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eJOURNAL OF THE INTERNATIONAL CHILD AND YOUTH CARE NETWORK (CYC-Net) – ISSN 1605-7406

ISSUE 49 FEBRUARY 2003 •  CONTENTS •  HOME PAGE

youth issues

Sexual minority youth and substance abuse: Addressing the issue

Sher Knox is a Human Services Student at Selkirk College in Nelson, British Columbia

Introduction
In recent years, there appears to be a growing awareness in society regarding the complex issue of developing sexual identity in adolescence. The teen years are fraught with a multitude of developmental concerns, sexuality among them. However, for adolescents who are questioning their sexual identity or who identify as gay, lesbian, bisexual, transgender, or intersex, the development of sexual identity may carry with it a host of other issues (Rathus, Nevid, Fishner-Rathus, 2000). As will be discussed in this paper, some of these concerns are of an interpersonal nature: violence, stigma, social pressure to conform, sexual health risks, school absenteeism, and family problems. Others are decidedly intrapersonal: internalized homophobia, depression, substance abuse, and suicide. For the subject youth, these issues may be compound and inseparable. This paper will endeavour to outline the nature and effects of homophobia on the subject population, show the correlation between this stigma and substance abuse and, finally, offer some recommendations as to how we, as child and youth care workers, may alleviate the harsh reality faced by the subject youth in our society today.

In an effort to simplify the complex and often controversial process of labeling the subjects of this paper, the author of this article will respectfully refer to lesbian, gay, bisexual, transgender, and intersex youth with the inclusive term "sexual minority" youth.

Regarding the factors contributing to substance use and abuse in the queer youth population, most speak directly to the challenges of sexual identity acceptance in a heterosexist world. Therein lies multiple layers of stigma that must be addressed by the subject youth whether from school, peers, family, societal hegemony or their own personal anxiety about living life outside the norm of institutionalized heterosexuality.

Concrete data on the percentage of youth in our society that actually belong to a sexual minority is difficult to ascertain because adolescence is a time of sexual identity formation and identifying as "other" or different from the norm involves huge risk and authentic self-disclosure. "…During adolescence, sexual identity is still developing and distressed youth may not be certain they are GLB [gay, lesbian, bisexual], or would not likely self-identify in such terms. Thus, the number of GLB persons is likely to be underestimated…" (McDaniel, Purcell, & Augelli, 2001, p. 86). There are also youth who engage in same-sex sexual behaviours who will never identify with a sexual minority, though they, too, may experience the effects of homophobia, externally and internally. The relationship between sexual behaviour and identity is complex, difficult to completely understand, and beyond the scope of this paper. Yet, it is another factor making research on this subject challenging to apply and interpret (McDaniel et al, 2001).

The issue
According to the American Psychiatric Association (1994), substance abuse is a maladaptive pattern of using alcohol or drugs that results in significant adverse consequences such as problems at home or school, placing oneself in potentially harmful situations, legal problems, or interpersonal problems. This can be distinguished from substance use, which is adaptive use of alcohol or drugs on occasion.

Substance abuse is widely considered a problem among youth. Sexual minority youth are at even higher risk of developing problems with substance abuse due, in part, to societal attitudes regarding homosexuality (Jordan, 2000). The society we live in is decidedly heterosexist: that is, "a belief in the superiority of heterosexuals, or heterosexuality evidenced by the exclusion, by omission or design of non-heterosexual persons in policies, procedures, events, or activities" (Carniol, 2000, p.15). Not only do sexual minority youth not see themselves reflected in any aspect of mainstream society; homophobic attitudes, discrimination, and intolerance are openly supported by many social, governmental, and religious institutions. In such a climate, sexual minority youth internalize societal homophobia and negative attitudes, which in turn may manifest as shame, self-hatred, and self-abuse (McDaniel et al, 2001).

The negative impact of homophobia and heterosexism correlates with substance abuse in youth. There is also a positive correlation between experience of homophobia and familial difficulties, suicidal ideation, depression, isolation, and violence (McDaniel et al, 2001). Recent research from the National Longitudinal Study of Adolescent Health shows evidence that American sexual minority youth are more likely than their peers to contemplate and attempt suicide (Russell & Joyner, 2001). The longitudinal study, the nature of which allows academics to study the same group over a period of time ranging from months to years, also showed youth with both-sex sexual attractions at higher risk for substance abuse than heterosexual youth (Russell, Driscoll, & Truong, 2002).

