Figuring out who you are and where you fit is a central task of adolescence and young adulthood. But for young people questioning their sexual orientation or gender identity, developing that sense of self takes on added pressures. When addiction or mental health issues are also in the picture, the added stressors around sexual identity can exacerbate and accelerate, creating a high-risk and high-stakes situation for young people. Sexual identity struggles add to the angst of adolescence. Adolescence is a time of tremendous change and stress on every level, including physical, emotional, and social. It's a time when young people are especially attuned to social expectations and pressures as they shape and form their beliefs, values, and self-identity. For young people who grow up questioning their sexual identity, adolescence brings another whole layer of stress. They are at the developmental stage of forming personal norms and values while also trying to figure out if they identify as an LGBTQ individual. This can be especially difficult when they don't have the acceptance or support of stable peers. And, for some, fear of parental rejection is part of the picture, too. LGBTQ adolescents and young adults are at heightened risk for addiction. Alcohol and other drug use among lesbian, gay, and bisexual adolescents and young adults is, on average, 190 percent higher than for heterosexual youth.* Research points to a number of factors that may contribute to drug abuse by young LGBTQ people, including self-medicating for anxiety or other mental health problems, escaping social stigma or rejection, and numbing sexual feelings. Regular use of alcohol or other drugs during the teenage years increases the likelihood of developing a full-blown substance use disorder. And more often than not, addiction comes with complicating factors, including mental health issues related to anxiety, depression, or trauma. Additionally, young LGBTQ individuals are at greater risk of suicidal ideation and self-harm. These are multifaceted issues for adolescents and young adults, and the consequences of their decisions can be life changing. With such complex disorders, the most effective care integrates addiction and mental health treatment so that all issues are addressed at the same time. Fear and denial are common reactions for parents. Having a child who struggles with both addiction and sexual or gender identity issues can hit every fear button for parents. It comes as a double shock to the family system. Denial is a common reaction to addiction, and it's a common reaction when parents learn their child is struggling with sexual orientation or gender identity. Some parents try to convince their son or daughter that they're just going through a phase. Other parents get angry and demand answers. Parents need to realize that coming out is a process for their child—a discernment process that isn't necessarily quick or definitive. Experimentation is a normal part of that process. Ambiguity is, too. Understanding is a process for parents as well. It often begins with looking at the beliefs and experiences that shape their attitudes and behaviors around LGBTQ identification so they can help and support their child. Twelve Step recovery is all about acceptance. Family dynamics around addiction are built on secrets. A young person's questioning of sexual or gender identity can become one more secret the family keeps, one more thing the family doesn't talk about. With addiction, families need to get things out in the open and reach out for help. It's important to keep the lines of communication open within the family and seek answers and support through therapy, Al-Anon, and other readily accessible resources. Addiction is about alienation. It takes us away from people. Recovery is about belonging. The principles of Twelve Step recovery focus on truth and acceptance, and the Twelve Step community provides a safe and healthy environment for LGBTQ adolescents and young adults and their families. * "Sexual Orientation and Adolescent Substance Use: A Meta-analysis and Methodological Review," Addiction, April, 2008.