Sexual minority (LGBQ+) women's experiences of accessing addiction services: a qualitative study

Introduction: Lesbian, gay, bisexual, queer and other non-heterosexual (sexual minority) women experience significant health inequities in comparison with heterosexual women. Both drug and alcohol use, and addiction to drugs and alcohol, are more prevalent for this group. They may also be more likely to underutilise addiction healthcare services in comparison to sexual minority men. Aims: We aimed to understand sexual minority women’s experiences of accessing addiction treatment services in England, UK; what prevented them from doing so if they did not; and what would have facilitated service access. Methods: A qualitative study was performed, using reflexive thematic analysis of 21 semi-structured interviews. Interviewees were self-identified sexual minority women, who all had experience of harmful or dependent use of drugs and/or alcohol. Results: A diverse group of sexual minority women (including cisgender and transgender women) were recruited. Few had accessed addiction treatment services, but those who had reported experiences of inadequate, fragmented, or disrupted care, with occasional positive experiences of acceptance and empowerment. Barriers to access included explicit homophobia and discrimination, fearing or anticipating stigma, and reluctance to approach services or label drug/alcohol use as problematic. Potential facilitators to access and engagement in treatment included being listened to and believed, having sexuality acknowledged and accepted, and being supported by LGBTQ+ peers or allies. Services could act either as sources or buffers of minority stress, but findings highlighted the impact of problematic structural and organisational factors. Discussion: Services and health professionals wishing to better help sexual minority women with addiction problems need to understand the specific needs of this marginalised group, and how these are affected by their other intersecting identities. Sexual minority women may also benefit from specific targeted interventions addressing barriers and facilitators to accessing addiction services.