A personal perspective about new data on behavioral health patterns in the LGB community

Editor’s Note: Richard Wolitski, Ph.D., Director, Office of HIV/AIDS and Infectious Disease Policy, U.S. Department of Health and Human ServicesWe know that homophobia and discrimination take a toll on the lives and health of lesbian, gay, bisexual and transgender (LGBT) women and men. Homophobia and discrimination create negative ripple effects that can cause LGBT people to experience a range of health problems. Last week, SAMHSA published data from the 2015 National Survey on Drug Use and Health that provide even more evidence that LGBT people experience higher rates of substance use and mental illness. These challenges can also place them at greater risk for HIV infection and other health issues. But by working to stop stigma and discrimination before they start—and by providing support, mental health services, and medical care that are culturally competent and affirming—we can break the chain, improve LGBT lives and health, and create a new future for ourselves and generations to come.

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As I began my recovery journey 24 years ago I made an important connection between my use of alcohol and drugs and the unresolved issues of my sexual orientation. Coming out as a gay man in early recovery offered me ample opportunities to explore both internalized and externalized shame, as well as the events of trauma that caused me to feel this misplaced shame. For me, the use of alcohol, drugs, and even tobacco was a way to cope with these issues. Feelings of isolation and a lack of acceptance are only some of many reasons that can lead to higher rates of substance use or mental illness for lesbian, gay, and bisexual adults.

For me, my substance use was also tied to one of the most important social spaces in gay culture – the nightclub. While it can be a place of safety, solidarity, and affirmation, most nightclubs also provide an environment awash with alcohol. Some nightclubs offer easy access to other drugs as well. As my substance use problems progresses, I came to realize that this was not an ideal environment for me. Early in my recovery, it was important to me to find community spaces that were supportive of me as both a gay man and someone who chose not to use alcohol or drugs.

My experiences were not totally unique. SAMHSA recently released the 2015 National Survey on Drug Use and Health and found that sexual minority adults — those who identify as lesbian, gay, or bisexual — have a higher prevalence of substance use and mental illness than adults who identify as heterosexual.

Specifically, the survey found that:

• Sexual minority adults were more likely to have participated in binge drinking in the past month than adults in the sexual majority —36.1 percent versus 26.7 percent
• Sexual minority adults were more than twice as likely to have used an illicit drug in the past year as other adults —39.1 percent versus 17.1 percent.
• Females in sexual minority groups were more likely (41.1 percent) than males in sexual minority groups (36.3 percent) to have used illicit drugs in the past year.
• Sexual minority adults were more than twice as likely to have experienced any mental illness in the past year —37.4 percent versus 17.1 percent for adults in the sexual majority.
• Sexual minority adults were more than three times as likely to have experienced serious mental illness in the past year —13.1 percent versus 3.6 percent for adults in the sexual majority.

While these rates raise many questions and concerns, the report does contain some good news. The findings show that lesbian, gay, and bisexual adults are more likely to seek help and treatment for both substance use disorders and mental illness. This presents a positive foundation for SAMHSA to build upon as we work to promote effective treatment – as well as prevention and recovery – to help lesbian, gay, bisexual, and, yes, transgender individuals, families, and communities achieve wellness.

The report, Sexual Orientation and Estimates of Adult Substance Use and Mental Health: Results from the 2015 National Survey on Drug Use and Health is available at https://www.samhsa.gov/data/sites/default/files/NSDUH-SexualOrientation-2015/NSDUH-SexualOrientation-2015/NSDUH-SexualOrientation-2015.htm.