Why are there no Straight Answers: Substance Misuse Issues within Lesbian, Gay, Bisexual and Transgender Communities.
This paper will look at the unique substance misuse issues associated to the lesbian, gay, bisexual and transgender/sexual communities (LGBT). The LGBT communities have been acknowledged for having higher rates of substance misuse and dependency than the general population whilst being early adopters of any new recreational or misused drug to enter the illicit market. In comparison to the general population, 32.8% have tried drugs as opposed to 10%, and LGBT are more inclined to be poly drug users (UKDPC, 2010). Although the UK has mainly limited or smaller, localised studies, these statistics also reflect the findings of respected published studies from Australia and the USA. To clarify these findings, it is essential to determine why LBGT persons are more predisposed to using substances, therefore it is essential to look at the cultural and social dimensions defining this minority group.
Lesbian and gay men are a substantial and increasingly visual minority of the UK population, with new statistics from the Department of Trade and Industry estimating that approximately between 1.5% and 6% of the population will identify with this group (ONS, 2010). As a result, it is essential to determine how these communities are constituted and defined, in order to relate and review their substance misuse patterns. The lesbian and gay community is constructed of subgroups and each subgroup has its own distinct culture, with its own books, magazines, newspapers, music, activities, interests and meeting places. Additionally, within each subculture there are many smaller subdivisions therefore the terms lesbian and gay refer not to sharp, definable communities but to relaxed aggregates of people who are diverse in character, values and attitudes. Members of some of the subcultures may never intermix with others, whilst others may work together on common social and political goals or may share certain social activities.
According to (Cabaj, 1989), three characteristics distinguish sexual minorities from everybody else: (a) having a sexual orientation that leads to the desire to have affectionate, sexual, sexual fantasy, and/or social needs met by a same sex partner than an opposite sex partner; (b) needing to negotiate a process of self-identity and self recognition as a gay man or woman who is different from the majority – a process known as coming out; (c) confronting widespread, culturally sanctioned and insidious dislike, hatred, and/or fear of gays and lesbians, their sexual activities and homosexual/gay feelings, known as homophobia. Transgender and Transsexual persons are often indiscriminately compiled within the group of LGBT although LGB are identified by their sexuality or sexual identity, Trans people should be identified by their gender. Research into Trans people and substance misuse as a primary subject is very scarce therefore there will be limited referral to research exclusive with this group.
To understand the sexual minorities, it is essential to distinguish between gender identity and gender role, which are often erroneously used interchangeably, and to emphasise the difference between sexual orientation and sexual behaviour. Sexual orientation refers to the desire for sex, love and affection from or with another person including fantasies whereas sexual behaviour refers strictly to sexual activities or conduct. For any individual, sexual behaviour may not always or consistently coincide with the more primary and enduring sexual orientation. For example, a gay man may be homosexual in orientation yet behave heterosexually. Gender identity is simply the sense of self as male or female. Gender role refers to the propensity to carry out “everyday” behaviours which are viewed as appropriately masculine or feminine by mainstream culture.
Gay men and lesbians have through their sexual orientation, self identified themselves as a sexual minority. That is they recognise that through the use of language or symbolic expressions that their sexual orientation places them apart from the sexual mainstream even though they may not describe themselves as “gay” or “lesbian.” Central to the definition is the view that gay men and lesbians see their relationships and connections to the same sex as primary, whether acted upon or not and identify themselves as outside the sexual mainstream.
Some gay women perceive choice as an important element in their sexual orientations whilst gay men, on the other hand, typically perceive their sexual orientation as a given, a central aspect of themselves, and feel that choice has little to do with it. Lesbians appear to perceive affectionate orientation and relationship dynamics as central to their self definition, while gay men appear to view sexual behaviour and fantasy as central. It may also concede that the nature of sexual orientation is different for men. Many of these reasons can help differentiate between the levels, patterns and substance choice that can occur between lesbian and gay men (Mc Crady & Epstein, 1999).
The LGBT's drugs of choice tend to be recreational (party) drugs which tend not to be adequately covered with the UK's drug strategy. The current drug treatment strategy is mainly aimed towards opiod and crack cocaine users within the criminal justice system with little emphasis towards the substances used by the majority. The substances most commonly abused within the community and with noted higher levels than the general population are tobacco, cannabis, alcohol, amyl nitrate (poppers), cocaine, GHB and ketamine. Crystal methamphetamine is a substance used considerably higher by gay men than lesbians although its usage in the UK has not seen proportions like the USA, Australia and certain Eastern European countries. It has been found that a small percentage within certain groups of gay men abuse this substance regularly (Bonelli & Weatherburn, 2008). Another substance which has been found to be abused with the community, mainly by gay men is anabolic steroids. With the emphasis on image and presentation by many gay men with the added pressure to achieve and maintain this look, gay male gym users have been found to use anabolic steroids (Bolding & Hart, 2002) (Sigma & THT, 2009).
