This holiday season offers an opportunity to address a topic that’s rarely discussed openly in our LGBT community – our relationship with drugs and alcohol and how these substances permeate and affect our lives, our relationships and our community. I’ve recently lost several friends, each of whom was struggling with addiction, and that’s what inspired me to focus on this topic.

In the most recent federal survey on drug use and health (2015), questions on sexual orientation were included for the first time. The report based on this survey (goo.gl/60VsyB) just came out in October.

The survey, performed by the Substance Abuse & Mental Health Services Administration, found that the rate of illicit drug and alcohol use disorders in the last year among LGBT individuals (15.1 percent) is nearly twice the rate for non-LGBT individuals (7.8 percent).

Lesbians and bisexual women face increased risk for alcohol and drug use disorders, gay and bisexual men have greater risk for illicit drug use, and bisexuality is related to increased risk for substance abuse, according to researchers Kelly Green and Brian Feinstein (goo.gl/yOx73e).

The SAMHSA survey results indicated that more than four times as many gay men (4.1 percent) used methamphetamine in the past year, compared to non-gay men (0.9 percent). Even cigarette smoking by adults was reported in the survey to be higher among LGBT individuals (32.2 percent) compared to non-LGBT individuals (20.6 percent).

Numerous theories have been suggested to explain the higher incidence of addictive disorders among LGBT people. These include:

Identity conflicts.

Internalized homophobia.

Internalized and repressed toxic shame.

Discrimination.

Gender roles and expectations.

The role of bars and circuit parties in socialization and support.

Triggers leading to use.

Perceived normality of use.

Targeted marketing by alcohol and tobacco companies.

A lack of cultural competence in the health-care system, which may discourage gay and transgender people from seeking help or result in inadequate or inappropriate treatment.

For many of us, it might be difficult to imagine the holidays without alcohol or other substances. Our extroverted culture encourages consumption to make us happy, and we are conditioned to resort to substances to moderate our mood. Many people experience higher levels of anxiety during social occasions, and alcohol reduces our anxiety.

But the more we rely on alcohol (or similar substances, like Xanax), the less likely we are to develop our own internal skills to regulate and manage anxiety. Over time, tolerance increases and it takes more drinks to get a buzz. Maybe another substance, such as cocaine, is added to the mix to keep the party going. Not everyone can moderate their use over time.

The label “alcoholic” is more destructive than useful, but many of us do have a problematic relationship with alcohol. It inhibits impulse control and changes our judgment, and as the problem progresses, it can have increasingly negative consequences on our relationships, our health, and our lives.

Patterns can be recognized in the use of various substances. Individuals who especially struggle with anger tend to be attracted to pain medication, such as opioids, to numb their emotional anguish. It is not surprising that opiate abuse has become epidemic. Cannabis can impair problem-solving and memory and diminish motivation, focus and productive engagement in the world. Marijuana may help some individuals (with ADHD, in particular) have better focus and may help some to relax or manage pain.

People who have bipolar disorder seem to be drawn to cocaine, alcohol and cannabis, all of which ultimately will destabilize their moods and make their conditions more unmanageable. Those who are prone to depression or who have ADHD tend to be drawn to amphetamines/stimulants (cocaine, meth, ecstasy/MDMA/Molly), which only postpone and intensify the depression they seek to avoid.

Many like to enhance sex with substances such as GHB, ketamine, alcohol, methamphetamine, cocaine, marijuana, ecstasy, Viagra and poppers and with pornographic stimulation. These substances and stimuli may heighten our senses and intensify our experience, but they also detract from relationships and may ultimately diminish our sensual experience and capacity for intimacy. Many who are in recovery speak of the challenges of re-learning sober sex.

Methamphetamine in particular is alluring and can seem innocuous at first. Many of us who begin to use it believe that we can do so occasionally and recreationally. But then the drug becomes entangled with our sexuality and life dulls in comparison as we forever chase our first euphoric high. We are led to dark places with disrupted sleep, fatigue, depression, paranoid delusions, and confused thought.

In the words of someone who later took their life, quoted in the Fall 2016 issue of RFD Magazine: “I look at it [meth] in terms of the shadow, that part of our personality that we hide away, the unlinked dark side, the parts of our unconscious – good or bad – that we have buried so deep that we are not aware of them, unless something, someone brings them forth. In its odd way, methamphetamine can bring our shadows out into the open. You can feel a clarity, a euphoria, hypersexuality, a super-consciousness. We are heroes, wild animals, superhuman. But in the end, it all dissolves like the white vapor rising from the pipe. The shadows go back into the unconscious, and we go back to life, either denying or facing our reality” [but diminished and broken].

Substance abuse is a chronic, progressive brain disease. Each of these substances overwhelms the brain’s natural reward center.

According to the surgeon general’s 2016 report on addiction (addiction.surgeongeneral.gov), which came out in November, addictive substances disrupt and hijack the functioning of several areas of the brain (basal ganglia, extended amygdala and pre-fontal cortex). These disruptions affect opioid receptors and reduce internal levels of dopamine and norepinephrine between our neurons. The changes in receptors and neuro-chemicals trigger substance-seeking, diminish our capacities for pleasure, cause higher levels of stress, and compromise our brain’s higher cognitive function. Impulse control and judgment are diminished, affecting our ability to make responsible, rational decisions. Addicted individuals get caught in a circular pattern of anticipation, intoxication and withdrawal. This evidence indicates that over time, substances actually alter brain functioning, and that finding supports the concept of addiction as a health condition. When we understand addiction as a health issue rather than a moral defect or character flaw, it offers hope in treatment rather than condemnation or judgment.

When does use become abuse or a disorder, and how will we know? Each of us will make our own decisions about substance use, and each of us is responsible for the consequences of our decisions. Whether or not we survive, end-stage addiction is never pretty.

Our community lived through the horror of the AIDS epidemic. Now we are challenged with addiction. Knowing that we live in a community that is especially at risk for substance abuse, how we respond is critical. When we suspect that a friend may be struggling, when we are getting partial stories, when accidents may not be fully explained, when someone suddenly loses weight, what do we do?

Do we pass the pipe? Pour a shot? Ignore? Set boundaries? Make excuses and rationalize? Treat this as normal? Gossip and judge? Show compassion and understanding without enabling? Encourage professional treatment?

Addiction affects not only the afflicted, but also those who love them and even the larger community. I hope that candid and concerned conversations may reduce our collective vulnerability and future losses.

In the words of the activist and speaker Robert Birch, my hope is that “community may fortify our immunity.”

Jason Carrigan, M.A., is a licensed professional counselor and marriage and family therapist practicing at Diversity Counseling. He is active in the leadership of the Greater Kansas City LGBT-Affirming Therapists Guild (www.lgbtguild.com).