Why LGBT Treatment?
By Ann Leible, LPC, PRIDE Institute
It is generally held among researchers that LGBTQ+ persons are more likely to use alcohol and drugs than the general population and more likely to abuse alcohol and drugs, as cited in the Center for Substance Abuse Treatments A Provider’s Introduction to Substance Abuse Treatment for Lesbian, Gay, Bisexual and Transgender Individuals, (2003). Twenty to twenty-five percent of gay men and lesbians are heavy alcohol users, compared to 3-10% of the heterosexual population, (CSAT, 2003).
Why is this?
What factors contribute to the prevalence of chemical abuse among gays and lesbians, bisexual and transgender individuals? And, finally, what can be done about it? Attitudes and assumptions regarding homosexuality and chemical abuse have evolved throughout the years. Until 1973, homosexuality was defined as a mental illness by the American Psychiatric Association. Alcoholism and chemical abuse issues, once treated solely as legal problems, now are seen as illnesses of the mind, body, and spirit. At one time it was believed that there was a causal relationship between homosexuality and alcoholism with the idea that suppressed homosexual tendencies actually triggered chemical abuse and dependency.
Today this myth has been dispelled by research. Instead, scientists believe that societal factors affect the relationship between chemical abuse and the experiences of members of the LGBTQ+ community. The society in which we live marginalizes the LGBTQ+ community. In fact, there is an everpresentness of possible oppression in LGBTQ+ people’s lives. Under such conditions, LGBTQ+ folk can experience varying degrees of heterosexism.
Heterosexism is defined as the stigmatization of nonheterosexual forms of emotional and affectional expression, sexual behavior or community (CSAT, 2003, p. xiv). Negative covert and overt messages about the gay and lesbian lifestyle as well as incidents of hate in the form of threats, acts of humiliation, emotional abuse, and even murder occur frequently. Other common examples of heterosexism include: rejection by family, friends, and peers; loss of employment or lack of promotion; and observing/hearing people make heterosexist jokes (Selvidge, 2000). Heterosexism can contribute to internalized homophobia, shame, and a negative self-concept.
Some LGBTQ+ individuals self-medicate with drugs and alcohol as a way to cope with or numb negative feelings associated with heterosexism, such as isolation, fear, depression, anxiety, anger, and mistrust. Others in the gay community may use mind altering substances as a way to cope with stressors caused by the tensions of living under the stigma of marginalization. In fact, substance use is a large part of the social life of many in the LGBTQ+ community. The gay bar scene is regarded as a risk factor for substance abuse among the gay community. But these bars have often been the only places where LGBTQ+ folks can socialize and feel free from the prevailing oppression that is experienced every day in a strongly heterosexist society. The LGBTQ+ individual who has experienced rejection from his or her biological family may find in the gay bar that one opportunity for identity affirmation and acceptance (Cheng, 2003).
Heterosexism also causes many LGBTQ+ folks to compartmentalize their lives. On the outside, they may follow the rules of the dominant society and behave in ways that are accepted as the norm in order to fit in and succeed. Kimeron N. Hardin, in The Gay and Lesbian Self-Esteem Book: A Guide to Loving Ourselves (1999), defines this identity as the public self. The secret self, on the other hand, is that part of self that is honest and consistent with how one truly feels and what one desires. It remains hidden and is often perceived by the LGBT identified individual as shameful, evil, or unworthy. Engaging in such actions of secret keeping, compartmentalizing, and self-degradation can take a huge emotional toll on an individual. As every 12 Step member knows, secrets keep us sick.
Substance use can provide an avenue of relief that is easily accessible and immediate in its effects. It can also mirror the coping mechanisms of self-compartmentalizing. The user can experience a chemically promoted dissociation, which the LGBTQ+ individual may find both familiar and comforting. Therefore, the compelling allure of alcohol and drugs manifest, and the user becomes vulnerable to the cycle of chemical addiction.
Barriers in treatment services
Heterosexism plays a part in the chemically dependent LGBTQ+ individual’s inability to access effective treatment services. Substance abuse treatment facilities are often not able to meet the needs of this special population. The treatment staff of such facilities may have varying heterosexist assumptions regarding the LGBTQ+ clients who access their services. They may be uninformed about LGBTQ+ issues, insensitive to or antagonistic toward LGBTQ+ clients or believe that homosexuality causes substance abuse or can be changed by therapy (CSAT, 2003, p. xvi).Other clients may have negative attitudes toward the LGBTQ+ client.
These issues become barriers in successful treatment experiences for the LGBTQ+ individual seeking those services. Treatment components designed to promote successful treatment experiences for the LGBTQ+ client include cultural sensitivity, an awareness of the impact of cultural victimization, and addressing issues of internalized shame and negative self acceptance. The integrated biological-psychological social model of chemical addiction treatment takes into account the effects of society on the individual and his or her relation to the use of chemicals.
Cognitive behavioral counseling techniques challenge internalized negative beliefs and promote emotional regulation. Such counseling helps the LGBTQ+ client reach for internal acceptance instead of the nearest bottle or drug.
The inclusive and accepting spirit promoted by Alcoholics Anonymous and other support groups provides an appropriate alternative to the gay bar. LGBTQ+ folks can find a way to transcend the in-authenticity promoted by cultural oppression through the affirming acceptance of others. As a result, they may find themselves living more integrated and expressive lives. Who needs alcohol or drugs when one’s life is so full?