This document discusses substance abuse among gay males and the relationship to minority stress. It notes that gay males experience discrimination and internalized stigma which contributes to higher rates of substance use disorders compared to straight males. The document outlines common substances of abuse, and notes that minority stress can lead gay males to use substances as a coping mechanism. Effective treatment needs to address the triggers of substance abuse and consider the experiences of discrimination. Treatment approaches discussed include motivational interviewing, harm reduction, and the stages of change model.

1. Gay male
and
substance
abuse
Tracy Pierre & Navaporn Tantana

2. Overview
Minority Stress & Substance
Use
Substances
Cycle of Addiction
Risk Factors
Implication for Assessment
& Treatment
Resources & Information

3. 3
“At the root of all
addiction is pain”

4. Minority Stress and substance abuse
● Chronic stressor includes experience of
prejudice, discriminaton, internalized
stigma, and anticipation of future
discrimination
● Sexual minorities face discrimination in both
individual and institutional levels which
inevitably pose them at risk in mental health
desparities related to their sexual
orientation
● Sexual minorities are at more risk
compared to their straight counterparts
for substance use disorder
● There is a strong relationship between
experiencing minority stress and the use
of substance as a coping mechanism for
life stressors
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5. Substances
List of substances
➔ Marijuana
➔ Rx depressants/
stimulants
➔ Heroine
➔ Methamphetamine
➔ Opiates
➔ Party drugs: cocaine,
ketamine, GHB,
Poppers
Prevalence in gay
youths’ substance
use
● 21.1 % of use for tobacco
● 14% for marijuana
● 18.9 % methamphetamine
● 11% MDMA/ecstasy
*LGB youths initiate alcohol and
illicit drugs earlier than non LGB
identified youths
Adults
★ Gay and Bisexual men in
the US are 1.4-1.9 times
more likely to meet the
criteria for a lifetime drug
use disorder compared to
heterosexual men
★ Ethnic / Racial minority gay
men also has even higher
rate of substance abuse
5
(Kelly et al., 2021) &
(Newcomb et al.,
2014)

6. Cycle of
addiction
Fantasy
Ritual
Drug use
6
Stressor/
trigger
Anxiety/depression
Shame/guilt
Loneliness/Isolation
.
Emotional
numbing
Release
Control

7. Other Risk Factors
● Aside form multiple minority stress, gay men face many other risk
factors; making them vulnerable for SUD as well
● Intersectionality problems of racial/ ethic stressors for gay minorities
● Isolation and struggles with intimacy
● Use of illicit drugs heighten risk for HIV infection
● Lack of social support and poverty
7

8. Implication
Assessment &
Treatment

9. Assessment
● Biopsychosocial- gather information from client such as
presenting problem, symptoms, medical history, family
history, etc.
● Assess and gather underlying conditions that can
impact mental health such as homelessness,
unemployment, etc.
● Use additional screening tools to help gather more
information regarding substance use.
9

10. Specific Dynamics and Concepts to
gather from Gay Males during
Assessment
● Discrimination
● Harassment
● Violence
● Internalized Homophobia
● Internalized Heterosexism
● Isolation
10
● Isolation
● Stigmatization
● HIV
● Sexual Negativity
● Self- Hatred
● Internalized Prejudice

11. Assessment Screening Tools
11
1 2 3 4

12. Why Gay Men and Substance Abuse?
- Erases self-doubts, including
body image, stigma
- Lecreases depressed mood
- Decreases anxiety about:
sexual performance, HIV, and
internalized homophobia
12
- Increases energy and
productivity at work, home,
and social scenes
- Facilitates uninhibited sexual
expression and enhancement

13. Treatment Needs
13
- Treatment and prevention of substance misuse, especially with
co-occurring mental health disorders, HIV/STI
- Treatment environments must be affirming ( or treatment
programs with specialized groups for gay men) and safe for
clients to be out about sexuality, substance use, shame, HIV,
body image, homophobia, etc
- Effective treatment must address triggers to substance misuse
in order to adequately address relapse and to assist clients in
re-establishing life and health without substance use

14. Motivational Interviewing
An approach use to elicit
clients' motivation to make
positive chances, in order to
reduce/eliminate drug abuse.
Treatment
Harm Reduction
A set of practical strategies
that meets clients where they
are at and reduce any harm
from drug use/abuse.
14

15. Stages of Change
15
1 3 5
6
4
2
Pre-Contemplation Determination Maintenance
Contemplation Action Relapse
(Connors & DiClemente, 2013)

16. Other Treatment Approaches
16
- 12 step program, AA, NA
- CBT
- Seeking Safety- focuses on PTSD and substance
use
- DBT
- REBT

17. .
3. Resources
&
Information

18. 18
Substance
Abuse and
LGBT
relationship
Show and explain your web, app
or software projects using these
gadget templates.

19. 19
Suggested
Information
Show and explain your web, app
or software projects using these
gadget templates.

20. 20
Discussion Questions
1. What are some main points that you took from this presentation?
2. How comfortable are you gathering information related specificially to gay
men?
3. Which Stages of change do you think are the most difficult for gay clients?
4. Have you ever experience a client coming to a session high or drunk? If
so, what did you do? If not, what would you do if a client came to therapy
while high or drunk?
5. How would you apply what you learned in your current or future work with
gay clients?

21. References
Evans-Polce, R. J., Veliz, P. T., Boyd, C. J., Hughes, T. L., & McCabe, S. E. (2019). Associations between sexual
orientation discrimination and substance use DISORDERS: Differences by age in US adults. Social Psychiatry and
Psychiatric Epidemiology, 55(1), 101–110. https://doi.org/10.1007/s00127-019-01694-x
Lea, T., de Wit, J., & Reynolds, R. (2014). Minority stress IN lesbian, gay, and BISEXUAL young adults in
AUSTRALIA: Associations with psychological Distress, Suicidality, and substance use. Archives of Sexual
Behavior, 43(8), 1571–1578. https://doi.org/10.1007/s10508-014-0266-6
Newcomb, M. E., Ryan, D. T., Greene, G. J., Garofalo, R., & Mustanski, B. (2014). Prevalence and patterns of
smoking, alcohol use, and illicit drug use in young men who have sex with men. Drug and Alcohol Dependence,
141, 65–71. https://doi.org/10.1016/j.drugalcdep.2014.05.005
Moody, R. L., Starks, T. J., Grov, C., & Parsons, J. T. (2017). Internalized homophobia and drug use in a National
cohort of gay and Bisexual MEN: Examining Depression, SEXUAL anxiety, and gay community attachment as
Mediating Factors. Archives of Sexual Behavior, 47(4), 1133–1144. https://doi.org/10.1007/s10508-017-1009-2
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22. References
Connors, G. J., DiClemente, C. C., Velasquez, M.M. & Donovan, D. M. (2013). Substance abuse treatment and the stages of
change, Second Edition. New York: The Guilford Press.
Green, K. E., & Feinstein, B. A. (2012). Substance use in lesbian, gay, and bisexual populations: An update on
empirical research and implications for treatment. Psychology of Addictive Behaviors, 26(2), 265-278.
Miller, L. (2021). Substance abuse treatment, techniques & therapy programs. American Addiction Centers.
https://americanaddictioncenters.org/therapy-treatment.
NIH Publication. (2012). Principles of Drug Addiction Treatment; A Research-Based guide (3rd ed.).
U.S. Department of Health and Human Services (2016). Office of the Surgeon General, Facing Addiction in America: The
Surgeon General’s Report on Alcohol, Drugs, and Health. Washington, DC: HHS, November 2016.
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