Fundamentals of LGBT Substance Use Disorders, written by Michael Shelton
Fundamentals of LGBT Substance Use Disorders: Multiple Identities, Multiple Challenges is a “successor edition” to the text Counseling Lesbian, Gay, Bisexual and Transgender Substance Abusers: Dual Identities (an updated edition of their 1987 seminal work) by NALGAP founders Dana Finnegan and Emily McNally. Since Finnegan and McNally’s first publication much has changed in what we know about substance use disorders, LGBT identities and LGBT substance use. Shelton masterfully presents the complexities of how intersectionality – the interconnected nature of social categorizations such as race, class and gender as they apply to an individual or group – impact affirmative and competent care of LGBT individuals seeking treatment for substance use disorders. To think that LGBT folks use substances primarily to overcome shame about their sexual orientation is outdated based on the research presented, and involves a much more complex interweaving of many factors, including minority stress. Shelton beautifully lays out the complexities in a way that is informative, easy to grasp and clinically applicable to the reader’s practice.
Each of the categories under the LGBT umbrella are addressed with a focus on the importance of treating clients as unique individuals with a range of possible vulnerabilities and risk factors to substance use disorders. In order to achieve the highest-level outcomes in treatment, Shelton posits, we must consider multiple factors that impact the individual’s life. Having a firm foundation in the cultural, developmental and psychological experiences of LGBT individuals in society is critical in putting the pieces together for excellent care of this underserved population. Shelton also addresses the research and presents best practices for work with LGBT youth, seniors, a range of LGBT family constellations, those involved in the criminal justice system and those living in rural areas. Each chapter concludes with points of discussion, making this text ideal as a teaching tool in both agency and academic environments. Any counselor or treatment facility wishing to provide affirmative care will benefit immensely from this book.
Craig Sloane, LCSW, CASAC, CSAT
Are We There Yet?
When my wife Dana Finnegan and I were asked to write an article for this newsletter for NALGAP, we were honored. We discussed some ideas and we decided to write individual articles about our experiences, thoughts, feelings, and perspectives. We are on a wonderful journey together, but we are each sharing some of our individual journey with you at this time.
Dana and I retired in 1999 and moved to Florida. I enjoyed retirement for a number of years, but I decided to return to work and I have been working full time as a licensed psychologist in a VA intensive outpatient substance abuse program for over 8 years. My past history in the LGBTQ health movement seems very, very long ago. I go to work each day to help veterans deal with substance use and co-occurring disorders such as depression, bipolar disorder, and PTSD in addition to homelessness, chronic pain, medical conditions, and legal problems related to their substance use. Dana and I became involved in “the gay health movement” in June 1979 with the founding of “NAGAP” at Rutgers University in New Brunswick, NJ. We could barely say the word “lesbian” at that time and the inclusion of lesbians and other groups in the name of the organization took place after much discussion and consciousness-raising. In November of 1979, we marched in Washington, DC for NAGAP with a small group of brave lesbians and gay men and we met a number of nurses, doctors, social workers, and other gay/lesbian professional groups. We continued to meet with the National Gay and Lesbian Health Coalition during the early 1980’s and we presented numerous workshops and presentations to spread the word about NALGAP to others in the addiction and health feld and in the gay and lesbian communities.
When I applied for my psychology internship at a VA in New Jersey as a part of my PhD program at NYU in 1983, I had to sign a “loyalty oath” saying that I was not a homosexual. At the time, I was actively involved in NALGAP, marching in Gay Pride Marches, teaching a “Sexual Identity in Recovery” course at Rutgers, living in Greenwich Village, and attending Big Apple Roundups in NYC, When I began my internship, I was afraid that someone would fnd out about my life and I would lose my job and my career. I spent a great deal of energy keeping my personal life and my lesbian and gay activities separate from my work at the VA.
During the past years there have been many positive changes in society, in the VA, and in my professional and personal life. Dana and I have been together since 1974 and we went to Vermont for a Civil Union in 2000 and to NYC to get married in 2012. We currently live in a lesbian community and we have a wonderful personal and social life here. We have a daughter, three grandchildren, and a great granddaughter who live about an hour away and family is one of the reasons why we moved to Florida.
About 15 years ago, we attended a public hearing at a local courthouse about whether sexual orientation should be included in a proposal to protect people from discrimination. Many people spoke out against including LGBT people, especially those who felt that it interfered with their religious freedom to speak about the sin of homosexuality. Others spoke about including sexual orientation, especially teachers who said that many students face bullying and discrimination in schools. The board of commissioners resolved the controversy by not adopting the whole document that a task force had spent two years researching and writing. Yes, that was the solution—rather than include discrimination based on sexual orientation, they dropped the whole document.
Fast-forward 15 years in that same town, a few miles from that courthouse, and there we are at the Women’s March on January 22, 2017 with our electric pink “Love is Love” sign. Many people in the crowd asked to take pictures of us with our sign. It was an exciting and inspiring day. My daughter, who was never an activist, marched with us. Several weeks ago, a few miles from that same courthouse, this town held its frst Gay Pride Event and they expected a few hundred people. Over 3500 showed up and it was a great success. Our oldest grandchild attended with her friends and she took our great granddaughter, who is 18 months old. Many young people today are more accepting of different sexual identities and various gender identities. Our hope is in our youth.
The government and the VA have changed for the better since I worked there in 1983. I was amazed when I found the VA LGBT List-serve on line at work. I can take family leave for my spouse, Dana, and I can include her on my health insurance. I can fle a joint tax return and I am “out” to my co-workers and colleagues. Recently a co-worker asked me if I could speak on a panel about LGBT issues in a local community MH clinic. The VA offers trainings and Webinars on health issues of lesbians and gay men and transgender veterans. One of their goals is to provide quality health care for these veterans.
