LGBTQ trauma and substance use are connected because stigma, rejection and violence can leave lasting trauma, and some people drink or use drugs to cope with the symptoms. Treating trauma and addiction together, in a program that affirms your identity, lets you work on both at the same time.
If you are thinking about suicide or are in danger right now, call or text 988, or call 911 in an emergency.
How are trauma and addiction connected for LGBTQ people?
SAMHSA, the Substance Abuse and Mental Health Services Administration, describes trauma as a harmful or frightening event, or set of events, that has lasting effects on your wellbeing. After trauma, your nervous system can stay on alert long after the danger has passed.
Alcohol and drugs can quiet that alarm for a while. Over time, the substance use adds its own harm, and trauma and addiction start to make each other worse.
For many LGBTQ people, trauma comes from how others react to their sexual orientation or gender identity. That makes LGBTQ trauma a response to how a person has been treated, and never a flaw in who they are.
Is there a link between trauma and substance use for everyone?
Yes. The link between trauma and addiction shows up across many groups, which is why SAMHSA recommends trauma-informed care in addiction treatment. LGBTQ trauma adds identity-based experiences on top of the traumas anyone can face.
What kinds of trauma do LGBTQ people experience?
LGBTQ people can go through the same traumas as anyone, such as accidents, abuse or the death of someone close. Many also face trauma tied to identity, and the prevalence of these experiences is one reason affirming care matters:
- Family rejection after coming out, including being told to leave home
- Bullying, harassment or threats at school, at work or online
- Physical or sexual violence aimed at sexual orientation or gender identity
- Pressure to take part in efforts to change sexual orientation or gender identity
- Repeated discrimination in housing, jobs or health care
- Everyday slights and misgendering that build up over years
Not every LGBTQ person goes through these, and trauma looks different for each person. Transgender and nonbinary people often describe being outed, being misgendered and facing discrimination in medical settings as part of their trauma.
The VA's National Center for PTSD explains that trauma includes assault, abuse and violence, and is not limited to combat or disasters. The PTSD symptoms it describes include reliving the event, avoiding reminders, negative changes in mood and thinking, and feeling constantly on edge.
How does minority stress contribute to trauma and substance use?
Minority stress is the extra strain a person carries when they belong to a group that faces stigma, prejudice and discrimination. It includes outside pressure, such as harassment, and inside pressure, such as hiding who you are or expecting to be rejected.
Minority stress is a risk factor, meaning it can raise the chance of a problem without causing it on its own. It can wear down sleep, mood and trust, and it can make alcohol and drugs feel like the only way to get through the day.
Internalized homophobia is one inside form of this stress. It means turning negative messages about sexual orientation against yourself, and a similar process can happen with gender identity. Internalized homophobia often shows up as shame, and shame is a common reason people use substances alone and in secret.
Why are LGBTQ people at higher risk for substance use disorders?
SAMHSA's national survey data show higher rates of substance use and mental health conditions among lesbian, gay and bisexual adults than among heterosexual adults. That gap is linked to minority stress, trauma and discrimination rather than to sexual orientation or gender identity itself.
Does using substances to cope with discrimination count as self-medication?
Yes, that is often what people mean by self-medication. Some trauma survivors drink or use drugs to sleep, calm down, feel numb or feel safe in social settings, and that relief can slowly turn into a substance use disorder. Seeing it as a way of coping makes it easier to talk about in treatment without shame.
Can family rejection lead to trauma and substance use in LGBTQ youth?
Family rejection can be traumatic at any age, and it can hit hardest for young people who still depend on family for a home and support. Losing that support can cut a young person off from their social networks and make substances feel like the only relief. Acceptance from family, when it is possible, can help protect a young person's mental health.
Is PTSD more common among LGBTQ adults?
PTSD appears to be more common among LGBTQ adults, largely because of higher exposure to violence, harassment and rejection. PTSD symptoms, anxiety and depression often appear alongside substance use, and when they happen together they are called co-occurring disorders.
What is integrated treatment for co-occurring trauma and substance use?
Integrated treatment means one team treats trauma and addiction in the same plan, at the same time. At Enhance Health Group this is part of dual diagnosis care, so you do not have to finish addiction treatment before you can start healing from trauma.
When withdrawal or safety is the immediate problem, detox or crisis care comes first. Trauma therapy starts once you are stable enough, and your therapist sets a pace you can manage.
Most trauma therapy happens in outpatient care or IOP, which runs a few hours a day, several days a week. A higher level of care fits when your safety or your substance use needs more support.
Which therapeutic modalities are used?
Your clinician chooses therapeutic modalities after your assessment, and a plan may combine several of these:
- Eye movement desensitization and reprocessing (EMDR), a trauma-focused therapy for painful memories that starts only when you both agree you are ready
- Cognitive behavioral therapy (CBT), which helps you change the beliefs trauma left behind
- Dialectical behavior therapy (DBT), which teaches skills for strong emotions and urges to use
- Group therapy led by a licensed therapist, where you practice skills with other people in recovery
- Family sessions, if you want family or chosen family involved
- Medication prescribed by a licensed psychiatrist, when it is part of your plan
How does trauma-informed care support LGBTQ people in addiction treatment?
Trauma-informed care means every part of treatment is designed to avoid causing more harm. SAMHSA's approach names safety, trust, peer support, collaboration, choice, and attention to culture, history and gender as its core principles.
For someone healing from LGBTQ trauma, stigma inside a treatment program can feel like a new injury. At Enhance, staff use your chosen name and pronouns, your assessment includes questions about identity, and you decide how much to share and whether family joins your sessions.
Cultural competence is part of the same idea. It means a care team understands how sexual orientation, gender identity, race, faith and family background can shape trauma, and takes them into account in the plan.
What should LGBTQ people look for in an affirming treatment program?
Ask these questions on the first call, and notice whether the answers are clear and direct:
- Will staff use my chosen name and pronouns in sessions and records?
- Does the assessment ask about identity, trauma and substance use?
- Can trauma and addiction be treated in the same plan?
- Is trauma therapy such as EMDR available, and who decides when it starts?
- Do I control whether family or chosen family takes part?
- How is my information kept private?
You can read how affirming LGBTQ care at Enhance fits into trauma and addiction treatment at every level of care.
How can you help an LGBTQ loved one with trauma and substance use?
Start by believing what they tell you about their experiences and using the name and pronouns they use. Ask what would help instead of pushing a plan, and offer practical support, such as looking up programs, sitting with them on a call or driving them to an appointment.
Seeking help for yourself counts too. Family support groups, peer support and LGBTQ community centers can connect you with people who have supported someone through trauma and addiction. Taking care of your own mental health makes it easier to stay steady for the person you love.
Can LGBTQ people use insurance for trauma and addiction treatment?
Yes, many health plans cover some mental health and addiction treatment, though benefits vary by plan. Enhance is in network with most insurance plans, and admissions checks your benefits with your insurer and explains your deductible and copay before you decide anything. Verification is not a guarantee of coverage.
Talk with admissions about trauma and substance use
You do not have to describe what happened to you on the first call. Call Enhance Health Group admissions at (714) 862-1907, and admissions will ask about your symptoms and explain which level of care fits. If you are in danger or may have overdosed, call 911, and for a mental health crisis, call or text 988.
