Substance Abuse and Cannabis Usage: Supporting and Affirming the LGBTQ Community and Youth

A Synchronous Struggle

Though separate entities, the LGBTQ and cannabis movements often find themselves on the same side of the fence in the fight for civil liberties. With goals that often go hand in hand, both crusades flourish from the efforts of tenacious individuals who stand in the face of adversity. Hence, it is no surprise that many cannabis activists are also from the LGBTQ community, as its members have a deep understanding of what it means to handle confrontation in the battle for acceptance.

Moreover, the two movements often get lumped together as proponents for a more progressive society. According to a report from the Harvard Business Review, states that legalized gay marriage and marijuana simultaneously experienced a 5–6 percent increase in innovation output. On the flip side, a state that passed an additional abortion restriction experienced a 1 percent decline. Such observations may lead us to conclude that these movements’ struggles are necessary for a forward-thinking society.

Along with being one of the oldest, if not the oldest, supporters of marijuana, the LGBTQ community is among its most enthusiastic consumers. The global purchasing power of the queer community alone has been estimated at $5.4 trillion, of which the cannabis market has been keen to tap. Many brand names in the cannabis industry have supported LGBTQ rights in the form of merchandising and donations to LGBTQ organizations.

Cannabis usage has a long history of easing the pain of the LGBTQ community. First, as a form of relief for HIV symptoms, and, second, as a method of dealing with rejection from society. Subsequently, LGBTQ persons have been the most affected by both the benefits and detriments of cannabis. It is in the best interest of both the LGBTQ and cannabis communities to support illuminative research regarding the plant’s usage. Understanding elements of addiction and supporting LGBTQ-friendly treatment programs is essential to ensure that cannabis can be safely used to assist with various issues among sexual minorities and majorities alike.

Any prohibition on civil liberties tends to impact marginalized communities the most... When you have identities that have been systematically discriminated — your gender, your sexuality — you are primed to be more marginalized by marijuana laws. If you are a cisgender white male, you are the least likely to be stopped for marijuana. If you are a person of color who is trans, you are more likely to be stopped, more likely to do time and the time will be longer.

Khadijah Tribble, Marijuana Policy, Harvard University's JFK School of Government
Khadijah Tribble, Marijuana Policy, Harvard University's JFK School of Government

Expert Advice from a Community Member

Matthew Fichtemaier

Matthew is an LGBTQ community leader, who attempts to inspire others through writing to lead lives of wellness and purpose.

Matthew Fichtemaier
LGBTQ community leader
How does the potential emotional strain and social aspects of being part of the LGBTQ community affect substance abuse and cannabis usage in particular?

I undeniably believe the psychological aspects of being LGBTQ attribute to a heightened susceptibility to substance abuse, with LGBTQ teens on average 190% more vulnerable according to studies. The general political and moral sentiments of where I grew up, a closeted LGBTQ youth, was overbearing and left me consistently fearful of judgment and abandonment. Socially, I struggled to avoid branding solely for my sexual identity while constantly attempting to maintain an image of masculinity, something I perceived as important at the time. The resulting low self-worth turned me into substance abuse. Bubbling over with insecurities, substance use inexplicably fooled me into believing I was doing it because I didn’t care what people thought of me, though it really meant I was so lost I didn't care for my well-being. Cannabis use on the other hand brought me solace, eased my depression, and opened a door to a community that didn’t judge me by who I loved: just what I smoked.

How do you view the severity of substance abuse as it specifically pertains to cannabis usage?

I view the substance abuse problem, especially among youth and young adults, as devastating. With cannabis in particular though, I find its frequent grouping with other substances far more troubling than abuse of the plant itself. Forget the marijuana naysayers but think of youth, who grow up under this stigmatization perceiving cannabis as taboo. In turn, they are treating marijuana with the same abusive, impulsive behavior as one might with other substances and disregarding its holistic, healing values. While I don’t condone youth consumption by any means, I think it is imperative future users respect and understand the plant. I believe if we want to maximize the wholesome benefits and continue to shift perceptions of cannabis we need to stop the glorification of the taboo aspect.

What specific steps would you recommend to help LGBTQ teens?

Where you are and who you are with doesn’t stop you from feeling insecure. While I did find bountiful love and support in the LGBTQ community, I also found it to be as ferocious at times as the bullies from high school. Only you can learn to love yourself and understand the true intentions behind your actions. As I said previously, my abuse came from deep self-doubt and misguided purpose. Make choices for your own self-love‒the respect and acceptance of others will follow.

