This first part of a DNA spe­cial series ex­plores ad­dic­tion and its causes in the LGBT com­mu­nity.

DNA Magazine - - CONTENT #225 - By Vanessa McQuar­rie

Stu Fen­ton be­lieves LGBT peo­ple ex­pe­ri­ence more trauma than they con­sciously iden­tify as trauma.

It seems there’s never been a bet­ter time to be gay, with mar­riage equal­ity cat­a­pult­ing us into the main­stream.

Yet, LGBTIQ peo­ple over­whelm­ingly ex­pe­ri­ence a higher in­ci­dence of men­tal health is­sues than our het­ero­sex­ual coun­ter­parts – even the young ones who are com­ing out in this cen­tury, this decade, this year, into what is in­creas­ingly a bet­ter, more tol­er­ant world.

De­spite the many wins we’ve racked up on the road to equal­ity, young LGBT peo­ple still strug­gle to come out and the re­al­ity is, none of us are ever com­pletely free from the con­stant threat of ho­mo­pho­bia or trans­pho­bia, re­gard­less of our age and cir­cum­stances.

The com­plex rea­sons why LGBT peo­ple ex­pe­ri­ence more men­tal health prob­lems are slowly be­ing un­packed. Syd­ney-based gen­eral prac­ti­tioner and health com­men­ta­tor Dr Brad McKay is quick to point out that our ex­pe­ri­enc­ing higher lev­els of men­tal health is­sues is not be­cause we are gay.

“Same-sex at­trac­tion doesn’t mean you are go­ing to be de­pressed,” he says. Rather, our col­lec­tive sus­cep­ti­bil­ity to de­pres­sion and other dis­or­ders can be due in part to other peo­ples’ re­sponses to our sex­u­al­ity. So­ci­etal pres­sures and the re­ac­tions of fam­ily, friends, col­leagues and peers can have a last­ing, neg­a­tive af­fect on the health and well­be­ing of LGBT peo­ple.

“There is grow­ing agree­ment among re­searchers that the higher lev­els of de­pres­sion, anx­i­ety dis­or­ders, self-harm, sui­cide and sui­ci­dal ideation seen among the LGBTI com­mu­nity are sig­nif­i­cantly at­trib­uted to ‘mi­nor­ity stress’ brought on by ex­pe­ri­ences or fears of abuse, dis­crim­i­na­tion, prej­u­dice and ex­clu­sion,” says Ni­co­las Parkhill, the CEO of ACON, a New South Wales-based health pro­mo­tion or­gan­i­sa­tion spe­cial­is­ing in HIV and LGBTI health.

An aca­demic in the United States, Ilan H Meyer, de­vel­oped the mi­nor­ity stress model to ex­plain how the stigma of be­ing gay, di­rect ex­pe­ri­ences of dis­crim­i­na­tion, ex­pec­ta­tions of re­jec­tion, in­ter­nalised ho­mo­pho­bia, hid­ing and con­ceal­ing sides of one­self from fam­ily, friends and col­leagues – and re­ly­ing on cop­ing mech­a­nisms to deal with it all – takes a toll.

In Aus­tralia, Grow­ing Up Queer, a re­port by the Co­op­er­a­tive Re­search Cen­tre and the Uni­ver­sity Of West­ern Syd­ney, ex­am­ined the im­pact com­ing-out had on the fam­ily, com­mu­nity and school life of young peo­ple who iden­ti­fied as LGBT. Some of the young par­tic­i­pants were com­pletely re­jected by their fam­i­lies and thrown out of home, forced to live in foster care or youth refuges.

Par­tic­i­pants in ru­ral and re­gional ar­eas wor­ried they had no-one to talk to, that they wouldn’t be ac­cepted if they came out, and that ev­ery­one in the com­mu­nity would find out. Some feared for their safety.

At school, par­tic­i­pants said they watched and learned from other young peo­ple who came out and saw, more of­ten than not, that “out” stu­dents were bul­lied. This prompted many to try to con­ceal their sex­ual ori­en­ta­tion or trans­gen­der sta­tus. “Keep­ing this in­for­ma­tion se­cret has im­pli­ca­tions for the health and well­be­ing of these young peo­ple,” the re­port notes.

Stu­dents who did come out at school en­coun­tered ho­mo­pho­bia from peers and teach­ers (es­pe­cially Phys­i­cal Ed­u­ca­tion teach­ers); sys­tem­atic ho­mo­pho­bia by the school at an or­gan­i­sa­tional level; so­cial iso­la­tion; and dis­rupted ed­u­ca­tion. Many stu­dents at­tended mul­ti­ple schools, or left school al­to­gether.

For many of the young par­tic­i­pants, re­jec­tion, alien­ation, bul­ly­ing and ha­rass­ment of­ten led to de­pres­sion, sui­ci­dal ideation and at­tempted sui­cide. “Some par­tic­i­pants spoke openly about mul­ti­ple sui­cide at­tempts as a re­sult of ne­go­ti­at­ing their sex­ual/gen­der ori­en­ta­tion at school, at home, and in their broader com­mu­ni­ties. Par­tic­i­pants who had at­tempted sui­cide were gen­er­ally liv­ing out of home in youth refuges, foster care, or alone once they had turned 18.”

