How Legalized Gay Marriage May Mean Less Addiction, Better Mental Health for Millions

When advanced ALS confined him to a bed and round-the-clock care, John Arthur and his partner of 20 years, Jim Obergefell, chartered a private plane with the help of generous donations from family and friends and headed off to get married. But after traveling from their home state of Ohio to Washington, D.C., to tie the knot officially, they soon discovered that their marriage would not be recognized on Arthur’s death certificate in Ohio. That is when the pair filed a civil lawsuit (knowing that Arthur would not live to see its resolution), asking that Ohio recognize their marriage. The rest is now history: last month, in a 5-4 vote, the Supreme Court made gay marriage a nationwide right, with the result that gay married couples can now put the name of their spouse on their death certificate and receive the same next-of-kin rights that heterosexual married couples may lay claim to when a spouse dies.

Same-Sex Marriage Grants LGBTQ Community Better Access to Mental Healthcare

And as in death, so too in life. The legal recognition of same-sex marriage now means that gay Americans have access to the same rights that the institution of marriage confers on heterosexual couples—among these, improved access to health insurance coverage, and in turn, better access to mental healthcare, including treatment for addiction and co-occurring disorders. That, at least, is the hope being expressed by leaders in the field. “The legalization of gay marriage should broaden opportunities for the LGBTQ community: more coverage to provide access to treatment, increased participation of partners—now spouses —in the family treatment process, and hopefully growth in services designed for the LGBTQ community, a traditionally underserved population,” said Brandi Ernst, vice president of business development for the largest private chemical dependency treatment provider in the Southwest, Texas-based The Right Step. “These changes could make significant inroads to reduce substance use disorder and co-occurring mental health issues in the adult population and hopefully create less of a stigma for LGBTQ youth.”

How Will Marriage Equality Improve the Mental Health of Gay Americans?

Marriage equality will improve mental health for gay Americans in many ways, experts say. And over the years, a large body of research has accumulated in favor of their projections. Beyond better access to mental healthcare, the LGBTQ community stands to benefit from other extensions of the recent decision to legalize gay marriage. These include:

  • A reduction in stress levels: A 2012 study by researchers at UCLA, which was published in the American Journal of Public Health, shows that gay couples see the same reduction in psychological distress once married that heterosexual couples experience. Moreover, the study concludes: “Same-sex married lesbian, gay, and bisexual persons were significantly less distressed than lesbian, gay, and bisexual persons not in a legally recognized relationship.”
  • A reduction in the stigma of gay relationships and, in turn, the negative health impact of this stigmatization. In 2003, a team of researchers looked at the healthcare patterns of gay and bisexual men in Massachusetts, both before and after the legalization of gay marriage in the state. In the year following the legalization of gay marriage, the researchers noted a 13 percent decrease in both physical and mental health visits to medical providers. “One mechanism that may explain these findings is a reduction in the amount and frequency of status-based stressors that sexual minority men experience when institutionalized forms of stigma are eliminated,” the researchers concluded in a 2011 article in the American Journal of Public Health. Reduced stigma means fewer visits to the doctor. Or so it seems.
  • A boost in self-esteem, thanks to the elimination of at least one important cause of lower self-esteem in the LGBTQ community: Advocates of marriage equality have long argued that denying gay couples the right to marriage is akin to treating them like second-class citizens, and in turn leads to a lower sense of self-worth and self-esteem. Such claims find validation in the findings of a 2013 study by the University of Michigan School of Public Health, which found that in states with marriage bans, gay men—particularly those with aspirations of fatherhood—reported lower self-esteem levels as well as higher depressive symptoms.

Linda Snook, who as a licensed chemical dependency counselor helps to direct The Right Step’s intensive outpatient LGBTQ program, says an increase in a sense of equality will contribute to greater relational security and “healthier, happier relationships, which helps with recovery from addictions and depression.”

  • The ending of a now well-established link between bans on gay marriage and significantly higher rates of mental illness, particularly anxiety disorders, in the gay community: The legalization of gay marriage means an end to the state bans that have been directly linked to drastically higher levels of mental illness in the LGBTQ community. One such study, this one conducted by Columbia University psychologist Mark Hatzenbuehler and sponsored in part by the National Institutes of Health, has found that gay people in states where same-sex marriage was banned suffered from psychiatric disorders at a much higher rate than those living in states where they could marry. Anxiety disorders topped the list of mental disorders, registering a 248 percent increase in states where a marriage ban was in place. Another study published in the journal Sexuality Research and Social Policy confirms a link between discrimination (and/or perceived discrimination) and reductions in “psychosocial fitness.”
  • The same long-term increases in happiness that heterosexual married couples benefit from: Studies like this one have shown a clear positive correlation between marriage and long-term well-being. Marriage, it seems, promotes greater overall life satisfaction as well as better physical and mental health.

If, based on the above factors, the LGBTQ community can expect to benefit from improved mental health, including lower rates of addiction and substance abuse, at least some in the LGTBQ community — those with drug and alcohol addiction and co-occurring disorders — found a downside. Snook asked her clients what they thought about the implications of the Supreme Court decision for gay and lesbian mental health. They say they believe mental health will improve, but that other new challenges accompanying legally recognized marriage, such as divorce, will now present themselves as stressors. In other words, the Supreme Court decision will not mean a bed of roses for gay and lesbian mental health, but is at least one more step in the right direction. By: Kristina Robb-Dover Follow Kristina on Twitter @saintplussinner

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