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Lesbian, Bisexual Women Face Greater Barriers to Alcohol Use Disorder Treatment

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Key Takeaways

  • Sexual minority women (SMW) navigate additional barriers to treatment for Alcohol Use Disorder (AUD).
  • SMW were more likely to face barriers to services to reduce alcohol use when younger, racialized, and lower income.
  • These findings necessitate more affirming treatment services to address problematic alcohol use among SMW.

A recent study published in Alcoholism: Clinical & Experimental Research found that sexual minority women—lesbian and bisexual— (SMW) face significant barriers when it comes to addressing problematic alcohol use.

Researchers found that 43% of sexual minority women reported heavy episodes of drinking in the past year, while 10% met the criteria for alcohol dependence, and 22% reported that they recently wanted to reduce their drinking.

Given how challenging it can be to seek help for alcohol use disorder, greater efforts are needed to support appropriate treatment for sexual minority women.

Understanding the Research

This study included 695 adult women of white, Black, and Latinx backgrounds, of which, 74% identified as lesbian, while 25% identified as bisexual, and found that alcohol outcomes varied by age and race/ethnicity, but not based on sexual identity or income.

Younger women were more likely than older women to report heavy episodes of drinking and alcohol-related consequences, while Black and Latinx women were more likely than white women to report heavy episodes of drinking and to meet criteria for alcohol dependence.

Black women were more than twice as likely as white women to be motivated to limit their alcohol use, and more likely than white women to access treatment but were more dissatisfied with service provision.

Negative Coping Skill for Stress

Deidra Thompson, DNP, FNP-C, PMHNP-BC, faculty member in Walden University’s MSN Psychiatric-Mental Health Nurse Practitioner program says, "Sexual minority women (SMW), particularly women of color, young age and low income, face significant barriers to alcohol use disorder (AUD) treatment and are often dissatisfied with treatment when they seek help."

Thompson explains, "Lesbian and bisexual women are at greater risk for AUD, and more research is needed to determine the factors that directly influence the increased risk for this population. It would also prove beneficial to develop interventions that will enhance the engagement of SMW in AUD treatment and improve outcomes."

There are other factors that can increase the risk for AUD, as Thompson notes family history, social influences and psychological factors such as a mental illness or past trauma. "Alcohol is also sometimes used as a negative coping skill for stress," she says.

Deidra Thompson, DNP, FNP-C, PMHNP-BC

There should be no place for discrimination in health care. Providers should seek education on cultural competence and avoid bias and discrimination when assessing and treating clients.

— Deidra Thompson, DNP, FNP-C, PMHNP-BC

Thompson highlights, "Unfortunately, discriminatory practices have plagued health care for decades. Individuals are sometimes discriminated against based on race or ethnicity, gender, disability, sexual identity, and age. Discrimination leads to disparities in health care."

The stress associated with discrimination can increase risks, as Thompson notes how it can exacerbate illnesses in individuals who are already vulnerable. "It can also cause individuals to avoid seeking health care for fear of discrimination and getting treated badly," she says. 

Thompson explains, "There should be no place for discrimination in health care. Providers should seek education on cultural competence and avoid bias and discrimination when assessing and treating clients."

Intersectional Understandings Needed

Social worker with Mindpath HealthKiana Shelton, LCSW, says, "Readers should take away a new respect for...self-determination and motivated individuals regardless of age, sexuality, race, or socioeconomic status. Help-seeking behavior holds...power when we think about change." 

Shelton highlights how this publication fits with the need for intersectionality as it relates to the LGBTQ+ community, as sexual minority women who were Black experienced greater challenges. "There still needs to be more LGBTQ+ focused studies to better understand the ways in which we can serve this minority community," she says.

Given that the study was limited geographically, Shelton notes that more research is needed on how an individual’s race along with sexual and gender identity may impact their drinking as a coping mechanism.

Kiana Shelton, LCSW

There still needs to be more LGBTQ+ focused studies to better understand the ways in which we can serve this minority community.

— Kiana Shelton, LCSW

Shelton explains, "Intersectionality is real, and we see it play out in every facet of life. It's important for us to never walk away from the ways in which multiple identities of a person intersect."

