As the opioid epidemic continues to dominate national news, another urgent crisis is wreaking havoc in communities throughout the United States. Methamphetamine addiction is on the rise, and it’s hitting communities hard, especially the LGBTQ+ community.
November 30th is National Methamphetamine Awareness Day, a poignant time to raise the alarm about the devastating impact of this drug and the reasons behind its growing prevalence within the LGBTQ+ community.
Based on 2020 and 2021 data compiled by the Substance Abuse and Mental Health Services Administration (SAMHSA), sexual minorities (gay, lesbian, or bisexual) adults were at least twice as likely to use stimulants in the past year as their heterosexual counterparts. Gay men were over four times more likely than straight men to have used meth in the past year.
As a mental health counselor and coordinator of the LGBTQ+ program at River Oaks Treatment Center in South Florida, I know firsthand how devastating meth addiction in this marginalized demographic can be. The National Institute on Drug Abuse notes that sexual minorities tend to enter treatment with more severe substance use disorders than those who identify as heterosexual, and I often find this to be the case in our patient population as well. Our LGBTQ+ patients face numerous challenges that may lead to substance use as a means of coping, such as discrimination, stigma, and trauma.
Our LGBTQ+ patients often talk about feeling their needs and experiences are invalidated by those around them. Constantly feeling unsafe or unable to live as one’s true self at a young age can have a lasting impact on a person’s mental health and is a risk factor for problematic substance use as a tool to manage shame and emotional pain.
Another complicating factor is that for many queer people, there are few safe spaces, and one of the first ones they encounter is gay bars, where drinking and/or substance use is the norm. Meth is popular in gay nightclubs and parties because it causes euphoria, increases libido, and raises energy, enabling people to party for many hours before crashing. But while use of the drug often begins voluntarily, it quickly becomes compulsive and very difficult to quit.
The brain quickly learns to link certain people, places, and activities with drug use, triggering uncontrollable cravings. Meth use is ubiquitous in the social circles or “chosen families” of some sexual and gender minorities, making avoiding the drug uniquely difficult. Quitting meth may require them to cut ties and break contact with people they’ve come to love and care about deeply.
Our LGBTQ+ patients sometimes express fear they won’t be able to experience sex and other activities in the same way once they quit using meth. Indeed, it can take some time for someone’s brain and body to return to normalcy after quitting. Methamphetamine has a profound effect on dopamine activity, a brain chemical associated with motivation and the urge to repeat pleasurable activities. Over time, this effect can limit someone’s ability to experience pleasure from healthy activities.
The effects of chronic meth use and withdrawal also complicate the early treatment and recovery process. Intense paranoia—a common long-term effect of meth use—makes it very difficult to trust people, a crucial facet of treatment that is necessary for building relationships with counselors, mentors, and peers.
Distrust of clinicians and treatment programs is often heightened among LGBTQ+ patients, who often face even more stigma when entering treatment programs and have a distrust of institutions like law enforcement, which they may associate with addiction treatment. To further this point, some of our patients have had bad experiences in the past and worry about treatment being safe for them. Many of our LGBTQ+ patients also have complicated relationships with their families, who might otherwise form the foundation of their support network in recovery.
These obstacles highlight the importance of specialized LGBTQ+ addiction treatment programs in which patients are surrounded by peers who can relate to their experiences. It’s crucial that treatment centers don’t just claim to be accepting of sexual and gender minorities but do the necessary work to make these patients feel safe and welcome, protecting them from harassment and mistreatment from both staff and other patients.
These programs also must work to address common issues that co-occur with addiction among LGBTQ+ patients, such as trauma, emotional turmoil, and interpersonal conflicts. For example, utilizing effective, evidence-based therapeutic approaches, such as dialectical behavior therapy (DBT).
DBT is among the techniques we use in our programs. Originally developed to treat borderline personality disorder (BPD), DBT has been expanded to treat many mental health disorders that involve emotional dysregulation, which is something we often see among our patients in early recovery from meth addiction.
The approach functions to enhance one’s capabilities to regulate emotions, practice mindfulness, improve interpersonal effectiveness, and strengthen distress tolerance before practicing these skills and encouraging patients to apply them in their daily lives. DBT also works to improve a patient’s motivation to track and reduce their dysfunctional behaviors.
On a nationwide level, it will take significant work to disentangle the grip of methamphetamine on the LGBTQ+ community. With the pervasiveness of illicitly manufactured fentanyl—a synthetic opioid that causes overdose in very small doses—in the drug supply, the need for action has never been more immediate.
A large part of this work involves changing the perception of society toward methamphetamine addiction and especially queer people who struggle with this disease. Rather than viewing it as a moral failure, we need to see it for what it truly is: a public health crisis. Much like at the start of the HIV/AIDS epidemic, the disease of addiction is heavily stigmatized, and too often, we place blame on those who are impacted rather than taking effective action to curb the crisis.
In addition to culturally competent addiction treatment, we desperately need more sober, safe spaces for the LGBTQ+ community. Upon exiting treatment, many find themselves on uncertain ground and in desperate need of sober friendships and networks that support their recovery. Substance-free community centers provide a useful model that can be implemented on a larger scale.
While these are trying times, I sincerely believe we can make a profound difference by confronting this issue with compassion and understanding. It will take a multi-faceted approach that involves the cooperation of treatment centers, queer people in recovery, allies, and the broader LGBTQ+ community.
Karah Moody, LMHC, CPP, MCAP, is a counselor and LGBTQ2+ Coordinator at River Oaks Treatment Center, an American Addiction Centers facility.
