It’s difficult to find an addiction treatment program that understands the unique needs of the LGBT community. For LGBT individuals, the top priority is finding a supportive therapeutic environment where they won’t feel judged for being who they are; in such treatment settings, they need to feel safe without having to pretend that they are straight in order to receive the best quality of treatment. Fortunately, as society becomes more accepting of individuals of all minorities, including sexual minorities, treatment providers are taking steps to recruit culturally competent staff who are compassionate, empathetic, and knowledgeable about issues relevant to LGBT health and substance use disorders.
Anyone who walks into an authentically LGBT-friendly addiction treatment center would be able to see an all-inclusive diverse group of clients and staff members alike. Clients will be able to find LGBT-specific services and policies that prohibit anti-gay stigma, which would create a warm and receptive environment for individuals of all sexual orientations and identities. Intake forms would include questions on gender identity and sexual orientation; this would give clients the opportunity to self-identify, therefore minimizing the fear of coming out. LGBT clients would feel safe as the treatment provider’s substance abuse counselors, clinicians and staff demonstrate openness to values and beliefs other than their own, which would be reflected in the way they treat individuals who self-identify as lesbian, gay, bisexual or transgender.
The “coming out” process is the process of transforming a negative self-identity into a positive one as individuals work though and accept their stigmatized sexual identity. For counselors to understand this process in substance abuse treatment, they must first be aware of their own biases that could affect treatment and be able to demonstrate cultural sensitivity before they can counsel LGBT clients. Heterosexual counselors are strongly encouraged to read about LGBT individuals and to familiarize themselves with LGBT resources in the community as they receive education and training about LGBT cultural competence.
Heterosexism, a form of discrimination that stigmatizes non-heterosexual identity expressions, behaviors and affections, places undue stress on LGBT individuals who may already suffer from pre-existing mental health disorders, such as bipolar disorder or depression. The combined pressures of heterosexism and homophobia may also induce mental health issues, leading LGBT individuals to resort to alcohol and illicit drugs as coping mechanisms to numb out the pain.
The fear of discrimination for who you are is a common barrier to adequate and quality treatment for many LGBT individuals. Either they conceal their true sexual identity when seeking treatment, or they don’t seek treatment at all, which results in higher rates of poor health.
Congress and the United States Department of Health and Human Services (HHS) have passed laws that severely restrict any treatment program’s ability to disclose information about individuals who are seeking substance abuse treatment. Under a set of regulations issued by the HHS, communications about clients who can be identified by specialty drug treatment programs are severely restricted (Vol. 42 of the Code of Federal Regulations [CFR], Part 2). A sample of a written Consent for the Release of Confidential Information is provided in SAMHSA’s Provider’s Introduction to Substance Abuse Treatment for Lesbian, Gay, Bisexual and Transgender Individuals (Exhibit 3-1, page 32). LGBT clients must give a written consent to the treatment provider if patient records are to be released, and clients can revoke their consent at any time. The consent form includes questions that allow clients to reserve their right to disclose information about their sexual orientation. Violation of client confidentiality are punishable by law, and treatment providers can be fined for up to $500 on the first offense and up to $5,000 for each subsequent offense. (For more information about LGBT legal rights, visit https://www.lambdalegal.org/)
Stereotypes and myths limit our perspectives about the diversity of the LGBT culture. For substance abuse counselors, being aware of these misconceptions and debunking them with facts will help them provide better services and improve treatment outcomes for LGBT individuals. Some of those myths are described as follows:
“Coming out only happens once.” The coming out process is not a one-time event. Each time someone meets a new neighbor, gets a new job, makes new friends or acquaintances, the individual must continually assess whether or not to disclose one’s sexual orientation.
“Sexual orientation is a choice.” Other related myths are (1) “lesbians would change their sexual orientation if they could” and “sexual orientation is a result of hormonal imbalance and can be rectified by taking the right hormones.” These myths hold underlying assumptions that heterosexuality is somehow superior to homosexuality.
“Life as a lesbian is about being sexual; lesbian identity is purely a sexual identity.” The lesbian identity is not strictly about one woman’s sexual attraction to other women; it is also about the importance of one’s affections and feelings for other women.
“Bisexual individuals are not fully gay or lesbian; they are in denial about their sexual orientation.” Sexual identity and behavior are two separate issues. Continuous bisexuality is established in one’s early years and continues throughout one’s lifetime; sequential bisexuality is expressed with same-sex partners or opposite-sex partners at different times in their lives (e.g., a bisexual woman may have heterosexual relations during her 20s and same-sex relations in her 30s). Concurrent bisexuality is expressed when individuals actively date same-sex and opposite-sex partners during the same time period.
“Women become lesbians because they’ve had bad relationships with men, have been abused by men, or do not feel adequately attractive to men.” Sexual orientation is not a decision you can turn on and off. Being sexually attracted to someone of the same sex and/or opposite sex is part of one’s sexual identity. Some people know their sexual orientation right away before puberty; others become aware of their sexual identity at a later age. You cannot “turn” a person gay. For example, a lesbian woman who’s had heterosexual relations doesn’t mean that she “turned” gay after a bad marriage; there could be many reasons why she hid her sexual identity until later in life.
The family you are born into is your family of origin; you are related to them by blood. For LGBT clients, families of origin are often the first source of psychological distress, and many clients have unresolved issues with them surrounding gender identity and sexual orientation. Culturally competent substance abuse counselors help identify and resolve issues that may obstruct LGBT clients’ progress in treatment and recovery.
Your family of choice may or may not include your biological relatives; it may be a group of people such as your friends or a group of individuals in recovery that you meet while in treatment for substance abuse. The family of choice is an important source of support, because they provide a safe space for LGBT individuals to be themselves. The family of choice plays a very important role in an LGBT client’s life and may serve as a protective factor against relapses in the future.