Substance use and substance use disorders are a serious problem among members of the LGBTQ (lesbian, gay, bisexual, transgender, and queer/questioning) community. Less than 5% of adults in the United States identify as sexual minorities. 1 Yet, a disproportionately high percentage of sexual minority adults struggle with substance use compared to heterosexual (i.e., straight) adults. 2 Substance use among LGBTQ adults may include engaging in heavy drinking, and using more serious drugs like methamphetamine, cocaine, heroin, and prescription opioids.

Coping through substances is not unique to LGBTQ people; heterosexual people can cope through substances as well. However, LGBTQ people experience minority stress, defined as high levels of stress due to the stigmatization of having a minority identity 3. Stigmatization might look like discrimination and prejudice towards LGBTQ people. Turning to alcohol and drugs to help cope with the difficult emotions (e.g., anger, sadness, and fear) from experiencing discrimination and prejudice is not uncommon. Although drugs and alcohol appear to help with these emotions initially, in the long-term they lead to several negative consequences, including addiction and other health complications.

LGBTQ people are twice as likely to meet criteria for any substance use disorder compared to heterosexual people. 4 Specifically, LGBTQ individuals are more likely to use methamphetamine, cocaine, or crack than heterosexual individuals. 5 Not only are substance use disorders more common among LGBTQ individuals, but members of this community suffer from more severe substance use problems than heterosexual individuals. 6 As a result, LGBTQ individuals need more intense, specialized addiction treatment and can benefit from better utilization of medical services to overcome their substance use disorders.

Risk Factors for Substance Use and Use Disorders Among LGBTQ Individuals

Members of the LGBTQ community continue to fear that they do not fit into society or perceive that society rejects them. There are two ways in which this happens (1) their minority stress influences their daily living experiences and (2) minority stress in the form of discrimination may be internalized. Both of these processes can lead to increased substance use. 7

Causes of Substance Use and Addiction Among LGBTQ Individuals

Several factors contribute to substance use and use disorders among LGBTQ individuals. People who identify as lesbian, gay, bisexual, transgender, or questioning/queer often face challenges that are not encountered by heterosexual individuals. For example, members of the LGBTQ community are at greater risk of facing social stigma, discrimination 8, violence 9 10, and harassment. As a result, mental health problems are common in this population. Some of the triggers that can lead to substance use and dependence in the LGBTQ population are listed below:

Sexual Identity Discrimination/ Social Stigma: Although there is a growing acceptance of LGBTQ individuals in the United States, almost every member of the community has faced social stigma. For example, homophobic victimization among adolescents, consisting of verbal insults, offensive words about the victim, and spreading rumors happens more frequently to gay/lesbian and bisexual students than to heterosexual students. 11 Dealing with social stigma and discrimination may drive some sexual minority individuals to drugs and alcohol as a means of coping with the stress.

Family Rejection: LGBTQ individuals are often subjected to rejection by their loved ones. Family rejection has a serious impact on the mental and physical health of sexual minorities. Studies have shown that LGBTQ young adults with high levels of family rejection are at 3 times higher risk for both suicidal ideation and suicide attempts compared to LGBTQ young adults with high levels of family acceptance. Low family acceptance is associated with more substance misuse for LGBTQ young adults compared to LGBTQ young adults who have high levels of family acceptance12

Lack of Support: Members of minority sexual communities often suffer from feelings of isolation, loneliness, and anxiety. This can lead to a variety of mental health issues. For example, studies show that transgender youth have higher rates of depression, self-harm, suicidal ideation, and eating disorders compared to their cisgender (i.e., assigned sex at birth aligns with gender identity) heterosexual peers.13