Directly manifesting from homophobic attitudes are violence and harassment toward sexual minority youth. Many report a legacy of verbal, physical, sexual, or psychological abuse at the hands of peers, family, and even teachers due to their perceived or actual sexual orientation. Youth who do not conform to gender typical behaviour are targeted, males in particular. "Boys especially learn to conform to gender norms if they can; if they cannot, they are commonly subject to harassment and violence" (McDaniel et al, 2001, p. 98).

As a result of stigma, harassment and stress, sexual minority youth are more likely to seek solace in the maladaptive coping mechanism of substance abuse. Isolation of the subject youth is also a factor contributing to violence. Sexual minority youth are unlike other minority youth in that they usually cannot find others "like" them with whom to band together for protection or peer support (McCaskell, 1999). Thus, sexual minority youth are even more in need of institutional support to protect them from violence and discrimination. It is appalling to consider that schools, meant to nurture and support our young, may actually act as institutions of oppression by not having in place specific policies and training meant to combat homophobia and its negative impact.

The psychological factor of internalized homophobia can be looked upon as one reason why sexual minority youth may use chemical substances in an attempt to escape the resultant pain and discomfort. Many may also seek relief from identifying as "different" or "other", and in doing so deny and dissociate from genuine feelings and needs.

Common to all members of marginalized groups is the damage done to self-image by the internalization of feelings associated with being marginalized. In any sexual minority it is virtually impossible for an individual to escape experiencing internalized homophobia, at least to some degree (Guss, 2000). Indeed, beginning early in life, before a youth may become aware of any sexual orientation difference, they will learn some of the dangers associated with being a non-heterosexual. Often these cues take the form of public derision, discrimination, and slurs aimed at peers.

Facing the external view of them that society has shown, it is no wonder that sexual minority youth internalize this view, have difficulty accepting a sexual minority identity, building self-esteem, and expressing their sexuality. A common result is to abuse substances to assist in the "coming out" process, medicate the anxiety or depression associated with concealing their orientation, and deal with rejection from peers, family, and society at large (Roy, 1995).

Sexual minority youth may use drugs and alcohol to facilitate many aspects of the "coming out" process. The sexual minority cultures are, in many cases, organized around bars and drinking events. In order to meet others of their own "kind", teens may frequent these meeting places and use the available substances. (Jordan, 2000). There is also no doubt that psychoactive substances (drugs that affect the psyche, including alcohol) may dull the feelings of being isolated or different and reduce sexual inhibitions. Alcohol consumption seems a socially acceptable way to deal with feelings of anxiety, alienation, and low self-esteem. It remains true that in most locales there is a lack of age-appropriate social venues for queer youth. As a result, their culture, if it exists at all, is often underground and unsupervised which increases the likelihood of exposure to substance use (Jordan, 2000).

Youth who question their sexual identity or have negative feelings around their sexual orientation may turn to chemical substances to reduce internal tension. Some may also anticipate rejection once their sexual preference becomes known and may use alcohol and drugs to self-medicate feelings of guilt and shame (Doweiko, 2002). For others, the consumption of psychoactive drugs allows for "easier" expression of repressed desires and needs. Sexual minority teens may use alcohol and drugs as a vehicle for rationalizing their feelings for and behaviour toward others of the same sex. The mixture of sexual behaviour and substance use may put teens in dangerous situations, exposing them to unsafe sexual practices and potentially nonconsensual sexual encounters (Jordan, 2000).

There are other risks associated with substance abuse among the subject population. Some subsequent problems may include running away, homelessness, prostitution, learning difficulties, school dropout, and crime (Jordan, 2000). To clarify, these consequences may not be directly caused by substance abuse; rather, exacerbated by it. In addition, life-threatening issues that have been identified with drug and alcohol abuse are frequent unprotected sex and suicide attempts (Jordan, 2000).

Another unfortunate consequence of using psychoactive substances to facilitate the expression of sexual desire is the repercussions of state dependent learning. If a youth uses drugs or alcohol during sexual exploration and learns how to relate sexually while "under the influence", a painful awakening may result once the substance is removed. A queer youth may feel as though they can only duplicate sexual acts with someone of the same sex while high or drunk. Thus, they may fear sexual intimacy while clean or sober.

