How the Family Unit Can Impact the Outcome of Substance Use Treatment in the LGBT Community

From the time I was 3 years old I knew I was different than my family, and they treated me differently. I am tolerated, none of my biological family ever inquires into my life and in fact are embarrassed if I ever mention anything personal. – In memory of Jeff Johnston.

Defining the Family Unit

There are several ways to define the Family:

  • Each Family unit is impacted and adjusted according to culture, religion, and family of origin rituals.
  • Rules, roles, relationships and patterns of behavior often define how each individual family system functions.
  • Family systems include blended families, step-families, and families with children who are non-biological and extended families.

The traditional definition of Family is a social unit consisting of parents and their children considered a group, whether dwelling together or not. Rainbowfamilies.org defines the Family differently stating: Love is what makes a family, whether your family consists of blood lines, adoption or foster care, friends, neighbors, people of the same sex or people of different sex, race or color.

There are several factors that affect definitions of family within the LGBT community. For many it is a ‘Chosen Family’, formed as a result of rejection and abandonment from their families of origin. Perceptions of the broader community and the social, societal and internal stigmatization around homosexuality also contribute to redefining this definition of family in the LGBT community.

Psychological distress caused by early family and childhood experiences of rejection and isolation rooted in gender and sexual identity, can lead to mental health and substance abuse issues into adulthood.

Factoring Substance Abuse

In addition to early childhood experiences, substance abuse within the LGBT community has been linked to social and interpersonal relationships, coming out, gender and sexual identity, the development of social and intimate relationships, cultural norms and internalized homophobia to name a few.

Family, regardless of biological or ‘Chosen’, can have a significant impact on substance abuse treatment outcomes. Family can be a significant trigger for continued drug use and relapse. In many cases, the biological family has disowned their LGBT child or sibling; others may tolerate – but not really accept – them.

If there is not a clear understanding and acceptance of the individual, it is likely the pattern of distress will continue.-Marni LowFamily systems issues such as these can trigger feelings of depression and anxiety, which can lead to self-medicating through drug and alcohol use. Similarly, many LGBT people are reluctant to engage family in the treatment process due to fear of further rejection, distance or abandonment. Conversely, where there is acceptance and support of sexual and gender identity, family therapy can have a positive outcome on the individual and family system as a whole.

Other Factors to Consider

When the substance abuser decides to stop or reduce his or her substance use, there are several factors to consider from a family perspective. Most importantly, when the family does take an active role in the substance abuser treatment, it is important for family members to have a clear understanding of how the substance user self-identifies. Given the family rejection of the individual’s self in early childhood, it is crucial the family has an understanding and acceptance of how they see themselves. This includes their birth, chosen gender and sexual identity.

It is also important to understand the person’s objectives and meet them where they’re at. What brought them to treatment? What is the outcome they are looking for? Do they want to stop using altogether or reduce use?

When taking on a support role, it is important for family members to consider several possible outcomes without being attached to one in particular. This may reduce additional distress, but if or when they do not meet expectations, it can continue the cycle of disappointment and resentment, which may lead to relapse.

Family participation in substance abuse treatment can also have significant positive outcomes for the individual and the family system as a whole.

Family therapy can provide a supportive environment to address maladaptive communication, relationship patterns and boundaries. Therapy can also provide a platform to educate family members around the substance users’ sexual and gender identity, which may assist in fostering connection, identification and acceptance.

Once the person is no longer actively using, the Family needs to redevelop and re-establish family rules, roles, relationships and communication patterns. Issues of co-dependency, trust, intimacy and mutual or independent roles within co-dependency must also be re-established. In order to maintain a clean and sober lifestyle, it’s important to recognize how the substance abuser will benefit from shifting their social interaction and engagement in particular relationships and activities.

Ongoing Support

Ongoing family support, biological or ‘Chosen’, with a clear understanding of the LGBT individual will enhance the likelihood of positive outcomes.

From a systems perspective this will foster a supportive environment for the individual to express their gender and sexual identities, formulate family and social relationships and reduce mental health and substance abuse related symptoms and behaviors.



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The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of Rehabs.com. We do believe in healthy dialogue on all topics and we welcome the opinions of our professional contributors.

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