Over the past year I've lost 2 friends to drug overdoses and have read the stories of countless others. I felt like I had stood by and watched my friend kill themselves. Could I have done more? What if I had been there that last time could I have saved them?
While drug and alcohol abuse are not exlcusive to the LGBT community many of us face a unique set of circumstances that may make us more susceptible to substance abuse.
People often use drugs and alcohol to cope with stress or emotional pain, escape from problems, or gain acceptance. Although anyone can become addicted, certain people are at greater risk, including lesbian, gay, bisexual and transgendered individuals.
What makes lesbian, gay, bisexual and transgendered individuals particularly vulnerable to drug and alcohol addiction?
Emotional challenges, such as rejection and isolation, surrounding the process of coming out
Fears of physical violence, prejudice and discrimination
Strong sense of shame, particularly among those LGBT individuals who lack family support
Low self-esteem from feeling “different” or not being accepted by friends and family
Pressure to fit into the LGBT party scene or subculture
High rates of depression and anxiety, often prompted by the stigma of being gay
Past emotional trauma, often in the form of physical, sexual or verbal abuse
Bullying and harassment by peers, especially during adolescence
Due to these unique pressures and challenges, the LGBT community suffers from a higher incidence of substance abuse than the heterosexual population. Some of the drugs most commonly abused by lesbian, gay, bisexual and transgendered individuals are cocaine, ecstasy, GHB, meth, marijuana and alcohol. Studies have shown that:
An estimated 55 percent of gay men struggle with drug addiction.
LGBT youth are three times more likely than their heterosexual peers to become addicted to drugs.
LGBT individuals are less likely to seek help for addiction. This means they are more likely to be exposed to the health complications of prolonged drug abuse and to continue abusing drugs later in life.
Suicide rates among LGBT teenagers are significantly higher than their heterosexual peers.
Why are LGBT individuals reluctant to get treatment for addiction? Some have been treated by health care providers who were intolerant or unsupportive, while others may be afraid of disclosing their sexual orientation.
The most effective drug rehabs for lesbian, gay, bisexual and transgendered individuals are gay-friendly programs that offer specialized support. The ideal program is culturally sensitive, employs LGBT-sensitive staff, honors a culture of diversity, and has contacts with LGBT self-help support group and related resources. By participating in a LGBT-friendly drug rehab program, patients are more likely to feel understood, supported and accepted and are less likely to leave treatment early.
While it can be a challenge to find specialized gay drug rehab programs, there are a number of centers that are gay-friendly. These centers incorporate all of the traditional drug rehab components, such as counseling, life skills training, relapse prevention planning and aftercare, but with an emphasis on personal identity, family dynamics, a social support network and the internal turmoil that leads to substance abuse.
Since many LGBT individuals struggle with depression, anxiety and other addictions, dual diagnosis treatment is an important part of the recovery process. Patients with issues related to HIV/AIDS may need a facility that provides medication management and additional therapeutic support.
So what can you do if you feel a friend has a substance abuse problem?
1. How Can I Tell If I’m Overreacting to a Substance Abuse Problem?
If you are noticing problems in friend or family member’s work, health, family, finances, relationships, social functioning, legal issues, self-esteem or self-respect, you are not overreacting.
Continuing to use substances in spite of the fact that such behavior is causing problems is a problem in and of itself; it shows that substance use has become more important than the problems it causes. Someone who is unwilling to discuss the issue or consider whether there might be a problem is a strong indicator that a problem exists.
Some actions you can take:
* Read about the signs and symptoms of substance use.
* Observe the person’s behavior closely over a period of days or weeks to understand what leads you to think there is a problem. This information will be good to have if you decide to talk with other family members about the situation, seek advice from a professional or speak directly with the person. But don’t feel you need an exhaustive picture of the problem before
* Share your observations with other family members and friends to determine how they see the situation. If they agree there is a problem, figure out who will talk to the person about getting help.
* Contact a substance abuse professional, mental health professional, physician, employee assistance professional, guidance counselor, clergy or other helping professional to help you. Describe your family member’s substance use pattern to see whether the professional would deem it a problem. Provide details such as the type of alcohol or other drugs, how much the person is using, how often, how long the pattern has continued, negative consequences and the person’s response to discussions or confrontations about substance use.
* Ensure that you and other family members are safe from potential physical or emotional harm. If there is a threat or feat of physical violence you should develop a safety plan.
2. What Are the Benefits of Early Identification and Action?
Movies, books and magazines often portray people who “hit bottom” before they can be helped. However, this representation is a myth. People do not need to bottom out to be helped. Research shows that early identification of the problem is a much more effective solution for substance use problems.
