Needs and Experiences of Sexual and Gender Minority Individuals in 12-Step Programs

BACKGROUND/PURPOSE:

Sexual and gender minorities (e.g., gay, bisexual, transgender individuals; SGM) are more likely than heterosexual and cisgender individuals to experience alcohol and other substance use disorders. Among the general population, 12-Step programs are the most common source of support for substance-related problems in the United States. Past research has painted an equivocal picture of the experiences of SGM in 12-Step programs, identifying that SGM may experience barriers to effective 12-Step involvement due to concerns about homophobia/transphobia and tensions with religious program themes but also finding that many SGM experience psychosocial benefits from 12-Step participation. Past research examining SGM’s experiences of 12-Step programs is often dated and relies on small samples of sexual minority individuals currently involved in 12-Step programs, limiting the generalizability of findings to transgender/non-binary individuals and those not currently involved in 12-Step programs. This study aims to identify factors that facilitate and inhibit initiating and sustaining 12-Step involvement among SGM.

METHODS:

A national sample of 1,150 SGM endorsing having ever had a problem with alcohol or another drug participated in an online survey in 2021 through The PRIDE Study. Respondents answered a series of open field questions about their experiences considering and engaging in 12-Step programs. A thematic analysis was conducted to identify factors that facilitate and inhibit initiating and sustaining 12-Step involvement among SGM. Researchers employed three rounds of coding: Open coding, clustering, and theme-building.

RESULTS:

Data suggest that SGM have a wide variety of intervention needs and experiences considering and engaging in 12-Step programs. SGM have needs from substance use services both related and unrelated to their sexual and gender identities. Overall, respondents expressed the following needs/preferences for substance use interventions: 1) Effective intervention for substance use; 2) Non-judgmental space; 3) Connection with community; 4) Sharing space with other LGBTQ people. While finding an effective substance use intervention was the primary factor motivating initiating involvement, the other three factors were important for sustaining involvement. Respondents reported mixed experiences about whether they found each factor through engaging in 12-Step programs.

CONCLUSIONS/IMPLICATIONS:

This study builds on past research of SGM’s experiences in 12-Step programs by providing updated responses that reflect a broader range of SGM experiences and perspectives of 12-Step programs, including experiences of individuals who decided to not become involved and those who terminated involvement. Furthermore, previous research has largely not considered the experiences and perspectives of 12-Step programs of transgender/non-binary individuals. Challenges with the rigidity of 12-Step approaches and practices that exclude transgender and non-binary participants emerged as central barriers to sustaining involvement not previously discussed in the extant literature. Nuance of responses was limited by the short-answer survey method; future research should employ interviews to allow respondents to elaborate on their responses, including why sharing space with LGBTQ people is critical for recovery. Practitioners should support SGM clients in determining their individual substance use intervention needs and preferences, use this information to determine whether 12-Step programs are an appropriate referral, and monitor whether needs are being addressed for SGM clients accessing 12-Step programs.