Beyond 12 Steps: Fostering LGBTQ2IA+ Inclusion in Drug Use Support Groups

By Susie Poore, Vital Strategies Overdose Prevention Program Intern

Early studies have found that sexual minority and transgender adults use drugs at higher rates than the overall adult population in the United States. The same is true among sexual minority youth and young adults, who use drugs at a rate that is two to three times higher than their straight peers. Numerous sociocultural and economic stressors inform these disparities, including systemic discrimination. These factors are only exacerbated for LGBTQ2IA+ (lesbian, gay, bisexual, transgender, queer/questioning, two spirit, intersex, asexual, +) people of color. Systemic discrimination also serves as a major barrier to access for healthcare services. According to “The State of the LGBTQ Community in 2020,” 15% of sexual minority folks and nearly 30% of transgender folks reported avoiding or postponing medical treatment this past year due to discrimination.

Further, LGBTQ2IA+ youth and adults generally face greater isolation and loneliness compared to the general population. Our society does not welcome the participation of sexual and gender minority people. Taken in the context of the COVID-19 pandemic, which has also seen a rise in overdose deaths and severe health risks for the LGBTQ2IA+ community, the need for inclusive drug use support spaces is more apparent than ever—and especially because LGBTQ2IA+ specific programs for drug use issues are not yet widely available.  

Support groups for people who use drugs are not often designed with the LGBTQ2IA+ community in mind. Whether it is how meetings are facilitated, what information is shared in brochures, or the “why” driving their missions, a straight and cisgender approach to drug use remains at the center of the revered 12 step program from Narcotics Anonymous, or SMART Recovery. LGBTQ2IA+ people are left with a resounding message: they are not heard, seen, understood, or wanted in community-based care settings. These spaces do not belong to them. As a result, sexual and gender minority people who use drugs are barred from receiving the critical benefits of interpersonal support and healthcare services that actually meet their holistic needs. 

What follows are four recommendations for drug use support groups to bridge access for LGBTQ2IA+ people: 

Update your core messaging and informational materials

Consider whether groups communicate a welcoming space for all LGBTQ2IA+ people. Every time a gender and/or sexual minority person enters a new space, they must decide 1) if they want to come out and 2) whether it is safe for them to do so. This decision process may be critical in a support group setting when a person’s drug use is intertwined with aspects of their sexual orientation and/or gender identity. Updates may involve removing binary references to gender on brochures, rewriting group literature to honor diverse family structures, and using social media to recognize significant LGBTQ2IA+ and BIPOC (Black, Indigenous, and People of Color) events. These actions are steps toward practicing visible and inclusive allyship, which can help alleviate stress around both accessing and coming out in that first support group meeting.  

Revise your intake process

Intake forms and information-gathering are an expected part of joining a support group. However, the questions may alienate sexual and gender minority people who use drugs if they do not identify with the checkboxes or options provided. Ask for chosen names and pronouns to ensure each new member is respected from day one. Create open-ended questions for racial/ethnic identity and gender identity. Shift the focus to understanding the person rather than gathering demographic statistics.   

Use people first, gender and sexual minority inclusive language

Evaluate whether group structure, facilitation styles, and meeting discussions diminish individual identity. Historically, LGBTQ2IA+ people have been reduced to nothing more than their sexual orientation and/or gender. People who use drugs encounter the same stigma; they become nothing more than “addicts” or “junkies” in our society.  Be mindful of generalizations, stereotypes, and privileges that shape perspectives. For example, a Black trans woman who uses drugs will have an inherently different experience than a gay white man. Recognize that difference. Put the person first, not one aspect of their lived experience. Train facilitators on inclusive language practices and create guidelines to share with group members before meetings.   

Conduct community-based outreach

The best way to create effective support groups for LGBTQ2IA+ people who use drugs is to involve them from the ground up.  

• Include LGBTQ2IA+ people with lived experience in the planning stages and subsequent program management.  
• Circulate community polls. Bring in LGBTQ2IA+ facilitators who can directly empathize with members.  
• Confirm whether current meeting locations are safe for LGBTQ2IA+ people and commit to finding new ones if not.  
• Expand virtual options if transportation is a barrier to attendance.  

Aim to expand resources so groups can meet the specific needs of nonbinary, transgender, Black, and Latinx people who use drugs. Put in the work to genuinely listen and make folks feel seen.  

As the overdose epidemic continues to spike, we must recognize the disproportionate suffering and mourning experienced by the LGBTQ2IA+ community. Sexual and gender minority people who use drugs deserve to come together in joy and support before shared grief. The actions above are by no means exhaustive. But they are a beginning. It is on all of us to keep doing more until all LGBTQ2IA+ people can participate in an affirming, community-driven support space that is wholly theirs. 

Learn more about the Overdose Prevention Program and follow us on Twitter @VitalStrat.