LGBT-Friendly Addiction Treatment


The American Psychiatric Association considered homosexuality a mental illness until 1973 when it was removed from the Diagnostic and Statistical Manual of Mental Disorders, the universal diagnostic tool for mental illnesses. More than 40 years later, homosexuality is a normal variation of human expression, but bigotry against the LGBT community is still rampant.

The stigma that still exists surrounding homosexuality often finds its way into substance abuse treatment, which can make it difficult for people who identify as LGBT to get the help they need to recover from an addiction. However, LGBT-friendly treatment can make an enormous difference in how people in the LGBT community recover.

The Prevalence of Substance Use Disorders in the LGBT Population


According to the National Institute on Drug Abuse (NIDA), the 2015 National Survey on Drug Use and Health found that adults who identified as lesbian, gay or bisexual were more than twice as likely as their heterosexual counterparts to have used an illicit drug in the past year. 1 A meta-analysis found that LGB adolescents were 90 percent more likely than heterosexual adolescents to engage in substance abuse, and other research shows that LGBT individuals are more likely than heterosexuals to have a substance use disorder, or SUD, in their lifetime. Their addiction is often more severe than their heterosexual counterparts’.

Reasons for Substance Use

A study published in the journal Psychology of Addictive Behaviors cites several reasons why LGBT populations are more likely to abuse drugs and alcohol: 2

  • The additional stresses of being a sexual minority may lead to substance abuse.
  • Historically, LGBT communities have been centered on drinking and drug use, which can make socializing difficult for non-users.
  • The social role bars play in LGBT culture can make it difficult for individuals to avoid triggers for substance use.
  • The perceived normality of drug and alcohol use among LGBT communities may increase the likelihood of LGBT individuals choosing to heavily use drugs or alcohol.

NIDA points out that while addiction treatment programs offering specialized treatment for lesbian, gay, bisexual and transgender clients show better outcomes, only 7.4 percent of programs in the U.S. offer specialized services for LGBT individuals.

The Benefits of LGBT-Focused Addiction Treatment


One of the National Institute on Drug Abuse’s 13 Principles of Drug Addiction Treatment is that effective treatment addresses the multiple needs of the individual, including medical, psychological, social, vocational and legal problems.3 As such, the Principles stress that treatment should be appropriate to an individual’s age, gender, ethnicity, and culture. In terms of the LGBT community, cultural competence means that treatment providers have an understanding of the unique issues faced by this population.

SAMHSA’s Guidance

Providers who are unaware of their own biases when working outside of the cultural norms of heterosexuality, monogamy and “traditional” marriage may end up doing harm to LGBT individuals in a treatment setting. SAMHSA stresses that a counselor is responsible for self-monitoring and adhering to professional and ethical standards. Counselors working with LGBT individuals must be aware of their feelings about LGBT individuals and work through their own issues that could impact the way they treat their LGBT clients.

According to the Substance Abuse and Mental Health Services Administration (SAMHSA,) treatment providers working with LGBT populations should:4

  • Respect the client and his or her frame of reference
  • Recognize the importance of collaboration with the client
  • Maintain professional objectivity
  • Recognize the need for flexibility and be able to adjust strategies according to the client’s needs
  • Appreciate their own role and power within the group
  • Be nonjudgmental and respectfully accepting of the client’s different values, culture and behavior

Identifying LGBT-Friendly Addiction Treatment

LGBT-friendly treatment involves providers who are trained in working with this population. This type of program will address the inclusion of LGBT issues in its policies and procedures, program design, training and advertising. Many LGBT-friendly programs provide ongoing training to help providers better understand LGBT issues and how to best serve this community. An LGBT-friendly program will help ensure clients feel safe and comfortable in treatment, as well as addressing a range of issues common among the LGBT population.