The Intertwined History of Cannabis and the LGBTQ Community

Unbeknownst to many, cannabis and the LGBTQ community have a long and intertwined history, dating back to the 80s and 90s AIDS epidemic. If it were not for the proponents of medical cannabis for treating the symptoms of AIDS, medical marijuana might not have become legal at all. “We had all these other diseases that marijuana helps for. But it wasn’t until the visual effect of young white men dying in the hospitals with AIDS that it shook the conscience of America and began to change the law,” said Paul Scott, president of the Los Angeles Black Gay Pride Association and longtime marijuana and HIV activist. 

Dennis Peron, a gay Air Force Veteran who served during the Vietnam War, led the push for the legalization of medical cannabis. Upon returning from the war, Peron sold marijuana to HIV positive men in the Castro, recognizing its benefits long before legalization became an active public concern. Emboldened by his partner’s death from AIDS in 1990, Peron organized Prop P and opened America’s first public dispensary, the San Francisco Cannabis Buyers Club. The dispensary eased the pain and discomfort of individuals with AIDS with no strings attached. It became a well-known resource for those with HIV, providing support even for those without funds.  

Peron also co-authored Proposition 215, which permitted the use of medical marijuana in California and was the first of its kind. Prop 215 paved the way for future marijuana legalization and is still in place today. Far from a hippie movement, the legalization of marijuana was motivated by the gay community as a response to the needs of those suffering from AIDS.

A Timeline of Marijuana’s History in the United States

Pre 1850s

The colonists of Jamestown grew hemp to support England cause and, later, to support expansion in America.

1911 - 1929

States enacted marijuana laws, many declaring it a poison.

1937, August 2

Congress passed the Marijuana Tax Act, which levied a fee on commercial cannabis transactions. Nearly every state had laws that criminalized marijuana possession and sales.

1970, October 27

The Comprehensive Drug Abuse Prevention and Control Act of 1970 repealed the 1937 Marijuana Tax Act. However, it also classified marijuana as a Schedule I controlled substance, making it illegal for physicians to prescribe it to patients.

1982

Most states had passed medical marijuana legislation. Therapeutic research programs allowed physicians to distribute cannabis to patients enrolled in approved clinical trials.

1990

Dennis Peron’s partner, Jonathan West, died from AIDS.

1991, November

Peron organized Prop P, a medical marijuana initiative that declared San Francisco’s support for medical marijuana.

1992

Peron opened the San Francisco Cannabis Buyers Club with John Entwistle.

1994 - 1995

California’s elected official approved laws that recognize the use of medical marijuana; however, then-Governor Pete Wilson vetoed both measures.

1996, November 5

Peron co-authored Proposition 215 with Anna Boyce, John Entwistle Jr., Valerie Corral, Dale Gieringer, William Panzer, Leo Paoli, and Tod H. Mikuriya

2000s

States decriminalize cannabis.

2000, September

Conant v. McCaffrey; a federal judiciary issued a ruling that limited federal officials' ability to punish physicians who prescribed medical marijuana.

2003

The California State Legislature passed the California Senate Bill 420, otherwise known as the Medical Marijuana Program Act. It established the California medical marijuana program and clarified the scope and application of California Proposition 215.

2012, November 6

Colorado and Washington became the first states to legalize the recreational use of cannabis.

2014, May

Congress passed the Rohrabacher-Farr amendment, which prohibited the federal prosecution of individuals acting within state medical cannabis laws.

Present Day

Most states have decriminalized marijuana or allow it for medicinal purposes. Some states have fully legalized marijuana, while it is still entirely illegal in others.

From the LGBTQ perspective, the fight for the legalization of marijuana represents their struggles, historically. Furthermore, legalizing cannabis is a step that will help advocates focus on arguably greater issues that plague the LGBTQ community, such as suicide, mental illness, and homelessness.

The Prevalence of Cannabis and Substance Abuse in the LGBTQ Community

Monitoring the line between beneficial and harmful cannabis usage is an exhaustive endeavor that has caught the LGBTQ community in its crossfire. While cannabis has certainly helped sexual minorities in times of need, the sad but unsurprising truth is that they also suffer from substance abuse problems at a disproportionately higher rate than the general population. As such, cannabis has been both a gift and a curse to the LGBTQ community.

