Common Mental Health Issues That LGBT Individuals May Face

Substance-using LGBT clients struggle with mental health concerns and illnesses similar to those of their heterosexual counterparts. They suffer from affective disorders, posttraumatic stress disorder (PTSD), sexual trauma, suicidal ideation and behaviors, eating disorders, and the full range of mental disorders.

However, LGBT individuals have the added stress of struggling to consolidate stigmatized sexual or gender identities, making choices about coming out to family and friends, fear of prejudice, and being at increased risk of violence. In general, researchers suggest that individuals who feel more comfortable about their sexuality and gender identity are more resilient, have better coping skills, and are better able to articulate their mental health needs. However, many clients in substance abuse treatment may not be out and may be very uncomfortable with their identity. This presents several stumbling blocks for the counselor and the client, including the possibility of inappropriate counseling and an increased risk of relapse. Research on the mental health needs of lesbians and gay men has increased substantially during the past two decades. However, significant gaps still exist. The process of coming out as a lesbian or gay man can be extremely stressful, yet there is virtually no research on effective ways of coping with this process, and there has been even less research on the mental health of lesbians and gay men who are nonwhite, adolescent, elderly, or coping with disabilities (Rothblum, 1994). There is also very little research on bisexual and transgender individuals. However, some suggest that many transgender individuals struggle with low self-esteem, depression, and fear about the reality of their vulnerability to personal violence.

Past sexual abuse and trauma may well lead to other mental illnesses, such as PTSD, and complicate treatment for substance abuse. For example, an outcome study of lesbians and gay men who had completed inpatient substance abuse treatment found that 44 percent had been sexually abused (37 percent of males and 67 percent of females) and abstinence was much more likely among those who had not experienced abuse (Ratner, Kosten & McLellan, 1991).