The lesbian community has been vastly underserved in mental health and addiction services so it should come as no surprise that alcohol and drug abuse is a major concern for individuals identifying as lesbian.  A report published by SAMHSA in 2011 found people who identify as LGBT (lesbian, gay, bisexual and transgender) are significantly more likely than the general population to use and abuse drugs or alcohol. This same study found lesbians are significantly more likely than heterosexual women to drink alcohol heavily. Another study published in 2004 from the Journal of Gay & Lesbian Social Services noted the incidence of substance abuse among lesbians is far higher than their heterosexual peers.  Knowing this what  are some of the key barriers to keep lesbians from getting the services that they deserve?  The following five themes highlight some of these key barriers:

(1)   Internalized Shame & Guilt: Addiction is a disease that coincides with tremendous shame and guilt. Many lesbians already struggle with internalized shame and guilt surrounding their sexuality, possibly having experienced rejection from family or friends, or simply as a result of living as a minority in today’s society rampant with hetero-sexist messages. Dealing with both their addiction and sexual orientation can feel like a double whammy, piling shame on top of shame.

(2)   Self-Medication: It is not uncommon for lesbians to use drugs or alcohol to self-medicate or numb themselves from feelings (such as inadequacy, shame, isolation, abandonment, sadness or anger) resulting from their sexual orientation. Unfortunately, this coping mechanism eventually backfires and the “solution” to the problem becomes worse than the problem itself. Drinking or using drugs to numb shame or other feelings may provide some temporary relief, but ultimately this coping strategy creates new problems and does nothing to resolve the feelings one tries to numb away.

(3)   Social Scene: The LGBT social scene is centralized in bars and clubs. Often, lesbians feel there is no way to be sober and remain social in the lesbian community. It is important to understand that the lesbian social scene provided in bars and clubs has specific meaning and importance. These places provide one of the only spaces where lesbians feel a sense of total acceptance, confident to fully be who they are, and allowed to safely and openly to show affection to loved ones.

(4)   “You’re Only as Sick as Your Secrets”: Honesty is one of the key principles of recovery. Lesbians may feel unsafe or uncomfortable outing themselves in treatment centers or 12-step meetings. The inability to express one’s true self can inhibit an individual’s ability to fully recover in mind, body, and spirit. Addiction treatment programs specializing in LGBT-specific concerns can offer lesbians struggling with drug or alcohol addiction a safe and supportive space in which they can fully heal and recover.

(5)   Spirituality vs. Religion: There is a common misconception that the spiritual foundation of 12-step programs is religious. This misconception may create a significant barrier to recovery. The idea of being forced back into religion could instill major resistance in lesbians whose religious upbringings may have been filled with shame, guilt, fear and rejection. It is important that addiction treatment programs educate lesbians about the difference between spirituality and religion, and provide an open setting for lesbians to identify their own conception of spirituality and a loving and accepting higher power.

Lesbians struggling with addiction face unique barriers that are critical to understand and address in treatment.  With this in mind, it is up to us as mental health clinicians to do better for the lesbian community.

Women snorting cocaine image available from Shutterstock.