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The Scope of Opioid Addiction in the LGBTQ Community
The lesbian, gay, bisexual, transgender, and queer (LGBTQ) community has , historically, suffered higher rates of substance abuse. As the Opioid Epidemic grows in the United States, LGBTQ Americans face alarmingly high rates of addiction and fatal overdose. It is estimated that between 20% and 30% of people in the LGBTQ community engage in drug or alcohol abuse, as compared to 9% of the general population. There is not much research on the rates of Opioid addiction in the LGBTQ community, but surveys do demonstrate the damaging effects of Opioids in LGBTQ lives. In 2015, 1 in 10 adults over the age of 18 who misused prescription Opioids (such as Hydrocodone or Oxycodone) identified as LGBTQ, and they were 3 times more likely to develop an addiction than heterosexual adults.
There are a variety of factors that play a significant role in the development of Opioid addiction in LGBTQ people, such as the consequences of prejudice, weak or absent support systems, and increased social pressure. To prevent or treat Opioid addiction in the LGBTQ community, it is important to address co-occurring disorders and increase LGBTQ access to evidence-based therapy. Most importantly, LGBTQ people need support from friends, family, and the community.
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Minority Stress and Other Factors That Contribute to Addiction
Different studies have found exceptionally high rates of substance use disorders within the LGBTQ community. Certain risk factors that contribute to developing an Opioid addiction are specific to the unique and often traumatic experiences of living as a lesbian, gay, bisexual, trans, or queer person in America. The primary factor that typically harms LGBTQ people has been described as “minority stress.” Psychologist define minority stress as everyday discrimination, marginalization, and victimization on the basis of a person’s sexual or gender minority status, and it has significant influence on the initiation of drug and alcohol abuse and the onset of a Substance Use Disorder (SUD).
The greatest predictor of a person’s risk for addiction is their family history and support system. Unfortunately, many LGBTQ teens lack a supportive home environment. LGBTQ teens are two times as likely to be bullied, excluded, or assaulted at school, but they are nearly 40% less likely to have an adult in their lives to whom they can turn to for support. Stress caused by high levels of external stigmatization can interrupt important psychological processes, such as the ability to cope adaptively, regulate emotions, and achieve positive interpersonal relationships. In LGBTQ youth, external stigmatization from minority stress may become internalized, leading to identity concealment, self-hate, feelings of worthlessness, and fear of rejection. In order to escape or mute these feelings, some teens may turn to Opioids and other substances that provide a sense of euphoria and relief. As a result, studies show that LGBTQ youth are twice as likely to experiment with drugs and alcohol than their non-LGBTQ peers.
Teens and young adults are more likely to use drugs and alcohol if parents and other adults in their lives react in a negative way when learning about their LGBTQ identity. A person’s risk of problems with substance abuse decreases as their family and friend’s acceptance of their identity increases. Parents and caregivers should actively discuss drug and alcohol abuse with their teens and provide positive reinforcement or show appreciation for the parts of life where the teen succeeds. Studies show teens with caregivers who support their identities are better able to withstand other sources of stress, like harassment at school.
Medical Opioid Use in LGBTQ Populations
People in the LGBTQ community are also exposed to Opioids at disproportionate rates within medical settings. As studies have shown, prescription drugs are the second most commonly used substances at the time when drug addiction begins. Although not much research has been done on the rates of Opioid addiction within sexual minorities, surveys show that among LGBTQ adults between 35 and 44 years old, 58% had received an Opioid prescription, compared to just 35% of the non-LGBTQ population.
Certain clinical situations can place a person who is LGBTQ at increased risk of Opioid exposure, such as the need for pain management. Although not all transgender people pursue gender affirmation surgery, recent data shows that the procedure is becoming more popular, causing an increase in the amount of pain killers prescribed. Opioid dependence is correlated with frequency of exposure. Since opioid therapy is the most common form of post-surgical pain management, each procedure places another transgender patient at increased risk of developing an Opioid addiction.