Race, sexual orientation, gender identity/expression and socioeconomic status were just a few examples that Shelton highlights to demonstrate how they may impact how one accesses treatment, the quality of that care, and their decision to remain in treatment.

As an LGBTQ affirming therapist, Shelton notes how crucial it is to hold awareness of your work environment and language. "As providers, we can say a lot about who we are before we even say a word, and this can hold a great impact on one's continual treatment for care," she says.

Equitable Care Access is Uncertain

Psychotherapist with Mindpath HealthTaish Malone, PhD, LPC-S, says, "While this article...has focused on alcohol treatment, readers should understand that the...findings whisper of a larger more consuming concern that leaks into multiple areas of the availability of aid for the betterment of certain demographics of the population."

The “us” and “them” mentality that has plagued America’s underbelly has become more noticeable, causing many to question rights, justice, and equity, according to Malone. "This article must be used to understand that the standard of expecting equitable care is now an uncertainty," she says.

Malone explains, "Too many are disproportionally unsupported and or unrepresented and may need to ensure they advocate for themselves and are mindful of and not discouraged from thriving despite the misrepresentation of humanity some may display."

Taish Malone, PhD, LPC-S

No one should be ostracized or refused the best level of care that should be afforded to all inhabitants of our country so that it can undoubtedly meet its claim to be great.

— Taish Malone, PhD, LPC-S

The LGBTQ+ population has significantly high rates of behavioral health issues, as Malone notes the impact of minority stress on the LGBTQ+ population. "The normalized disparagement of these subpopulations leave them vulnerable to excessive stress and therefore more susceptible to both mental and physical manifestations," she says.

Malone explains that such research highlights the need for more diverse offerings regarding treatment. "No one should be ostracized or refused the best level of care that should be afforded to all inhabitants of our country so that it can undoubtedly meet its claim to be great," she says.

As healthcare providers, Malone notes the need to stand firm in ethical principles to “do no harm,” by helping to understand, reach, and serve all.

Lived Experience of Queerness Helps

Therapist with Mindpath HealthBrandi Garza, LPC, says, "This article uses data from 2010-2012. The Supreme Court ruling on marriage equality wasn’t until 2015, and since then there have been massive shifts in the visual acceptance of the LGBTQI+ and would include the sexual minority women subgroup that is the focus [of]...the...study."

Garza highlights, "The study noted that younger, lower income and women of color face even more complex barriers when seeking treatment. Those subgroups...are...a more vulnerable group for many mental health concerns, and thus, treatment is also difficult to attain, due to much less cultural awareness and SMW focus." 

One of the most critical aspects of the therapeutic relationship is self-disclosure, according to Garza. "It is important for companies to not only hire therapists and counselors and tech assistants and doctors who are on the spectrum of sexuality and gender, but we must also encourage them to live openly in the manner they feel is appropriate," she says.

Brandi Garza, LPC

It is important for companies to not only hire therapists and counselors and tech assistants and doctors who are on the spectrum of sexuality and gender, but we must also encourage them to live openly in the manner they feel is appropriate.

— Brandi Garza, LPC

Garza highlights, "In doing this, there will be more clients who come forward seeking treatment knowing that they are in similar company and similar narratives as their own."

Having worked in addiction treatment and recovery for 15 years, Garza notes that there is no population that easily finds sobriety.

Garza explains that there can be vast differences in power differentials when working with marginalized populations, as she advocates for more inclusive treatment facilities that offer financial aid and higher diversity of staff that reflect the population they serve.

What This Means For You

As this study demonstrates, sexual minority women may face greater barriers to treatment for problematic alcohol use. This is a public health issue that deserves greater attention to promote equitable outcomes for lesbian and bisexual women in need of treatment.

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  1. Scheer JR, Batchelder AW, Bochicchio LA, Kidd JD, Hughes TL. Alcohol use, behavioral and mental health help‐seeking, and treatment satisfaction among sexual minority womenAlcohol Clin & Exp Res. 2022;46(4):641-656. doi:10.1111/acer.14789