Substance use among diverse lesbian, gay, bisexual, and transgender populations: A qualitative investigation

Research has found elevated rates of substance use and abuse among lesbian, gay, bisexual, and transgender (LGBT) populations, yet less is known about unique factors that might contribute to these problems. Furthermore, little is known about the recovery process for LGBT people with substance abuse problems. We investigated these questions by conducting semi-structured interviews and focus groups with ethnically diverse LGBT adults from urban and rural areas of Washington State. We specifically recruited LGBT people in recovery, those with current substance use, and those who abstain. One hundred nineteen participants were interviewed, 46% of whom identified as persons of color. Interviews were transcribed and analyzed using a grounded theory approach in Atlas.ti version 5.0 software. Regarding pathways to substance abuse, participants noted many reasons common to other populations, including family history, life stressors, and mental health problems. Two interrelated, LGBT-specific themes were revealed: minority stress and cultural norms. Participants discussed how negative experiences associated with coming out, discrimination, internalized homophobia, lack of safety, and longing for connection contributed to the initiation and maintenance of substance use problems. Cultural norms in LGBT communities, shaped in part by the availability of resources and the broader social context of heterosexism, also were linked to substance abuse. Regarding challenges in recovery, themes included discrimination and harassment by providers and other patients, as well as difficulty finding providers and programs that could address unique LGBT issues. Implications for public health practice, as well as suggestions for future research in this area, will be discussed.