Internalized Homophobia: Many people in the LGBTQ population develop self-loathing or self-hatred and start identifying with stigmas. This is known as internalized homophobia/transphobia. It prevents LGBTQ individuals from feeling comfortable with their sexual/gender minority identity. As a result, they sometimes use alcohol and drugs to cope with negative thoughts. Internalized homophobia has been found to have a direct positive association with depression and drug problems among gay and bisexual men. 14 Among sexual minority women (i.e., lesbian, bisexual), internalized homophobia is associated with more substance use as well. 15

Legal Issues and Addiction in the LGBTQ Community

Many states in the US have implemented laws making it illegal to discriminate based on sexual orientation. In a landmark ruling in June 2020, the U.S. Supreme Court held that it is unlawful for employers to discriminate against an employee based on their gender identity or sexual orientation. 16 These advances in societal acceptance of non-heterosexual orientations hopefully will help decrease rates of substance use and substance use disorders in the future.

Yet, at the current time, many LGBTQ individuals continue to face prejudices in the workplace. They may be forced to conceal their sexual orientation because of hostile work environments. Concealment is linked to feelings of isolation as well as a lower likelihood of reporting discriminatory incidents. 17 This can become a vicious cycle in which hostile attitudes force concealment and concealment limits the ability to confront homophobic behavior. Moreover, people in the LGBTQ community face discrimination in a range of areas, such as housing 18, harassment regarding bathroom use 19 and health coverage for spouses. 20 These stressors are risk factors for substance use and addiction in the LGBTQ population.

Health Challenges Faced by the LGBTQ Community

Mental Health Disorders: The prevalence of mental health disorders, such as anxiety, depression, suicidal ideation, and substance use disorders is significantly higher in sexual minority groups 21 22. Roughly 37% of sexual minority adults have mental illness compared to 17% of sexual majority adults. Dealing with these co-occurring mental health conditions can predispose the LGBTQ population to substance use and use disorders and also interfere with the desire to seek addiction treatment.

Physical Health Conditions: In addition to an increased incidence of mental health issues, the LGBTQ community also has higher odds of suffering from chronic medical conditions, activity limitations, smoking, obesity, and binge drinking (i.e., drinking 5 or more drinks for men or 4 or more drinks for women in one occasion). 23 Individuals who have not revealed their sexual orientation to others are sometimes hesitant to seek treatment for medical issues, including substance use disorders, for fear that healthcare providers will disclose this information.

HIV/AIDS: LGBTQ individuals are at greater risk of acquiring HIV/AIDS due to risky sexual behaviors. In particular, gay and bisexual men (men who have sex with men) and transgender women who have sex with men are at high risk of HIV infection. Treatment for substance use disorders is important to reduce HIV transmission in this community. Addiction treatment can reduce drug use, protect against intravenous needle transmission, and also lead to a decrease in risky sexual behaviors.

Facts and Figures: Addiction Stats in LGBTQ People

Surveys and studies have only recently started tracking data on substance use in sexual minorities. Surveys thus far have revealed that substance use disorders are more common among sexual minorities compared to people who identify as heterosexual.Long-term trends will emerge over the coming years, but here is what the data currently shows about addiction in LGBTQ populations. 24 25 26 27

  • According to the 2018 NSDUH Survey, 2.1 million LGB adults had a substance use disorder, 1.5 million had both substance use disorder and mental illness (e.g., depression, anxiety, suicidal ideation), and 5.7 million had mental illness.
  • Approximately 38% of sexual minority adults report past-year use of marijuana compared to a prevalence of 16% in the overall adult population in the US.
  • Past-year misuse of prescription opioids or heroin was reported by 9% of sexual minority adults on the 2018 NSDUH survey in comparison to less than 4% of the overall adult population. The majority of people who misuse prescription opioids obtain the medications from friends or relatives, either for free or by stealing or buying. More than 1.1 million LGB adults received medication-assisted treatment for opioid use disorder in 2018.
  • Roughly 64% of LGB adults report alcohol use compared to 56% of the overall US population. Approximately 12% of sexual minority young adults aged 18-25 report alcohol use disorder compared to 10% in the overall population.
  • Transgender women have a higher likelihood of seeking treatment for substance use disorders compared to non-transgender people.
  • LGBTQ individuals have elevated rates of smoking and vaping compared to heterosexual individuals.

