How to choose treatment for LGBTQ+ individuals

Five steps to choose affirming care

The following steps can help you narrow down your options and choose a clinically appropriate and affirming treatment program.

• Step 1: Get an assessment. Seek a clinical assessment to determine the best level of care for your needs.
• Step 2: Check your insurance. Confirm your insurance coverage and look for in-network programs. 
• Step 3: Build your shortlist. Look for programs that offer the level of care and treatment services you need and indicate experience working with LGBTQ+ clients.
• Step 4: Verify what "LGBTQ+-affirming" means. Contact each program and ask specific questions about how they support LGBTQ+ clients. 
• Step 5: Choose the best fit for you. Select the program that best matches your clinical needs, accepts your insurance, and has an environment where you feel safe, respected, and comfortable.

What should you think about when choosing an LGBTQ+ program?

When looking for treatment, you cannot just look for a facility that lists "all welcome" on its website. The best option is not necessarily the one that is closest to you or the first one that you find that accepts your insurance. Keep the following factors in mind:

• The level of care you need: Some people may benefit from outpatient care, while others may need more intensive support, such as residential treatment. If you're unsure which level of care is appropriate, a clinical assessment can help determine the best option based on your treatment needs.
• Co-occurring mental health conditions: Experiences such as discrimination, stigma, social isolation, or family rejection can contribute to substance use and mental health concerns for some LGBTQ+ individuals. If you have co-occurring conditions, look for a program that can address these needs alongside substance use treatment.
• LGBTQ+-affirming care: A program that welcomes LGBTQ+ clients may not necessarily have clinicians experienced in providing affirming care. Ask about staff training, inclusive policies, and experience treating LGBTQ+ individuals. 
• Your individual needs: Consider whether you would prefer LGBTQ+-specific therapy groups or a general treatment program that provides affirming care. If you're transgender or nonbinary, ask about housing, the use of affirmed pronouns, and how the facility coordinates ongoing gender-affirming care, including hormone therapy when applicable.

What makes a program truly LGBTQ+-affirming?

Accepting LGBTQ+ clients and providing affirming care are not the same. When comparing programs, ask how they put their inclusive policies into practice. For example, find out how staff use affirmed names and pronouns, address discrimination, accommodate transgender and nonbinary clients, and coordinate gender-affirming medical care when applicable.

Programs should be able to explain their experience working with LGBTQ+ clients, any specialized services they offer, and how they support individual treatment needs.

What level of care is right for you?

Deciding on the right level of treatment depends on how severe your substance use is, whether you are at risk for withdrawal symptoms, whether you can safely remain at home during treatment, and whether you have co-occurring mental health conditions that also require support.

Common levels of care include:

• Withdrawal management (detox): You receive short-term, medically supervised care to help you safely stop using alcohol or other drugs and manage withdrawal symptoms. Withdrawal management may take place in a hospital, residential, or outpatient setting, depending on your withdrawal symptoms and risk of complications, and is often the first step before ongoing treatment. Withdrawal management should always be directly linked to longer-term treatment. Some programs may be connected to longer-term inpatient treatment or a residential program. In other cases, outpatient treatment may be appropriate after completion of withdrawal management.
• Inpatient: You stay overnight and receive 24/7 care in a structured setting. This can be in a hospital or a nonhospital residential program, and can be especially helpful if you need intensive support for substance use and other health concerns. Inpatient care often follows withdrawal management when additional stabilization or intensive treatment is needed.
• Hospital: You stay in a hospital and receive medically managed, highly structured care, including 24/7 nursing for substance use and other serious biomedical or mental health conditions. Hospital care often focuses on stabilization and may be short term.
• Outpatient: You live at home and go to a clinic or facility regularly for individual, group, or family sessions with addiction treatment professionals. Outpatient care can range from an hour or less per week to several days per week. Depending on your needs, outpatient treatment may include a partial hospitalization program (PHP), an intensive outpatient program (IOP), or standard outpatient therapy. Typically, higher intensity treatment is advised initially, and once you’ve achieved recovery, sessions can be shorter and/or more spaced out. Some people may also complete withdrawal management on an outpatient basis before continuing treatment.
• Telehealth: You meet with addiction treatment professionals by phone or secure video instead of in person. Outpatient care may be delivered exclusively via telehealth or through a combination of virtual and in-person visits. Telehealth can also supplement residential or hospital-based care.

If you don't know which level of care you need, speak with a medical professional for an assessment.

Can you start treatment today?

You may be able to start treatment in just a few days, but availability depends on the level of care you need, your location, and facility capacity. Outpatient programs may be able to accommodate new clients within days, while residential treatment can take longer.

If you're experiencing a medical emergency, overdose, severe withdrawal, or immediate risk of harm, call 911 or go to the nearest emergency department. If you or someone you know is experiencing a mental health crisis, call or text 988 to reach the Suicide & Crisis Lifeline.

What if the program you want is full?

If a specialized facility tells you they have no open spots, ask the following questions:

• Do you offer telehealth services, intensive outpatient support, or "bridge care" for support while I wait for a spot?
• Can we schedule an assessment now so that my paperwork is ready when a bed does open?
• Is there an LGBTQ+-friendly provider or participating program nearby that you can refer me to?

Should you stay local or travel for care?

You may be able to find effective, LGBTQ+-affirming treatment close to home. For outpatient care, including counseling, intensive outpatient programs (IOPs), and peer support groups, staying local can make it easier to attend sessions consistently and maintain community support. However, if you're having difficulty finding affirming care or need specialized residential treatment, you may want to expand your search. Consider traveling if:

• Local programs do not offer adequate programming.
• You want a residential program with dedicated LGBTQ+-specific programming.
• You need specialized care for co-occurring trauma or mental health conditions.

Additional considerations when choosing a program

• Housing and room assignment policies: High-quality affirming rehabs should offer clear, written policies that allow clients to be housed according to their gender identity. Ask about features like gender-neutral bathrooms, single-occupancy rooms, and roommate matching protocols.
• Strict length-of-stay requirements vs. flexible care: Be cautious of programs with fixed timelines, such as 28-day programs. Treatment duration should be based on clinical needs and progress rather than a fixed timeline. Ask how the program's length of stay is determined and how treatment needs are reassessed. Look for a flexible length of stay and a clear step-down path to outpatient therapy or affirming sober living environments.

What questions should you ask before starting treatment?

Before choosing a treatment program, call the admissions office and ask:

• What is your experience treating LGBTQ+ clients?
• Do you offer LGBTQ+-specific therapy groups or peer support?
• How are your clinicians trained in LGBTQ+-affirming care?
• How do you support transgender and nonbinary clients during treatment?
• What are your housing policies for transgender clients in residential treatment?
• Can clients continue gender-affirming medical care during treatment if needed?
• How do you treat trauma, mental health conditions, and substance use together?
• How do you address discrimination or harassment if it occurs?
• What do discharge planning and aftercare look like?

What is the best rehab for an LGBTQ+ person?

The best rehab is not necessarily the one with the largest LGBTQ+ program or the most prominent marketing campaign. It's the one that matches your clinical needs, provides evidence-based addiction treatment, treats co-occurring mental health conditions as needed, and supports long-term recovery. The best rehab should make you feel safe, respected, and able to participate honestly in treatment.

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