Chapter 44. Gay Men and Lesbians

Robert Paul Cabaj, M.D.
DOI: 10.1176/appi.books.9781585623440.357658



Gay men and lesbians, as well as bisexual men and women and transgender people, require a special consideration in any literature focused on substance use, abuse, and treatment. Gay men and lesbians (the groups most studied) have higher rates of alcohol use and drug use than the general population, have higher rates of mood and anxiety disorders, and may respond best to gay-sensitive and gay-affirmative treatments. In addition, gay men are more likely to use and abuse "club drugs" and, in particular, methamphetamine—the use of which in some cities is described as at epidemic or crisis levels. Furthermore, risky behaviors, such as unprotected anal intercourse or sharing needles, that expose people to HIV and AIDS often occur under the influence of alcohol and drugs, so gay men who use such drugs may be at greater risk. Finally, transgender people—although not as well studied—seem to have very high rates of substance use and will need specific help when entering treatment.

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Table Reference Number

Substance use plays a prominent role in the lives of many gay men and lesbians, and gay men and lesbians have higher rates of substance use and abuse than in the general population.

The higher rates of use and abuse can be explained by a combination of biological, social, environmental, and developmental factors.

The internalized homophobia most gay and lesbians must confront in their own lives may have created a psychological structure with the overdevelopment of the defense mechanisms of denial, suppression, and repression. The effects of drugs and alcohol have a natural ability to support denial, suppression, and repression.

Antigay bias seen throughout society contributes to many life stressors and creates a "ghetto mentality" for many gay men and lesbians—encasing themselves in social environments that feel protective but are often associated with drug and alcohol use.

Although all types of drugs and alcohol are used by those gay men and lesbians who use, the explosive use of methamphetamine has been especially noteworthy among gay men.

Recovery for most gay men and lesbians requires self-acceptance of their sexual orientation (which may have been a source of conflict).

The ideal treatments for gay men and lesbians will be gay-affirmative or, at a minimum, gay-sensitive.


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