Frequently Used Drugs by LGBTQ Individuals

Members of the LGBTQ community use many different addictive substances, but the following substances are the ones that are most commonly used:

Tobacco: The tobacco industry specifically markets its products to LGBT persons through direct and indirect advertising. 28 Research consistently shows that tobacco use is higher among LGBT adults compared to the general population. Roughly 1 in 3 LGBTQ individuals report smoking currently. An additional 25% of LGBTQ individuals are former smokers. 29

Alcohol: Among heterosexual individuals, men are more likely than women to drink alcohol and to drink heavily. However, studies on alcohol use among sexual minorities have revealed a more complex picture. Nonetheless, those who identify themselves as sexual minorities have a 3 times higher chance of lifetime alcohol use disorder and lifetime substance use disorder compared to heterosexual women. 30

Marijuana: Nearly 38% of sexual minority adults report marijuana use in the past year compared to 16% of the general population. Moreover, regular marijuana use (more than or equal to once weekly in the past 3 months) is associated with HIV positivity and mental health problems among gay, bisexual, and other men who have sex with men. 31

Methamphetamine: Crystal meth is a stimulant that became popular with urban gay and bisexual men in the 1990s and 2000s because of its perceived benefits, such as increased sex drive and pleasure, weight loss, easing of social anxiety, and lowering of sexual inhibitions. However, meth use is associated with sexual compulsivity, sexually risky behaviors, and sexually transmitted infections in the LGBTQ population. 32Approximately 2.3% of sexual minority adults report past-year meth use compared to 0.6% of sexual majority individuals. 33

Prescription Pain Relievers: Within the past year, more than 10% of sexual minority individuals report misusing prescription pain pills compared to less than 5% of sexual majority adults in the United States. 34

Other Illegal Drugs: In the past year, 0.9% of sexual minority adults report heroin use compared to 0.3% of sexual majority adults. Drug use is also higher in the LGBTQ community for cocaine, hallucinogens (LSD and Ecstasy), inhalants, prescription tranquilizers, prescription stimulants, and prescription sedatives. 35

The above-mentioned statistics are worrisome and there is a need to work towards increased acceptance of sexual minority individuals, which may help reduce the rates of addiction in the LGBTQ community. Studies show that sexual minority adolescents who reside in communities with a supportive LGBTQ environment (i.e., more supportive climates and more LGBTQ events) have lower odds of illegal drug use, marijuana use, and smoking during their lifetime.  36

Preventing Addiction in the LGBTQ Population

The LGBTQ population is particularly vulnerable to substance use and use disorders. Drug and alcohol addiction in sexual minorities is a serious problem that warrants immediate attention. Yet, homophobia and discrimination against LGBTQ people make it difficult for them to seek addiction treatment. Many drug rehab facilities do not cater to LGBTQ individuals. The staff at many rehab facilities are insensitive or hostile towards members of these communities. More needs to be done to reduce the risk of addiction in the LGBTQ community. Some of the strategies that can help mitigate addiction in the LGBTQ population include:

Decrease bullying of LGBTQ teenagers:

Lesbian, gay, bisexual, transgender, and queer/questioning teens experience more bullying and sexual harassment than heterosexual teens. Bullying is associated with poorer physical health and more trauma symptoms among LGBTQ teens. 37 This is hypothesized to place them at risk of substance use disorders. Anti-bullying campaigns may help create safer environments for LGBTQ youth and thus prevent drug and alcohol addiction in this population.

