____________________________________ Substance Use Disorders: Assessment and Treatment, 2nd Edition
‒ The role of external homophobia and substance use must be explored.
and bisexual men who do not fit these images and contribute to low self-esteem.
• Internalized homophobia ‒ It is very difficult to grow up in a culture in which heterosexist attitudes dominate and not internalize them to some extent. ‒ Resolving internalized homophobia and
• HIV and other health concerns
‒ HIV and AIDS, as well as hepatitis, are
principal components of the lives of gay and bisexual male clients. It is important to assess individuals’ concerns or fears about these diseases, as well as the impact the diseases have had on them as members of the gay community.
shame related to sexual orientation is one of the most important issues for LGBT clients during treatment.
‒ Practicing safe sex is always an important health issue.
‒ There is special need for a sensitive and compassionate exploration of internalized homophobia and its obviously important relationship with substance use. • Family and social support ‒ Issues surrounding the traditional family
The inclusion of these topics in a treatment program devel- oped for LGBT individuals with SUDs would seem critical in addressing the specific needs of this population. Additionally, if group therapy is to be used, the group should be limited to LGBT individuals to ensure acceptance and a sense of comfort. It is important to understand that accessing specialized care for LGBT individuals may be difficult outside of large metropoli- tan areas. Even treatment facilities that claim to have LGBT programs might not necessarily do anything special or different in these programs. Of 911 SUDs treatment programs in the United States and Puerto Rico listed by the Substance Abuse and Mental Health Services Administration (SAMHSA), only 11.8% indicated that they offered specialized services for LGBT clients. Furthermore, despite the availability of some special- ized programs, LGBT individuals consistently underutilize treatment for SUDs, and more work is needed to reach this population (McCabe et al., 2013). YOUTH Unlike adults’ relatively constant rate of alcohol and drug abuse over time, substance use among young people fluctuates according to the availability of particular substances and their popularity among certain subgroups. Some of the variation reported is also attributable to changes in government data col- lection methods (Straussner, 2014). The scope of substance use by young people in the United States is studied annually by a national school-based survey titled Monitoring the Future (MTF). Beginning in 1975, Lloyd Johnston and his colleagues at the Institute for Social Research at the University of Michigan have conducted MTF under National Institute on Drug Abuse sponsorship, with the aim of monitoring the annual trends in substance use and abuse among adolescents (Johnston, O’Malley, Miech et al., 2016; Miech et al., 2017). This survey gathers information on alcohol and drug use by high school students in 8th, 10th, and 12th grades (and, more recently, by college students and young adults; Johnston, Bachman, O’Malley et al., 2016). After a relatively high use of illicit substances by young people in the 1960s and 1970s, the proportion of high-school and col- lege students using any illicit drug has decreased significantly. Current survey results show a continuing decrease in the use of cigarettes, alcohol, prescription opioid pain relievers, and syn-
or family of origin have a different theme and impact for LGBT people than for heterosexuals. LGBT clients may fear the reaction of parents and family to disclosure of their sexual orientation. In order to maintain a positive and supportive relationship with family members, some LGBT people choose not to reveal their sexual orientation. Others who choose to come out do not receive support from their family during or after coming out.
‒ There needs to be a clear awareness that many of those who have faced familial rejection have different support systems or “chosen” families. Clinicians should also acknowledge that LGBT people may also create families of their own by becoming parents. ‒ Significant others in the lives of LGBT individuals in substance use treatment should be included as family in the treatment process. • Socializing ‒ Bars, clubs, and other social spaces within the LGBT community provide environments that are safe from homophobia where LGBT people can meet and socialize. However, in these spaces, there is often a tremendous presence of alcohol and various recreational substances. ‒ Learning to socialize without exposure to high-risk environments is one of the most difficult skills for recovering LGBT individuals to develop. • Body image issues ‒ The gay and bisexual social culture places
great emphasis on the lean and muscular body ideal, youth, appearance, and fashion. Stereotypes of male beauty may alienate gay
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