Introduction
Lesbian, gay, bisexual, and transgender (LGBT) individuals are entitled to services provided in a safe and appropriate environ- ment and should not be denied services based on their sexual orientation. The treatment provided should be sensitive to and supportive of the unique needs of the client. Therefore, substance abuse treatment providers, counselors, therapists, adminis- trators, and facility directors need to become aware of the issues facing LGBT clients. With this knowledge, they can design quality treatment programs that provide effective, ethical, and informed care for LGBT clients. This improvement in care will improve outcomes for LGBT clients, and treatment providers will reach a previously underserved population.
Recommendations for Research LGBT populations abuse substances at rates that are the same as or higher than the rates in the general population, but more information is needed in this area. Future studies should create a clearer distinction between substance use and substance abuse, employ more vigorous sampling methodology, establish prevalence and incidence rates for the specific substances of abuse, and identify the effects that age, sexual identity, discrimination, and
heterosexism have on substance use and abuse among LGBT individuals. In addition, substance abuse among lesbians, bisexual
Recommendations
women, and transgender individuals should be further studied and substance abuse among them distinguished from substance abuse among gay and bisexual men.
Innovative LGBT-specific intervention and treat- ment approaches are needed and should be researched and developed. Health care
providers and delivery systems should develop new models of intervention and treatment targeted especially to LGBT individuals. Researchers, government agencies, and community-based organizations should work together to create innovative outreach efforts, prevention campaigns, and standards of treatment for LGBT individuals.
LGBT-identified researchers, scientists, and consumers should be included in public health policy formulation and resource decision matters related to substance abuse prevention and treatment.
Recommendations for Clinicians To provide quality care for LGBT clients, treatment providers need to learn about sexual orientation and gender identity and how these are determined. Counselors need to know more about how LGBT individuals learn to acknowledge and accept their sexual orienta- tion, about the stages of coming out, and about how to meet the needs of clients, regardless of sexual orientation. Counselors can help LGBT clients recover from substance abuse and addiction by being empathic, supportive, and nonjudgmental and assisting clients to:
heterosexism, internalized homophobia, and substance abuse.
The counselor should help the recovering LGBT individual connect with a community that
will help him or her heal, such as 12-step or other self-help groups, other LGBT individuals in recovery, and the client’s own family of choice. The counselors should learn to provide sensitive support for LGBT clients’ families and partners.
Counselors should remember that LGBT clients may have additional health concerns such as co-occurring mental illnesses, HIV/AIDS, STDs, liver disease, hormone-related issues, and hepatitis B or C. Counselors should screen for other health problems and for domestic vio- lence. Any assessment should be framed with sensitivity.
Counselors must confront their own negative or ambivalent feelings about homosexuality and learn to provide quality care that is sensitive, supportive, and comprehensive.
It is a challenging task to provide services that are appropriate, accessible, cost-effective, and quality driven. The following section includes selected recommendations for achieving this goal.
reexamine their treatment approaches and take steps to move them to LGBT-sensitive and supportive modalities.
and heterosexism may contribute to the use of alcohol and drugs by LGBT individuals. Providers should learn the effects of these negative biases on the LGBT individual and community and how to help LGBT clients affirm themselves and address negative feelings. A better understanding is needed of the interplay between sexual orientation and the sociocultural context in relation to
substance use, abuse, and treatment.
substance abuse in the LGBT community. Substance use, especially alcohol, is often an integral part of the LGBT social life and
is connected to sexual identity formation, coming out, and self-acceptance processes for many LGBT persons.
individual client’s comfort level related to his or her sexual orientation issues and consider how the client’s feelings about his or her sex- ual orientation affect the client’s recovery.
stereotypes and myths about LGBT individu- als are true. Each LGBT individual is unique. Recommendations for Training
A limited number of facilities offer LGBT-
sensitive treatment. The training of professional and support staff to serve LGBT individuals in their own communities is critical for improving treatment and treatment outcomes.
Considerations for improving training to enhance treatment for the LGBT community follow.
diversity and sexual orientation sensitivity to promote better understanding of LGBT popu- lations. Education topics should be diverse and applicable to all LGBT populations and include topics of sexual orientation, sexual identity, gender, and sexual behaviors.
programs to ensure that quality care is provided. Educators and trainers with expertise in LGBT issues should develop training programs, manuals, books, videos, films, CD-ROMS, and other interactive training technology focused on LGBT treatment that can be widely disseminated.
clients and heterosexual clients attend the same group therapy sessions. Counselors should protect LGBT clients from homopho- bic behavior. LGBT clients should not be forced to discuss sexual orientation or
behaviors if they are not comfortable doing so. If the facility provides LGBT-only groups, attendance should be voluntary and confi- dentiality should be respected.
competence in serving LGBT individuals before developing a training program, during training, and after providing training.
Recommendations for Administrators
Managed Care
Managed care and other health care provider networks should strive to improve their LGBT sensitivity.
of providers should include LGBT providers and LGBT-sensitive providers.
- tions should request that MCOs include LGBT providers and an LGBT category as a recognized subgroup of the health insurance plan.
organizations should be able to inform case workers of subcategories of providers; for example, a caseworker should have enough information to be able to refer a client to substance abuse treatment services that are identified as LGBT sensitive.
to ensure culturally competent services.
maintenance organizations, and employee assistance programs should identify and use resources for providing culturally competent substance abuse treatment services to LGBT clients.
Recommendations
Recommendations
Program Planning
program directors, and substance abuse treatment educators should encourage planning for and implementation of training programs to serve substance-abusing LGBT clients.
established, providers should develop programs for drugs such as cocaine, crack, methamphetamine, and other addictive drugs that are challenging to treat.
Quality Assurance
To ensure high-quality treatment:
They should collect appropriate demographic data to establish baseline information about LGBT clients. They should design and implement appropriate client satisfaction measures that provide specific feedback about how well the organization is serving LGBT clients.
associations, and others engaged in training mental health and social work professionals and support staff should review and revise their existing policies to reflect LGBT needs.
procedures to improve sensitivity toward and effectiveness in serving LGBT clients.
specific outcome data. They should compare the numbers of clients served, overall
satisfaction results, and treatment outcomes among identified LGBT clients with data pertaining to the general treatment population.
expertise in LGBT issues, such as clients, staff, advocacy groups, or organizations, to provide assistance in developing an LGBT program that is sensitive, supportive, and effective.
standards by accrediting bodies such as the Joint Commission on Accreditation of Healthcare Organizations, the National Committee for Quality Assurance, and the Commission for the Accreditation of Rehabilitation Facilities to specifically acknowledge and address the needs of LGBT individuals and provide appropriate education for surveyors from these bodies. Treatment accreditation bodies should mandate demonstrated proficiency in LGBT health and safety issues.
It is hoped that this volume will assist
administrators and clinicians in forming a better understanding of LGBT people, their problems with substance abuse, and the unique
challenges they face and that the knowledge gained about designing programs for LGBT clients will be used to create a more