June is LGBTQ+ Pride Month — a time when we celebrate the beautiful and vibrant people within the lesbian, gay, bisexual, transgender, queer, or questioning community.
It’s also an appropriate time to bring attention to some of the issues affecting this population. One such issue is addiction — an exceedingly complex and chronic brain disease that has become an epidemic and major public health crisis in America.
While it is well-documented that LGBTQ+ individuals have dramatically higher rates of substance misuse and addiction than their heterosexual counterparts, few may understand or have ever stopped to wonder why.
If you examine the social determinants of health, the many inequities surrounding this community and ultimately driving addiction become clear.
The social determinants of health are non-medical factors that shape our health and well-being, based on where we are born, grow, work, live, worship, and more. This extensive list of forces and systems includes things like access to education, safe housing, transportation, clean water, nutritious foods, job opportunities, quality healthcare, and so on.
Some of the main social determinants of health that impact the LGBTQ+ population are discrimination, violence, social inclusion, and economic stability.
We see it in the news right now with the mass shootings at Club Q last year in Colorado Springs and Pulse nightclub in Orlando in 2016, when 49 people were killed. 49! It is still difficult to believe.
Transgender and gender-nonconforming people are particularly at risk and have increasingly become the targets of transphobic hate crimes. As a result, we’re seeing more incidents of homelessness, intimate partner violence, sexual assault, and other crimes within this group.
Additionally, because of the stress associated with such violence and discrimination, the trans community has some of the highest suicide rates among any minority community. This is one of the most alarming health disparities facing this population. Multiple studies show that 40 percent or more of trans individuals have attempted suicide at least once in their lifetime.
Another key determinant is social inclusion. To live happy healthy lives, people need to feel accepted and supported.
Although we as a collective society have made strides over recent years to fight prejudice and promote inclusiveness, we must do better.
This population continues to experience multiple layers of intersecting discrimination. Things like restricting healthcare for trans youth, banning education on LGBTQ+ subjects in schools (e.g., the “don’t say gay” law), and most recently, Florida governor Ron DeSantis’s much-publicized feud with Disney.
These are just mechanisms for harassment. This community has been “othered” by the outside world, and when you're marginalized or being used as political pawns, that really affects your ability to feel socially included.
Issues like fear of violence or discrimination and lack of social inclusion tie into economic stability, another essential social determinant of health.
These factors disrupt relationships and employment, which is a primary source of health insurance for many people. This, in turn, impacts access to quality healthcare and vital resources, as well as a person’s capacity to pay for safe housing, healthy food and activities, and so much more.
And unfortunately, all this can trigger or worsen drug and alcohol use. Many of these factors that determine our quality of life are also considered environmental risk factors for addiction, including trauma, poverty, and mental health.
Mental illness is very common in people with addiction and is associated with poorer treatment outcomes. Based on data from 2021, an estimated 44 percent of American adults suffer from both a substance use disorder and another mental health condition, such as depression, anxiety, or PTSD. And the vast majority of these people are not getting the help they need.
Statistically speaking, lesbian, gay, and bisexual individuals utilize addiction treatment more than their heterosexual counterparts. But that doesn’t tell the full story of all those who remain untreated, those who may be self-medicating with drugs and alcohol and hiding from the shame and stigma they feel.
Shame is probably the worst emotion a human can feel. It damages self-esteem and how people take care of themselves. When people feel shameful about things, that's when they tend to become reclusive and hide. And negative emotions can really fester in hiding.
In the field of addiction medicine, we must do more to foster inclusiveness and break down barriers to treatment. According to one study, only 7 percent of rehab programs offer specialized LGBTQ+ services. So, there is an urgent, research-based need to create more addiction treatment programs that address this community’s unique challenges.
Addiction treatment is not one size fits all. It’s important to remember that each person is an individual and deserves to be treated according to their individuality.
One of the measures of a civilized society is its ability to care for the sick and vulnerable. Regardless of sexual orientation, gender identity, or a person’s lifestyle choices, we're all human, and we must take care of each other.
That’s where the true beauty and opportunity of Pride Month lies. It’s a chance to highlight the many colors that define our society — and also a time to acknowledge where we can do better and do more.
LaQuicha Westervelt-House is a nurse practitioner at Laguna Treatment Hospital, an evidence-based detox and rehab facility in Orange County, Calif.