Barriers and facilitators to accessing addiction treatment services for sexual minority (LGBQ+) people: systematic review

Background Sexual minority (lesbian, gay, bisexual, queer and other non-heterosexual) people experience significant disparities in addiction problems compared with heterosexual people.  Aims We aimed to answer the question, what are the barriers and facilitators to accessing drug/alcohol addiction treatment services for sexual minority adults?’.  Method A systematic review was conducted by searching Medline, PsycINFO, CINAHL, Web of Science, and Sociological Abstracts for any English-language primary research article (qualitative, quantitative or mixed methods) relevant to the study aims, from inception up to 18 April 2025. Quality of included studies was assessed using the Mixed-Methods Appraisal Tool (MMAT-2018). Barriers and facilitators were categorised into ‘service-related’ and ‘patient-related’ dimensions of accessibility, and synthesised narratively.  Results We screened 3282 abstracts, with full-text review of 238 articles; 62 studies met the inclusion criteria. Common service-related barriers included explicit harassment, discrimination, violence or abuse toward sexual minority people in services and lack of expertise or ‘culturally competent’ provision for their specific addiction problems. Facilitators included affirming, non-judgemental staff attitudes and sexual minority-specific treatment or outreach services. Patient-related barriers included ambivalence around drug/alcohol use and a fear of stigma (e.g. around sexualised drug use). Facilitators included signposting to services via community networks or peer advocates, and allowing patients to set their own treatment goals. Conclusions Although barriers and facilitators vary across global contexts and time periods, both qualitative and quantitative research highlighted similar key issues. Implementing practical changes to address these may improve sexual minority people’s access to addiction services, reducing the burden of addiction-related health inequity for this community.