Provide access to mental health services: LGBTQ individuals have 2 times higher risk of suffering a mental illness like generalized anxiety disorder or major depression compared to others 38 For those who are still “in the closet,” the fear of being rejected can lead to anxiety, post-traumatic stress disorder, suicidal ideation, and substance use. Those who have come out still struggle with various discriminations and social stigmas. There is a need to increase access to mental health services for the LGBTQ community. According to SAMHSA, 40% of LGB young adults and 31% of LGB adults with serious mental illness received no treatment.  39 Moreover, therapists and counselors need to be provided with up-to-date knowledge and adequate training to understand the unique needs of this population.

Assist victims of abuse: LGBTQ individuals are at high risk of poverty, marginalization, stigma, hate crimes, and sexual assault. There is a need to not only prevent these crimes against sexual minorities but to also provide increased support and care for survivors of these crimes. This may include both raising awareness and making more resources available to LGBTQ victims of crime.

Advocate for equal rights: Marginalization may cause LGBTQ people to turn to drugs or drink alcohol to cope. 40 Advocating for equal rights for everyone is important to reduce the exposure of the LGBTQ community to discrimination and prejudice.

Specialized Addiction Treatment Programs

LGBTQ individuals deal with a unique set of challenges that puts them at higher risk of substance use disorders. In the United States alone there are 1.7 million sexual minority adults in need of substance use disorder treatment. When LGBTQ individuals are seeking alcohol or drug treatment, treatment centers should be sensitive to the needs of the LGBTQ community. Interviews with LGBTQ patients indicate that they prefer therapists who share a minority identity, to have in depth experience with LGBTQ patients, experience with LGBTQ specific issues, to not assume a heterosexual identity, and generally to be LGBTQ “friendly” (therapist explicitly sharing their views on gender/sexuality, rainbow flag, sexual minority specific language on their website) 41

Sober Sex and Addiction Treatment

Another facet of addiction treatment in the LGBTQ community is the idea of sober sex. People who use crystal meth, for example, often believe that sober sex can never replicate the intense pleasure of sex under the influence of meth. Therefore, sex becomes a trigger for meth use.

Treatment providers, therefore, have to change the perception that sober sex is boring or cannot be as good as sex on meth. Many sexual minority individuals feel having sober sex will lead to fantasies of sex on meth and thereby promote drug use. There is also the misconception that meeting people for sex will lead to drug use. LGBTQ specific methamphetamine treatment is helpful in reducing methamphetamine use as well as reducing psychological distress. 42

Features of LGBTQ Culturally Appropriate Treatment For Addiction

LGBT specialized addiction treatment produces more favorable results than traditional drug and alcohol rehab programs. 43Yet, only 11% of substance use treatment programs in the United States offer specialized services for LGBTQ patients. Moreover, 7 out of 10 programs that claim to cater to the LGBT population offer services that are no different than the services offered to the general population. Less than 8% of addiction treatment programs have services specifically tailored to the needs of LGBT patients. 44

Last updated: September 7, 2020

About the author

Dr. Gabriela López

Dr. Gabriela López is a postdoctoral fellow at the Department of Behavioral and Social Sciences Center for Alcohol and Addictions Studies at Brown University’s School of Public Health. She received her PhD in 2020 from the University of New Mexico.

Dr. López focuses on the intersection of alcohol use and sexual violence among sexual and racial/ethnic minority women. Her work has been recognized by the Association for Psychological Science for outstanding research with socially underrepresented populations.

Dr. Jennifer Merrill
Dr. Jennifer Merrill

Dr. Jennifer Merrill is an Associate Professor in the Department of Behavioral and Social Sciences at Brown University. She received her PhD in 2012 from the University at Buffalo, and is a licensed clinical psychologist in Rhode Island (Credential ID: PS01479).

Dr. Merrill has published over 70 peer-reviewed articles in journals such as Psychology of Addictive Behaviors, Addictive Behaviors and Journal of Studies on Alcohol and Drugs. Her published work includes 'Drinking over the lifespan: Focus on college ages' and 'Event-level correlates of drinking events characterized by alcohol-induced blackouts'.

