Members of the LGBT community who face substance use disorders likely do so with many scientifically known co-occurring phenomena brought on by years of trauma. Yet, few clinicians are trained in how that research informs treatment plans known to work for LGBT individuals.
“We have the research now, and it’s simply not leaking down to the practitioner level,” said Michael Shelton, a Philadelphia-based therapist and author of the new book, Fundamentals of LGBT Substance Use Disorders: Multiple Identities, Multiple Challenges, in an exclusive interview with Michael’s House.
The book serves as must-have text for the office bookshelves of all addiction treatment professionals and primary care physicians. “We need to have more LGBT-specific (treatment) programs across the country, but it’s just not to happen,” Shelton told Michael’s House. “There are 50 to 60 LGBT-specific programs in the U.S., but we need such programs offered in every drug and alcohol program in this country. There needs to be competence to work with LGBT folks. Period.”
What makes LGBT folks’ needs so unique?
Most people diagnosed with a substance use disorder also have a co-occurring mental disorder, such as depression, anxiety or PTSD. This is especially true within the LGBT community.
Per Shelton’s book, which replaces a similar text published by Harrington Park Press 30 years ago titled Counseling Lesbian, Gay, Bisexual and Transgender Substance Abusers: Dual Identities, a 2013 study by McCabe and colleagues based on a large national sample “determined that the odds of substance abuse treatment utilization for sexual minority women and men tended to be greater than for heterosexual women and men. Still, the study authors determined that many sexual minority members who need substance use treatment do not receive it, and for those who do, the quality of the treatment may be inadequate.”
Meth Use Especially Rampant Among Gay, Lesbian Communities
Per the book, research published in 2015 shows that crystal meth is often the drug of choice among gay men and lesbians. “Meth users often stay awake for days at a time. These episodes can lead to violent behavior, anxiety, delusions and paranoia extreme enough to require hospitalization,” the authors report. “Overall, one of the most common reasons that gay men give for using meth is its impact on sex.” They report that meth leads to performance stamina, delayed ejaculation and the ability to override any internalized minority stress that may bring into the act that could detract from their enjoyment. Bauermeister surveyed Latino gay men, who said that “meth use not only increased sexual arousal and pleasure but also temporarily clouded over any feelings of internalized heterosexism, sexual unattractiveness and concerns about HIV.”
There’s also great diversity within the LGBT community itself. In Fundamentals of LGBT Substance Use Disorders, Shelton reviews the latest medical science as it pertains to LGBT substance abuse. He emphasizes the need for affirmative therapeutic practices as well as trauma-informed and culturally competent care.
While the LGBT community has many shared experiences that put it at greater risk for substance abuse, successful modes of treatment can vary widely among LGBT youth, the elderly and family units.
Shelton refers to the chapters on LGBT youth and the elderly as his “aspirational chapters.” He notes that a glut of new research in the past decade has shone a light on the need for substance use treatment among these communities and how to effectively reach them.
Special challenges exist as it pertains to criminal justice issues and LGBT individuals, serving LGBT populations in rural areas, and serving bisexual and transgender people looking to become sober.
Shelton says too many agencies that offer affordable addiction treatment ignore the special needs faced by LGBT people or worry that if they offer special services for LGBT people, other clients will stop coming.
Research has shown that more and more LGBT people who left rural areas for more inconclusive bigger cities are returning to the country again, Shelton said. Meanwhile, rural areas in general are finding themselves amid substance use problems like never before because of the opioid painkiller and heroin epidemic.
Cycle of Shame Works Against Quest for Sobriety in LGBT Community
Shelton has served as a board member for NALGAP (National Association of Lesbian, Gay, Bisexual, Transgender Addiction Professionals and Their Allies). Among his previous books are Gay Men and Substance Abuse: A Basic Guide for Addicts and Those Who Care for Them, which was awarded Best LGBT Book of the Year by the Independent Book Publishers Association, and Family Pride: What LGBT Families Should Know About Navigating Home, School and Safety in Their Neighborhoods.
He currently is working on a book detailing the challenges gay immigrants face. “When immigrants come into our culture it is very shame-inducing for them,” Shelton explained in his interview with Michael’s House. “The amount of shame in our population is just astounding to me.”
And shame fuels substance use and abuse.
“It starts with alcohol, marijuana and nicotine,” Shelton says. “And then our populations tend to be more willing to experiment with the newer substances. Some people in my field believe that gay men are trendsetters when it comes to drug use. And I’m not saying that in a positive sense.”
1. Shelton, M. Fundamentals of LGBT Substance Use Disorders. 2017, New York: Harrington Park Press.
Written by David Heitz