Research Paper on "Glbt Substance Abuse Therapies the Path"

Research Paper 10 pages (3295 words) Sources: 10

[EXCERPT] . . . .

GLBT Substance Abuse Therapies

The path to sobriety for substance abusing adolescents that are gay, lesbian, bisexual and transgender (and "questioning") is not a well-marked route. In fact for many LGBT adolescents there are detours, barricades, slippery slopes and other road hazards along the way. And there is not an abundance of readily available services for these young people. But there are indeed recovery strategies and rehabilitation programs available for this minority population, and this paper describes several remedies.

The Literature on substance abuse treatment for LGBT adolescents

In a national survey of substance abuse disorders within the LGBT community, the Office of Applied Studies in the U.S. Department of Health and Human Services reports that the "extent of substance abuse disorders" within the LGBT population is significant. Indeed, between 20 and 30% of LGBT individuals are currently abusing alcohol or drugs or both (OAS), according to the literature. Moreover, the National Survey of Substance Abuse Treatment Services (N-SSATS) reports that as of 2008, of the 13,688 substance abuse facilities, 777 facilities (about 6%) offer specialized services for the LGBT population. Interestingly, 5.7% of those 777 facilities provide substance abuse only; 3% of the 777 facilities offer just mental health treatment; 7.1% of those 777 facilities provide a "Mix of Mental Health and Substance Use" services; and 2.3% of the 777 facilities for the LGBT population provide just "General Health Care" (OAS).

The U.S. Department of Health and Human Services offers a wide range of research information for healthcare professionals to utilize in approaching the delivery of services to substance abusing LGBT clients. The Executive Summary in the 228-page "…Introduction to Substance Abuse Treatment for Lesbian, Gay, Bisexual, and Transgender Individuals" explains that, to begin with, those involved with programs designed to treat this minority population should adhere to the following: a) clients' confidentiality must be respected; b) clients need to be advised to "think carefully about how self-disclosure information will be received" prior to acknowledging their sexual orientation to others; c) staff members must be fully educated regarding regulations that apply to LGBT persons; d) clients should be encouraged to take a good inventory of their legal rights and what steps are necessary to protect those rights (www.Samhsa.gov).

The federal government has identified some treatment programs that are "LGBT-tolerant" (token awareness of the need for specialized services for LGBT clients); some are "LGBT-sensitive" (LGBT people are "treated with respect and dignity" but are not zeroed in on the special nature of LGBT issues); and others are "LGBT-affirmative" (these services "actively promote self-acceptance of an LGBT identity as part of recovery") (Cabaj, et al., 2008, p. 49).

Dr. Cabaj references a Pride Institute study that shows that "acknowledging one's sexual orientation" is pivotal in any recovery program. A empirically-based Pride study referenced by Cabaj (Ratner, Kosten & McLellan, 1991) -- and based on an "LGBT-affirmative" program -- shows that after a 14-month follow-up with verifiable reporting, "74% of all patients treated 5 or more days abstained from alcohol use continuously, and 67% abstained from all drugs" (Cabaj, 52). When juxtaposed with four similar studies using facilities that are not "LGBT-affirmative" -- but rather "LGBT-sensitive" -- the results are dramatically different: to wit, follow-ups taken between 11 months to 24 months show abstinence rates of "43, 55, 57, and 63%" (Cabaj, 52). Clearly the facilities that are fully prepared to be LGBT-affirmative do the most effective job in helping adolescents in that minority community.

Local 12-step programs like the Alcoholics Anonymous (AA) program are open to LGBT individuals, Cabaj explains, but there is a caveat. Members of AA may have "prejudices" against LGBT persons, and moreover, some Narcotics Anonymous (NA) and AA groups use religion in their recovery programs. As a result, Cabaj continues, and as a result, LGBT people avoid attending NA and AA meetings "…since many religious institutions denounce or condemn homosexuality" (57).