The following findings from SAMHSA’s 2018 National Survey on Drug Use and Health exhibit cannabis’s pervasiveness in the LGBTQ community:

  • 1

    16.5% of LGB adults (18 or older) have a substance abuse disorder (SUD).

  • 2

    Marijuana is the most used illicit drug among LGB adults, with a usage rate of 37.6% compared to 16.2% of the general population, as shown in bar chart one (illicit drug use among LGB adults) below.

  • 3

    33.4% of LGB aged 18–25 use marijuana compared to 22.1% of the general population.

  • 4

    20.8% of LGB over the age of 26 use marijuana, compared to 8.6% of the general population. This is an increase from recent years, as shown by bar chart two (marijuana use among LGB adults) below.

  • 5

    34.2% of LGB females use cannabis compared to 31.5% of LGB males. Only 20% of heterosexual females and 24.2% of heterosexual males use cannabis. 

  • 6

    8.5% of LGB users aged 18-25 have a cannabis use disorder, compared to 2.5% over the age of 26. 

The survey also found that frequent marijuana use was associated with opioid misuse, heavy alcohol use, and depression in LGB youth and young adults ranging from ages 12–25. In addition to having a higher risk for SUDs, LGBTQ persons often enter treatment with more severe cases of SUDs

Why the Risk of Substance Use Disorder May Be Higher for LGBTQ People

Many issues plaguing the LGBTQ community are connected and feed off of each other, resulting in an arduous cycle. For instance:

  • The stressors that are common to the sexual minority tend to lead to serious mental illnesses, such as major depressive disorder. 
  • Those suffering from such oppressive conditions are increasingly likely to self-medicate with cannabis, alcohol, or other substances—leading to a substance abuse disorder (SUD). 
  • Following, co-occurring SUD is associated with increased suicidality risk among LGB adults. 

The conditions that lead them to seek cannabis as a reprieve become, in turn, symptoms of the treatment. To unpack why LGBTQ people are more susceptible to SUDs, one must understand the plight that comes with being a part of the marginalized. As stated in a PRIDE study:

elevated substance use among sexual minority people results from increased exposure to enacted stigma or prejudice (including trauma), expectations of prejudice, identity concealment, and internalized stigma. Numerous studies have identified links between minority stress and increased likelihood of substance use.

Published: 07 Feb 2020
Published: 07 Feb 2020

Some of the contributing factors to why LGBTQ people suffer from higher rates of SUD include:

Social stigma and shame

Sexual minorities experience additional pressure from a predominantly heterosexual society. For example, heterosexism commonly instills shame in LGBTQ individuals who may internalize the homophobia that society directs toward them. To deal with emotions of shame and self-doubt, individuals may turn to mind-altering substances. 

Internal confusion may also be associated with a higher risk for SUDs. Those who identify as gay or lesbian are more than twice as likely as heterosexuals to have a severe alcohol or tobacco use disorder. Additionally, people who identify as bisexual are three times as likely to have a SUD. Furthermore, those who are unsure of their sexual identity are five times as likely to have a SUD.

Post-traumatic stress

A disproportionate number of LGBTQ people have PTSD at the hands of an increased likelihood of harassment or violence compared to the sexual majority. Along with other prejudiced events, these instances can be traumatizing to the individual, with long-lasting symptoms. Cannabis is a common self-medication method, especially for those who do not receive outside treatment, such as behavioral therapy.

Rejection and social isolation

Being part of the minority can result in oppressive feelings of loneliness as well as an inability to feel a sense of belonging. To combat such emotion, the “high” aspects of cannabis use can be appealing. 

Similarly, LGBTQ individuals often struggle with the inevitable event of coming out to their friends and family, along with the stress that comes with perceived insecurities regarding rejection. LGBT young adults who reported high family rejection during adolescence were 3.4 times more likely to use illegal drugs.

Pursuit of safe spaces

Historically, bars have been a place of congregation for LGBTQ gatherings. The prospect of a safe haven combined with alcohol’s tendency to help people loosen up or feel more comfortable in their skin makes bars a natural meeting place for sexual minorities. Unfortunately, the nightlife culture lends itself to substance use and abuse, exposing its participants to SUDs.