Opioid addiction in the LGBTQ community also has the potential to increase HIV risk via sexual and injection-drug behaviors. Many Opioid use disorders begin with the abuse of prescription drugs and lead to abusing illegal substances in order to achieve a more intense and longer-lasting high. Since Opioids carry such a high risk of addiction, even normal use as prescribed by a doctor can result in a physical dependence. Opioid dependence can cause withdrawal symptoms if usage is stopped and, in order to prevent withdrawal, some people may turn to illicit Opioids such as Heroin and Fentanyl.
Statistics show that men who have sex with men (MSM) are 9.5 times more likely to abuse Heroin than men who do not. Non-medical Opioid use among MSM is associated with increased risks of condom-free sexual intercourse, increased number of sexual partners, and sharing needles. Addressing Opioid use disorder is detrimental in LGBTQ populations, as treatment for addiction has been shown to be associated with a reduction of high-risk sexual and injection-drug behaviors and an increase in condom use.
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Will Treatment Interfere with Hormone or Antiretroviral Therapy?
Some gay and transgender patients may delay seeking Opioid addiction treatment because they fear that it could interfere with their hormone therapy or antiretroviral therapy (ART). Opioid agonists, which includes treatments such as Methadone and Buprenorphine, have been known to interact with certain ART medications, particularly Efavirenz, and with hormone-modulating medications, such as Spironolactone. However, co-prescription of these medications is safe and feasible with appropriate monitoring and follow-up with a healthcare provider.
Co-occurring Mental Health and Behavioral Disorders
Addiction can worsen symptoms of mental health illnesses such as depression, anxiety, and Post-Traumatic Stress Disorder. Likewise, untreated mental health disorders can push a person to self-medicate by taking drugs in order to feel better or “normal”. Co-occurring disorders in people with Substance Abuse Disorders can be fairly common due to overlapping life factors that make up a person’s behavioral and mental health. Unfortunately, LGBTQ communities are disproportionately affected by mental health disorders caused by minority stress and discrimination. A lack of access to affordable and culturally competent health care can also contribute to the experience of minority stress. Some common Opioid addiction treatment modalities have been shown to be effective for LGBTQ people, including motivational interviewing, social support therapy, contingency management, and cognitive-behavioral therapy. Treatment for Opioid addiction which also targets trauma and stress in an integrated manner has proven to be acceptable and effective in community addiction treatment programs.
When starting any Opioid addiction treatment program, medication-assisted therapy (MAT) is recommended in combination with detox and therapy. One study demonstrated that addiction programs which offer groups specialized for gay and bisexual men yield better outcomes for those clients than non-specialized programs. Current research indicates that treatment should address unique factors in the lives of LGBTQ patients, such as homophobia/transphobia, family problems, violence, and social isolation.
|Motivational interviewing||Technique to resolve insecurities and find internal motivation necessary to change damaging behaviors.|
|Social support therapy||Can be emotional support, tangible aid, advice, or providing information that prompts self-assessment.|
|Contingency management||Provides incentives to change negative behaviors and reinforce positive ones.|
|Cognitive behavioral therapy (CBT)||Focuses on recognizing inaccurate patterns of thinking and the foundations that created them, then forming coping strategies.|
|Cognitive processing therapy (CPT)||Used to recover from trauma and PTSD.|
Finding Opioid Addiction Treatment for the LGBTQ Community
Opioid addiction treatment for people in the LGBTQ community should provide specialized care that addresses the unique needs of LGBTQ individuals. Staff should be trained to use gender-affirming pronouns as well as understand how to avoid terms which highlight harmful stigma and stereotypes. Seeking treatment can be an intimidating process, but it doesn’t have to be. Please contact a dedicated rehab provider today who can help you find an LGBTQ-friendly rehab center that offers effective, high-quality treatment for overcoming Opioid addiction.
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