Addiction Treatment Barriers in the LGBT Community
Long Term Care Shows Best Outcomes
It’s commonly understood that the best chance most people have of recovering from drug and alcohol addiction is through receiving professional treatment. In fact, the National Institute on Drug Abuse or NIDA (run by the National Institutes of Health – NIH) supports the claim that people who suffer from addiction generally require long-term, extended professional care to adequately treat their substance use disorder (SUD). The same is true of members of the Lesbian, Gay, Bisexual, and Transgender (LGBT) community. However, specific factors can get in the way of helping LBGT people.
What are the main addiction treatment barriers that affect the LGBT community? How can these barriers be addressed and overcome? We review here, and invite your questions and feedback in the designated section at the end of the page.
Insufficient Treatment in the General Population and in the LGBT Community
Unfortunately, many people aren’t getting the care they need to deal with their drug and alcohol addiction. According to the Surgeon General of the United States, only 1 out of 10 of the people who need treatment actually get it. This problem is even worse in traditionally marginalized groups who already don’t have access to sufficient resources, such as the LGBT community.
In this population, addiction rates are higher than average. In fact, according to the Substance Abuse and Mental Health Services Administration (SAMHSA), drug and alcohol addiction rates in this population are as high as 20 to 30%, or 2 to 3 times the average for the general population. Clearly, addiction treatment is necessary for members of this community. But there are some unique barriers to treatment that affect the LGBT community that must be addressed in order to make adequate treatment for the population a reality.
General barriers to addiction treatment access
The barriers to treatment that generally prevent people from getting the care they need are varied, but they are mostly related to:
1. Shortages of Facilities – Treatment is in high demand in many communities, and in some places there just aren’t enough available beds. For example, the wait for a spot in treatment can be as long as a year in places like Maine, where the opioid addiction epidemic has hit especially hard. People who suffer from drug and alcohol addiction can’t wait that long- many die before getting treatment.
2. Lack of Insurance – Many insurance companies don’t cover treatment or can legally deny care for people.
3. Lack of Finances – People without insurance (or subpar insurance) may never be able to afford care out of pocket.
LGBT Specific Barriers to Treatment
These same issues affect the LGBT community, but they are compounded by cultural and social factors. In addition to grappling with shortage of care and preventative costs, members of this community also face the following barriers to getting treatment for drug and alcohol addiction:
Lack of Insurance: According to a recent Gallup poll, LGBT people are less likely to be insured than non-LGBT identifying individuals, making it impossible for many of them to afford routine medical care, much less highly specialized addiction treatment.
Financial Disparities: The Williams Institute, of the University of California Los Angeles School of Law, found that on average, LGBT individuals make less in the workplace than their heteresexual, cisgender counterparts. Unemployment and poverty rates are particularly high among transgender people. With less financial resources, many members of the LGBT community can’t afford things like drug and alcohol addiction treatment, or may only have access to sub-par, underfunded public programs.
Social Isolation and Rejection: Part of successful recovery comes from having a strong support network of friends and family. Unfortunately, members of the LGBT community are:
1. More likely to be estranged from or rejected by their family members and friends.
2. More likely to experience abuse from those close to them.
3. More likely to be homeless (especially at a young age.)
Without these support networks, seeking treatment in the midst of active addiction is even more difficult…In addition to these logistical concerns, some of the barriers to treatment for the LGBT community are cultural and social. Most significantly, this community faces a lack of access to quality treatment and poor medical care as the result of a lack of knowledge regarding their specific needs.
Lack of Access to Quality Treatment
The National Institute on Drug Abuse (NIDA) says that effective treatment should follow several principles. Included in these guidelines are the stipulations that:
- Treatment should address clients’ social, medical, psychological, vocational and legal problems
- Behavioral therapy is a part of treatment, and this includes family counseling, peer support, and group therapy.
The problem with all of these important parts of addiction treatment for the LGBT community is that this population often faces inadequate care and medical professionals that don’t understand their needs or properly meet them.
“Treatment should address clients’ social, medical, psychological, vocational and legal problems”
Clinical staff may be well-trained in dealing with the legal and vocational needs of clients. But what about gay or lesbian clients who face workplace discrimination? Oftentimes there is no network of care equipped to help these clients seek gainful employment in a safe work environment. Without knowledge of the needs of LGBT clients, how can a case manager direct them toward an LGBT-friendly workplace, for example?
And what about transgender clients, who often have changed their legal name or wish to be referred to by a name other than their given name? These issues are deeply personal and affect the psychological health of people in this population. Without adequate education about how to avoid misgendering clients, or how to help them navigate the legal quagmire of dealing with court appearances after legally changing their gender, clinical staff will fall short of providing comprehensive treatment.
In order to help LGBT clients form social support and relationships, therapists and treatment staff need to have a thorough understanding of the impact of rejection, homophobia, and fear on someone’s social and emotional health. Truly being able to treat these concerns requires training and experience in dealing with them, which clinical staff does not always have at every facility.
“Behavioral therapy is a part of treatment, and this includes family counseling, peer support, and group therapy.”
Family therapy and group therapy may also be tough. Given the levels of estrangement and homelessness in the LGBT community, having family counseling sessions may not even be an option. Peer support may also be inadequate at facilities where LGBT people may feel that their fellow patients can’t relate to their life experience or struggles.
Facing These Barriers
Ultimately, drug and alcohol addiction is a complex disease of physical, psychological, and social elements. For a community that experiences higher levels of isolation, less access to financial resources, and a greater risk of social problems as the result of rejection from interpersonal networks, addiction can become even more complex to treat. And these same factors make accessing that treatment even more difficult.
In order to offer the LGBT community effective treatment for drug and alcohol addiction, as every person who suffers from substance abuse deserves, we have to recognize these unique factors and take steps to address them.