If you or someone you know is in crisis right now: call or text 988 (Suicide & Crisis Lifeline). For a possible overdose or any medical emergency, call 911. For help finding treatment, the SAMHSA National Helpline is free and open 24/7 at 1-800-662-4357.
The short answer
LGBTQ+ people can face added stress, stigma and discrimination that affect mental health and substance use, and they often do better in treatment that is affirming: staff who respect their identity, inclusive policies and clinicians trained in LGBTQ+ health. You can find affirming care by asking specific questions, and you should avoid any program that tries to change who you are.
Why affirming care matters
Many LGBTQ+ people have experienced rejection, harassment, trauma or discrimination, and these stressors are linked with higher rates of anxiety, depression and substance use in some groups. A program that is not welcoming can make people feel unsafe, hide parts of themselves or leave treatment early. Affirming care helps people stay engaged.
What “affirming” looks like
- A written nondiscrimination policy that covers sexual orientation and gender identity
- Staff training in LGBTQ+ health and cultural competence
- Inclusive intake forms that ask about name, pronouns and relationships respectfully
- Clear housing and bathroom policies, including for transgender and nonbinary clients
- Clinicians with experience treating LGBTQ+ clients and understanding minority stress
- Respect for your name and pronouns from staff and, where possible, from peers
- LGBTQ+ groups or peer support, or at least a program that welcomes them
- Integrated health care, including HIV care and prevention, and gender-affirming care referrals when relevant
- Treatment of co-occurring mental health conditions and trauma. (See [Dual Diagnosis Treatment: When Addiction and Mental Health Overlap].)
- Support for family and chosen family
Questions to ask a program
- Do you have a written nondiscrimination policy that includes sexual orientation and gender identity?
- Is staff trained in LGBTQ+ care, and how often?
- How do you handle names and pronouns?
- How do you decide housing and room assignments for transgender and nonbinary clients?
- Do you have clinicians experienced with LGBTQ+ clients?
- Are there LGBTQ+ groups or peer support?
- Can you coordinate with my doctor for HIV care or gender-affirming care?
- What happens if a client or staff member is disrespectful?
- Can my partner or chosen family take part in sessions?
(See [15 Questions to Ask a Rehab Center Before You Sign Up].)
How to find affirming programs
- SAMHSA helpline (1-800-662-4357) and FindTreatment.gov. Search by location and ask programs about their policies. (See [How to Use FindTreatment.gov and the SAMHSA National Helpline].)
- Local LGBTQ+ community centers, which often keep lists of affirming providers.
- Your doctor or therapist, especially if they are LGBTQ+-affirming.
- Telehealth, which can widen your options if there are few providers nearby. (See [Is Telehealth Addiction Treatment Effective? Pros, Cons and Costs].)
- Peer groups: many AA, NA and SMART Recovery communities have LGBTQ+ meetings in person and online. (See [AA vs SMART Recovery vs Other Mutual-Help Groups: Which Fits You?].)
- Online communities for LGBTQ+ people in recovery.
Warning signs
- A program that will not answer questions about its policies
- Staff who misgender or dismiss your identity
- Pressure to hide who you are
- Any program that claims it can change your sexual orientation or gender identity. Major medical and mental health organizations do not consider these practices effective or safe, and some states restrict them. Walk away.
- Housing policies that put you at risk
(See [How to Find a Legitimate Rehab Center: Accreditation and Red Flags].)
Substance use and health topics that may come up
- Sexualized drug use: a good clinician discusses it without judgment and focuses on safety, health and your goals.
- HIV and sexual health: testing, treatment and prevention are part of whole-person care.
- Trauma and minority stress: care should address them.
- Medication: make sure the program supports treatment for alcohol and opioid use disorders. (See [Medication-Assisted Treatment (MAT): How It Works and Who It’s For].)
Support for young people
LGBTQ+ youth face higher risks and need affirming care and supportive adults. The Trevor Project offers crisis support and resources for LGBTQ+ young people. Check its current contact details at thetrevorproject.org. (See [Teen and Adolescent Rehab: Levels of Care and Parental Rights].)
Cost and coverage
Insurance, Medicaid and Medicare can cover treatment, and some affirming programs offer sliding-scale fees. (See [Does Insurance Cover Rehab? How to Check Your Benefits Step by Step] and [Free and Low-Cost Rehab Options Without Insurance].)
If you are a family member or friend
Show acceptance, use the person’s name and pronouns, and learn about affirming options. Support them in choosing a program where they feel safe. (See [How to Talk to a Loved One About Addiction Without Pushing Them Away].)
Frequently asked questions
What is LGBTQ+-affirming addiction treatment?
Treatment in which staff respect your identity, policies are inclusive and clinicians understand LGBTQ+ health.
How do I find an affirming rehab?
Ask specific questions about policies and training, contact local LGBTQ+ centers and use FindTreatment.gov and the SAMHSA helpline.
Should I avoid programs that try to change my identity?
Yes. These practices are not considered effective or safe.
Are there LGBTQ+ recovery groups?
Yes. Many 12-step and SMART Recovery groups have LGBTQ+ meetings, in person and online.
Can I bring my partner to family sessions?
Ask the program. Many affirming programs welcome partners and chosen family.
Sources
- SAMHSA. Substance Use Disorder Treatment for People With Co-Occurring Disorders and LGBTQI+ resources. samhsa.gov
- National Institute on Drug Abuse. Substance Use and SUDs in LGBTQ Populations. nida.nih.gov
- The Trevor Project. thetrevorproject.org
This article is for general information only and is not medical advice. Programs vary, so ask each one about its policies.