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A Provider's Introduction to Substance Abuse Treatment for Lesbian, Gay

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A Provider's Introduction to Substance Abuse Treatment for Lesbian, Gay Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment A Provider’s Introduction to Substance Abuse Treatment for Lesbian, Gay, Bisexual, and Transgender Individuals A Provider’s Introduction to Substance Abuse Treatment for Lesbian, Gay, Bisexual, and Transgender Individuals U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment 1 Choke Cherry Road Rockville, MD 20857 All material appearing in this volume may be reproduced or copied without permission from the Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) Center for Substance Abuse Treatment (CSAT) or the authors. Citation of the source is appreciated. The material appearing on pages 12 and 13 is under copyright and reproduced herein with the permission of the copyright holders. Before reprinting, readers are advised to determine the copy­ right status of all such material or to secure permission of the copyright holders. This publication was developed by SAMHSA’s CSAT under purchase order 99M004228. Edwin Craft, Dr.P.H., served as the CSAT Government Project Officer. Saul Levin, M.D., M.P.A., Access Consulting International, Inc., served as the Project Director for the development of the original draft document. This document was edited and prepared for publication by CSAT’s Knowledge Application Program (KAP) under contract number 270-99-7072 with JBS International, Inc., and The CDM Group. Karl White, Ed.D., served as the CSAT KAP Government Project Officer. The opinions expressed herein are the views of the authors and do not represent the official posi­ tion of CSAT, SAMHSA, or any other part of the U.S. Department of Health and Human Services (HHS). This publication may be ordered from SAMHSA’s Publications Ordering Web page at http:// store.samhsa.gov. Or, please call SAMHSA at 1-877-SAMHSA-7 (1-877-726-4727) (English and Español). The document can be downloaded from the KAP Web site at http://kap.samhsa.gov. HHS Publication No. (SMA) 12–4104 First printed 2001 Revised 2003, 2009, and 2012 Table of Contents Foreword .........................................................................................................................................ix Acknowledgments ..........................................................................................................................xi Executive Summary ..................................................................................................................... xiii Substance Abuse in the LGBT Community ........................................................................ xiii Sexual Orientation and Gender Identity ............................................................................. xiv Homophobia and Heterosexism ......................................................................................... xiv Cultural Issues .....................................................................................................................xv Legal Issues ........................................................................................................................xv Treatment Accessibility, Modalities, and the Continuum of Care ....................................... xvi The Coming Out Process .................................................................................................. xvii Families of Origin and Families of Choice ......................................................................... xvii Clinical Issues ....................................................................................................................xviii Related Health Issues ........................................................................................................ xxi Interpersonal Violence in the LGBT Community ................................................................ xxi Counselor Competence in Treating LGBT Clients ............................................................ xxii Administrative Issues ......................................................................................................... xxii Training and Education ...................................................................................................... xxii Alliances and Networks .....................................................................................................xxiii Conclusion .........................................................................................................................xxiii SECTION I: OVERVIEW Chapter 1—An Overview for Providers Treating LGBT Clients..................................................1 Introduction ............................................................................................................................1 Substance Use and Abuse in the LGBT Community ............................................................1 Definition of Terms and Concepts Related to LGBT Issues ................................................4 Estimates of the Number of LGBT Individuals ......................................................................5 Homophobia and Heterosexism ............................................................................................6 How Heterosexism Contributes to Substance Abuse ..........................................................8 Perspectives on Homosexuality ............................................................................................8 Perspectives on Bisexuality .................................................................................................10 Sexual Orientation Over Time .............................................................................................10 Assessing Sexual Orientation ..............................................................................................11 Life Cycle Issues .................................................................................................................11 Summary .............................................................................................................................14 Chapter 2—Cultural Issues in Working With LGBT Individuals ...............................................15 Introduction ..........................................................................................................................15 iii Definitions of Terms .............................................................................................................15 Cultural Competency Overview ...........................................................................................16 General Issues in Cross-Cultural Treatment .......................................................................18 Dimensions of Culture ........................................................................................................ 19 Introduction to the LGBT Community and Culture ..............................................................19 Ethnic Minority Groups ........................................................................................................22 Summary .............................................................................................................................27 Chapter 3—Legal Issues for Programs Treating LGBT Clients ...............................................29 Table of Contents of Table Introduction ..........................................................................................................................29 Protecting the Confidentiality of LGBT Individuals in Substance Abuse Treatment Programs ...........................................................................30 Discrimination Against LGBT Individuals ............................................................................35 Do LGBT Individuals in Substance Abuse Treatment Have Any Legal Protections? ...........................................................................................39 Recommendations ...............................................................................................................44 Resources ............................................................................................................................45 Chapter 4—Overview of Treatment Approaches, Modalities, and Issues of Accessibility in the Continuum of Care ..........................................................................49 Introduction ..........................................................................................................................49 Approaches ..........................................................................................................................50 Levels of Care .....................................................................................................................50 Continuum of Care ..............................................................................................................51 Accessibility .........................................................................................................................51 Specific Issues .....................................................................................................................53 Modalities .............................................................................................................................56 SECTION II: CLINICIAN’S GUIDE Chapter 5—The Coming Out Process for Lesbians and Gay Men ...........................................63 Introduction
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