Sexual orientation/gender identity as a predictor of co-occurring disorders and treatment outcomes among clients seeking publicly funded substance abuse treatment services in Washington State

Aims: To compare risk markers associated with lesbian/gay/bisexual/questioning sexual orientation or transgender identity (LGBTQ) at admission to substance abuse (SA) treatment, and to examine orientation/identity as a predictor of co-occurring disorders (COD), treatment completion, and subsequent treatment reentry in the year following discharge.

Methods: A retrospective cohort study using data from publicly funded SA treatment services in Washington State from 2004-2008. Bivariate comparisons were conducted using chi-square tests; logistic regression was conducted to estimate adjusted odds ratios (AOR) and 95% confidence intervals (CI) for each outcome.

Results: Risk markers associated with LGBTQ status included increased past year healthcare utilization, SA severity, self-reported SA treatment need, and COD; some factors varied among females and males. In multivariate analyses, female and male LGBTQ clients were more likely than heterosexuals to have COD (AOR 2.26, CI 1.99-2.58 and AOR 3.55, CI 3.06-4.12, respectively). LGBTQ males, but not females, were less likely to complete treatment (AOR 0.78, CI 0.65-0.93). Neither females nor males were more likely to re-enter treatment compared to heterosexuals. COD was independently and negatively associated with treatment completion and positively associated with treatment re-entry.

Conclusions: These findings suggest that LGBTQ clients seeking SA treatment are more likely to have more severe SA and COD, and male GBTQ have poorer treatment outcomes. Primary and secondary prevention efforts in SA and mental health should be a priority in programs focused on LGBTQ clients; assessing substance abuse and COD among LGBTQ clients in social service and healthcare settings may help to identify treatment needs.