Enhancing treatment for the lesbian population first requires an educated, open mind about lesbians, according to Dr. Dana Finnegan. "There is no one lesbian client," Finnegan explains; indeed there is "tremendous diversity among lesbians" (Finnegan, 2008, 73). Counselors and therapists working with lesbians struggling with substance issues should be aware that due to the "effects of homophobia and heterosexism" lesbian clients struggling to recover from alcoholism or drug addiction are "…vulnerable and easily hurt and can relapse when wounded or unsupported" (Finnegan, 76). Wise interventions in terms of recovery programs should include: a) empowering the client, "the primary goal, no matter how it is reached"; b) using "nonjudgmental language" and avoiding labels; c) avoiding confrontational approaches, instead using supportive and explorative dialogue; d) totally respecting the client's position ("I'm not a lesbian" or "I'm confused") whatever it may be; and e) respecting lesbians' unwillingness to go to NA or AA because lesbians feel that these are "male institutions with no room for them as women" (Finnegan, 77).

Dr. Fred Rachman believes the treatment for adolescent substance abusers within the LGBT community can be greatly enhanced if the caregivers and healthcare professionals embrace strategies clearly aligned with fairness and justice. For example, when gathering baseline information: a) are the relevant medical and social issues "effectively and comfortably identified" for LGBT clients? b) is the system that has been set up to collect data acceptable to LGBT clients? c) are educational programs not only accessible to LGBT clients but also to their significant others and/or family members? d) do program assessments take into account "the special needs of LGBT clients" and does the information system allow for "tracking performance and outcome data for the LGBT client base"? e) are client satisfaction surveys used? And f) are focus groups being used to examine the quality of services -- and are data being kept to indicate the success or lack of success of therapy for the LGBT client?

Historically LGBT adolescent substance abuse lacks attention / remedies

Psychology professor Karen Jordan of the University of Illinois (at Chicago) suggests first that the origins of substance abuse among "sexual minority teens" can be linked to this group's sense of being "marginalized by society"; e.g., these adolescents are seeking relief for their feelings of isolation and depression (Jordan, 2000, p. 201). Also, Jordon continues, LGBT youth are known to experiment with drugs and alcohol due to their desire to shake off the "chronic stress associated with being stigmatized both interpersonally and intrapersonally" (201).

The reason that substance abuse is "disproportionately evident" in LGBT individuals can be partially attributed to the fact that young people are "ill-equipped developmentally to handle the strain of being different" (Jordan, 202). Jordan references a study of Hispanic and African-American gay and bisexual male youths in New York City that showed 76% were abusing alcohol, 42% were using marijuana and 25% were into the cocaine or crack habit (203).

Meanwhile, adolescent substance abuse has been called the most "frequently missed pediatric diagnosis" and that is because substance use is considered "a nearly universal right of passage" for all adolescents (Ryan, et al., 1998), hence some use of alcohol and drugs is expected. If substance abuse is not adequately catalogued within the adolescent community in general, one can be certain that updated, factual diagnosis is often absent with reference to LGBT young people. One study outcome that Ryan references in her book Lesbian & Gay Youth: Care & Counseling, shows that 60-80% of gay and lesbian adolescents admitted for inpatient substance abuse treatment "are diagnosed with depression" (86). Why did these psychological problems not surface until the young person became abusive towards alcohol and drugs? There is a predominant "lack of knowledge about the needs of lesbians and gay males" that hinders the chances of LGBT adolescents getting the treatment they need.

One study of a county-funded alcohol and drug treatment program in San Francisco, "more than half of the treatment staff (56%) had no prior training on treatment needs of lesbian and gay clients" and an equal number of staff lacked any knowledge of "appropriate self-help/support referrals" (Ryan, 88). Because of this dearth of training among staff at treatment centers, Ryan suggests that agencies should be very certain of the quality of service available to LGBT adolescents prior to making the referral; many agencies are "still guided by outdated information based on inappropriate treatment philosophies" (89).

Counselors have obligations to the LGBT community that according to author Carolyn Stone they are not living up to, for reasons that Stone points out in the journal Multicultural Counseling and Development (Stone, 2003, p. 143). Since the literature referenced in this paper clearly points to the isolation and depression that many LGBT students struggle through -- which leads them, according to the literature, to abuse alcohol and drugs -- it seems reasonable that school counselors should be available to these students before they go off the deep end vis-a-vis substances to abuse. Stone insists (146) that it is "well-documented" that "gay, lesbian, and bisexual students are severely at risk for depression and suicide"; unfortunately, Stone goes on, "systemic support in schools… READ MORE

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