What Are LGBTQ+ People’s Experiences of Alcohol Services in Scotland? A Qualitative Study of Service Users and Service Providers
LGBTQ+ service users
The study conducted individual interviews with a diverse sample of 14 respondents aged 19 to 65 years who had experienced alcohol services in Scotland. Two identified as lesbian, six as gay, three as bisexual, two as heterosexual and one as heteroflexible. Three identified as trans and 11 as cisgender.
The impact of COVID-19 on respondents’ alcohol use and on service provision form an important backdrop to the findings.
Many respondents thought their alcohol use was inextricably linked to their LGBTQ+ identity, as a response to shame, stigma, or family rejection. Almost all spontaneously discussed connections between mental health, alcohol use and LGBTQ+ identity.
Services are still perceived to be aimed at middle aged (straight) men who have been using alcohol for decades.
Respondents were rarely asked about their sexuality / gender identity by service providers. They reported a lack of understanding or exploration about their identity and how this might impact alcohol use and service use. Lesbians reported assumptions that their partners were men.
Respondents, particularly trans people, were wary of negative reactions from other service users. Lesbian and bisexual women reported feeling silenced and vulnerable in some group settings.
There was agreement across the sample that trans people were particularly stigmatised and misunderstood and that barriers experienced by others in the LGBTQ+ community were amplified for trans people.
The study collected data from 15 service providers. Nine were clinicians (Consultant Psychiatrists or Specialist Doctors) working for NHS addiction services, three worked for third sector alcohol prevention and support organisations, and three worked for third sector LGBTQ+ services.
Service providers reported that many alcohol services were temporarily suspended and that COVID-19 had a negative impact on clients’ wellbeing. They described the challenges of their increased workload and the difficulty of communicating without face-to-face meetings.
Some service providers were uncomfortable discussing LGBTQ+ issues (particularly trans issues) given their lack of training, or did not see sexuality or gender identity as relevant to alcohol treatment. Others stressed the importance of a holistic approach where identity was an important aspect of clients’ lives. Statutory service providers were particularly uncertain about how to ask clients about their sexuality / gender identity.
Service providers suggested that training around LGBTQ+ issues (particularly trans issues) and appropriate language would help overcome their fears about ‘making a mistake’ and upsetting clients and improve the experience of alcohol services for LGBTQ+ people.
Some third sector respondents suggested the need for a ‘one stop shop’ for LGBTQ+ health encompassing addictions, mental health, sexual health and a gender identity clinic. Others (both third sector and statutory respondents) argued that mainstream alcohol services should be tailored to be more inclusive of LGBTQ+ people.
Service providers emphasised the multiple issues and inequalities faced by some of their clients (e.g. trauma, racism, homophobia, transphobia, lack of resources). They argued that increased public acceptance and understanding of LGBTQ+ issues and alcohol-free LGBTQ+ spaces would help reduce alcohol-related harm in this population.
- Alcohol-free spaces for LGBTQ+ people should be prioritised to de-normalise alcohol use in this community and to facilitate recovery.
- Services should monitor gender identity, trans status and sexual orientation to assess whether they are reaching LGBTQ+ people and consider how they might tailor and improve their services (see www.scottishtrans.org/trans- equality/equalities-monitoring/).
- When alcohol services are commissioned, there should be a requirement for organisations to demonstrate that they have appropriate inclusivity / diversity policies and processes in place and that staff receive training about the needs of LGBTQ+ populations.
- LGBTQ+ diversity training should be undertaken by all staff working in alcohol services. This should include information about the use of alcohol among LGBTQ+ populations, appropriate ways to ask clients about sexual orientation and trans identity, and how to discuss how central, or peripheral, LGBTQ+ identity is to clients’ alcohol use. Trans-specific training is particularly necessary.
- Alcohol services should work toward the LGBT Charter which supports organisations to ensure they are inclusive and provide high quality services to LGBTQ+ service users.
- Services need to signal LGBTQ+ inclusivity in both physical and online spaces. They should include content aimed at LGBTQ+ people on their websites and ensure they are advertising their services via LGBTQ+ organisations and in LGBTQ+ spaces where they will be seen by people in need.
- Services should ensure they are safe spaces (online and offline) for LGBTQ+ people. This includes both one-to-one and group settings. The separate needs of lesbian, gay, bisexual and trans people should be considered.
- Future alcohol research should focus on the needs of trans people and sexual minority women.
- Flexible, non-judgemental, low threshold services are required which emphasise discretion and are easy to engagewith.
- More visible signposting to LGBTQ+ and women-only Alcoholics Anonymous (AA) groups and Fellowships would be beneficial.
- Alcohol services need stronger links to mental health, and other services, to ensure that clients receive seamless and timely care.
- At a broader level, more public understanding and acceptance of LGBTQ+ people would improve their health and make it easier for them to access services.