The re­search con­cluded that the real and po­ten­tial ex­pe­ri­ences of re­jec­tion and alien­ation can re­sult in de­pres­sion, home­less­ness, drug and al­co­hol abuse and sui­cide ideation for many young peo­ple.

It’s a lot for a young per­son to carry, and although the re­port did stress that the ma­jor­ity (two out of three) of young peo­ple who par­tic­i­pated felt happy and con­tent with their cur­rent lives, de­spite the dif­fi­cul­ties in their younger years, we know that even if trauma ex­pe­ri­enced dur­ing child­hood and ado­les­cence dis­si­pates, it doesn’t sim­ply dis­ap­pear with­out treat­ment.

Treat­ment, un­for­tu­nately, poses prob­lems, too. “We know that LGBTI peo­ple can be re­luc­tant to seek men­tal health treat­ment be­cause of con­cerns about prej­u­dice and dis­crim­i­na­tion that can be ex­pe­ri­enced through more main­stream sup­port ser­vices,” ex­plains Parkhill.

ACON pro­vides a range of coun­selling and sup­port ser­vices to help im­prove the men­tal health of LGBTI peo­ple. It also of­fers help to peo­ple with prob­lem­atic sub­stance use. Like men­tal health prob­lems, we know that our rate of drug and al­co­hol use is higher than that of het­ero­sex­u­als. A 2016 Na­tional Drug Strat­egy sur­vey found that in the pre­ced­ing 12 months, gay men, les­bians and bi­sex­u­als were 5.8 times more likely to have used ecstasy, 3.2 times more likely to use cannabis, 3.7 times more likely to use co­caine and more likely to smoke daily, con­sume al­co­hol in risky quan­ti­ties, use il­licit drugs and mis­use phar­ma­ceu­ti­cals.

“While most LGBTIQ peo­ple who use al­co­hol and other drugs do so in a non-prob­lem­atic way, some peo­ple ex­pe­ri­ence harms re­lated to their use due to risk fac­tors such as dis­crim­i­na­tion, abuse or is­sues sur­round­ing com­ing-out,” says Parkhill. “Tar­geted in­ter­ven­tions that as­sist in man­ag­ing use, mon­i­tor­ing changes and get­ting sup­port are im­por­tant.”

Dr McKay, who treats LGBT pa­tients for ad­dic­tion, notes that drug and al­co­hol use is what clin­i­cians call “nor­malised” on the gay scene. It is also, with­out a doubt, used as a cop­ing mech­a­nism (“self med­i­cat­ing”) to deal with stress and trauma.

Dr McKay says drug and al­co­hol “re­hab” can be done at home with the right sup­port but notes that some main­stream men­tal health and ad­dic­tion ser­vices are re­li­gious and may not be suited for LGBT peo­ple. He rec­om­mends sim­i­lar gayfriendly and/or ev­i­dence-based pro­grams. Other re­ha­bil­i­ta­tion op­tions can be ac­cessed via the pub­lic hospi­tal sys­tem (though the wait­ing lists are “hor­rific”) or at a pri­vate clinic, with the ben­e­fit of be­ing away from your ev­ery­day en­vi­ron­ment, in an iso­lated and con­trolled fa­cil­ity.

Stu Fen­ton, a clin­i­cian and ther­a­pist at Re­sort 12, a pri­vate clinic in Thai­land specif­i­cally for LGBT clients, be­lieves LGBT peo­ple ex­pe­ri­ence more trauma than they con­sciously iden­tify as trauma. Ad­dic­tion and other dis­or­ders are the long-term out­comes of trauma, he says.

The tra­di­tional def­i­ni­tion of trauma is usu­ally based on a sin­gle, ex­treme in­ci­dent like a car ac­ci­dent or vi­o­lent crime, when, in fact, most LGBT peo­ple ex­pe­ri­ence trauma be­cause of bul­ly­ing and stigma, ho­mo­pho­bia within the fam­ily sys­tem, re­jec­tion by friends, ver­bal abuse and tar­get­ing and an over­all lack of sup­port and re­spect.

More­over, many of us might have ex­pe­ri­enced sex­ual and phys­i­cal abuse as a child, the break­down of the fam­ily unit due to one par­ent hav­ing an af­fair, the fam­ily favour­ing one child over an­other, and a myr­iad of other trau­matic in­ci­dents ex­pe­ri­enced by chil­dren in gen­eral, he says. “Any­thing less than nur­tur­ing,” is the def­i­ni­tion Fen­ton uses. Peo­ple put all sorts of cop­ing mech­a­nisms in place “to stop them­selves from mak­ing con­tact with the painful and dif­fi­cult emo­tions that are the re­sult of this trauma.”

“Res­i­den­tial treat­ment is a very pow­er­ful ve­hi­cle for this be­cause you are there 24/7 and you have eyes on you all that time – both coun­sel­lors and peers can help peo­ple iden­tify dys­func­tional cop­ing mech­a­nisms and blind spots.”

In the next is­sue of DNA, we con­tinue to ex­plore ad­dic­tion, look­ing at how you can tell if a friend, fam­ily mem­ber or your­self needs help, and fur­ther ex­am­in­ing treat­ment op­tions.

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