I’m encouraged by the progress in society today – with more acceptance of the Lesbian, Gay, Bisexual, Transgender, Queer (or Questioning), Intersex, Asexual (LGBTQIA+) community. However, there are still significant ongoing barriers and prejudices to overcome as we continue to be a target for hate crimes in America.
This realization is tragically reflected in the higher rates of mental illness and addiction in our community. In fact, the LGBTQIA+ community experiences extensive PTSD and trauma and is two times more likely to develop a mental health condition or a substance use disorder.
Many treatment centers are quick to post rainbows on their websites. But few treatment centers offer specialized programming focused on the unique issues facing those from the LGBTQIA+ community who suffer from substance use and behavioral health disorders. That needs to change, and I am proud to say that Caron is at the forefront in having specialty treatment programming that supports the LGBTQIA+ community.
Research tells us that recovery rates for this community improve when treatment addresses internalized homophobia, gender identity, family dynamics, rejection and trauma. Some of these topics simply aren't discussed in mainstream treatment programs, which doesn’t serve the LGBTQIA+ community well.
We've had a weekly Pride group session in place at Caron for several years, which typically has more than a dozen participants. Patients told us that attending the Pride group helped them feel connected, even across age groups and genders. They looked forward to that session every week and communicated they wanted more, which drove us to create specialty LGBTQIA+ programming.
Touchpoints for the LGBTQIA+ community
As I mentioned, those of us who identify as LGBTQIA+ face unique life experiences and challenges. The same extends to treatment and recovery from a substance use disorder, in ways the cisgendered world may not be aware of, such as:
Internalized homophobia. Many of the patients in our Pride group deal with internalized homophobia. This results in shame, guilt and low self-esteem as people experience self-hatred about their sexual orientation or gender identity. We try to break that down by challenging the core beliefs and cognitive distortions that were instilled in them as a child or when they first came out, either by family members or peers.
The interplay of substance use and sexual orientation. Partying can play a strong role in this community. At times, chemical substance use is mixed in with sexual orientation: Chemsex describes the use of psychoactive substances during sex. An important part of treatment is rethinking such connections and exploring how to have fun in recovery. What does life after treatment look like? It’s important for anyone undergoing treatment but can be especially critical for those in the LGBTQIA+ community.
Family of origin and family of choice issues. There can be barriers to overcome with a person’s family of origin, either from messages received during their upbringing or from the family’s reaction during the coming out process or a decision to marry. As a result, individuals in this community may gravitate towards a “family of choice” – individuals they feel comfortable with. They may even refer to them as mother, father, sister or brother.
Our family and relationships group explores the issues around both family of choice and family of origin. Oftentimes, members of a person’s family of choice will still be using substances. It’s important to plan how to navigate those relationships once a patient gets out of treatment, to know what boundaries need to be set, and understand the difference between healthy and unhealthy relationships and what it means to their recovery process.
Reawakening a sense of the spiritual. Many in the LGBTQIA+ community have grown up in a faith-based institution where they either didn't feel accepted, or they felt they couldn’t be authentic for who they are or who they love. That experience leads some to shy away from 12-Step programs because of a mention of God. Nevertheless, spirituality, gratitude and service remain important components of recovery.
Caron’s LGBTQIA+ programming offers a spirituality group that explores the difference between spirituality and religion, breaking down the stigma and shame that often stem from religious institutions. Reverend Zoë of Caron’s spiritual care staff helps patients see – despite the messages received in their religious upbringing – that they have the right to be who they are, that spiritual wealth is still freely available to them, and that there are still religious communities that will accept them.
Importance of creating a safe space
Safety is a critical issue for the LGBTQIA+ community.
Our community tends to shy away from seeking care for mental health, addiction, and even medical care because many people don't feel safe, either physically, mentally or emotionally. There may be a fear of judgment by their providers, or the providers won’t have an understanding or competency about sexual orientation or gender identity.
Addiction is a disease of isolation, and members of our community tend to isolate more because of shame or internalized homophobia. In a treatment setting, a person may shut down when they find themselves the only person identifying as LGBTQIA+. They might not feel comfortable talking about their same-gender partner or their homophobic or trans-phobic experiences, resulting in trauma staying buried, and limiting their ability to free themselves from addiction. It’s important to foster an environment where people feel open to speaking about the issues that are important to them, in a group setting, without fear of judgment by group members or the therapist.
We encourage people to seek out providers who ask questions about sexual orientation and gender identity on their intake form, or have a pride flag in their office, something that indicates that it's a safe space to talk about their struggles and that there's an understanding of their needs.
Treatment must be a secure space where all patients can be authentic. Whether they are sharing painful family secrets, deep-seated feelings of shame or challenges with self-esteem, their emotional, physical and mental safety is essential to work through issues specific to their LGBTQIA+ identity, so they feel empowered and prepared to manage their recovery among their heterosexual and cisgendered counterparts.
By Reverend Jack Abel, MBA, MDiv