Due to the heteronormative nature of treatment and support programs, those in the LGBTQ+ community with substance use disorders often face barriers when seeking services.

When David Harvey first entered recovery, he struggled with anxiety about receiving residential treatment for his methamphetamine use disorder. Harvey, 38, who identifies as gay, was nervous about living with other men who might not understand or be receptive to his sexuality.

“There are a lot of things that relate to my sexuality and are very kind of core, or co-occurring, that are entangled in my addiction and my history,” Harvey said.

Harvey found treatment at the Pride Institute in Minneapolis, which offers residential and outpatient treatment programs that primarily serve the LGBTQ+ community.

“Pride Institute was great because it allowed me the space to talk about things you might experience that you might not have been comfortable sharing in a straight space,” Harvey said.

Though Harvey had a positive experience there, he did begin using drugs again after his time there. Eventually, he sought treatment again from a more traditional long-term facility in the Poconos, and while the second facility was not a designated LGBTQ+ space, it ended up being a better fit for him, he said. Harvey said he also attributes much of his success in his early recovery to 12-step meetings.

“The kind of anxieties I had didn’t turn out to be the case when I went to a general kind of substance use and treatment facility,” Harvey said. “But at the same time, I know that they kind of inhibited me from seeking help as early in the process that probably should have.”

According to Harvey, he doesn’t know many LGBTQ+-specific inpatient programs aside from the Pride Institute, and he feels lucky to have had private insurance at the time which allowed him to receive treatment there. He said creating safe recovery spaces to hold people’s queer experiences is very important.

“There are a lot of things that relate to my sexuality and are very kind of core, or co-occurring, that are entangled in my addiction and my history."

— David Harvey, Person in recovery

A lack of safe spaces

According to Substance Abuse and Mental Health Services Administration (SAMHSA), substance use disorders are more likely to occur in the LGBTQ+ community compared to those who don’t identify as LGBTQ+.

However, people in the LGBTQ+ community who have substance use disorders often face a number of obstacles when trying to seek out treatment and recovery resources, such as not feeling welcome in recovery spaces, according to advocates.  

“A huge barrier that the LGBTQ+ community faces is finding substance abuse treatment providers who have the knowledge and skills and the desire to create a truly safe space that recognizes LGBTQ people as whole people,” said Laura Sorensen, the director of Morris Home, a recovery center that serves transgender and gender non-conforming people in Philadelphia.

Brooke Feldman, a social worker and president of Sparkling Solutions LLC, said that LGBTQ+-identifying people are often discriminated against throughout the levels of treatment and recovery because of the heteronormative nature of many treatment centers, recovery houses, and support groups.

“Overall it’s a very gender-binary-constructed institution,” Feldman said.

"Overall it’s a very gender-binary constructed institution." 

— Brooke Feldman, Person in recovery

Finding LGBTQ+ treatment options

Finding the right treatment or rehabilitation center — one that is accepting and affirming is an important step for people with substance use disorders seeking treatment, according to Beck Gee-Cohen, an advocate for the LGBTQ+ community. While there are treatment centers that will admit people in the LGBTQ+ community, Gee-Cohen said it’s difficult for people  to find treatment facilities with affirming care after entry into the program.

“I think that what’s missing is a real knowledge base on how to treat the community,” he said. “We all have our overarching issues revolving around addiction, but I think that from a societal level, from a cultural level, and from a community level that we’re running into things that the straight cisgender community doesn’t have.”

Gee-Cohen, who identifies as transgender, is highly active in helping facilities shift their focus and change their policies in order to become more welcoming of LGBTQ+ people in treatment and recovery. He decided to get involved in this type of activism after going through recovery himself, he added.

Based on his own experiences, Gee-Cohen said that a positive solution would be state-funded medical treatment, which would allow people to go to the treatment center that could best fit their needs rather than the one that’s closest to their location.

“I was very lucky,” Gee-Cohen said. “When I got sober, I moved from California to Montana and got sober in Montana in the rooms of AA. I don’t think I could have gotten sober at an AA in a big city, personally.”

Gee-Cohen said another large issue he has seen for the transgender community is that many state-funded treatment facilities are gender-specific.

However, Morris Home in Philadelphia is changing the way addiction treatment looks for the transgender community.

“Some treatment programs are specifically gendered,” said Cade Collins, the lead therapist in Morris Home. “And so for trans folks, that can be hard to find an appropriate placement. So a lot of people face a lot of harassment from other people in treatment, or even staff programs.”

According to Resources for Human Development, Morris Home is the first and only inpatient recovery program in the United States that strictly focuses on the transgender and gender non-conforming community.

“I think the barriers would mostly be that a lot of the programs aren’t necessarily competent to serve those populations,” Collins said. “A lot of people here talk about being in previous programs, and not really being able to talk openly about their gender, their sexuality and having people not being able to understand or relate.”  

Morris Home provides similar resources to many other treatment facilities, such as daily group and individual therapy, case management and they help connect people to medical and psychiatric care, Collins said. They also empower those in treatment to advocate for themselves.

“We do a lot of advocacy, we really believe in increasing self-advocacy through advocacy,” said Sorensen. “So our members have lobbied in Harrisburg, or go to the Trans March, or present workshops and do education on the trans-community.”