The LGBT persons tend to have higher incidences of psychological distress, mental illness and dual diagnosis than the general population. It has been found that gay and bisexual men are five and a half times more likely to self harm whilst lesbians are two and a half times compared to their heterosexual counterparts (Skegg, 2003). Gay men are more likely to commit suicide than their straight peers with a research project at University College London Hospital finding “significantly” higher rates of mental illness than others. It is likely that social hostility, stigma and discrimination that most LGBT experience is to be at least a part of the reason for psychological morbidity (Bennett, 2004). Many of the figures could be understated due to the lack of acknowledgement towards sexuality when compiling the results of much of the available data. Prejudice towards homosexuality is unlike other intolerances as it can reach within the family unit. It has been found that rejection by siblings and parents can have a detrimental effect on emotional wellbeing (CSIP, 2008).
The social exclusion of LGBT people encourages social contact within specific LGBT venues such as clubs, pubs and bars. This social environment will encourage and promote substance misuse with access to alcohol and drugs within these venues aggravating mental distress. Young gay and lesbian people are very vulnerable to adopting patterns of substance misuse, in particular, homeless youth. The majority of homeless youth in studies in Brighton and London cite their sexual identity or transgender identity as the primary or a main reason to becoming homeless (Cull, Platzer, & Ballock, 2006).
An important aspect of this paper is the association between drug use and HIV transmission or status. It has been found that HIV gay men are more inclined to take substances and to use poly substances (Aguinaldo & al, 2009, pp. 1395-1406). There has been found a link between unsafe sexual intercourse and substance use through many studies, GHB, Crystal methametaphine, ketamine and Amyl Nitrate are popular drugs within some gay men's groups as aids towards sexual pleasure and intensity. With the exception of Amyl Nitrate to an extent, the other drugs are known to make the user lose inhibitions and more inclined to indulge in unsafe sexual practice possibly over long periods of time and with multiple partners. Alcohol has often been cited by participants within surveys for their HIV seroconversion. It has been found that people of HIV status are more inclined to use drugs and be more inclined to have unsafe sex. Research from the USA into the use of Crystal methamphetamine and HIV transmission found that gay men were twice as likely to practice unsafe sex whilst using this substance compared to the next drug. In the UK, although Crystal methamphetamine is not used at proportions as seen in the USA or Australia, one in 10 gay men reported taking it within the last 12 months and most used it infrequently. However HIV positive men were one and a half times more likely to use it than their negative status counterparts.
From much of the studies and reports into substance misuse between LGBT, it was found that there were high incidences of poly drug use. The most commonly used in combination were tobacco and alcohol (predictably) although these users were found more likely to use other substances. A common combination of substances included Viagra in many studies. Excessive use of most drugs and alcohol can affect sexual performance. Usage of Crystal methamphetamine which is a stimulant like cocaine but with a stronger high and can last longer (sometimes days), with a heightened insatiable arousal is one drug which is used in combination with Viagra (THT, 2006). A substance user's age is also taken into account when taking this drug.
LBT women have shown lower rates (in terms of percentage of the groups) of substance abuse amongst the whole LGBT community with exception to cannabis and tobacco. However, a 2007 study in the West Midlands found that the smoking rates for women aged 16 years or older were reported between 25-37% against an average of 7% of the general female population, lesbian and bisexual women were almost twice as likely to consume alcohol on three or more nights as heterosexual women (Meads & Buckley, (1995-2005) (2007)). Transsexuals' substance usage is not documented very well although due to the inner conflict of gender dysphoria, social exclusion, discrimination and the other challenges they face, what is known, their usage of substances is high (Purnell, 2004). Many have alternative lifestyles and are living on the fringes of society with this group having the highest representation per capita in sex work than any other.
The treatment needs of the LGBT groups have been neglected and a significant number have expressed the problems of institutionalised sexism and homophobia. LGBT substance misusers are associated with recreation “party” drug use as opposed to heroin or crack cocaine as stated earlier, treatment options may not be available towards them. There is only one clinic within the UK which is set up to deal with the effects of party drugs, after one year its leading consultant, Dr James Bell found that its main service users were young gay men. The South London clinic is the only clinic within the UK to offer withdrawal treatments from GBL/GHB whilst acknowledging that many drug services do not recognise the extent and intensity of addiction to such and similar classed drugs (Bell, 2010). There are insufficient drug and alcohol services which cater to GLT needs within a non judgemental environment. Many service users have negative experiences of staff attitudes or a service not taking the LGBT aspect within the treatment program. As many substance users may have used substances to mask conflict or turmoil of their sexuality or identity, addressing this is an important means towards recovery (Fish, 2010).
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