Substance Use in LGBT Older Adults

August 2012 | Laurens G. Van Sluytman, PhD, MA, LCSW

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Over four million seniors will need substance abuse treatment services by 2020. [i],[ii]  Lesbian, gay, bisexual, and transgender (LGBT) community members will undoubtedly represent a portion of this number. Research shows that substance use risk factors and use of substances are higher for LGBT individuals than their heterosexual counterparts. Among the risk factors for this population are the use of substances to cope with uncomfortable feelings related to stigma associated with homosexuality, heterosexism and general societal pressure to conform. Research also indicates that discrimination associated with sexual orientation, race and gender, when combined, contributes to increasing the odds of substance use and misuse among LGBT community members.[iii] In as much as these risk factors exist, so too do the social aspects of substance use and misuse among members of the LGBT community.

While our knowledge concerning substance abuse among LGBT community members increases, information concerning LGBT elders is emerging from researchers such as Dr. Noell Rowan of University of Louisville  who has presented findings from her research on resiliency and quality of life among older adult lesbians and alcoholism. Additionally, in 2011, The Aging and Health Report: Disparities and Resilience among Lesbian, Gay, Bisexual, and Transgender Older Adults  indicates that 10 percent of older LGBT community members were excessive drinker (5 or more drinks for men on a single occasion and 4 or more for women) and 12% used drugs that were not prescribed. Also, chronic pain is frequent in late life and is a common reason for nonprescription use of prescription pain medications. Further, given the cumulative effect of aging, race, gender and sexual orientation on substance use, as stated above, special attention should be given to elders within the LGBT community.

Findings from the Primary Care Research in Substance Abuse and Mental Health for Elderly Study (PRISM-E) recommended screening for mental health problems and at-risk drinking for patients in primary care. The study finding also recommended implementing brief interventions by primary care providers. Though funded in part by the Substance Abuse and Mental Health Services Administration (SAMHSA), the Veteran's Administration (VA), and Health Resources and Services Administration (HRSA), this study did not examine the plethora of other substances: prescribed, over the counter and illegal, that elders may use. Nor does the study explore substance use/misuse among LGBT community members. The dearth of information raises many important questions for LGBT serving organizations, its membership and community stakeholders. For example how does substance use impact elder functioning and overall well-being? What are outcomes of substance use/misuse for medication compliance? How do limited resources, isolation or impairment impact access to treatment, exposure to violence and high risk behavior?

Without answers, we are limited in our capacity to develop and implement practice methods grounded in evidence that attends to gender, race and class for the LGBT community at large. Despite these challenges stakeholders must continue to advocate for attention and service with and for elder LGBT community members. Services and Advocacy for Gay, Lesbian, Bisexual and Transgender Elders (SAGE) and LGBT Movement Advancement Project (MAP) along with their partners, American Society on Aging (ASA), National Senior Citizens Law Center (NSCLC), Center for American Progress and AARP its 2010 report, Improving the Lives of LGBT Older Adults: Full Report, asserted that members of the LGBT community and the organizations that provide services are integral to the determining the degree to which policy and advocacy are given attention. As such, we must advocate for intervention research that is grounded in deeply exploring the multiple issues impacting elders LGBT who use or misuse illicit substances and prescribed medication. That is research and treatment methods that focus on the social and sexual contexts of substance misuse and aging. Next we must provide training and resources to support and improves existing treatment modalities that recognize existing socio-economic differences and incorporates elders’ LGBT voices. Finally, we must develop specific knowledge and skills for working with the population while providing road maps for others who share our concern and work with the population.

Laurens G. Van Sluytman, PhD, MA, LCSW is an Assistant Professor at Morgan State University, School of Social Work. His research objectives comprise efforts to identify the role that micro, messo and macro-level factors play in black men’s individual wellness, the lives of their families, communities and larger local and national processes toward developing and implementing effective policies  addressing poverty and disparities in health outcomes. He co-authored several papers and presented findings at several national conferences on addiction and aging. His community partners include GRIOT Circle, an intergenerational culturally diverse CBO serving the needs of elder LGBT POC and STAR Inc. Baltimore.

[i] Gfroerer J, Penne M, Pemberton M, Folsom R. 2003. Substance abuse treatment need among older adults in 2020: the impact of the aging baby-boom cohort. Drug Alcohol Depend 69(2):127–135.

[ii] Lee, H., Mericle, A. A., Ayalon, L., & Areán, P. A. (2009). Harm reduction among at-risk elderly drinkers: a site-specific analysis from the multi-site Primary Care Research in Substance Abuse and Mental Health for Elderly (PRISM-E) study. International Journal Of Geriatric Psychiatry, 24(1), 54-60. doi:10.1002/gps.2073

[iii] McCabe, S., Bostwick, W. B., Hughes, T. L., West, B. T., & Boyd, C. J. (2010). The Relationship Between Discrimination and Substance Use Disorders Among Lesbian, Gay, and Bisexual Adults in the United States. American Journal Of Public Health, 100(10), 1946-1952. doi:10.2105/AJPH.2009.163147