National Coming Out Day: Stress, Substance Use and Finding Affirming Care

Today, October 11, is National Coming Out Day. It was first observed in 1988, on the anniversary of the 1987 National March on Washington for Lesbian and Gay Rights, and the Human Rights Campaign has led it since the 1990s. The idea behind it is simple: silence makes stigma easier, and being known makes it harder.

For many LGBTQ+ people, coming out is a relief. It can also be one of the most stressful things they ever do, and stress is where a lot of substance use begins.

What the research shows

Federal survey data makes the pattern hard to ignore. In SAMHSA’s report on the behavioral health of adolescents across sexual identities, drawn from the 2023 National Survey on Drug Use and Health:

• LGB+ youths were more likely than straight youths to have used alcohol in the past month.
• LGB+ male youths were about 4 times more likely than straight male youths to have had a major depressive episode.
• LGB+ male youths were about 9 times as likely as straight male youths to have had both a major depressive episode and a substance use disorder.
• LGB+ female youths were about 3 times more likely than straight female youths to have misused prescription drugs.

The same report points to something hopeful. More than 90% of young people, regardless of sexual identity, said they had someone they could turn to about a serious problem. Support exists. The work is making sure it reaches the people who need it.

Why the risk is higher

Being LGBTQ+ does not cause addiction. What raises the risk is what often comes with it: rejection from family or friends, harassment at school or work, hiding part of yourself for years, and the steady background worry about how people will react.

SAMHSA’s report names these directly. LGB+ young people face unique stressors such as bullying and discrimination, and those stressors can contribute to substance use and mental health problems. Alcohol or drugs can feel like a way to quiet that stress, especially before or after coming out. Over time, the relief fades and the dependence grows.

Depression and anxiety often travel alongside it. As we wrote yesterday for World Mental Health Day, substance use and mental health are rarely separate stories, and care works best when it treats both.

What affirming treatment looks like

Many LGBTQ+ people delay treatment because they expect to be judged, or to spend their time explaining themselves instead of getting better. That fear is understandable. Good treatment should feel like the opposite.

When you are comparing programs, look for:

• Respect without making identity the problem.Your sexual orientation or gender identity is part of your story, not the thing being treated.
• Care for co-occurring conditions.Depression, anxiety and trauma should be assessed and treated alongside substance use.
• A safe group environment.Groups are a big part of most programs. Staff should set clear expectations about respect and act on them.
• Room for your chosen family.Recovery goes better with support, and that support may not look like a traditional family.
• A plan for after treatment.Ask about aftercare and community support where you live, including LGBTQ+-friendly recovery meetings.

Our page on LGBTQ addiction help in Austin lists local recovery groups and resources.

Questions to ask any treatment center

It is fair to ask these on the first call, including to us:

• How do you handle names, pronouns and room assignments?
• How do staff respond if another client is disrespectful?
• Do you treat depression, anxiety or trauma alongside substance use?
• Can my partner or chosen family take part in family sessions?
• What happens when I leave, and can you connect me with support near home?

At Nova, the admissions process starts with a confidential phone conversation about your situation, and everything you share during that assessment stays confidential. If Nova is not the right fit for what you need, the team will help you find resources that are.

Common Questions