From one perspective, positive changes have been huge in society with the acceptance of marriage equality and openly LGBT people being included in the military. However, being included does not necessarily mean being “safe.” We need to remember that there are still many places in the country where it is not safe to be out as a gay man or a lesbian or a transgender person. Violence against “difference” has been on the rise in recent years and especially since last year, both pre and post election. Many states are enacting laws against LGBTQ people under the guise of “religious freedom.”
I remember being at an event in a small bookstore in CA with some other LGBT people in 1979 when Ronald Reagan was running for President. A lesbian who had been a leader in an LGBT health center in Seattle shared her dire prediction if Reagan was elected. She said the first losses would be all the progress we had made during the 1960’s and 70’s toward improving the health, welfare and social services for the LGBT people. She could not have known how terrible it would turn out to be when AIDS came along in the 1980’s and Reagan and our government ignored it for many years. Some of us in NALGAP had been working on getting “sexual orientation” included in government documents and programs about underserved populations and that progress did not happen for many years.
This is our challenge today-to not lose the progress we have made in the past years. We need to work together as we have for many years to defeat the forces of evil that put money before people’s lives and that let greed and self-interest determine their decisions. We need to remember that if social progress means we take two steps forward and one back, that it is our commitment in life to keep those two steps forward going and going and going.
When I first saw the Empire State Building lit up in lavender or rainbow colors, I felt proud of the contributions Dana and I made to the progress of a better life for LGBTQ people. I feel humbled and grateful to have been part of an important and meaningful movement for many years, especially the early years when our voices were few and the challenges were many. I remember all the leaders we lost over the years who made great contributions and did not live to see the changes that they helped bring about. I like to think that we are all carrying memories of those who were on the front lines with us.
I feel blessed to still be sharing this journey with Dana, who has a beautiful heart and a brilliant mind. She has always been there for me and for my family, during some dark and difficult times. She helped me through the death of both my parents, the tragedy of an addicted, mentally ill son, graduate school and a dissertation and through some of my most painful years of destructive “therapy.” She is still my support and my safe haven and she is a great cook and is known and respected in our lesbian community as a leader of the writer’s group and a star player of chair-volleyball.
The title, “Are We There Yet?” relates to what I said many years ago when NALGAP was getting started. I told someone that our task, as I saw it, was to put ourselves out of business. I imagined that some day, there would not be a need for NALGAP, because the LGBTQ community would not need information, advocacy, training, and support about alcohol and other drug problems and the addiction field would not need to be reminded of homo-bi-trans-phobia, heterosexism, and other issues of LGBTQ people. I leave it to you to answer the question for yourself, but I hope you know my answer. I think NALGAP is needed and we all need each other more than ever.
Emily B. McNally
NALGAP: Then and Now
When Emily and I met, lightning struck. We moved in together, raised three kids, and struggled with our own and society’s homophobia.
In the summer of 1979, as alcoholism counselors, we attended the three-week Rutgers Summer School of Alcohol Studies program. In the second week there was a meeting of gay and lesbian people and interested parties – and the people in it changed our lives. Eighteen of us talked excitedly about forming a group to help lesbians and gay men who were struggling with addiction in the face of homophobic institutions, counselors, and societal mores.
We formed an association to address these issues— NAGAP (the National Association of Gay Alcoholism Professionals). Emily and I volunteered to get a post office box for NAGAP. After that, we plunged into publicizing and seeking support for NAGAP, even as we struggled with our own internalized homophobia.
Since that time, with a lot of work by many dedicated people, NALGAP has grown and thrived. We have become more inclusive—of transgender, queer, and straight allies. We now annually take part in NCAD’s national addiction conference, our members (among them Joe Amico, current NALGAP Vice President and Phil McCabe, current NALGAP President) have contributed to national publications; we have written two books for counselors (Dual Identities and Counseling LGBT Substance Abusers); and the Foreword to Fundamentals of LGBT Substance Use Disorders, by Michael Shelton; and many NALGAP members have done innumerable trainings for addiction counselors. NALGAP has become a national voice of LGBTQ addiction treatment.
All of this has taken place against a backdrop of political and societal turmoil—of changes that were unthinkable in 1979. Changes such as the repeal of “Don’t Ask, Don’t Tell”; legal decisions protecting lesbian/gay workers; gay marriage; treatment centers that provide non-homophobic addiction treatment; the growth of trainings for counselors working with LGBTQ substance users.
I look back with fondness at the early days of the movement. We went to speak at numerous addiction conferences and often had to face having only one or two people (if we were lucky) attend our presentations. Our workshops often stirred up not-so-hidden homophobia, and it was scary to consider that at times there were people in our audiences that were homophobic and hostile.
At Rutgers Summer School, when Emily, I, and our gay male friend, David Cook, taught about sexual identity, we faced curiosity, sometimes hostility, from some people. But we also learned first-hand about people’s terror and anguish as they tried to deal and live with their own and others’ homophobia, often while trying to get and stay sober.
With the gracious and courageous support of Gail Milgram (the director of the school) I got the chance to give a general lecture on Alcoholism and Homosexuality to the Summer School student body. That experience was both terrifying and immensely gratifying.
When I consider Emily’s and my journey together, I am deeply grateful for her–brave, smart, funny, compassionate, and my personal inspiration and cheerleader.
Looking back, I feel great satisfaction and pleasure about our and many, many others’ courage and dedication, about what has occurred, and what NALGAP has contributed. I also know there is much more to do. But, happily, NALGAP has a Board and members across the country that can and will do the work!