My name is Alann Weissman-Ward and I work at Boulder. I’ve worked in medicine since 2005, specializing in gender affirming care and addiction medicine. Before that I was a patient like everyone else. As a trans man, I’ve had wonderful experiences and terrible experiences in healthcare, and a lot of opportunities to think about what differentiates them.
The disparities faced by the LGBTQ+ community in addiction treatment demand our attention.
Understanding the specific challenges and consequences is crucial for promoting inclusivity and improving outcomes. It is our collective responsibility in the medical field to address these disparities through increased support, research, and advocacy.
Boulder leads by example, making healthcare accessible and “user friendly.”
While Substance Use Disorder is, of course, caused by a combination of genetic, psychological, and social factors, membership in marginalized groups can exacerbate all the stressors that lead to increased risk. For example, there are over five million gay and bisexual adults with SUD, and people who are transgender are four times as likely to become addicted than people who are cisgender. Twenty percent had Alcohol Use Disorder, specifically, which is double the rate of the general population. The CDC finds that nearly a quarter of LGB youth have abused prescription medication, about twice the rate of their heterosexual peers. LGBTQ+ opioid and alcohol users are more likely to experience the worst effects of SUD because of the challenges of seeking help and the lack of targeted prevention and harm reduction efforts.
Why are LGBTQ+ people more at risk?
In every social determinant of health, people who are homosexual, transgender, or in other sexual minority groups face uphill battles. 20-40% of homeless youth identify as members of the LGBTQ+ community. 86% of queer youth reported being harassed or assaulted at school in a 2019 poll. Trauma, poverty, and inadequate mental health care are all among the top social factors for Opioid and Alcohol Use Disorders, and all are associated with the rejection still faced by far too many queer Americans, especially youth. That same CDC data that indicates LGB youth are twice as likely to abuse prescription medications also finds them twice as likely to experience bullying, and four times as likely to experience sexual assault or consider suicide.
There is also a more complicated reality that spaces of queer joy and safety have often been bars. The first time I went into a gay bar is imprinted deeply in my memory; it was the first place I could be with other people looking for a similar connection.
For many of us, gay bars represent a rite of passage.
The most iconic example is Stonewall, an actual bar and the birthplace of Pride. It would be shortsighted and wrong to vilify these spaces, but it’s also worth acknowledging that substances, especially alcohol, are a part of them.
And in a world that strives for inclusivity and equality, it is disheartening to acknowledge that, in addition, marginalized communities often face additional barriers when seeking treatment. Discrimination, stigma, and lack of culturally competent care can create immense hurdles for LGBTQ+ individuals on their path to recovery. This is especially true for patients whose identities include intersecting factors, like race or disability, which also limit access to healthcare, supportive resources, and employment opportunities, further exacerbating the risk of heightened substance use and the associated consequences.
At least 60% of transgender patients say that they’ve avoided SUD treatment specifically because they were worried about the stigma, and less than 5% of inpatient providers are formally trained on culturally competent trans care.
What is even more egregious is that many SUD treatment programs will advertise LGBTQIA+ competency without providing any training to their clinicians or support staff. (I have personally contacted programs to ask what made them competent to treat trans patients, and they had no answer.)
So what can we do to help?
The challenges facing SUD patients who are also members of the LGBTQ+ community are complex, so the support offered must be comprehensive, deeply considered, and seen to with urgency.
The long term goal should be to advocate for inclusive policies and legislation that protect the rights and safety of LGBTQ+ individuals. The best way to make sure alcohol and opioids aren’t disproportionately affecting marginalized groups is to work to bring them to the center.
While that’s happening, it’s essential to promote education and training for healthcare providers, enhancing their understanding of the unique needs and experiences of their LGBTQ+ patients. The Substances and Mental Health Services Administration provides guides and manuals on providing Substance Use Disorder treatment that is sensitive to the specific needs of LGBTQ+ patients.
Increased general awareness of inclusive treatment options, such as Boulder Care, can also contribute to a more supportive and accessible healthcare landscape.
And, of course, the best way to make treatment safer is proactive hiring of LGBTQIA+ staff. Many of us will search a practice's website to find someone who is in the community, and if I don’t find more than one of us working in a space, I tend to become skeptical of how welcoming that practice will be. Even something like language on intake forms can make a huge difference in putting a queer patient at ease, such as including a space for pronouns and alternative names, and these considerations will always be more thoughtful and thorough when constructed by a member of the community.
Making an impact
Telehealth is hugely valuable to any patients facing access barriers. Patients might be far from a clinic, have mobility issues, poor access to transit, or face mental health difficulties leaving their homes. All of these become more difficult to overcome when they intersect with issues of identity. Boulder is safe not just because our teams are made up of such caring, well trained providers, but because telehealth itself protects patients from the discrimination and judgment they might otherwise face between their door and their doctor’s, and even in the waiting room.
In a medical field with so much room for improvement, it’s more important now than ever, when we have come so far in acceptance and legal equity, to commit to providing equality in healthcare. By fostering an environment that embraces diversity and eliminates barriers to care, we can work towards a future where every individual, regardless of their sexual orientation or gender identity, can access the support they need to lead healthy and fulfilling lives.