Hi XXXXXXX

As a psychologist who has to treat substance use problems in XXXXXXX lesbian, bisexual, and transgender clients, it is very important to first be aware of the nature, prevalence and pattern of substance use disorders in this group. Only then, the treatment needs of this group can be met effectively.
The significance of the special needs of sexual minorities (gay, lesbian, bisexual, transgender) is being gradually recognised more and more. Traditionally, this group of persons were subject to a lot of discrimination, social stigma and prejudice. Research data show that the prevalence of mental health related issues is higher in this group, compared to the general population. Surveys conducted in North XXXXXXX and Holland confirm that non-heterosexual people are at higher risk for a mental disorder, substance misuse, suicidal ideation, and self-harm than heterosexual people.
Coming to the issue of substance abuse, the prevalence of substance use disorders have been found to be significantly more in non-heterosexuals when compared to heterosexuals. Research has shown that Lesbian, XXXXXXX Bisexual and Transgender (LGBT) alcohol, tobacco and other drug use is 2 to 4 fold higher than in the broader heterosexual community.

One school of thought proposed is that discrimination and social ostracization of XXXXXXX lesbian, bisexual and transgender individuals may contribute to the higher levels of substance use problems seen in these populations.
Reasons for the elevated use of drugs within LGBT communities can include:
• Stress associated with belonging to an often despised minority
• Stress associated with managing a minority identity,such as needing to hide identity to keep job or experiencing harassment/discrimination
• The stress associated with coming out to family, friends and work colleagues
• Confusion around sexual orientation or gender identity
• The role of XXXXXXX bars as a major social outlet, leading to finding friends and partners in bar settings, thus increasing the likelihood of adopting a “heavy drinking”/using peer group
• Greater likelihood of loss of family and community support


Now, in order to be more effective in the approach and management of substance abuse in this group, we first need to know about the pattern and trends of substance use in this group.

There are some obvious differences in the pattern of alcohol and drug use between non-heterosexuals and heterosexuals. LGBT people are:

• less likely to abstain from substance use
• more likely to drink moderately.
• more likely to suffer substance use-related problems
• less likely to stop using both illicit drugs and alcohol as they
grow older

A well-conducted survey done in Queensland, Australia showed the following pattern of substance use:

Tobacco:
44.8% smoked at least daily, with an average of 11-20 cigarettes per day.

Alcohol:
41.4% of people had more than 8 alcoholic drinks per week.
41.4% of the survey respondents described themselves as being a binge drinker.
Only 10.2% didn’t drink at all.

Marijuana:
21.2% smoked marijuana more than once per week
7.8% smoked marijuana daily

A large study done in the United Kingdom using data from the Adult Psychiatric Morbidity Survey 2007 showed that the prevalence of alcohol dependence was 8.6 % among non-heterosexuals, and 5.4% among heterosexuals.

Several other studies in different parts of the world reflect the same higher prevalence of substance use disorders among these sexual minorities. So, it becomes obvious that this group needs more attention when planning treatment services.

Now that we know that there are significant differences in the prevalence and patterns of substance use in this group, the next step is to plan how we tailor our treatment approach to best suit the needs of this group. We need to keep the following things in mind:

-     LGBT people are less likely to seek help and present to health providers much later than those in the broader community. This is due to fear of experiencing discrimination and or believing that service providers are not equipped to deal with LGBT issues.
-     Because of the effect of social stigma, LGBT people may have different treatment needs and these can be overlooked in substance use treatment programs
-     The involvement or support from the family is not the same as that in heterosexuals. So, more individualized therapies and a greater reliance on other support groups may be necessary.
-     Most importantly, the psychologist needs to be unbiased, sensitive and confident in addressing the treatment needs of this group.

Dr, Jonas Sundarakumar
Consultant Psychiatrist

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