found that LGB individuals are 37.4 percent more likely than heterosexual individuals (at 17.1 percent) to experience a mental illness. National Alliance on Mental Illness (NAMI) found that LGBT individuals are three times more likely to suffer from major depression or generalized anxiety than their heterosexual peers. This can be attributed to inherent fears related to coming out and discrimination based on sexual orientation and gender identity.
Given the uniqueness of our experience as LGBT individuals, it is important to understand that treatment requires a unique perspective as well. Let’s look at an example of someone who presents a substance-abuse concern that is co-occurring with a mental-health issue such as depression. In cases like this, we often find substance abuse is just a response to the depression (that is, again, a response to one of the traumas considered above), which can feel overwhelming. Therefore, the substance abuse is actually used as a coping tool, similar to how some people use working, exercising, eating or shopping too much as a coping tool.
My intention here is not to minimize substance abuse but rather to suggest it is due less to any inherent fault or flaw of the user and more to it being used as a maladaptive tool brought on in response to the traumas noted above. Using this line of thinking, the belief is, upon healing the current relationship substance users have with blame and shame, a different perspective can be created — a perspective that can help positively influence the patient’s recovery. There is some good news for the LGBT community involving treatment: In a 2016 SAMHSA study, LGBT individuals were more likely to seek treatment than their heterosexual peers (48.5 percent vs. 42.6 percent).
What are some of the ways individuals could receive help? For some folks, outpatient treatment is adequate to help with this struggle. Helping some folks understand when substance abuse is being used as a coping tool for another problem and helping them understand how negative internal and external messages and experiences can influence substance abuse and then helping them adopt new, different ways of managing their experience are foci for this struggle in conjunction with relapse-prevention techniques and community support. It should be noted, however, that for some individuals, outpatient treatment is not intensive enough. Sometimes, a more consistent, extensive approach such as that provided by an intensive-outpatient program (IOP) is needed. IOP provides treatment three days a week, three hours each day. It combines a group-therapy focus targeting specific topics that are familiar to substance abusers, along with individual therapy and other supports that come together to provide more structure and assistance that is often needed for this population.
If an IOP environment is going to be effective for the LGBT community, it needs to be sensitive to the specific needs of our community as well as create programming that focuses on the struggles that are unique to us. Recognizing that LGBT folks are sometimes confronted by treatment centers that are not well-versed in working with LGBT individuals, Mazzoni Center will be opening its own IOP in January. It will follow the standard IOP format — group sessions three days a week, three hours a day along with psychiatric care, and individual and family therapy. Mazzoni Center is also adding a Certified Recovery Specialist (CRS) — a peer whose lived experience as an LGBT individual in recovery can be useful in the recovery process as individuals who are struggling with substance abuse can adopt the story that their struggle is unique, that no one else will ever understand. This negative thinking is not only laden with self-judgment but can ultimately keep the individual isolated and in the cycle of substance abuse. Finally, curricula that we feel more intimately speaks to the needs of the LGBT community will be added in — the impact of shame and blame, the role sex/intimacy play, and managing social apps, to name a few. To minimize barriers to care, the Mazzoni Center IOP will accept most major insurance, including Medicaid, some Medicare and Ryan White.
At Mazzoni Center, we are dedicated to the health and wellness of the LGBT community. We hope anyone struggling with the overwhelming consequences of substance abuse will consider us as a resource. But also, if you have a loved one or someone in your life who could use extra support, we encourage you to be an advocate for that person as well and reach out to us.
To learn more about the Intensive Outpatient Program at Mazzoni Center, go to www.mazzonicenter.org/iop or call 215-563-0652 ext. 248.
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