Early identification occurs at the first signs of a problem — before anyone has suffered a traumatic event, dropped out of school or lost important relationships, jobs, their health or self-respect.
Identification can be done through a screening by a health care professional, employee assistance professional or even a family member. What happens after the screening depends on the results of the test. Some people can learn to cut back, while some need further assessment and possibly treatment.
In general, though, all people are better equipped to work on recovery if their substance use problem is discovered and confronted early. Treatment in the early stages of a substance use disorder is likely to be less intense, less disruptive and cause less anxiety.
Waiting for people to ask for help is a risky strategy. Without help, family members can expect crises like arrests, medical emergencies, job loss, public embarrassment and even death.
Also, as untreated problems continue, family members develop their own issues. Partners of people who have substance use problems can suffer greatly. Common symptoms include headaches, backaches, digestive problems, depression, anxiety and panic attacks. Children of substance users can experience school behavior problems and poor academic performance and are more likely to become substance users themselves.
It is not easy to live with someone who is using mind-altering substances. Taking steps to begin treatment and recovery can be a painful process, but it is the only path that holds promise for something better. As long as family members deny that there is a problem, the problem will progress and so will the suffering.
Start by getting help for yourself. Restore your own emotional stability and bring new direction and meaning to your life. You will be better equipped to deflect crises and arguments, and shift interactions with your impaired friend or family member. Getting help for yourself may seem counter-intuitive, but is crucial so you can better cope with the myriad problems that emerge and effectively overcome the obstacles to wellness and recovery.
Some people find when they seek help for themselves that the person with the substance use problem gets angry, perhaps because the efforts represent a loss of control. Also, getting help signals that you are serious about changing the situation.
Some people threaten those seeking help to stop their efforts. Remain firm in your resolve to go forward, and be aware of your personal safety.
It’s never too soon for you or for the substance user to seek help.
3. How Can I Bring Up the Subject with the Substance User? Will the Discussion Make the Situation Worse?
People often worry that initiating a discussion with the person with the problem will lead him or her to take drastic steps. They might make a scene in front of other family members, move out of the house, drop out of school, secretly drink or use other drugs even more and hide it from everyone or retaliate against them or other family members.
However, you might find the conversation to be a wonderfully productive experience. Perhaps the person simply hasn’t noticed behavior changes, or doesn’t realize that his or her substance use was a problem or was causing problems. And, without change, the problems may become so severe that the same drastic outcomes could result.
Following a few guidelines will help you have a discussion:
* Don’t bring up the subject when the person is under the influence of alcohol or other drugs. When people are high, they are less able to understand logic and are more likely to be impatient, dismissive, angry and blaming. Some people have poor impulse control and may act irrationally or violently if the subject is brought up while he or she is under the influence.
* Don’t be under the influence of substances yourself.
* Establish a time to talk when the two of you can have more than a few minutes alone. Your goal is to have a dialogue — a two-way conversation in which you can state your concerns and understand the person’s perception of the situation. Ask if you can set a time to speak in the next few days to discuss something on your mind. If the person responds by saying, “Now is fine,” tell them you’d prefer to set time aside and not be interrupted.
* When you meet, tell your family member that you care for him or her. Emphasize that it’s this concern for their well-being that has led you to have this conversation.
* List the behaviors you’ve observed, state that you are worried about the effect drinking or drug use is having and express concern about continued use.
* Create a two-way dialogue so the person doesn’t feel lectured or badgered. Use open-ended questions.
* If the person states that there is definitely not a problem, ask to talk again at some point in the future. Your goal is not to convince the person that there is a problem, but to let them know that you believe there is one and that your belief is based on observable behaviors.
* Don’t try to speculate, explore motives or judge. It can sidetrack you from the main point.
* Don’t expect a dramatic shift in thinking or behavior right away; this conversation may be the first time the person has thought about this problem.
* Keep in mind that there is no quick fix – prepare yourself for the long haul.
If the problem has only occurred over a short period of time, or has not reached a severe stage, it is possible that the adult you care about could successfully cut back on the use of alcohol or other drugs. If the person has not tried cutting back, you could suggest this strategy as a first step. Some people in the risky or abuse stages of substance use, or even in the early stage of addiction, are able to cut back and consistently use only minimal amounts in the future.
You may find, though — as many do — that people who can cut back are the exception, not the rule. Many people try to cut down and discover that they can’t. Or, they can only cut back for a few days or a few weeks before resuming heavy or excessive use. Trying to cut down and failing may help the person realize that the problem is more extensive than once thought.
You may also find that the person is able to stop completely. But many addicts have tried this strategy and couldn’t stop or remain abstinent for any significant amount of time. Ideally, the person should be assessed by a professional who can determine the best course of action depending on the severity of the problem and the person’s medical, psychological and social history. If you sense the person is willing to consider that there is a problem, suggest that an evaluation or a consultation with a trusted medical or mental health professional. (This suggestion may be too threatening for some people during a first conversation of this kind.)