So, the next 20 years or so, all I knew was that if you are gay, you go to bars and clubs," he told Healthline. "Over the years, you’re just trapped. You don’t have a choice. It’s like ‘you’re gay, here’s a bottle, here’s a bag.

anonymous gay man, who recovered from drug and alcohol abuse
anonymous gay man, who recovered from drug and alcohol abuse

What was once a useful tool as an invaluable treatment for HIV has become an unintended and harmful consequence of the struggle with marginalization and oppression. It is deeply saddening that within the LGBTQ community, higher rates of cannabis usage and SUD co-exist with increased rates of depression, anxiety, PTSD, eating disorders, suicidal thoughts, and homelessness.

What are the Risks for LGBTQ Youth? How and Why Does it Differ from Standard Youth Risk Factors?

As adolescents grow up and learn more about themselves, they often encounter situations that challenge their identities. For some, sexual identification is an ongoing process that is subject to change over time. With proper support, children can mature from such occasions and gain an increased understanding of themselves. For LGBTQ youth, these events often lead to self-crisis. 

LGBTQ youth experience risk factors exclusive to the sexual minority in addition to the risk factors that impact all youth. Due to these additional risk factors, LGBTQ youth engage in substance abuse at a significantly higher rate than straight peers, as indicated by national prevalence data. Some of these risk factors include:

Bullying and harassment

While all children are susceptible, LGBTQ youth are twice as likely to have been excluded, verbally harassed, or physically assaulted, according to a survey conducted by the Human Rights Campaign Fund. Furthermore, LGBTQ youth who are more open with their sexual orientation or exhibit gender-atypical behavior are more likely to be victimized. Seventy percent of students who took the 2018 Human Rights Campaign (HRC) LGBTQ Teen Survey reported being bullied at school because of their sexual orientation.

Such abusive experiences are directly related to increased substance abuse, mental health problems, and sexual risk-taking behavior. Several studies have shown that non-victimized LGBTQ students did not have an increased risk for substance abuse, suggesting that bullying was the direct cause. Bullying induces substance abuse, and LGBTQ students are more likely to be victims of bullying and harassment.

Disclosure of sexual orientation

The event of disclosing one’s sexual orientation to either family or friends is considered a high-risk moment for LGBTQ youth. Notably, the reaction they receive when they initially come out tends to stick and has a long-term impact.

A negative response can influence the likelihood of substance abuse years later—even if relationships have since improved. Furthermore, accepting reactions were found to buffer the negative association of rejection. In other words, numerous positive responses to coming out may help combat the consequences of adverse reactions.

Family conflict

Parental support is one of the most significant protective factors against adolescent drug use. LGBTQ youth often experience strained relationships with parents or caregivers due to conflict over sexual orientation, gender identity, or gender expression. According to the Youth Survey mentioned below, only 49 percent of LGBTQ teens said they could turn to an adult in their family for help compared to 79 percent of non-LGBTQ teens. Furthermore, 67 percent of respondents to the 2017 HRC LGBTQ Teen Survey reported that they had heard negative comments about LGBTQ people from their family members.

A study that looked explicitly at parental awareness found that LGBTQ youth whose families were aware of their sexual orientation reported significantly less internalized homophobia and increased family support. They were also less afraid of future negative family reactions than youth with unaware parents, whether or not their sexual orientation was received favorably. Most often, LGB youth neglect to disclose their sexual orientation to their parents due to fear of negative reaction, rejection, or even eviction. Of the unaccompanied homeless youth, up to 40 percent are LGBTQ. Homelessness puts adolescents at extreme risk for future substance abuse and mental health issues.

Minority Stress

While bullying and harassment have a more obvious impact on the risk of substance abuse, exposure to inherent homophobia in society degrades the self-worth and confidence of LGBTQ youth. Ninety-two percent of the LGBTQ participants in the YRBS survey mentioned below reported hearing negative messages about being LGBTQ. Examples include overhearing slurs and seeing negative stereotypes on TV.

Latent heterosexism pervades modern societal customs and institutions. As with racism, sexual prejudice is rooted in historical contexts and exists in many forms—both out in the open and hidden. Support from family and friends is crucial to offset enduring minority stress.

Childhood abuse

A study on disparities in childhood sexual abuse concluded, “The higher rates of abuse experienced by sexual minority youths may be one of the driving mechanisms underlying higher rates of mental health problems, substance use, risky sexual behavior, and HIV reported by sexual minority adults.” The study also highlighted that, compared to sexual majority adolescents, sexual minority adolescents were on average 2.9 times more likely to report childhood sexual abuse.