Issues Faced and How LGBT-Friendly Treatment Helps With Recovery From Addiction


A treatment program that operates under the assumption that every individual is heterosexual won’t effectively address the unique challenges faced by LGBT people, who may be afraid to reveal their sexual orientation for fear of bias, discrimination and outright contempt. An LGBT-friendly treatment program will ensure LGBT clients feel safe expressing themselves with honesty and openness. It will be equipped to effectively address a range of issues faced by the LGBT community, including the following.

Mental Health Issues

Sexual minorities with substance use disorders are more likely than heterosexuals with SUDs to have a co-occurring mental illness, according to NIDA. Lesbians, gay men, and bisexual men and women are more likely than heterosexuals to report mental distress and depression, and transgender children and adolescents have higher rates of depression, suicide, self-harm and eating disorders than their non-transgender counterparts.

Because some of the issues that may lead to mental illnesses, like depression and eating disorders, are unique to the LGBT community, an LGBT-friendly treatment program will be better equipped to address and get to the bottom of co-occurring disorders.

LGBT Stigma

The stigma against the LGBT community is expressed as heterosexism and homophobia. Heterosexism ignores, denies and denigrates non-heterosexual forms of affection and expression. Homophobia is an irrational fear of or aversion to LGBT people or their behaviors. Heterosexism and homophobia in a treatment setting make it difficult for LGBT individuals to reveal their sexual orientation in treatment, which in turn makes it hard for them to be open and honest-essential traits in treatment. SAMHSA stresses that heterosexism and homophobia in treatment may:

  • Increase shame in LGBT individuals, whose shame may already be negatively affecting their lives, including being at the core of their substances abuse
  • Lead to self-blame for their victimization
  • Intensify a negative self-concept that results from negative messages about homosexuality
  • Increase feelings of inadequacy, hopelessness and despair and create a victim mentality
  • Inhibit emotional development and growth


Trauma is a major factor for substance abuse, and it’s a common underlying cause of addiction. According to an article published in the journal Traumatology, LGBT individuals are more likely to be targets of interpersonal violence than their heterosexual counterparts, and they’re more likely to be abused by their families of origin.5 LGBT adolescents are bullied by peers more frequently than heterosexual youth, and LGBT individuals account for 40 percent of homeless youth, which increases the risk of exposure to sexual trauma and violence.

Working through trauma is an important focus in treatment, and an LGBT-friendly treatment program will likely offer trauma-informed treatment in order to address the traumas that are common in and unique to the LGBT community.


Feelings of shame can emerge at an early age, especially if a person is bullied, discriminated against and treated like a pariah by family members and others in the community. Shame is a powerful trigger for substance abuse as a way to cope with the negative emotions and low self-esteem shame brings with it. Working through these feelings requires opening up about one’s sexuality and coming to healthy terms with it.

Family Problems

Many LGBT individuals have been disowned by family members and may have suffered physical or emotional abuse due to their sexual orientation. Many young people run away from home and live on the streets when faced with an unsupportive or even dangerous home life.

Addressing family dysfunction is an important part of treatment, and many LGBT clients have family issues that have profoundly affected their lives. One family issue that most outside of the LGBT community don’t experience is disownment. For many LGBT individuals, being disowned by the family they grew up with can lead to unhealthy thought and behavior patterns as a way of coping with the emotional devastation it causes. These and other LGBT-specific family issues should be addressed in an LGBT-friendly treatment program.

Family Dynamics

Family therapy in an LGBT-focused program may look very different from family therapy in traditional treatment. For many LGBT individuals, the family that’s central in their lives may be their family of choice rather than their family of origin. A family therapist in an LGBT-friendly program will have an understanding of LGBT-specific family issues and dynamics and will be knowledgeable, comfortable and effective in counseling same-sex couples and other by-choice family members.

Spiritual Issues

Because of the segments of society that loudly proclaim the LGBT community “ungodly” and “sinners,” LGBT individuals may have spiritual issues stemming from being shunned by their church or family members and other negative sentiments shared by members of religious communities. LGBT-friendly treatment can help these individuals find peace and validation within their spiritual lives.