References

  1. SAMHSA. NSDUH Data Review. Sexual Orientation and Estimates of Adult Substance Use and Mental Health: Results from the 2015 National Survey on Drug Use and Health. October 2016. Available online. https://www.samhsa.gov/data/sites/default/files/NSDUH-SexualOrientation-2015/NSDUH-SexualOrientation-2015/NSDUH-SexualOrientation-2015.htm
  2. McCabe, S. E., Hughes, T. L., Bostwick, W. B., West, B. T., & Boyd, C. J. (2009). Sexual orientation, substance use behaviors and substance dependence in the United States. Addiction, 104, 1333-1345. doi:10.1111/j.1360-0443.2009.02596.x
  3. Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5), 674–697
  4. Kerridge, B. T., Pickering, R. P., Saha, T. D., Ruan, W. J., Chou, S. P., Zhang, H., … & Hasin, D. S. (2017). Prevalence, sociodemographic correlates and DSM-5 substance use disorders and other psychiatric disorders among sexual minorities in the United States. Drug and alcohol dependence170, 82-92.
  5. Cochran BN, Cauce AM. Characteristics of lesbian, gay, bisexual, and transgender individuals entering substance abuse treatment. J Subst Abuse Treat. 2006;30(2):135-146. doi:10.1016/j.jsat.2005.11.009
  6. Cochran BN, Cauce AM. Characteristics of lesbian, gay, bisexual, and transgender individuals entering substance abuse treatment. J Subst Abuse Treat. 2006;30(2):135-146. doi:10.1016/j.jsat.2005.11.009
  7. Cochran BN, Cauce AM. Characteristics of lesbian, gay, bisexual, and transgender individuals entering substance abuse treatment. J Subst Abuse Treat. 2006;30(2):135-146. doi:10.1016/j.jsat.2005.11.009
  8. Evans-Polce, R. J., Veliz, P. T., Boyd, C. J., Hughes, T. L., & McCabe, S. E. (2020). Associations between sexual orientation discrimination and substance use disorders: differences by age in US adults. Social Psychiatry and Psychiatric Epidemiology55(1), 101-110.
  9. D’Augelli, A. R., & Grossman, A. H. (2001). Disclosure of sexual orientation, victimization, and mental health among lesbian, gay, and bisexual older adults. Journal of Interpersonal Violence, 16(10), 1008–1027.
  10. Edwards, K. M., Sylaska, K. M., Barry, J. E., Moynihan, M. M., Banyard, V. L., Cohn, E. S., Walsh, W. A., & Ward, S. K. (2015). Physical dating violence, sexual violence, and unwanted pursuit victimization: A comparison of incidence rates among sexual-minority and heterosexual college students. Journal of Interpersonal Violence, 30(4), 580-600.
  11. Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5), 674–697.
  12. Ryan C, Huebner D, Diaz RM, Sanchez J. Family rejection as a predictor of negative health outcomes in white and Latino lesbian, gay, and bisexual young adults. Pediatrics. 2009;123(1):346-352. doi:10.1542/peds.2007-3524
  13. Connolly MD, Zervos MJ, Barone CJ 2nd, Johnson CC, Joseph CL. The Mental Health of Transgender Youth: Advances in Understanding. J Adolesc Health. 2016;59(5):489-495. doi:10.1016/j.jadohealth.2016.06.012
  14. Moody RL, Starks TJ, Grov C, Parsons JT. Internalized Homophobia and Drug Use in a National Cohort of Gay and Bisexual Men: Examining Depression, Sexual Anxiety, and Gay Community Attachment as Mediating Factors. Arch Sex Behav. 2018;47(4):1133-1144. doi:10.1007/s10508-017-1009-2
  15. Lehavot, K., & Simoni, J. M. (2011). The impact of minority stress on mental health and substance use among sexual minority women. Journal of consulting and clinical psychology79(2), 159.
