LGBTQ people are more likely to have alcohol or other substance abuse issues.
A UK study earlier this decade found that drug use among gay and bi people is seven times higher than straight people, while gay men are twice as likely to binge drink. And it’s not just young people. A 2013 US study found over 50s are also likely to drink more.
If you’re concerned about a friend or loved one, what’s the best way to bring the subject up with them?
“There really isn’t ‘one way’ to talk to someone about their use,’ says Dr David Baker-Hargrove, President and Co-Founder of Two Spirit Health Services in Florida.
He suggests: “Don’t lecture the person or try to ‘educate’ them … [It’s] not likely to work and only cause the person to become defensive.
“Avoid any type of argument around ‘You need to get your life together.’ It’s important to be aware that most approaches will be met with denial or resistance.
“The best way to start might be sitting down for a chat and begin with, ‘How are you doing, lately? Is anything going on that’s bothering you?’
“If the conversation leads to use behaviors, then you could ask ‘have you thought about stopping?’ The goal of the conversation should be about introducing the idea of recovery, rather than persuading, making a case for it, or giving the person an ultimatum.”
Dr Boris Thomas, a psychotherapist based in New York City, agrees.
“Point to the concrete changes you’ve noticed. For example, ‘I’m very concerned. Have you noticed that all our mutual friends have fallen away from you? And I wonder what that’s like for you?’
“If you just say, ‘I think you’re having too much,’ they’ll likely say, ‘It’s not too much, I can handle it.’ Those kinds of conversations tend not to go anywhere.”
Dominic Davies is the founder of Pink Therapy in the UK.
“My approach would be to ask about and acknowledge the obvious pleasures and benefits they get from their substances of choice and ask them whether they have any concerns about their use,” he says.
“I’d state I missed them from my life and would love to spend time hanging out with them.
“My experience as a therapist working with people who get lost in chemsex chill-outs is that many of my clients party to manage their loneliness and they are craving intimacy and connection.
“So rather than judge or expect them to stop it, offer to spend some quality time with them doing things. Cook them a meal mid-week and watch Netflix, just be a friend. Not a judgemental friend, just a solid mate.”
Thomas also says it’s important to think about the reasons your friend may have, or be developing, a problem.
“I think that most people who have addictions, there’s a part of them that knows there’s something wrong. There might be a biological factor or genetic factor at play, but they also know they’re trying to escape something or manage something.
“So I think you can also talk to some people about what they’re avoiding. For example, ‘I know that the death of your partner was very hard for you. Since then you’ve been drinking a lot. Do you think you might want to get some help?’ If you just say, “You’re drinking too much!”, that’s just focussing on the behavior.”
Baker-Hargrove adds that you should also think about your motivations.
“It’s extremely important to ask yourself why you want to talk to this person about their use behaviors. It’s easy to say “I care about them”, but often we intervene in other’s lives based upon something we want for ourselves.
“The person has to want to address their behaviors. You can’t want it more for them than they want it for themselves.”
“Substance use is a symptom,” says Baker-Hargrove. “A behavior to mask or avoid an underlying mental health problem in which the symptom has now become a problem itself.
“The person is in pain for some reason, and the better the discussion can focus on that, the better the chance the person will want to address the substance use behaviors as a sideline to dealing with the underlying mental health issues.”
Monty Moncrieff is the CEO of London Friend, an organization that helps members of the LGBTQ community with alcohol and substance abuse problems. Much of this includes men who find themselves part of the chemsex or ‘party’n’play’ scene.
It’s produced a guide for the friends and families of men in this sort of situation, but some of the advice will apply to other substance abuse issues.
It includes expressing love and care for your friend, avoiding being judgemental, asking open questions, being honest about the impact their behavior has on you but also being sure to spend quality time together that doesn’t always include difficult conversations.
“It’s really difficult when someone else’s drinking or drug use is starting to have an impact on you too,” Moncrieff says. “You might be worried about their health and wellbeing, or about the impact it’s having on your relationship with them. If it’s a partner that you’re living with it might feel like there’s nowhere to escape to.
“It can be really difficult to bring the subject up. The other person may become defensive, or feel they’re being judged, or they may be struggling to acknowledge to themselves they have an issue.
“It can be helpful to ask them open questions about what’s going on for them, listening and letting them know about the love you have for them. Try to avoid anything that may make them feel judged and focus on the impact their drinking or drug use has on you to help them understand how you’re feeling.
“It’s also important to make sure you look after your own health and wellbeing whilst you’re looking out for somebody else.”
Thomas agrees. Although you may want to do what you can to help someone, you must take care of yourself and have clear boundaries around the behavior you will and won’t accept.
“I met a couple, and they both drank a bit too much. One of them was sweet when they drank and the other one was nasty.
“I said to the sweet one, who wanted to maintain a friendship with me, ‘I want you to know, I’m not going to be friends with your partner, because when he gets drunk he’s nasty, and drinking is a big part of your life. I’m happy to have a cocktail or two with you, but when it starts to go to you having four or five cocktails, I can’t tolerate the outcome of what happens with your partner.’
“Having boundaries is very important.”
Baker-Hargrove acknowledges it can be to bring up with issues with someone.
“These are very hard conversations. It might be a good idea to go see a professional first to see how you want to have the discussion. Recovery is a process, not a this-or-that principle.”
And in case it needs saying, it’s always best to have these sorts of conversations when the person is sober.