Addiction and Sexual and Gender Diversity

When it comes to addiction services, LGBTQI+ people do not feel understood, supported or even considered

Seeking help

LGBTQI+ people who use drugs also have the right to reach out and be helped, yet many countries still criminalize same-sex relationships, and violence and discrimination are widespread – Photo by Alexander Grey on Unsplash

By the editorial team – According to the Universal Declaration of Human Rights, “all human beings are born free and equal in dignity and rights”. Yet some people are a little ‘less equal’ than others, and this so-called equality remains a chimera. People who do not conform to normative sexual orientation and gender continue to face social stigma, violence and even criminalization simply for being who they are: people who identify as lesbian, gay, bisexual, transgender, queer/questioning and intersex (LGBTQI+).


The reason for this? A largely heteronormative culture that tends to oppress and marginalize expressions of gender and forms of sexuality that are perceived as non-standard, and therefore deviant.

This mental and cultural framework, in which heterosexuality is perceived as ‘normal and natural’, fosters a system in which LGBTQI+ people are discriminated against in areas such as marriage, employment, taxation and access to health services, in flagrant violation of their fundamental rights. Worse still, this hegemonic heteronormative culture fosters stigmatizing attitudes towards these sexual minorities, attitudes that themselves often contribute to the psychological difficulties they face. Heteronormative culture opens the door to violence, from its most symbolic expressions (e.g. LGTBIphobic jokes) to its most alarming, such as hate crimes and assaults.

The burden of stigma

Stigmatization of LGBTQI+ people refers to negative attitudes, beliefs and stereotypes towards people who identify as such. Despite significant progress since the 1980s in recognizing the rights of sexual and gender minorities, these stigmatizing attitudes and sometimes violence against them persist.

Stigma can take many forms. For example, there is internalized stigma, or self-stigma, where people internalize negative attitudes and beliefs about their sexual orientation, gender expression or gender identity, which can lead to feelings of shame and self-hatred. Finally, there are all forms of institutional stigma, which can lead to unequal treatment or even marginalization of LGBTQI+ people, particularly in education, employment and health services.

Mental health and substance use

Throughout their lives, LGBTQI+ people face stress, discrimination and violence of all kinds, which affects their mental health. Research has shown, for example, that lesbian, gay and bisexual people are at increased risk of experiencing a major depressive episode and are twice as likely to attempt suicide as those whose sexuality is exclusively heterosexual. Studies also show that the deterioration in mental health is largely due to the physical and/or verbal violence to which these people are particularly exposed.

Moreover, because of their impact on the mental health of LGBTQI+ people, these stressors also increase their risk of resorting to substance use as a coping strategy, and thus of suffering from substance use disorders. In fact, the prevalence of substance use is particularly high among people from diverse backgrounds, in part due to the stigma and self-stigma they face and the invisibility of their realities, resulting in a lack of adequate models of indicated prevention.

Access to addiction services

It is well known that LGBTQI+ people who use drugs and have problems resulting from their use tend to avoid seeking help from addiction services or care providers because of past or anticipated experiences of discrimination.

In addition to the stigma and discrimination they face, there are many other barriers. These include the lack of training and awareness of addiction professionals (and of other health services in general) about the problems and realities of LGBTQI+ people; the low level of knowledge about their realities and the lack of expertise among teams; the lack of specialized providers and services; the absence of an intervention model that meets their specific needs; and even the inadequate use of language and verbal and non-verbal communication tools by professionals.

All these barriers mean that LGTBIQ+ people who use drugs do not feel understood, supported or even considered in the field of addiction and health and social services in general. As a result, they do not seek the help they need, or the few who do, do not stay in treatment.

An intersectional approach is essential

Caring for these people requires a holistic approach that takes into account the barriers they face as well as their specific and diverse needs. The intersectional approach makes it possible to take into account the multiple and intersecting areas of discrimination that LGBTQI+ people who use drugs face, particularly in terms of access to employment, housing and health care, but also in terms of their legal or judicial situation, financial problems, or ethnicity, among others.

Finally, although we have referred to the LGBTQI+ population as a whole in this short article, it should be remembered that it is essential to consider and recognize the multiple experiences and realities of the individuals who make up this population. L.G.B.T.Q.I.+. Each letter represents a different reality and a unique set of needs.

This is why it is crucial, particularly in the field of addiction, to promote an inclusive model of intervention, capable of meeting the needs of all, in safe spaces where people can express themselves without being singled out or discriminated against.