Guest blog: Alcohol and mental health in the LGBTQ+ community
Brian Ching (he/him), mental health researcher at University College London, looks at the link between alcohol use and mental health.
Time and time again we have been shown that compared to cisgender heterosexual people, LGBTQ+ people are more likely to have higher rates of alcohol misuse.1 This may especially be the case during COVID-19, where people may be more likely to drink with lockdown measures now relaxed. It is also clear that LGBTQ+ people who drink more have poorer mental health and are more likely to struggle with depression and anxiety than cisgender heterosexual people.2
To support the LGBTQ+ community with alcohol use, it is first important to unravel the specific reasons why we, as queer people, may drink in order to support campaigns or policies that can improve health outcomes.
Like all human behaviour, the reasons for alcohol use are complex and individual. Here, I’ll explore some LGBTQ+ specific qualitative experiences and potential reasons rooted in scientific research. However, this does not mean that the reasons below are exhaustive, as factors outside of our queer identities can play a part as well. Reasons why people drink alcohol can also vary for every LGBTQ+ individual.
Drinking to connect
LGBTQ+ spaces are historically safe havens, where our community can openly express minority sexual and gender identities and escape from cisgender heterosexual normativity. With drinking being central to the commercial queer scene, many may use alcohol as a ‘social lubricant’ to feel confident and relaxed, to socialise with strangers and party with friends. It may be a way for queer people to feel validated and accepted,3 whilst celebrating the union of the LGBTQ+ community in such spaces.
This inherent need to connect with others who share similar experiences may nudge us to have another drink or take that tequila shot in the club. Even during the early phases of the pandemic where methods to connect were mostly virtual, opportunities were heavily saturated with alcohol.4 With belonging being so vital to good mental health and heavy alcohol use a vehicle to that same belonging, particularly in queer spaces; alcohol use risks become a problematic double-edged sword for LGBTQ+ people.
Pressure to fit in
Alcohol use may also contribute to the identity construction of LGBTQ+ people.5 Its consumption may perpetuate conventional notions of binary gender where drinking ‘straight’ alcohol, beer or hard liquors are associated with ‘manliness’ and sweet, colourful drinks, like ‘alcopops’, are more ‘feminine’. Some may feel the pressure to drink ‘appropriately’ to fit in, and others may use certain drinks to display their sexual identity or to blend in amongst heterosexual spaces.
However, alcohol use may also be utilised to express and challenge preconceptions of gender. For some non-binary and transgender people, choosing to drink certain types of alcohol may be a way to break stereotypes and allow people to convey who they are in LGBTQ+ spaces. Visibility can be tremendously validating and is protective for LGBTQ+ mental health, and of course, sexual and gender identities should and can be expressed with or without the help of alcohol.
Using alcohol to cope
As sexual and gender minorities, LGBTQ+ people experience many stressors and traumas that cisgender heterosexual counterparts do not.6,7 Intersectionality is key here as discrimination may be experienced significantly differently depending on the multiple identities we have as marginalised people.8
Some may drink to numb out the fear of rejection from loved ones and society, but also internalised shame and guilt. Hurtful reactions of rejection, disapproval, and disappointment from unsupportive families and friends may make ‘coming out’ and living ‘authentically’ distressing for many. Acts of violence against the LGBTQ+ community can range from microaggressions,9 such as derogatory comments and ignorant jokes, to physical harm and abuse, which are unfortunately still very prevalent and rising.10 This may be worsened by anti-LGBTQ+ governmental policies that attack the existence of queer people.
Some people may also use alcohol to allay worries of how they may be perceived by others in social settings (queer or not). This is especially pertinent with the double discrimination certain groups experience outside and within LGBTQ+ spaces, such as in bisexual and transgender people, and those who are HIV positive. As a result, alcohol may be consumed to cope with the minority stress and scrutiny we are constantly under in heteronormative societies.
LGBTQ+ alcohol support
To help reduce alcohol use and improve mental health in LGBTQ+ people, it is essential for health providers to understand the potential reasons why queer people may use alcohol. Having a richer understanding of why alcohol is important in the LGBTQ+ community may help inform targeted interventions to promote the reduction of alcohol use. Granted, this differs for every single person and practitioners should always have open discussions when coming up with ways to support LGBTQ+ people with their alcohol use.
There also needs to be more discussion about drinking culture in the LGBTQ+ community and how this impacts inclusivity, diversity, and mental health. How we can connect, express, and cope without alcohol as a community also needs to be further explored. More research and investment should be put into this to ensure everyone, regardless of drinking behaviours, can feel included in LGBTQ+ spaces.
If you’re struggling with your drinking, please speak to a health professional at your GP surgery who can provide advice and signpost you to services that can help reduce your drinking. Drinkaware also has a list of specific support services for LGBTQ+ people.
Find out more
Where to access support and treatment
References
[1] Zeeman, L., Meads, C., Sherriff, N., & Aranda, K. (2022). A systematic scoping review of alcohol use amongst gender and sexual minorities: LGBT+ Drinkaware.
[2] The mental health of lesbian, gay, and bisexual adults compared with heterosexual adults: results of two nationally representative English household probability samples. Accessible at https://doi.org/10.1017/S0033291721000052
[3] Wasted opportunities: problematic alcohol and drug use among gay men and bisexual men. Accessible at http://sigmaresearch.org.uk/files/report2009c.pdf
[4] Understanding alcohol and marijuana use among sexual minority women during the COVID-19 pandemic: a descriptive phenomenological study. Accessible at https://doi.org/10.1080/00918369.2020.1868187
[5] The role of alcohol in identity construction among LGBT people: a qualitative study. Accessible at https://doi.org/10.1111/1467-9566.12605
[6] Stress, coping, and context: examining substance use among LGBTQ young adults with probable substance use disorders. Accessible at https://doi.org/10.1176/appi.ps.201900029
[7] Sexual-minority women and alcohol: intersections between drinking, relational contexts, stress, and coping. Accessible at https://doi.org/10.1080/10538720.2011.588930
[8] Minority stress and drinking: connecting race, gender identity and sexual orientation. Accessible at https://doi.org/10.1177/0011000019887493
[9] Seeking acceptance: LGBTQ and membership in alcoholics anonymous (AA). Accessible at https://doi.org/10.1080/07347324.2020.1738295
[10] Recorded homophobic hate crimes soared in pandemic, figures show. Accessible at https://www.theguardian.com/world/2021/dec/03/recorded-homophobic-hate-crimes-soared-in-pandemic-figures-show
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