Recommendations
Many youth dare not come out in their school settings. Internalized and externalized homophobia, resulting in substance abuse and other self-destructive behaviours, can be linked to the taunts, contempt and violence directed toward youth who exhibit "gender atypical" behaviour (McCaskell, 1999) or who simply defy the norms in any way, real or imagined. In such a climate of hostility, it is not difficult to imagine why a youth might not speak out about a differing sexual orientation or even speak about it at all.

Racist and sexist slurs in schools seem to have given way, in recent times, to homophobic slurs. Indeed, from anecdotal experience, homophobia seems to be a last bastion of socially "acceptable" discrimination in contemporary society. Schools and other public institutions must implement "zero tolerance" policies regarding homophobic verbiage. These policies need to be specific and enforced. What a travesty that sexual minority youth receive their only visibility via remarks meant to hurt and degrade.

Sexual minority youth are unique among minorities in that they generally have no role model, no positive example in their family, and no loving parent who has endured the same experience to support them in their unique challenges. Mentoring programs, matching youth with adults of the same sexual orientation, may provide positive role modeling and support for the youth that struggles. However, the author of this essay notes that such a mentoring program need be regulated, and those adults participating, screened and trained accordingly. The subject population, vulnerable by nature, must be protected whenever possible from any extraneous harm.

A major obstacle to changing the hostile school environment for sexual minority youth may rest in the homophobic and heterosexist attitudes of some educators. More research must be done of a large scale and reputable nature to illustrate the destructive consequences homophobia exacts on youth, and the resultant necessity for educator training to broaden the attitudes and abilities of teachers and all members of the school community. Teachers and helpers in the Human Services field must be comfortable with not just the terminology but also voicing the issues around sexual orientation. For example, a teacher, child and youth care worker or counsellor who has difficulty saying the word "gay" will be extremely challenged to have a youth disclose their feelings around sexual identity. The youth will not be comfortable if the helper is stumbling.
Schools and school districts, in addition to creating policies to prohibit discrimination and harassment on the basis of sexual orientation, must design educational programs for students (and information for their caregivers) to accompany these policies. In order for individuals to authentically change their attitudes and behaviour they must have a personally valid reason for doing so. Otherwise, in the opinion of this author, such policies may be viewed as autocratic and dictatorial. This may not be the most effective approach with the teen population.

Youth with weak networks of social support and poor coping skills are at greater risk of engaging in self-destructive behaviour, no matter what their sexual orientation. Therefore, youth with adequate coping skills will be at lesser risk of succumbing to substance abuse, despite the great stress of "coming out". This is evidenced by research findings that many sexual minority youth are engaged in healthy, positive activities (Jordan, 2000). Thus, there is a need for implementing and strengthening the support networks that apply to sexual minority youth.

Patricia Shelby, in a report for British Columbia’s South Fraser Regional Health Board, stated that sexual minority youth are largely unsupported by health service providers, educators, and parents. However, she notes that pockets of support are growing (Shelby, 1998). "Creating Safe Spaces", a youth outreach project about to be launched in a tri-city area of British Columbia’s southern interior, is one such program designed to respond to the needs of sexual minority youth living in the region. The project, sponsored by various community-based organizations, will facilitate youth groups in these communities, educational and social opportunities, and gay/straight alliances in area high schools.

School clubs for lesbian, gay, bisexual, transgender, and questioning students are commonly referred to as gay/straight alliances. They provide a forum for peer support, information around sexual orientation and gender identity and often ensure that schools respect their rights. Despite these positive attributes, such clubs often encounter opposition from school boards and administrators. Karen Jordan, in her 1999 study, aptly states: "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. A sense of community is naturally important, but for marginalized populations it is imperative" (Jordan, 1999, p. 204). Considering these factors, the author of this essay suggests that school boards not only support but also co-initiate such groups.

Conclusion
Because of the many factors contributing to substance abuse within the sexual minority youth population, it is inevitable that in some cases the abuse will lead to addiction. In consideration of even the abbreviated research contained in this paper, an argument may be offered for substance abuse treatment programs equipped with counsellors who are trained to deal with the issues of sexual minority youth. Lesbian, gay, bisexual, transgender, and intersex youth that are addicted have concerns and treatment needs that are common to all addicts. In addition, they have unique concerns to address such as the experience of alienation and isolation living in a society that oppresses them. To effectively treat youth with substance abuse and addiction issues, the intrapersonal factors surrounding sexual identity and orientation (internalized homophobia, oppression, and the psychology of difference) must be examined for healing to happen on a holistic level. As a result of investigating this issue, the author of this essay plans to further explore ways to assist sexual minority youth suffering from substance abuse and addiction.

