Why It Matters: Recognising LGBTQIA+ Struggles in Addiction and Accessing Support

Written By Lisa Gardener

Written by Wezz Killinaul

As a proud trans woman who has been through addiction and is in recovery this is something that I feel very strong about, and as it feels like we are going backwards with our rights and progress in the world now is the time to be louder, more informed and supportive than ever.

Too often, conversations about addiction and recovery overlook the specific realities faced by LGBTQIA+ people. Yet the evidence is clear: lesbian, gay, bisexual, trans, queer and other LGBTQIA+ communities experience higher rates of substance use and significant barriers when trying to access support. These are not simply individual issues. They are shaped by stigma, discrimination, exclusion and the long-term impact of minority stress. Recognising these struggles is essential if we want treatment services to be genuinely fair, effective and compassionate.


Why these inequalities exist

For many LGBTQIA+ people, substance use cannot be understood without looking at the wider social context. Experiences such as bullying, family rejection, harassment, discrimination in healthcare, housing or employment, and pressure to hide one’s identity can have a cumulative effect over time. Research describes this as minority stress: the chronic strain that comes from living in a society where your identity may be questioned, judged or unsafe. For some people, alcohol or drugs can become a way of coping with trauma, anxiety, shame, loneliness or social exclusion. This does not define LGBTQIA+ communities, but it does help explain why the risks are often higher. Mental Health Research, and The British Journal of General Practice, and The LGBT Foundation all highlight how discrimination and cumulative inequality contribute to poorer health outcomes, including substance-related harm.


Barriers to accessing treatment services

Even when support is available, many LGBTQIA+ people do not feel safe accessing it. Some fear being judged, misunderstood or outed. Others have already experienced poor treatment, such as being misgendered, having their identity ignored, or encountering assumptions that services are designed only for heterosexual and cisgender people. A recent systematic review in The British Journal of Psychiatry found recurring barriers including harassment, discrimination, lack of culturally competent care, and fear of stigma.

This can lead to delayed help-seeking, early dropout from treatment, or reliance on informal support instead of professional care. For trans and non-binary people in particular, anxiety about disrespect, inappropriate language, or disruption to gender-affirming care can be especially significant. The Anti-Stigma Network and research reported through Health & Care Scotland both stress that stigma, lack of understanding, and wider health inequalities continue to reinforce these barriers.


Why this matters in Scotland

As someone living in Scotland, I've seen these issues reflected in conversations about addiction, recovery and access to healthcare. Scotland's experience offers one example of how wider inequalities can affect LGBTQIA+ people seeking support.

These concerns sit within a broader context. In Scotland, the wider picture around alcohol and drug harm already shows how important timely, person-centred support is. Reports from NHS Greater Glasgow and Clyde and the Scottish Drugs Forum point to ongoing stigma, unequal experiences of care, and the need for better joined-up services. When these general barriers are combined with LGBTQIA+ discrimination or invisibility, the risk of people falling through the gaps becomes even greater. That is why inclusive treatment is not an optional extra. It is part of delivering equitable healthcare.


What better support can look like

  • Creating services where people are respected, believed and addressed appropriately.

  • Training staff to understand LGBTQIA+ identities, minority stress and the impact of discrimination on recovery.

  • Offering non-judgemental, affirming support rather than expecting people to fit into one model of treatment.

  • Working with peer networks and community organisations to improve trust and signposting.

  • Recognising that people may have intersecting experiences of poverty, trauma, racism, disability or homelessness which affect access to care.

  • Displaying the Flag in services, on information leaflets, on websites and even wearing a pin badge can make it easily identifiable that a service is LGBTQIA+ Friendly / Informed.


A call to recognise, listen and act

Recognising the struggles LGBTQIA+ people face in relation to addiction is not about reinforcing stereotypes. It is about acknowledging the real impact of stigma, discrimination and exclusion, and ensuring that treatment services respond with dignity, safety and understanding. If we want recovery systems that work for everyone, then LGBTQIA+ voices, evidence and lived experience must be part of how services are designed, delivered and improved. Real inclusion has the power to save lives.

As we move through Pride Month lets make sure that as a whole we are acknowledging, respecting and listening to LGBTQIA+ community members and giving them the care and compassion they truly deserve, one human to another.

References

Lisa Gardener
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