Vital Voice

Book review:
Fundamentals of LGBT Substance Use Disorders, written by Michael Shelton

When it comes to treating LGBT substance abuse know this: we are the same but different from our straight counterparts. While treatment and intervention for alcoholism and drug addiction in lesbian, gay, bisexual and trans patients often mirrors that offered to the general population, if it often does not acknowledge the complexity of the experiences, emotions and challenges faced by LGBT patients, it runs the risk of being rendered ineffective, counterproductive or even detrimental to recovery.

In “Fundamentals of LGBT Substance Use Disorders,” the new book released by Columbia University Press-distributed LGBTQ publisher Harrington Park Press, Philadelphia clinician Michael Shelton sums up what is known about the prevalence of LGBT substance abuse and treatment, and emphasizes the importance of affirmative therapy practices—counseling that supports and embraces client sexual identity.

The book looks at not only how lesbians, gay men, bisexuals, and transgender individuals differ in their susceptibility to substance abuse, but stresses that treatment programs must consider many additional factors, including race, ethnicity, age, family relations, and place of residence in order to succeed.

Michael Shelton’s “Fundamentals of LGBT Substance Use Disorders,” continues the work began by Dana G. Finnegan and Emily B. McNally, the married lesbian professional counseling couple widely considered two unsung pioneering heroes of LGBT substance abuse research and counseling.

The book is the first new comprehensive resource for LGBT substance abuse counselors to be released since a free government-funded guide was released by SAMHSA (Substance Abuse and Mental Health Services Administration) fifteen years ago, in 2001.

While there have been significant LGBT cultural victories since the study of LGBT substance use began, there remains a dearth of counselors specifically trained in LGBT issues.

“Fundamentals of LGBT Substance Use Disorders” is at once an introduction, textbook, and handbook for LGBT-focused and general substance-use disorder counselors, offering optimum care guidelines, current terminology and sobering facts about substance abuse—most strikingly regarding those who identify as bisexual. The following are a few key terms and factoids from the book.

What to Look for in Effective LGBT Substance Abuse Treatment

LGBT people face barriers to entering treatment and challenges while in a treatment setting—ranging from prejudicial and discriminatory treatment from staff and peers to “therapeutic neutrality” (being prescribed the same treatment regardless of gender or sexual identity). Below is a short list of key requirements LGBT people should look for when seeking effective substance abuse treatment.

  • LGBT-specific programs are available.
  • Treatment embraces “affirmative therapy” (see below)
  • Facility operates as a safe place for LGBT patients. Just one bad experience with a staff member or even a random person working in the same building is enough to destroy a clinic’s effectiveness and reputation in the LGBT community.
  • LGBT employees on staff: A clinic or program with no LGBT employees is a red flag and does not bode well for LGBT patient success.

What are “Affirmative Therapy,” “Trauma Informed Care,” and “Cultural Competency”? Three Terms You Need to Know When Seeking LGBT Counseling

  • “Affirmative Therapy” recognizes, embraces and supports an individual’s self-identity, and operates on the tenet that sexual orientation is not the problem for an LGBT person but societal heterosexism is. (Hello!)
  • “Trauma Informed Care” takes into account the distress and suffering that may have led to substance abuse and the need to seek treatment.
  • “Cultural Competency” entails an understanding and respect for LGBT cultural differences and experiences by providing an inclusive, safe environment that cannot exist in a program that claims therapeutic neutrality (treating LGBT patients and non-LGBT patients the same).

It’s Not Me, It’s You. Heterosexism and 7 other Terms You May Have Experienced, but Not Known Are a Thing

  • Minority Stress: Stress caused by just being a member of a minority, mostly due to everything on this list.
  • Microaggressions: Brief and commonplace verbal and behavioral indignities made towards LGBT people, which are considered more damaging than overt expressions of bigotry precisely because they are small, and therefore often ignored or downplayed, leading the victim to feel self-doubt rather than justifiably angry, and isolated rather than supported. In three bitter flavors: microassuaults (verbal attacks or avoidant behavior: slurs, bullying, hate speech), microinsults(rudeness and insensitivity that demeans a person’s heritage or identity: “forgetting” to use trans person’s preferred name or gender pronoun or name), microinvalidations (interactions that exclude, negate, or nullify a person’s thoughts or feelings: straight folks stating or implying that minority stress does not exist. “We are all human beings.”)
    • Social Stigma: Extreme disapproval of a person or group based on stereotypes to segregate them from society. Think HB2, Ted Cruz, One Million Moms, Trump.
    • Stigma Consciousness: The chronic expectation to be stereotyped by others.
    • Stereotype Threat: The fear of being seen through the lens of a negative stereotype or of doing something that would inadvertently confirm that stereotype. The MTV short film “America Male” is good, though exaggerated example.
    • Heteronormativity: The belief that hetero is not only bettero, but is the only normal sexual orientation.
    • Heterosexism: The enforcement of heteronormativity. Works just like the other negative isms – racism, sexism – the expression of heteronormativity through discrimination.
    • Implicit Bias: Even if you feel you are not biased, you are. Assuming the Latina is a maid, the black man in the hoodie is a thug, or all gay men are diseased. Think you’re not biased? Take this test.

    Five Not-So-Fun Facts about LGBT Substance Abuse

    • Bisexuals make up the largest single population in the LGBT community, are the most troubled and most susceptible to substance abuse issues, yet they remain the least researched and understood. The odds of substance use for bisexual youth were 340% higher than for heterosexual youth.
    • Two-thirds of LGBT people experience at least one of three forms of discrimination (sexual orientation, gender, and race). Substance abuse is four times greater among those who experience all three types of discrimination, than those who experience none.
    • LGBT men and women demonstrate a smaller decline (or none at all) in substance use as they age, in contrast to heterosexuals, who typically reduce or end their substance use as they get older.
    • Baby boomers represent the fastest growing group in need of substance abuse care.
    • Most gay men and lesbian women do not have a substance use issue, although their risk is elevated in comparison to that of heterosexuals.

    Via Press Release


    http://www.thevitalvoice.com/new-book-addresses-the-fundamentals-of-lgbt-alcohol-and-substance-abuse/