To talk with others struggling with similar issues, consider SMART Recovery Friends & Family, which offer science-based, secular support group meeting (both online and in-person) to help those who are affected by the substance abuse, drug abuse, alcohol abuse or other addictions or Al-Aanon, a Twelve-Step organization providing help to family members of alcoholics. Meetings are widely available and free of charge.
Although you probably want the substance use to stop as soon as possible, immediate abstinence from certain drugs has risks, including withdrawal symptoms with serious medical consequences. Many people need to be admitted to a detoxification center to help them physically withdraw.
Even if detoxification is not necessary, a formal, structured treatment program is vital for sustained abstinence. A health care professional or substance use counselor can help you and the person in need assess your options.
To encourage the person to stop, you might want to tell them ways you would be willing to help make it easier – for example, going to counseling together, or providing transportation or childcare.
4. How Do I Help Someone Understand That He or She Has a Problem?
Friends and family members may feel that they constantly express concerns about a loved one’s substance use but never see any changes. You may have reached this point after weeks or months of giving lectures, making threats, ignoring behaviors, accepting promises of change, giving second chances or imposing consequences.
Experts recommend developing and repeating a consistent, positive message: “We care about you and we want you to get help.” Define substance use as a problem for you and others who care about the person. Avoid blaming, arguing and reproaching; and expect denial, distortion, avoidance, rationalization and intellectualization of the problem.
Perhaps a friend, another family member, doctor, clergy, boss, co-worker or other significant person might be able to have an effective discussion. Or maybe the substance user would respond to activities you can do together, such as reviewing brochures or videos, meeting with a professional or going to a self-help, SMART Recovery or Twelve Step meeting.
DOs and DON’Ts
As you continue to try to talk to the person in need of help, please remember these important details:
* Don’t try to talk when either one of you is under the influence.
* Do protect yourself and others around you from physical harm.
* Do call police if there is violence.
* Do set limits that will protect your home, finances and relationships, and stick to those limits.
And if you are at your wits’ end, you might consider a formal intervention.
5. How Do I Help Someone Who May Need Treatment?
Mention the word “treatment” in relation to substance use and many people think of long-term residential facilities or detox. In fact, treatment includes both of these options — and a variety of others.
Treatment addresses the individual’s physical, psychological, emotional and social conditions. Sustained reduction in alcohol or other drug use and sustained increases in personal health and social function are the primary goals.
The type of treatment is based on the severity of the problem. For risky users, treatment can be as simple as a screening and a brief intervention. For people exhibiting signs of dependence or addiction, a screening will probably lead to a referral for more intense level of care.
All treatment starts with a screening, which is a series of questions about the amount and frequency of alcohol or other drug use and the consequences it may be causing. Screening can be done by many types of professionals, including a physician in a hospital or an office, a nurse, a clinical social worker, or a licensed substance abuse counselor.
After a screening, some people may need a brief intervention, usually done by a health professional. During a brief intervention, people receive feedback on their substance use based on the screening results. Frequently, people are asked to cut back or stop their use. If they are ready to cut down, the health care professional will work with them to set a goal based on lower consumption. They may also be encouraged to reflect on why they use and how their lives will change by lowering their use. People who want to stop substance use will most likely be referred for additional evaluation or treatment.
To help someone you know who you think may have a substance use problem, you first need to get them screened. Your best bet is to talk to your own physician or employee assistance professional about referring you to someone who can help, such as a licensed substance abuse counselor or family therapist.
6. How Do I Help Someone Who Needs Treatment?
Formal treatment takes many forms, and no one type of treatment is best for everyone. There are many roads to recovery.
You may think that you need to choose just the right program for your family member and if you don’t, treatment will fail. But experts believe that any of a number of programs can lead to success – if the person is willing to accept help from others and invest energy in working on recovery. A physician or another health care professional can also help you choose where someone should go for treatment.
To find a treatment program, visit SAMHSA’s Substance Abuse Treatment Facility Locator.
7. What Should I Do in an Alcohol or Drug Emergency?
Does your loved one have any of the following symptoms? If so, call 911 or other emergency services immediately.
* Lost consciousness after taking drugs.
* Became unconscious after drinking alcohol, especially if five or more drinks were consumed in a short period of time.
* Had a seizure.
* Had been drinking and is seriously considering suicide.
* Has a history of heavy drinking and has severe withdrawal symptoms, such as confusion and severe trembling. Severe withdrawal symptoms, such as delirium tremens (DTs), can cause death.