Treatment Access and Experience

Sexuality diverse people access treatment for alcohol use at higher rates than heterosexual people. In Australia, GB men have twice the odds and LB women three times the odds of having ever attended substance use treatment compared to heterosexual people. There is no evidence on gender diverse people’s treatment seeking. Sexuality and gender diverse people entering substance use treatment are more likely to have mental health comorbidity and/or accessed mental health treatment.

A central concern in the literature is that an inability to be honest and open about sexuality or gender will leave patients unable to undertake the therapeutic work necessary to address the issues that contributed to the onset of their alcohol problems, maintenance of those problems and the risk of relapse . There is evidence of lower levels of satisfaction and connection with treatment, with LGB people feeling vulnerable, unsafe, isolated, alienated, or misunderstood. Gender diverse people report much lower levels of feeling supported, ability to be honest and open, satisfaction, program completion and abstinence. Levels of openness with staff has been positively associated with feeling therapeutically supported and connected to treatment, and with program completion, and negatively associated with leaving treatment or being discharged; there was no association with abstinence.  

Disclosure of sexuality or gender identity is a personal risk, with many patients having direct experience of discrimination in healthcare or vicariously experienced discrimination through the accounts of others. Disclosure decisions by patients are often made on a practitioner by practitioner, consultation by consultation basis. Health care providers tend not to ask about sexuality believing it is the patient’s responsibility to disclose. Health care providers who are uncomfortable with or actively hostile towards sexuality or gender diverse patients may fail to acquire clinically important information about the potential impact of stress and distress related to having a minority identity, the patient’s support and social network and the role of alcohol in their social networks¹. Health care providers report they are not receiving education or training on providing care for sexuality and gender diverse patients.

¹ Substance Abuse and Mental Health Services Administration. (2012). A provider’s introduction to substance abuse treatment for lesbian, gay, bisexual, and transgender individuals. Retrieved from Rockville, MD