Addiction & Intersecting Identities

The addiction crisis continues to rage on – and LGBTQ+ and BIPOC communities are hit the hardest. 

According to the CDC, there were over 107,000 fatal overdoses in the U.S. in 2021. These figures are staggering. Each number represents a family member, friend, coworker, brother, sister, or parent that was lost to the addiction epidemic. 

Unfortunately, the LGBTQ+ and BIPOC communities both face increased risks of developing addiction. LGBTQ+ stands for lesbian, gay, bisexual, transgender, queer/questioning, and other sexual minorities, while BIPOC stands for Black, Indigenous, and people of color. 

LGBTQ+ and BIPOC individuals tend to experience addiction at higher rates than their heterosexual, white counterparts. But why is that? Stress, trauma, and social pressures drastically increase the risk of developing addiction. Unfortunately, LGBTQ+ and BIPOC individuals deal with these issues just by being themselves in a world that often doesn’t accept them. 

Why is the LGBTQ+ community at increased risk for addiction?

The LGBTQ+ community faces societal and cultural obstacles that their heterosexual counterparts typically don’t face. These obstacles include things like discrimination, hate crimes, rejection from family and friends after coming out, public humiliation, loss of employment, and even loss of housing. In fact, of the 4.2 million people experiencing homelessness, up to 40% of them identify as LGBTQ+. This is largely due to their family rejecting or disowning them after they come out. 

These social pressures can cause mental health disorders like depression, anxiety, self-harm, and eating disorders. In fact, LGB individuals are twice as likely to experience a mental health disorder, while transgender individuals are four times as likely. Despite this, only 7% of addiction treatment programs offer specialized services for LGBTQ+ patients. 

Queer people might feel the urge to turn to drugs or alcohol as a way temporarily cope with social pressures and mental health conditions. While these substances may appear to be beneficial at first, there is a large risk of developing addiction with continued use. 

According to some estimates, 30% of the LGBTQ+ community lives with addiction compared to just 9% of the general population. 

How does addiction affect Transgender people? 

Within the LGBTQ+ community, transgender people are especially vulnerable to addiction. This is largely because transgender people face a heightened level of stigma. Before going further, let's define the terms: cisgender and transgender. Cisgender is defined as identifying with the gender you were assigned at birth, while transgender is defined as not identifying with it. 

Trans people face all the social stigma that queer people face along with the pressure to “pass” as a certain gender. Transgender people also face legislation that seeks to bar them from engaging in daily activities–like using public restrooms or joining sports teams. 

This legislation has only increased over recent months. There are currently 540 proposed anti-trans bills in the United States. Each of these bills seeks to limit the rights of transgender people. These laws limit freedom of expression, restrict how trans people can be themselves, criminalize drag shows, and seek to ban gender affirming care. 

All of this stigma has dangerous effects. These social pressures can cause transgender people to turn to alcohol and substances in order to numb their feelings of anxiety, depression, and social isolation. According to one study, transgender students were twice as likely to abuse prescription medications like opioids when compared to their cisgender counterparts. 

What is Gender Affirming Care? 

Gender affirming care has been in the news a lot recently. But what is it exactly? The World Health Organization defines it as a range of social, behavioral, and medical interventions "designed to support and affirm an individual's gender identity" when it conflicts with the gender they were assigned at birth. 

Gender affirming care looks different to everyone. A few specific examples include: 

• Counseling that helps transgender individuals come out to their family and peers. 
• Resources that help individuals change their outward appearance and gender presentation to match how they feel internally. 
• Receiving medication that suppresses the release of sex hormones. 
• Speech therapy to help match vocal characteristics with gender identity
• Beginning hormone therapy to increase levels of estrogen or testosterone to develop characteristics more closely aligned with their gender identity. 

How does addiction affect BIPOC communities?

BIPOC individuals also face societal obstacles their non-BIPOC counterparts typically do not face. Racism, hate crimes, stress, trauma, hiring discrimination, and housing discrimination all lead to an increased risk of developing mental health conditions and addiction.

Similarly to LGBTQ+ individuals, BIPOC individuals may turn to alcohol or other substances as a way to temporarily cope with social pressures and systemic discrimination. 

According to several studies, Black communities are particularly at risk for addiction. Within the last 5 years, there has been a rise in opioid-related overdoses among Black Americans. During this time period, 43% of all overdoses were experienced by Black people. This is especially jarring since Black people only make up approximately 12% of the general population. 

BIPOC individuals also face barriers when trying to access treatment.

These barriers can take the form of familial stigma, cultural stigma, limited healthcare access, systematic discrimination, and regulatory barriers. 

Another considerable barrier to treatment is healthcare providers who lack cultural competency. Healthcare providers who lack a cultural understanding can underdiagnose or misdiagnose their patients. This can add an additional layer of frustration that keeps BIPOC individuals from seeking help. Cultural incompetence can look like language differences, stigma of mental illness among minority groups, and cultural differences in how symptoms present. 

When Identities Intersect

When discussing addiction treatment, it’s vital to acknowledge intersectionality. Intersectionality is defined as an individual's overlap of social identities such as gender, sexuality, race, and mobility. BIPOC and LGBTQ+ individuals need specialized care that addresses their trauma and lived experiences, while also respecting their cultural values. 

A lot of research still needs to be done to understand how addiction impacts people with overlapping marginalized identities. The few studies that have been conducted suggest addiction rates are dramatically higher for those who are part of both the LGBTQ+ and BIPOC communities. 

It shouldn’t come as a surprise that being in multiple marginalized groups can make it more difficult to seek help from healthcare providers. According to one survey, 34% of Black transgender people who saw a healthcare provider in the past year reported having a negative experience related to their gender. This includes being verbally harassed, being physically assaulted, or being refused treatment entirely. 

This behavior is unacceptable, especially coming from healthcare workers and treatment programs.

In order to make treatment available for everyone, we need to ensure healthcare providers are educated on how to interact with LGBTQ+ and BIPOC individuals. Treatment centers need to be open, accepting places that are respectful towards pronouns, different relationship models, and racial and cultural differences. Studies have proven this type of care has higher levels of engagement, improved patient outcomes, and higher levels of patient satisfaction for LGBTQ+ and BIPOC individuals.