Opioid Addiction in the LGBTQ Community

In 2020, there were 2,263 deaths due to opiate use in England and Wales.(1) The LGBTQ community in particular is seriously impacted by opioid and substance abuse. It’s really beneficial for those affected by addiction as well as loved ones and professionals to understand addiction in light of the LGBTQ experience.

Why is there an increased likelihood for LGBTQ people to develop an addiction?

The LGBTQ community are highly affected by addiction. The National LGBTQ survey research report states, “it is the negative experiences of being LGBT, such as abuse, discrimination and marginalisation, that cause alcohol and drug abuse/misuse”.(2)

Unfortunately, the community faces stigma attached to gender identity and sexuality. Hate incidents such as verbal abuse, threats, and physical attacks are much more likely for this minority than for the general public.

LGBTQ people often face negative experiences from all angles in life. Hate incidents take place in educational, work, and home environments.

There’s actually a “heightened risk for substance involvement” amongst those who are considered sexual minority adults.(3)

As life goes on with this lived experience, people turn to substances in order to self-medicate. If a person feels depressed due to terrible things that have happened to them, they might turn to drugs to try and feel happy, relaxed, escape, or ease emotional pain.

The community also has “higher inequalities in health satisfaction and outcomes”.(2)

With the discrimination, harassment, and violence the community faces, it’s not surprising that trauma, as well as other mental health conditions, arise. Negative mental health is highly correlated with addiction.

The LGBTQ community and mental health

Many people who are LGBTQ come to internalise the stigma attached to sexuality and gender. This, of course, makes up a huge part of who a person is. This can severely impact how people cope, regulate emotions and develop relationships. In fact, the LGBTQ population has less life satisfaction than the general population.(2)

Dual diagnosis: addiction and mental health issues

Addiction is highly linked to mental health issues such as depression, anxiety, and suicidal thoughts. Often, it’s difficult to identify what came first: the addiction or mental health problem.

Where people have a mental health condition, they might turn to substances to self-medicate. Doing so long-term can create addiction.

On the other side of the coin, people might develop mental health problems such as anxiety or psychosis after using drugs.

Sadly, even where LGBTQ people are living a comfortable life in terms of outcomes in the present, damage and trauma from the past can have ongoing effects.

This understandably links to ongoing mental health and substance misuse issues.

Those who are LGB are more likely to experience symptoms related to mental distress. (4) With this as a reality, it’s understandable that people then turn to drugs and alcohol to try and ease mental health symptoms.

How substance misuse affects the LGBTQ community in the UK

Actually, a lot more research could be done in this area. The National LGBTQ survey research report recently came out and revealed important information about the lived experiences of the LGBTQ community. More could be explored, however, in relation to the community and addiction.

One UK study has shown that LGBT people have higher rates of substance misuse in younger age than the older generation.(3)

Another revealed that more younger people in the LGBTQ community use drugs, whereas the older generation uses alcohol more often.(5)

In the National LGBTQ survey research report, it was revealed that respondents felt that the best way of addressing substance abuse was by first tackling prejudices against people who are LGBTQ.

This, of course, makes sense; if society as a whole was accepting of the community, hate incidents would be reduced, the community would have improved mental health and thereafter a lower likelihood of developing addictions.

The LGBTQ community and opioid use

For those who are LGB, there’s a relationship between sexual orientation and using drugs by injecting. In fact, lesbian women are reported as being 11-12 times more likely to be dependent on drugs than heterosexual women.(3)

An American report revealed that LGBTQ people are more likely to abuse prescription painkillers.

The community is also three times more likely to be opioid-dependent. Many people use substances to deal with rejection from others and the wider society.(6)

Interestingly, people who are addicted to opioids have often suffered from deep emotional pain. The LGBTQ community are often the victims of emotional, mental, and physical abuse which causes pain.

These are the types of issues that need to be considered by the treatment team when people enter recovery programmes.

Effects of opioid addiction

Opioids are synthetic or man-made opiates. They’re designed to relieve pain. In the medical community, they might be used to treat chronic pain or in opioid substitution therapy (to wean a person off an illegally used opiate).

They’re highly addictive and have the following effects:

Slowed down breathing.
Reduced heart rate.
Drowsiness.
Sedation.
Confusion.
Nausea.
Constipation.

As well to the initial physical effects, there are the long-term consequences of addiction.

Such as increased risk of illnesses and disease, as well as negative problems in relation to family, education, employment, and general wellbeing.

Withdrawal symptoms include:

Shaking.
Sweating.
Runny nose and flu-like symptoms.
Hallucinations.
Sickness and diarrhoea.
Cramps.
Severe muscle pain.

People quickly build up a tolerance and due to the distressing withdrawal effects usually relapse even when they desperately want to stop using. This is why recovery programmes are essential.

HIV health implications where opioid use is present

Substance use increases the risk of high-risk behaviours. For the gay community, this has further implications.

There’s an increased risk of contracting HIV when drug-taking and heavy drinking occurs.(7) This is mainly linked to people sharing syringes, not using protection, and being involved with more sexual partners.

Opioid addiction treatment in relation to the LGBTQ community

Medications for physical symptoms

In terms of medications, it’s really important that people are supported by a professional team that understands how various medications interact with each other. Methadone and Subutex are often used in treatment for those addicted to heroin.

Both of these medications are known to interact with some hormone therapies that trans people might have as well as antiretroviral therapy for people who are being treated for HIV.

Therapies for the psychological aspects of addiction

For many, substance use is directly linked to negative experiences of being LGBTQ within a heteronormative society. Therapies approach addiction in light of the various conditions which created it, including how the external world has treated people because of their sexuality and gender.

Cognitive therapies to treat opioid use in the LGBTQ community

There are various therapies that are used in treating people with opioid addictions.

Talking therapies might feature, however, the most useful for addicted people are cognitive therapies, including:

Cognitive Behavioural Therapy (CBT). This focuses on becoming aware of thoughts, triggers, and how thought patterns create behaviours and habits. People learn how to change behaviours through changing thoughts.
Cognitive Processing Therapy (CPT). This is a specialist branch of CBT for those who have PTSD and serious trauma from events such as child abuse and rape.
Cognitive Dialectical therapy (CDT). This is used for people who have deep emotional pain. People learn how to take control of emotional reactions and turn them into healthy responses.

It’s acknowledged in therapies that the majority of LGBTQ people come to internalise the negative things that have happened to them.

Minority stress is a reality and the external environment is largely responsible for how people have to come to internalise a huge amount of stigma, shame, and pain.

Final thoughts

Research shows that gay men and lesbian women are more likely to use heroin.(8) The LGBTQ community as a whole is at a higher risk of substance abuse. This is due to how society marginalises the community and how this sentiment is internalised.

There are many barriers for people to accessing LGBTQ focused support. This is often linked to internalised feelings and previous negative experiences.

Although societal progress has been slow, it is happening. The medical world and addiction treatment programmes are becoming more inclusive and LGBTQ friendly.

It’s incredibly important to access support and get the treatments and therapies you need if you’re LGBTQ and have an addiction. Professional teams are receiving increased training on LGBTQ issues and are able to offer the support you need to live a substance-free life.