However, Morris Home only has room to house up to eight people at a time.

In addition to Morris Home’s treatment services, a big factor in what the organization is doing that other treatment facilities are not is educating other programs on how to treat and care for trans people with substance use disorders.

“We do a lot of trans competency trainings around the city,” Collins said. “At assessment centers, we teach people how to refer trans people to treatment. We also go to outside conferences and educate people with ways in which they can take their programs that already exist and make them trans inclusive or competent.”

When Morris Home participates in such events, residents are given the opportunity to work alongside employees and help them train other treatment and recovery providers. The residents can share their stories about how different their recovery experiences were when trying to access services at facilities that are less-educated about the transgender community than Morris Home.

“I think provider education is a huge part when it comes to solutions as well as people advocating the needs for the community,” Sorensen said. “Other places could be way more affirming. I think providing that sort of education to doctors, social workers, counselors and organizations to invest in changing the culture.”

Morris Home has been open to the transgender community since 2011. They are now planning on moving and expanding over the next year.

“We are really excited that we’re going to be able to serve more folks,” Sorensen said.  

“We all have our overarching issues revolving around addiction, but I think that from a societal level, from a cultural level, and from a community level that we’re running into things that the straight cisgender community doesn’t have.”

— Beck Gee-Cohen, LGBTQ+ advocate

Finding LGBTQ+ recovery housing

According to advocates, some of the same barriers the LGBTQ+ community faces in treatment centers can be found in recovery housing, too. Gee-Cohen and Feldman stated that such issues include gender conforming forms and living situations, as well as not feeling accepted or comfortable talking openly in recovery spaces.

“Access is limited when you feel like you have to go to a place that you don’t feel welcome,” Feldman said. “The larger environment is still very heteronormative and there are the same issues when it comes to mental health. I think that the forms having ‘M’ or ‘F’ is an issue because it doesn’t make people who are a part of the LGBTQ community feel welcome.”

Recovery houses are often gendered environments where residents are separated into groups of men and women, Gee-Cohen said. He said this is a problematic system for the LGBTQ+ community due to the fact that other residents of the house may not be accepting of people who identify as gay or lesbian. Additionally, people who identify as transgender may be placed into either individual rooms or into spaces based on the gender they were assigned at birth rather than their correct gender, he added.

“Right off the bat you’re already telling me that I’m not being seen if you put me in an individual room,” Gee-Cohen said. “A lot of programs who say that they are trans-affirming are putting people in their own rooms. Addiction is isolating and what if the person isn’t out as trans and people start asking them why they get their own room? So we’re putting them in a place to lie, which totally goes against 12-step programs and against the absolute first step which is honesty. If you don’t understand these kinds of micro-aggressions and you’re not understanding how this affects the community, then that’s a problem.”

One recovery house that is working to help the LGBTQ+ community is LGBTQ Home for Hope in Philadelphia, a nonprofit organization that offers recovery housing and free shelter services to mainly the LGBTQ+ community. However, they accept and welcome everyone regardless of sexual orientation or gender identity. According to Lenzie Faison, Home for Hope’s director, Home for Hope has a total of 33 beds, 25 of which are strictly for people in recovery. The remaining eight are shelter beds for anyone in need of safe housing.

“LGBTQ Home for Hope tries to empower and employ the LGBTQ community,” said Sakina Dean, founder and chief executive officer of LGBTQ Home for Hope. “We need to address the need for individual’s goals and to provide affirmative recovery to help these individuals to cultivate and prosper.”  

To ensure people who enter into recovery at LGBTQ Home for Hope feel safe and included, Faison trains his staff to be supportive and aware of LGBTQ+ terminology.

“We allow people to be defined the way they want to be defined,” Faison said. “We created a safe place for them to come to be exactly who they are. Unfortunately, in this country, services are connected to your identity. But when they walk through this door, they tell us who they are.”

“We allow people to be defined the way they want to be defined."

— Lenzie Faison, LGBTQ Home for Hope

Finding LGBTQ+ support groups

For members of the LGBTQ+ community, one of the biggest challenges with support groups is speaking about their identity and their journeys in largely straight spaces, Harvey said.

“It’s important to create spaces with people from similar backgrounds in which you can share your stories openly,” said Harvey. “I definitely shared a lot more of my experience at Pride than the primarily straight treatment facility I was at. Creating safe spaces to hold people’s queer experiences is really important.”

According to Sorenson, to begin resolving these issues, there needs to be more research.

“I think that we need to do a better job of collecting information about different LGBTQ+ people’s experiences in treatment,” Sorenson said.

Collins said that educating people early on about the LGBTQ+ community, especially those who identify as transgender, will eventually help to destigmatize the community.

“More people doing education, self educating themselves, attending trainings, going to the trans wellness conference and learning how to be a better provider for this community would make a big difference,” Collins said.

According to Feldman, the larger part of the world is still very heteronormative, and until those views and issues are addressed, there is no chance for change in the way people in the LGBTQ+ community are being treated when they seek support and services.

“It’s difficult to find services,” Feldman said. “Raising the awareness of the difficulty is important.”