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Substance Use Treatment: LGBTQ+ Affirming Therapy Matters



LGBTQ+ (Lesbian, Gay, Bisexual, Transgender, Queer/Questioning) people have unique needs in substance use treatment due to the discrimination, stigma, and social exclusion they experience in society. It makes sense that some people use substances to cope with the pain of these experiences. This can result in higher rates of substance use disorders among LGBTQ+ communities.


When seeking out treatment for addiction or substance use disorder, there are many reasons why queer or trans people may prefer a queer-affirming therapist. Some of these are about comfort and preference, but others are supported by research about what LGBTQ+ people need in order to make substance use treatment successful.


These are some of the unique needs of LGBTQ+ people in substance use treatment:


1. Addressing Internalized Stigma and Shame: Many LGBTQ+ individuals experience internalized stigma and shame related to their sexual orientation or gender identity. This can contribute to chronic feelings of shame and poor self-concept, which may make it harder for them to seek help for substance use. Research suggests that substance use treatment for LGBTQ+ people is more effective when it directly addresses internalized homophobia or transphobia.


2. Queer and Trans Affirming Treatment: LGBTQ+ individuals may benefit from treatment that is affirming of their sexual orientation and gender identity. Affirming treatment recognizes and validates the unique experiences, identities, and needs of LGBTQ+ individuals. It is a treatment approach that affirms and supports LGBTQ+ individuals, and recognizes that heterosexuality and cisgender identities are not the only valid ways of being. As MSW graduates, Stillwaters therapists are trained to look at the relationship between the client and their relationship, and to make connections about how a non-supportive environment (either in the present or the past) may shape ways of coping in the present.


3. Addressing Trauma: LGBTQ+ individuals are more likely to have experienced trauma related to their sexual orientation or gender identity, such as rejection from loved ones or discrimination at work or school. Trauma dysregulates the nervous system, leading to overwhelming emotions and sensations in the body, and for some people, substances are a way to live with these feelings. LGBTQ+ affirming therapists consider the role of trauma in an addiction or substance use problem.


4. Building Social Support: LGBTQ+ people frequently face social isolation and may benefit from connecting with a supportive community. Treatment providers can help connect clients with LGBTQ+ support groups and resources to help build a sense of community and reduce the impact of isolation.


4. Addressing Co-Occurring Mental Health Disorders: Mental health disorders such as depression or anxiety are more common in the LGBTQ+ community, and may co-occur alongside substance use problems. LGBTQ+ affirming treatment providers don’t just look at the substance use problem, but consider the whole person, including their mental health, physical health, and social environment in order to develop a comprehensive treatment plan.


Internalized Homophobia and Transphobia


Addressing internalized homophobia and transphobia is a crucial part of substance use treatment for LGBTQ+ individuals. Internalized homophobia refers to negative attitudes and beliefs about one's own sexual orientation or gender identity that LGBTQ+ people “take on” and start to believe about themselves due stigma and discrimination in their families or in society.


One study, published in the Journal of Substance Abuse Treatment, found that among a sample of LGBTQ individuals seeking substance use treatment, those with higher levels of internalized homophobia had poorer treatment outcomes, including less time in treatment and a higher likelihood of relapse. This research supports the idea that addressing internalized homophobia in substance use treatment may be important for improving outcomes in this population.


Internalized homophobia may impact substance use treatment in several ways:


1. Barriers to Seeking Treatment: LGBTQ+ individuals who have internalized homophobia may feel shame or fear related to their sexual orientation or gender identity, which can make it difficult for them to seek treatment for substance use disorders.


2. Difficulty Building Trust with Providers: If LGBTQ+ people feel shame, fear, or trauma related to their sexual orientation or gender identity, they may find it hard to build trust with substance use treatment providers. This can make it difficult for providers to establish a therapeutic relationship and deliver effective treatment.


3. Self-Medicating to Cope: LGBTQ+ people who live with internalized homophobia may use substances as a way of coping with negative feelings related to their sexual orientation or gender identity. This can lead to a higher risk of developing substance use disorders and make treatment more challenging.


4. Poor Treatment Outcomes: Research suggests that LGBTQ+ people with internalized homophobia may have poorer treatment outcomes for substance use disorders compared to those without internalized homophobia. This may be due to a range of factors, including difficulty engaging in treatment, stigma-related stress, and challenges in building social support.


The Benefits of an LGBTQ+ Affirming Therapist



As a queer or trans person seeking substance use treatment, it may be beneficial to work with a therapist who is affirming of your sexual orientation or gender identity. An affirming therapist is someone who is knowledgeable about LGBTQ+ issues and is accepting and supportive of LGBTQ+ individuals. Some people find it helpful to work with a therapist with lived experience in the LGBTQ+ community, because it eliminates a level of shame and the possibility of being misunderstood, which can interfere with feeling comfortable talking about vulnerable issues in therapy.


Here are some reasons why working with an affirming therapist may be beneficial:


1. Reduced Stigma and Discrimination: LGBTQ+ individuals may face discrimination and stigma in society, including in healthcare settings. Working with an affirming therapist can help reduce the risk of encountering negative attitudes or beliefs related to sexual orientation or gender identity.


2. Improved Treatment Outcomes: Research has shown that LGBTQ+ individuals who work with affirming therapists have improved mental health outcomes compared to those who do not. This may be due to feeling more accepted and understood by their therapist.


3. Better Therapeutic Relationship: Working with a therapist who is affirming of your sexual orientation or gender identity can help build trust and rapport in the therapeutic relationship. This can make it easier to discuss sensitive topics related to substance use and mental health. The quality of the therapeutic relationship is one of the best predictors of how successful therapy will be in meeting treatment goals.


4. Addressing Unique Needs: As discussed earlier in this post, LGBTQ+ individuals may have unique needs related to substance use treatment, such as addressing internalized homophobia or building social support. An affirming therapist can help address these needs in a supportive and understanding way.


Not all LGBTQ+ people feel the need to work with an affirming therapist! Ultimately, the most important factor in choosing a therapist is finding someone who is knowledgeable, empathetic, and supportive of your individual needs and goals in treatment. For some people, bring LGBTQ+ affirming is an important part of getting the right “fit,” but for other people, other factors are more important. If you are interested in finding out if one of our Stillwaters counsellors might be a good fit, I encourage you to book a consultation in our online calendar or get in touch by email! We look forward to working with you.




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