A sibling study indicated that in instances of sexual minority and majority sibling pairs, the sexual minority child reported more childhood psychological and physical abuse. Such results suggest that parents may single out the sexual minority youth for maltreatment.

Gender stereotypes

Gender exploration is a normal part of development, supported by research showing that only a small percentage of gender variant children develop an adult transgender identity. Moving into adolescence, however, gender norms become more impactful, enforced through society and its institutions, such as sports and Boy and Girl Scouts. 

LGBTQ youth often exhibit non-conforming behavior that defies typical gender expectations. Some evidence suggests that such conduct is a risk factor for adolescent substance and abuse. This phenomenon is particularly abundant among more masculine LBQ women who possibly experience more harassment due to their lack of femininity. Therefore, a tangible link may exist between the lack of gender conformity and harassment, which leads to an increased risk for substance abuse.

Peer influence

The risks for LGBTQ youth and substance abuse come full circle when evaluating peer influence. While friendships with peers who use drugs are a risk factor for all youth, LGBTQ youth are more likely to have friends who use drugs or alcohol—which, in turn, makes them more likely to use. 

In an effort to seek places where they belong, LGBTQ youth are also more likely to immerse themselves with older crowds that they meet through support groups or forums. In some cases, this leads them to visit environments where substance use is typical.

Statistical Data Regarding Cannabis Use and Risk Factors for LGBTQ Youth

The Youth Risk Behavior Surveillance System (YRBSS) monitors health-related behaviors among youth and young adults. In conjunction with the CDC and state and large urban school districts, they conducted a Youth Risk Behavior Survey (YRBS). The survey found that sexual minority students engaged in health-risk behaviors significantly more than sexual majority students.

The results revealed the following about LGBTQ youth cannabis usage:

  • 1

    50.4% of gay, lesbian, and bisexual (LGB) students had used marijuana compared to 28.8% of unsure students and 35.2% of heterosexual students.

  • 2

    11.1% of LGB students had tried marijuana before the age of 13 compared to 8.7% of unsure students and 6.3% of heterosexual students.

  • 3

    Current marijuana prevalence was 30.6% among LGB students, 18.9% among unsure students, and 19.1% among heterosexual students.

As with adults, youth who engage in risky behavior are generally more susceptible to cannabis use and SUDs. The YRBS revealed that for almost every health-risk behavior, sexual minority students had a higher prevalence compared to sexual majority students. 

The following table contains additional results from the survey regarding risk factors:

Studies have also found that those with SUDs are seven times more likely to die by suicide. Tangentially, national prevalence data on LGB high school students indicates that LGB youth engage in substance use at a significantly higher rate than straight peers. It is important to distinguish that being LGBTQ does not cause substance abuse; rather, the consequences of prejudice wear down the support systems of LGBTQ adolescents, increasing pressure and the likelihood of drug and alcohol usage. With the proper support structures in place, LGBTQ teens can grow up healthy and substance-free.

How to Take Action? How Do Parents and Caregivers Help LGBTQ Teens?

Compared to 8.4% of the general population, 20–30% of the LGBTQ population suffer from substance abuse disorders. On top of that, rates of substance abuse increase the earlier an individual starts using, making it particularly dangerous for adolescents to partake in.

Parental support is one of the primary protective factors for helping teenagers resist substance temptation. Unfortunately, LGBTQ youth are 40%t less likely to have an adult in their family that they can confide in. As a parent or guardian, simply showing your child that you not only accept their sexual identity but also embrace them as they are can go a long way. According to the 2018 HRC LGBTQ Youth Report, only 24% of LGBTQ youth reported that they could “definitely” be themselves as an LGBTQ person at home. 

Re-affirming Actions That Family Members Can Take
  • Talking openly with your teenager about their sexual identity.
  • Inviting their LGBTQ friends to join family activities.
  • Attending LGBTQ-friendly events together.
  • Appreciating gender-atypical style.
  • Helping them find an LGBTQ support group.
  • Staying informed about LGBTQ issues and struggles.
  • Advocating for LGBTQ-friendly programs and extra-curricular activities. 
  • Being aware of policies affecting LGBTQ youth.

While you might not be able to control everything that happens to your teenager in the outside world, providing a safe space within the home can have a significant impact on their well-being. Supplying your child with love and support is the best thing you can give them to arm them against the hazards of minority stress and substance abuse.

To learn more about how to talk to your teenager specifically about cannabis, check out this article.

For more information on how to support your LGBTQ teenager

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