forthcoming-fundamentals

FUNDAMENTALS OF LGBT
SUBSTANCE USE DISORDERS
Multiple Identities, Multiple Challenges

By
Michael Shelton
Forward by Dana G. Finnegan and Emily B. McNally

352 pages
Paperback, $45.00 ISBN: 9781939594112
Hardcover, $85.00 ISBN: 9781939594129
E-book, $41.99 ISBN: 9781939594136

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In this new book, the successor to the classic in the field Counseling Lesbian, Gay, Bisexual, and Transgender Substance Abusers: Dual Identities by Dana G. Finnegan and Emily B. McNally, Michael Shelton reviews the empirical literature and synthesizes what we know about the prevalence of LGBT substance use, abuse, and treatment availability, emphasizing the need for affirmative therapeutic
practices. The principles of trauma-informed and culturally competent treatment/intervention are explained and assessed, as well as the challenges of minority stress and microaggressions experienced by the LGBT population. Separate sections focus on the sub-populations of lesbians, gay men, bisexuals, and transgender individuals. Separate chapters focus on LGBT youth, the elderly, family constellations and concerns, criminal justice issues, and rural LGBT substance abuse. This volume provides an introduction to the field that will be useful both as a primary textbook and as a handbook/reference for LGBT-focused and general substance-use disorder clinics and their administrators, clinicians, trainees, allies and volunteers.
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TABLE OF CONTENTS

FOREWORD
Dana G. Finnegan and Emily B. McNally

245
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SECTION ONE | AN OVERVIEW OF LGBT SUBSTANCE USE

334
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1. An Introduction to LGBT Substance Use DisordersFree Chapter

Until 1973, the goal for those seeking treatment for homosexuality was to decrease the intensity and frequency of homosexual thoughts, feelings, and behaviors while simultaneously increasing heterosexual thoughts, feelings, and behaviors. The removal of homosexuality from the DSM that year led to efforts to promote the physical and mental health of gay men and lesbians, including an understanding of the impact of substance use by these populations. Early studies found very high rates of substance use. Later methodological improvements cast doubt on the conclusions of early studies but still found elevated rates of substance use. Later studies came to the same conclusion for bisexual and transgender individuals.

Treatment is also problematic. While the majority of individuals with a substance use problem do not seek professional help, LGBT individuals’ reluctance to seek treatment often stems from a confluence of prejudicial treatment from health-care staff and a lack of knowledgeable providers.

summary
2. Factors Leading to LGBT Substance Abuse
3. Treatment of LGBT Substance Abuse
SECTION TWO | LGBT-SPECIFIC SUBSTANCE USE PATTERNS

301
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4. Trans People and Substance UseFree Chapter

The definition of transgender has become increasingly encompassing and inclusive, and society is slowly recognizing the existence of a diverse group of individuals who depart from traditional gender norms and identification. While studies of substance use by transgender individuals did not get under way in earnest until the late 1990s, they find strikingly high rates. Research also finds that many transgender individuals experience cumulative and catastrophic levels of minority stress, which can help to explain a high prevalence of co-occurring disorders.

Treatment providers often have little information and/or negative attitudes about transgender individuals; treatment facilities are often unprepared to work with members of this group. Successful treatment must factor in the unfortunately common experiences of discrimination, violence, stigma, poverty, co-occurring disorders, HIV, and other health concerns.

summary
5. Bisexual Individuals and Substance Use
6. Lesbians and Substance Use
7. Gay Men and Substance Use

SECTION THREE | INTERSECTING IDENTITIES

8. LGBT Youth and Substance Use
9. LGBT Elders and Substance Use
10. Substance Use and LGBT Family Constellations

11. LGBT Substance Users in the Criminal Justice System

12. LGBT Individuals in Rural Environments

APPENDIX I
Treatment Agency Self-Audit: Policy and Procedures

APPENDIX II
Treatment Agency Self-Audit: LGBT Employees

APPENDIX III
The Gay Affirmative Practice Scale

ABBREVIATIONS

NOTES

BIBLIOGRAPHY

RESOURCES ON LGBT SUBSTANCE USE AND TREATMENT

317
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