FUNDAMENTALS OF LGBT
SUBSTANCE USE DISORDERS
Multiple Identities, Multiple Challenges
Forward by Dana G. Finnegan and Emily B. McNally
Paperback, $45.00 ISBN: 9781939594112
Hardcover, $85.00 ISBN: 9781939594129
E-book, $41.99 ISBN: 9781939594136
Clinical environments demonstrating cultural competence reduce fear of discrimination, increase LGBT patients’ willingness to access care, and improve provider-patient communication about health concerns related to sexual orientation and/or gender identity. One manifestation of cultural competence in addressing LGBT groups is affrmative treatment, which is a way of helping sexual minorities move from shame to pride and undoing the damage of heterosexism and minority stress. Trauma-informed treatment recognizes the bidirectional relationship between trauma and substance use, acknowledges that many LGBT individuals experience trauma during their lives, and aims to prevent retraumatization during the treatment process. Support groups have a history of inclusion, but some LGBT individuals have had negative experiences with them. Helping LGBT substance users to locate welcoming twelvestep groups is important.
Programs that pride themselves on their competence in working, with LGBT people often have little expertise with bisexuals, and bisexuals typically receive treatment protocols tailored for lesbians and gay men. Treatment of bisexual individuals who engage in substance use must take into consideration concerns such as minority stress, double discrimination, and invisibility
From a historical perspective, substance abuse treatment was developed for adult men. Interventions for lesbians are thus hampered by the lack of research on female substance use in general. Though lesbians are more likely than heterosexual women to seek treatment for a substance use problem, research on lesbian substance use interventions and modalities is sorely lacking.
SECTION THREE | INTERSECTING IDENTITIES
LGBT older adults often experience a culmination of risk factors for poor mental-health outcomes, including substance use. These risk factors include those that are generic for older adults in general and those that are LGBT-specific. However, there are few studies of older adult substance use treatment, and even fewer for LGBT older adults. Many among the latter group fear discrimination and rejection during treatment. Considerations during treatment include a lifetime of minority stress for many clients, inadequate support systems, co-occurring disorders, creating social networks that do not involve clubs and bars, the coming-out process as an older adult, and financial issues.
Research on family involvement for LGBT substance users is sparse, and there are additional issues that traditional families do not experience and rarely even consider that must be factored into treatment decisions. First, the definition of family is more expansive for LGBT members. Second, unresolved family-of-origin issues related to sexual orientation or gender identity are common. Third, the coming-out process and community disclosure might affect treatment. Finally, one or more family members might be struggling with their sexuality and/or gender identity. It appears that most prevailing models of family therapy can be tailored to LGBT family and couples’ dynamics.
LGBT individuals are involved in the criminal justice system at multiple levels, including through interactions with police, in the courts, in jails and prisons, and on probation and parole. It is unclear how many LGBT individuals are in the legal system for substance use-related charges or convictions; many, though, are dependent on underground economies involving illicit substances that lead to police involvement. Transgender women and LGBT people of color are the most likely to come into police contact. Research highlights the special problems they face: discrimination, harassment, violence, inadequate provision of treatment, a lack of knowledge regarding LGBT populations, and a lack of awareness of their presence in the legal system. Finally, while current substance abuse treatment for most in the criminal justice system is inadequate, sexual minorities are even less likely to have a positive treatment experience.
While it is commonly believed that rural life is inhospitable to LGBT individuals, recent data inform us that many say they are satisfied living in these communities. Additionally, some LGBT urbanites are returning to their rural roots and others are relocating for the first time to rural areas for what they see as an improved quality of life. Those with a substance use issue may encounter the aforementioned challenges as well as negative views and misconceptions regarding LGBT individuals held by some treatment providers and a lack of knowledge regarding LGBT clients. There is a particular need for culturally competent treatment in rural areas.
Treatment Agency Self-Audit: Policy and Procedures
Treatment Agency Self-Audit: LGBT Employees
The Gay Affirmative Practice Scale
RESOURCES ON LGBT SUBSTANCE USE AND TREATMENT