Substance Use Disorders: Assessment and Treatment, 2nd Edition _ ___________________________________
Therapist : I really admire your candor. Can we talk some more about what needs to change first? SEXUAL IDENTITY AND GENDER EXPRESSION Although data regarding SUDs among lesbian, gay, bisexual, transsexual, and queer (LGBTQ) individuals are inconsistent, some research studies indicate that overall SUDs may be as high as 20% to 30% among the adult LGBTQ population, compared with 9% in the general adult population (Redding, 2014). Higher rates of alcohol use among LGBTQ popula- tions compared to their cisgender, heterosexual counterparts are thought to result from specific stressors that LGBT indi- viduals encounter, which lead to increased use (Centers for Disease Control and Prevention, 2022a). This concept is called “minority stress,” and it is associated with negative health out- comes, including substance use. For example, among lesbian and bisexual women, minority stress is associated with more alcohol-related problems (Wilson et al., 2016). Therefore, clini- cians need to consider important additional stressors among this population that may increase the likelihood of substance use and related consequences. Other findings show that: • Gay men and lesbians are less likely to be abstainers from alcohol than heterosexuals. • Gay men are not at greater risk of alcohol use disorders compared to heterosexual men. • Lesbians tend to be at higher risk than heterosexual women for alcohol abuse and match both heterosexual and gay men in heavy and problematic drinking. • Illicit drug use among LGBT groups is higher than among heterosexuals. • Certain drugs have particularly high usage in the gay male community. For example,
in rates of methamphetamine use or in rates of unsafe sexual practices at 6 and 12 months after the onset of treatment. Even so, receiving treatment that is specifically designed for the LGBT community does seem to increase a sense of treatment satisfaction as well as improve therapeutic alliance (Senreich, 2010a). This seems especially to be the case when treatment programs invite the significant others of LGBT individuals in treatment to participate in program activities designed for families (Senreich, 2010b). However, it is clear that LGBT specialized treatment programs and groups will not necessar- ily be helpful for gay/bisexual men if they are not staffed with competent, sensitive clinicians who are trained to work with this population. Even though there is no consensus concerning the effective- ness of specialized treatment, an extensive qualitative study by Barbara (2002) did identify elements of specialized treatment for the LGBT community that both providers of specialized services and the LGBT community regard as important: • Openness about sexual orientation ‒ Therapists need to be comfortable and relaxed in discussing sexual orientation with clients. The therapist’s body language, the use of inclusive language, and a nonjudgmental attitude are crucial. ‒ Clients need to be reassured that they are in a safe environment where bias and intolerance will not be allowed. · “Coming out” as a process, not an event • There is need for open discussions of the complexities associated with the developmental challenge of coming out. Coming out is regarded as an important step toward a positive self-identity. ‒ Therapists need to promote recognition that, although coming out may have caused pain or difficulty in the past, it is an ongoing process rather than a finite one. The choice of coming out is continually faced by LGBT people when they meet new people and find themselves in new situations. ‒ The role of substance use and the process of coming out must be explored. • Societal homophobia ‒ Treatment must provide a safe place where
methamphetamine use has increased dramatically among gay and bisexual men, who report rates 10 times greater than the general population (CDC, 2020a)
Relatively few studies exist on the outcome of specialized treatment for LGBT individuals, and the findings are not consistent. Senreich (2010a) found that in a sample of spe- cialized treatment programs in New York, gay/bisexual men in specialized LGBT treatment had more positive outcomes than gay/bisexual men in traditional substance abuse treat- ment. Shoptaw and colleagues (2005), in studying cognitive- behavioral therapy specifically designed for gay/bisexual men who used methamphetamine compared with three traditional substance abuse treatment approaches, found that the cognitive-behavioral treatment condition resulted in significantly greater reductions in unsafe sexual practices as compared with the other groups during the first 16 weeks of treatment. However, no significant differences were found
individuals can recount personal incidents of external homophobia: name-calling, social exclusion, rejection, bullying, verbal abuse, and gay bashing. It is important for service providers to acknowledge that clients must deal with negative and prejudiced attitudes toward LGBT people.
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