In substance abuse treatment, as in all therapeutic environments, cultural competency is critical in delivering services for all communities.
If a facility or therapist is not competent regarding a specific culture or ethnic group, it is difficult for the client to feel understood, safe and trusting. It also becomes difficult for the client to develop a rapport with the therapist, which is crucial to the therapeutic relationship. The Lesbian, Gay, Bi, Trans, and Questioning/Queer population is no different. Cultural sensitivity maybe even more critical for this population that has been so marginalized by society.
This population, like other diverse groups, has its own set of special needs and concerns. According to The Substance Abuse and Mental Health Services Administration, statistics show that LGBTQ persons are generally more prone to substance abuse than the general population. (SAMHSA HHS Publication No. (SMA) 12–4104).
Alarming Statistics for LGBTQ Substance Abuse
Alcohol use disorders are, by some studies, as high as 25% to 30% in gay and lesbian populations. 3-10% in heterosexuals. It is speculated that the added stressors for LGBTQ persons may contribute to these statistics and a social environment that, for some segments of the LGBTQ population, involves the frequent use of alcohol and other drugs.
The stigma of sexual preference, gender identity diversity, and diverse sexual orientation is equal to or possibly greater than the stigma associated with addiction. With stigmas and prejudice comes denial and the fear of being found out.
Proper Treatment For LGBTQ Addiction Treatment
For an LGBTQ person suffering from addiction, there is a double dose of potential bias and discrimination, increasing the potential for denial and shame. Confidentiality issues become even more critical, as do the importance of culturally competent staff and sensitivity to these issues. For LGBTQ persons, many considerations do not affect the heterosexual population. Heterosexism and homophobia can create a hostile environment in the treatment setting. There may be legal issues and other forms of discrimination that do not correspond to the heterosexual population. Internalized homophobia may contribute to low self-esteem and self-loathing, which is already a common trend for addicts and alcoholics.
An environment and staff that is understanding and supportive to the LGBTQ addiction treatment client is crucial to a positive treatment outcome. A client must feel safe and supported to develop the positive rapport necessary for a therapeutic alliance. Sensitivity and knowledge of issues and needs in this population are critical in delivering services that are appropriate and supportive.
If a client that is looking for LGBTQ addiction treatment is not supported in group counseling sessions and is not counseled individually with regards to appropriate and mindful consideration of when, where, and how much to disclose regarding their sexual and gender issues, they may fall prey to discrimination by other clients.
Trained and culturally competent staff members must foster a group atmosphere of acceptance and support, and any homophobia or discrimination must not be tolerated. All group members may have a powerful healing experience when acceptance and support are given to LGBTQ group members by their non-LGBTQ peers. New attitudes of acceptance may be learned by non-LGBTQ clients that may have initially harbored negative attitudes. If any prejudice or aggression towards the LGBTQ client is observed, staff must advocate for the LGBTQ client, as client safety must be paramount. Consideration of special needs in discharge planning and family services must also be a part of LGBTQ sensitive treatment.
Medical issues may also be a factor, due in part to the increased prevalence of STDs in the LGBTQ client population and the use of IV drugs. Medical staff and screenings must be attuned to the concerns and vulnerabilities of the LGBTQ client, who may have been marginalized in the healthcare system previously. Co-occurring disorders may be a factor, as with all substance abuse clients, and trauma resulting in PTSD is common. LGBTQ clients may be resistant to disclosure and treatment for these issues because of their heightened sensitivity to discrimination and their past histories of marginalization.
Creating a comprehensive treatment experience for LGBTQ clients is an important piece in the overall scope of treatment planning. With a population over the average in numbers of chemical dependency, the LGBTQ addiction treatment client is often underserved and undertreated.
The right rehab treatment center will help LGBTQ clients understand their issues and provide a supportive, safe treatment environment to further recovery for all populations.
This post was written by: Elizabeth Ossip, LCSW, CAP, ICADC.