02.01.16
Drug and alcohol use among LGB people
Source: NHE Jan/Feb 16
Laurence Webb, Pride in Practice co-ordinator, explores the heightened risk of alcohol and drug abuse among lesbian, gay and bisexual people, and how the NHS can support them.
Evidence shows that problematic patterns of drinking are much more common among LGBT people, with available comparable data suggesting that LGB people are approximately twice as likely to binge drink at least once a week than heterosexual people.
Sexualised drug use, sometimes known as chemsex, has been shown to be on the rise among men who have sex with men, with sexual health clinics in London and Manchester opening specialised chemsex clinics where people struggling with their sexualised drug use can access support. Antidote, the UK’s only service specifically targeting LGBT drug and alcohol users, say that increasingly service users seeking support report using mephedrone, crystal methamphetamine and GHB/GBL in sexualised contexts with multiple partners.
Discrimination and psychological distress
The Center for American Progress found that over 25% of trans people misused drugs, including alcohol, specifically to cope with the discrimination they faced due to their gender identity or expression. Growing evidence shows that transgender people are more likely to suffer from psychological distress than cisgender individuals, and that these heightened levels of distress cannot be fully explained by gender dysphoria. This burden is thought to be due to unique psychosocial stressors experienced by trans people due in part to ‘minority stress’, a term for chronically high levels of stress faced by those from stigmatised minority groups. Of the trans respondents to AUDIT-C questions, 62% gave answers that suggested alcohol dependency.
A study exploring minority stress in substance-using gay and bisexual men found a greater likelihood of sexual risk behaviour among those with higher rates of perceived stigma and expectations of rejection from their community. Studies show that while there is little widespread use of crystal meth in the UK, those who are using it are almost all men who have sex with men.
People from marginalised groups within LGBT communities can be particularly vulnerable, with studies showing that migrant gay men are at higher risk of mental ill-health and sexual risk-taking and that black and minority ethnic (BME) LGBT people are much more likely to experience harassment and physical abuse than white LGBT people. Lesbian and bisexual women are far more likely to drink heavily than heterosexual women and evidence suggests higher rates of drug use among BME LB women.
Worryingly, of respondents to ‘Part of the Picture’, a five-year study exploring drug and alcohol use among lesbian, gay and bisexual people in England, over a quarter scored as substance dependent and a third of those who scored as substance dependent said they would not seek information, advice or treatment, even if they were worried about their alcohol or drug use. Those surveyed cited fears around breaches of confidentiality relating to their sexual orientation as well as feelings of shame and embarrassment as barriers that prevented them from accessing support. Those who did access support were much more likely to turn to informal sources, such as friends, family, partners and the internet rather than professional services.
Support and guidance
However, there are ways we can support people from LGBT communities who are struggling with problematic drug and alcohol use.
Monitoring sexual orientation and gender identity is a great way to identify if LGBT people are using your services and if they rate them as highly as heterosexual service users. The LGBT Foundation has produced a guide to sexual orientation monitoring, and the Scottish Transgender Alliance has a guide on monitoring gender identity. Both can be downloaded free online.
Assessments provide an opportunity to discuss the relationship between a patient’s sexual orientation and/or gender identity and their alcohol and substance use. While for some people there may be no correlation, for others they may well be linked and patients may disclose that they are using alcohol and substances as a coping mechanism for dealing with homophobic, biphobic or transphobic harassment. Gay bars, clubs and similar social environments are often the places where people first explore their identity, which means that alcohol and drug use can be closely tied in with this. It is not uncommon for people to express that they fear becoming socially isolated by not participating in drug and alcohol use.
Having a specific LGBT worker within your service, or hosting an outreach clinic within an LGBT-friendly environment, such as a community resource centre, means that people who may have fears around a service not being inclusive will feel more confident about being able to access it and being able to be open about experiences of substance use that relate to their identity as an LGBT person.
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