LGBTQ+ individuals recommend strategies to promote affirming substance use treatment care

A new study by doctoral alumna Dr. Margaret Paschen-Wolff and colleagues, published in Substance Abuse Treatment, Prevention, and Policy, offers concrete recommendations for delivering LGBTQ+-affirming care for substance use and disorders, which could reduce disparities and drug overdose mortality overall.

LGBTQ+ individuals have higher rates of substance use and disorders compared to heterosexual and cisgender populations. Such disparities can be attributed to minority stress, including stigma and discrimination in health care settings. LGBTQ+-affirming treatment and related services remain limited.

The study—part of a Smithers Pilot Grant for Research Related to Substance Use Disorders—sought to characterize LGBTQ+ people's experiences in substance use services and recommendations for LGBTQ+-affirming care from the perspective of LGBTQ+ people with lived experience in substance use treatment and related services.

The findings demonstrate that LGBTQ+ people continue to experience discrimination and stigma within substance use services at multiple levels, including from peers, providers, and organizational structures; yet many LGBTQ+ individuals also experience support from the same sources. Such discrimination can exacerbate minority stress processes such as identity concealment, and stress coping responses like substance use relapse, while support can assuage negative outcomes of minority stress and facilitate treatment engagement and retention.

Based on their experiences with substance use programming, the participants recommended a range of strategies to promote affirming care, including non-discrimination policies, LGBTQ+-specific and gender-affirming programming, rigorous staff training, and direct LGBTQ+ client involvement in substance use treatment planning and policy making.

"This study offers concrete recommendations from the perspective of LGBTQ+ people who have been in treatment themselves," says Paschen-Wolff. "Future research could further explore how to effectively develop, implement, and evaluate the recommendations described in this study. It is my hope that the study findings will be used in real-world substance use treatment and service settings to ensure that programming is welcoming and affirming of all LGBTQ+ people and to promote positive health outcomes for our communities."