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Substance Abuse: Treating the Addicted Teen Client
There have been numerous reports that substance abuse is more prevalent among gay, lesbian, and bisexual adolescents than among their heterosexual counterparts. For example, Remafedi (1987) found that 58% of his small sample of Minneapolis gay and bisexual youth met criteria for substance abuse. Another study found high rates of alcohol abuse (76%), marijuana use (42%), and cocaine/crack use (25%) among a sample of predominantly Hispanic and African-American gay and bisexual males in New York City (Rotheram-Borus et al., 1994). Estimates for substance abuse in heterosexual youth vary widely (and often include sexual minority youth because studies neglect to ask questions about sexual orientation), but estimates are that 4% of youth drink alcohol daily, 33% have had 5 or more drinks at one time within the past two weeks, and more than 90% of high school seniors have experimented with alcohol at some time in their life (Adger, 1991). A recent study that surveyed students in 59 schools in Massachusetts found that gay, lesbian, and bisexual students (who represented 2.5% of the population) were more likely than students who did not report they were gay, lesbian, or bisexual to engage in 24 substance-use related behaviors including using alcohol before age 13 (59% vs. 30%), binge drinking (46% vs. 33%), using marijuana (69% vs. 47%), using cocaine (33% vs. 7%), and sharing needles (16% vs. 1%) (Garofalo et al., 1998).
Minimal information exists for substance abuse patterns among lesbian and bisexual female adolescents. However, at least two reports have indicated that similar patterns exist among adult lesbians and adult gay men (Anderson, 1996; Glaus, 1988). McKirnan & Peterson (1989) found slightly lower rates of alcoholism in lesbians than gay men (9% vs. 17%), rates which were similar to those for heterosexual women (7%) and men (21%).
These statistics must be interpreted with caution because the youth included in the studies are not a representative sample of sexual minority youth. Rather, they are youth that have been willing to identify themselves as gay, lesbian, bisexual, transgender or questioning youth to researchers or participate in some organized activity for sexual minority youth. Furthermore, the samples are predominantly male.
It should be noted, as well, that youth with poor coping skills and poor networks of social support are at a greater risk of engaging in self-destructive behavior, regardless of their sexual orientation. Thus, youth with good coping skills will be at less risk of succumbing to substance abuse, even though the stress of "coming out" is great. This is supported by research findings mat many sexual minority youth are engaged in healthy, positive activities (e.g., Jordan, Vaughan, & Woodworth, 1997).
Two additional life-threatening issues associated with drug and alcohol abuse are frequent unprotected sexual encounters and suicide attempts. Both of these behaviors have been noted to increase when substance use is present (e.g., Rotheram-Borus et al., 1994). Gibson (1989) reported that as many as 20% to 35% of gay youth have experienced suicidal ideation. Studies have found that substance abuse may be linked to higher levels of suicidal ideation and attempts (Roles, 1983) and that gay-related stressors are more common among adolescents who had attempted suicide than those who had not (Rotheram-Borus, Hunter, & Rosario, 1994). Use of drugs and alcohol may impair judgment and lead youth to engage in more risky sexual behaviors such as sex with multiple partners or unsafe sex practices (Rotheram-Borus et al., 1994).
School psychologists are in a unique position to respond to and affect this problem. One growing phenomenon is the presence of gay, lesbian, and bisexual groups or clubs in high schools, often supported by faculty and administration. These groups offer age-appropriate opportunities for socialization and for meeting other gay, lesbian, bisexual, transgender, questioning, or supportive teens thereby providing social support and furnishing opportunities for developing social skills. In addition, these programs may offer avenues for addressing the prevalent harassment of gay, lesbian, bisexual, transgender, and questioning teens in schools, thereby reducing stimuli for substance abuse. In one study of sexual minority youth in the Chicago area, gay, lesbian, and bisexual high school students reported that school-based groups or clubs for gay, lesbian and bisexual students and straight supportive allies, with administrative support and assistance, were an important part of making the school environment amenable to sexual minority students and alleviating their sense of alienation and differentness (Jordan, Vaughan, & Woodworth, 1997).
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