  16. Bostock v. Clayton County, No. 17-1618 590 U.S. _ (2020)
  17. Fric, K. How does being out at work relate to discrimination and unemployment of gays and lesbians?. J Labour Market Res 53, 14 (2019). https://doi.org/10.1186/s12651-019-0264-1
  18. Kattari, S. K., Whitfield, D. L., Walls, N. E., Langenderfer-Magruder, L., & Ramos, D. (2016). Policing gender through housing and employment discrimination: comparison of discrimination experiences of transgender and cisgender LGBQ individuals. Journal of the Society for Social Work and Research7(3), 427-447
  19. Casey, L. S., Reisner, S. L., Findling, M. G., Blendon, R. J., Benson, J. M., Sayde, J. M., & Miller, C. (2019). Discrimination in the United States: Experiences of lesbian, gay, bisexual, transgender, and queer Americans. Health Services Research54, 1454-1466.
  20. Ponce NA, Cochran SD, Pizer JC, Mays VM. The effects of unequal access to health insurance for same-sex couples in California. Health Aff (Millwood). 2010;29(8):1539-1548. doi:10.1377/hlthaff.2009.0583
  21. Kerridge, B. T., Pickering, R. P., Saha, T. D., Ruan, W. J., Chou, S. P., Zhang, H., … & Hasin, D. S. (2017). Prevalence, sociodemographic correlates and DSM-5 substance use disorders and other psychiatric disorders among sexual minorities in the United States. Drug and alcohol dependence170, 82-92.
  22. Spittlehouse JK, Boden JM, Horwood LJ (2019). Sexual orientation and mental health over the life course in a birth cohort. Psychological Medicine 1–8. https://doi.org/10.1017/S0033291719001284
  23. Gonzales G, Henning-Smith C. Health Disparities by Sexual Orientation: Results and Implications from the Behavioral Risk Factor Surveillance System. J Community Health. 2017;42(6):1163-1172. doi:10.1007/s10900-017-0366-z
  24. SAMHSA. 2018 National Survey on Drug Use and Health: Lesbian, Gay, and Bisexual (LGB) Adults. No date. Available online. https://www.samhsa.gov/data/sites/default/files/reports/rpt23252/7_LGB_2020_01_14_508.pdf
  25. Keuroghlian AS, Reisner SL, White JM, Weiss RD. Substance use and treatment of substance use disorders in a community sample of transgender adults. Drug Alcohol Depend. 2015;152:139-146. doi:10.1016/j.drugalcdep.2015.04.008.
  26. Blackwell CW, et al. Use of electronic nicotine delivery systems (ENDS) in lesbian, gay, bisexual, transgender and queer persons: Implications for public health nursing. Journal of Public Health Nursing. Published May 2020. doi: https://doi.org/10.1111/phn.12746
  27. Medley G, Lipari R, Bose J, Cribb D, Kroutil L, McHenry G. Sexual Orientation and Estimates of Adult Substance Use and Mental Health: Results from the 2015 National Survey on Drug Use and Health. NSDUH Data Review. https://www.samhsa.gov/data/sites/default/files/NSDUH-SexualOrientation-2015/NSDUH-SexualOrientation-2015/NSDUH-SexualOrientation-2015.htm. Published October 2016.
  28. Stevens P, Carlson LM, Hinman JM. An analysis of tobacco industry marketing to lesbian, gay, bisexual, and transgender (LGBT) populations: strategies for mainstream tobacco control and prevention. Health Promot Pract. 2004;5(3 Suppl):129S-134S. doi:10.1177/1524839904264617
  29. Clarke MP, Coughlin JR. Prevalence of smoking among the lesbian, gay, bisexual, transsexual, transgender and queer (LGBTTQ) subpopulations in Toronto–the Toronto Rainbow Tobacco Survey (TRTS). Can J Public Health. 2012;103(2):132-136. doi:10.1007/BF03404218