The American LGBT population isn’t provided with the same federal and state protections as other groups, including people recovering from substance abuse. It’s not uncommon for LGBT individuals to experience workplace or housing discrimination, which can lead to feelings of despair, helplessness and low self-esteem. The legal system may also discriminate against LGBT individuals, particularly in custody cases. An LGBT-friendly treatment program will be very sensitive to the effects of discrimination as well as the possibility that discrimination might occur if an individual were to widely disclose his or her sexual orientation.

Coming Out

While some people in treatment may be fully out, others may be in the process of coming out or may not have come out at all due to being uncomfortable with their sexual identity or afraid of others’ reactions. Providers in an LGBT-friendly program will understand the important impacts of coming out -or not coming out -and know how to counsel LGBT individuals regardless of what coming-out phase they’re in.

Levels of LGBT-Sensitive Treatment for Recovery From Addiction


The Substance Abuse and Mental Health Services Administration identifies six different LGBT sensitivity models, based on how sensitive the program is to the needs and challenges of the LGBT community.


Anti-LGBT Treatment
Anti-LGBT treatment is antagonistic toward LGBT individuals, and treatment focuses exclusively on heterosexuals and specifically excludes LGBT clients.
Traditional Treatment
Traditional treatment generally has no LGBT sensitivity and doesn’t consider that not everyone is heterosexual.
LGBT-Naive Treatment
LGBT-naive treatment has no LGBT sensitivity, although it realizes that there are LGBT clients. However, as a program, it doesn’t address the special issues faced by the LGBT community.
LGBT-Tolerant treatment
LGBT-tolerant treatment has minimal LGBT sensitivity, recognizing that some clients are LGBT, but discussions concerning sexual orientation are limited to individual sessions, and there are no treatment components specific to LGBT.
LGBT-Sensitive Treatment
LGBT-sensitive treatment has moderate LGBT sensitivity, with some clients and staff members being open about their sexual identity. Some workshops and groups focus on LGBT issues, and some program components are LGBT-specific.
LGBT-Affirming Treatment
LGBT-affirming treatment has a high level of LGBT sensitivity. The program primarily targets the LGBT population, and all workshops and groups are specifically designed for LGBT individuals.

How LGBT Friendly Treatment For Addiction Works


LGBT-friendly treatment follows the same protocol and industry best-practices as a traditional treatment program, but its therapists are equipped with the knowledge and understanding of LGBT issues. They’re equipped to address the unique problems and challenges of recovery faced by the LGBT community.

A Holistic Approach to Treating Addiction

A high-quality treatment program will take a holistic approach to treatment that addresses issues of body, mind and spirit to promote whole-person healing. It will utilize a variety of traditional and complementary therapies, interventions and workshops to address an individual’s multiple needs.

Through these therapies, individuals in treatment:

  • Identify unhealthy patterns of thinking and behaving and learn to think and behave in healthier ways.
  • Develop the coping skills needed to handle triggers like stress, negative emotions and cravings.
  • Address a range of underlying issues behind the substance abuse and addiction, including chronic stress, trauma or mental illness.
  • Learn to relax and have fun without drugs or alcohol.
  • Find purposeand meaning in sobriety.
  • Repair damaged relationships and address household and family dysfunction.

Length of Treatment for Addiction

Treatment works for most people who engage with their treatment plan and stay in treatment for an adequate period of time. According to the National Institute on Drug Abuse, anything less than 90 days is of limited effectiveness, because just as it takes time to develop the unhealthy thought and behavior patterns that underlie an addiction, it takes time to re-learn how to think and behave in ways that promote long-term recovery.6

A Life of Healing in Recovery From Addiction

LGBT-friendly addiction treatment can make an enormous difference in your life and in the way you recover from a substance use disorder. It offers support, validation and LGBT-focused therapies that can help you heal from old and new wounds and move forward with clarity, pride and the motivation and resolve you need to recover from an addiction once and for all. Treatment works, and it can work for you.