Miriam Hillyard

Dr. Miriam Hillyard is an MRC Addictions Research Clinical Fellow at the National Addiction Centre. She is completing a PhD on the experiences of sexual minority adults with addiction problems, focusing particularly on women and the barriers they face accessing addiction services. She is also a General Practice trainee working clinically in Tower Hamlets, East London.

Barriers and facilitators to accessing addictions treatment services for sexual minority (LGBQ+) people: a systematic review

Background / Aims: Sexual minority (SM) individuals experience significantly higher drug and alcohol use prevalence, and drug and alcohol use disorders, compared with heterosexual peers. However, accessing appropriate addictions treatment may be complex for this group. This systematic review aimed to answer the question, ‘What are the barriers and facilitators to accessing addictions treatment services for SM people?’.

Methods: A systematic search of the literature was performed using MEDLINE, PsychINFO, CINAHL, Web of Science, and Sociological Abstracts databases. The search strategy (A+B+C+D) combined MeSH terms / subject headings and keywords relating to the following constructs: (A) sexual minorities; (B) addiction; (C) treatment service; and (D) barriers and facilitators.

Results: 2,016 abstracts were screened, and 114 full-text articles were assessed for potential inclusion in the systematic review. 29 studies (a mixture of qualitative and quantitative research) met the inclusion criteria. Barriers and facilitators to access were categorised according to five ‘service’ and five ‘service user’ factors. These included both SM-specific barriers, such as explicit homophobia from staff, and more generalised barriers, such as being unable to pay for addictions treatment. Similarly, there were specific facilitators, such as outreach to gay venues, and general facilitators, such as incorporating mental health care or housing support into addictions treatment.

Conclusions: A wide range of barriers contribute to the ‘treatment gap’ in addictions for SM people. General barriers to addictions treatment (such as cost and geographical accessibility) may also be more likely to affect SM people than heterosexual people due to their increased marginalisation.