On a more positive note, we may look to resilient sexual minority youth to access important information about how they overcome the difficulties they face generally as adolescents and specifically as sexual minority youth. "Focusing on both adaptive and maladaptive development of GLB [gay, lesbian, bisexual] youths ultimately will provide a more accurate picture of this diverse group" (McDaniel et al, 2001, p. 102). Homophobia is what makes the coming out process so particularly difficult for sexual minority youth, not the differing sexual orientation itself. Ignoring the needs of these individuals, indeed, ignoring that they exist at all, will only increase isolation and maladaptive coping mechanisms such as substance abuse.

To further address this issue, we as child and youth care workers ought consider the evidence and deal individually and collectively with the problems underlying the prevalence of substance abuse for sexual minority youth. At the very heart of this problem are issues of basic civil rights and human dignity. As a society, we need to be able to differ in opinion about certain issues while simultaneously protecting the interests of all our members. Especially vital are the interests of our young, who may have scarce means of protecting themselves.

Appendix A: Glossary of Terms

Bisexual – attracted to persons of both sexes.
Gay – attracted to a person of the same sex. Used in this paper to refer to a male homosexual.
Gender Identity – a person’s internal sense of being male or female.
Homophobia – fear or hatred of homosexuals.
Intersex – persons who have anatomical characteristics of both sexes. A physiology that is outside the medical definition of "male" or "female".
Lesbian – a female who is attracted to other females.
Sexual Orientation – one’s attraction to the same sex, the opposite sex, or both sexes.
Transgender – one whose identity or behaviour falls outside of stereotypical gender norms (often shortened to "trans").
Queer – often used as a slur to refer to gay, lesbian, bisexual, transgender, and intersex persons. The term "queer" has been reclaimed by many of the aforementioned persons – particularly by youth – as an expression of pride in one’s sexual orientation and gender identity.
Questioning – persons who are uncertain of their sexual orientation or gender identity.

 

References

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
Carniol, B. (2000). Case critical: Challenging social services in Canada (4th ed.). Toronto: Between the Lines.

Doweiko, H.E. (2002). Concepts of chemical dependency (5th ed.). Pacific Grove, CA: Thompson Learning.

Guss, J.R., & Drescher, J. (2000). Addictions in the gay and lesbian community. Journal of Gay and Lesbian Psychotherapy. Vol.3, 3/4. New York: Haworth Medical Press.

Jordan, K.M. (2000). Substance abuse among gay, lesbian, bisexual, transgender, and questioning adolescents. School Psychology Review, 29 (2), p.201, 6 p. Retrieved October 17, 2002, from Academic Search FullText Elite database.

McCaskell, T. (1999). Homophobic violence in schools. Orbit, 29 (4). P 20, 2 p. Retrieved October 18, 2002, from CBCA Fulltext Education database.

McDaniel, J. S., Purcell, D., & D’Augelli, A.R. (2001). The relationship between sexual orientation and risk for suicide: Research findings and future directions for research and prevention. Suicide and Life-Threatening Behaviour, 31, p.84, 22 p. Retrieved October 17 from eb-psyc database.

Rathus, S.A., Nevid, J.S., & Fischner-Rathus, L. (2000). Human sexuality in a world of Diversity (4th ed.). Boston: Allyn and Bacon.

Roy, J.D. (1995). Alcoholism and addiction in homosexuals: Etiology, prevalence, and treatment. Retrieved October 12, 2002, from http://www.royy.com/paper.pdf

 Russell, S.T., Driscoll, A.K., & Truong, N. (2002). Adolescent same-sex romantic attractions and relationships: Implications for substance use and abuse. American Journal of Public Health, 92 (2), p. 198, 6p. Retrieved October 18, 2002, from Health Source: Nursing/Academic Edition database.

Russell, S.T., & Joyner, K. (2001). Adolescent sexual orientation and suicide risk: Evidence from a national study. American Journal of Public Health, 91 (8), p. 1276, 6p. Retrieved October 16, 2002, from Academic Search Elite database.

Shelby, P. (1998). Isolated and invisible: Gay, lesbian, bisexual and transgender youth. Report for the South Fraser Regional Health Board. Retrieved October 18, 2002, from ERIC database.