Substance Abuse and Counseling in the LGBT Community By Nicole Folmar
Substance Abuse Problems in the LGBT Community
Sexual orientation minority populations report higher rates of drug use and related problems (Grellaet al, 2009). Many studies that demonstrate this result have used convenience sampling, where subjects are drawn from gay bars and pride parades where a great deal of celebration and drinking is present, so this finding may not be accurate. Possible reasons for abuse: Internalized homophobia: one study showed a small to moderate correlation (Brubaker et al, 2002). Heterosexism Harassment and intolerance Shame Family rejection Gay bars as a center for social life Acceptability of use within the community
Other Reasons Low self-esteem Loneliness Less societal support for self and relationships Depression and anxiety Lack of traditional social roles that slow drinking and substance abuse. Studies show that SA is moderated by marriage, employment, and children (Hughes & Eliason, 2002). Fewer LGBTs have children, commitment unions are not as supported by society, and employment discrimination is rampant (Hughes & Eliason, 2002).
Good News for LGBTs Substance use among lesbians and gay men— particularly alcohol use—has declined over the past two decades (Hughes & Eliason, 2002). LGBTs are more likely to seek treatment and help for abuse and addiction problems as opposed to their heterosexual counterparts (Stahl et al, 2001).
Race and Ethnicity White men and women are more likely than their nonwhite counterparts to report use of almost all licit and illicit drugs. Blacks report lower rates of current, binge, and heavy alcohol use and lifetime illicit drug use than do Whites. In recent years, however, Blacks have reported slightly higher rates of current illicit drug use (9.7% vs. 8.1%). Blacks also experience more frequent and more severe consequences of drug and alcohol use, including poorer physical health outcomes and more severe social consequences, such as higher incarceration rates. Latino gay men may have higher rates of drinking than either group (African American or Caucasian) alone. (Harawa et al, 2008)
Special Issues for LGBT couples with Substance Abuse Problems Questions to ask: What is both partners’ level of comfort being LGBT person ? What stage of coming out are they both at? Do both members of the couple have an adequate family/support/social network? Are there significant health factors (either resulting from substance abuse or not)? Under which circumstances and situations did they use? Are there connections between the partners’ drug use and sexual identity or sexual behavior? Do both partners use?
Have either of the clients experienced gay bashing ? Is same-gender domestic violence present ? Was the client or their partner out as LGBT in past treatment experiences ? Is any of the above correlated with periods of sobriety? (NIDA, 2010)
Couples Therapy for Treatment of Addiction A meta-analysis of drug user treatment outcomes demonstrated that not only is family-couples therapy more effective than no therapy, it also documented that family-couples therapy is more successful than (1) individual counseling (2) peer group therapy, and (3) family psychoeducation (Stanton & Shadish, 1997). Positive treatment outcomes include better relationship satisfaction and reductions in substance abuse. Note: this research was done on a heterosexual population. Mutual support, the acquisition of better problem-solving skills, and enhanced communication may be the reason (illustrated in Fig. 1)
Communication Skills Training Increased caring behaviors Problem-solving skills Continuing Recovery Plan Standard Substance Abuse Treatment Recovery Contract Self-help Support Figure 1. ‘Virtuous cycle illustrating concurrent treatment for substance use and relationship functioning. (Stewart et al, 2009)
Special Problems for Couples Facing Substance Abuse Problems
Sex Many people in recovery report sexual problems (heightened inhibitions and anxieties, higher levels of depression, etc.). Some partners of LGBTs having sexual dysfunction in sobriety may feel it is their fault. Many substance abusing partners may have had unprotected sex or sex with another party without their partners consent or knowledge. This places their partner at increased risk for disease as well as creates distrust in the relationship.
Lies Substance addicted partners often have to lie to continue using their drug of choice. This creates distrust between partners The addict sees his partner as someone to hide important information from. The partner sees the addict as someone whose word they cannot trust. Addicted persons may have stolen from their partners or their loved ones.
Irresponsibility Substance addicted partners may have a history of failing to show up for important events and appointments, not coming home at night, and failing to keep jobs or finish tasks. Partners may feel the need to compensate or overcompensate for their addicted loved ones failings. They may find themselves lying for their addicted partner or making justifications for their substance abuse or irresponsible behavior. Partners end up feeling just as isolated and out of control as their addict counterparts.
Abuse Physical, verbal, and emotional abuse can be an issue. The abusive partner may or may not be the addict/alcoholic. Frustrated partners of addicts can resort to abuse when they run out of options to prevent the addictive behaviors.
The Six S’s for Partner’s Affected by Addiction (Ligon, 2004) 1. Separate yourself, detach from the problem. 2. Set limits, roles, and boundaries. 3. Solidify your position, know where you stand. 4. Support sobriety. 5. Simplify your approach by setting up goals. 6. Sustain your physical, mental, and spiritual health.
Support Groups In addition to therapy, couples can seek individual support groups to help them with their specific needs Alcoholics Anonymous—gay and lesbian meetings exist that can help to provide social support and friendship with other LGBT alcoholics. Al-anon—friends and family of alcoholics and addicts are encouraged to attend to learn to live with their partners and to stop enabling their addictions.
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