  30. Hughes TL, Wilsnack SC, Kantor LW. The Influence of Gender and Sexual Orientation on Alcohol Use and Alcohol-Related Problems: Toward a Global Perspective. Alcohol Res. 2016;38(1):121-132.
  31. Chou FY, Armstrong HL, Wang L, et al. A longitudinal analysis of cannabis use and mental health symptoms among gay, bisexual, and other men who have sex with men in Vancouver, Canada. J Affect Disord. 2019;247:125-133. doi:10.1016/j.jad.2019.01.015
  32. NAADAC. The Perfect Storm: Gay Men, Crystal Meth and Sex, Cultural Considerations for Gay Affirming Treatment. No date. Available online. https://www.naadac.org/assets/2416/craig_sloane_-_naadac_handouts.pdf
  33. SAMHSA. NSDUH Data Review. Sexual Orientation and Estimates of Adult Substance Use and Mental Health: Results from the 2015 National Survey on Drug Use and Health. October 2016. Available online. https://www.samhsa.gov/data/sites/default/files/NSDUH-SexualOrientation-2015/NSDUH-SexualOrientation-2015/NSDUH-SexualOrientation-2015.htm 
  34. SAMHSA. NSDUH Data Review. Sexual Orientation and Estimates of Adult Substance Use and Mental Health: Results from the 2015 National Survey on Drug Use and Health. October 2016. Available online. https://www.samhsa.gov/data/sites/default/files/NSDUH-SexualOrientation-2015/NSDUH-SexualOrientation-2015/NSDUH-SexualOrientation-2015.htm 
  35. SAMHSA. NSDUH Data Review. Sexual Orientation and Estimates of Adult Substance Use and Mental Health: Results from the 2015 National Survey on Drug Use and Health. October 2016. Available online. https://www.samhsa.gov/data/sites/default/files/NSDUH-SexualOrientation-2015/NSDUH-SexualOrientation-2015/NSDUH-SexualOrientation-2015.htm
  36. Watson RJ, Park M, Taylor AB, et al. Associations Between Community-Level LGBTQ-Supportive Factors and Substance Use Among Sexual Minority Adolescents. LGBT Health. 2020;7(2):82-89. doi:10.1089/lgbt.2019.0205
  37. Gruber, J. E., & Fineran, S. (2008). Comparing the impact of bullying and sexual harassment victimization on the mental and physical health of adolescents. Sex roles59(1-2), 1.
  38. National Alliance on Mental Illness (NAMI). LGBTQI. No date. Available online. https://www.nami.org/Your-Journey/Identity-and-Cultural-Dimensions/LGBTQI
  39. SAMHSA. 2018 National Survey on Drug Use and Health: Lesbian, Gay, and Bisexual (LGB) Adults. No date. Available online. https://www.samhsa.gov/data/sites/default/files/reports/rpt23252/7_LGB_2020_01_14_508.pdf
  40. Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin129(5), 674–697
  41. Berke, D. S., Maples-Keller, J. L., & Richards, P. (2016). LGBTQ perceptions of psychotherapy: A consensual qualitative analysis. Professional Psychology: Research and Practice47(6), 373.
  42. Lea T, Kolstee J, Lambert S, Ness R, Hannan S, Holt M. Methamphetamine treatment outcomes among gay men attending a LGBTI-specific treatment service in Sydney, Australia. PLoS One. 2017;12(2):e0172560. Published 2017 Feb 16. doi:10.1371/journal.pone.0172560
  43. Senreich E. Are specialized LGBT program components helpful for gay and bisexual men in substance abuse treatment?. Subst Use Misuse. 2010;45(7-8):1077-1096. doi:10.3109/10826080903483855
  44. Cochran BN, Peavy KM, Robohm JS. Do specialized services exist for LGBT individuals seeking treatment for substance misuse? A study of available treatment programs. Subst Use Misuse. 2007;42(1):161-176. doi:10.1080/10826080601094207