Addictions Counselors' Attitudes and Behaviors toward Gay, Lesbian, and Bisexual Clients

Article excerpt

It is difficult to determine the prevalence of addiction among the gay, lesbian, and bisexual population. Early studies (e.g., Fifield, 1975; Lewis, Saghir, & Robins, 1982; Saghir & Robins, 1973) suggested rates of alcoholism, or at least problematic drinking, to be around 30% or more for the lesbian and gay population, substantially higher than in the general population. These studies have, however, been widely criticized for methodological weaknesses (e.g., Beatty et al., 1999; Bux, 1996; Paul, Stall, & Bloomfield, 1991). These weaknesses included such problems as sampling primarily from patrons of gay bars, sampling only from large metropolitan areas, and inconsistent definitions of problem drinking. Later studies (McKirnan & Peterson, 1989; Skinner, 1994; Skinner & Otis, 1996) found less glaring differences in heavy alcohol and drug use between gay and lesbian and heterosexual populations; however, there were differences in patterns and consequences of use. Whether or not gay men, lesbians, and bisexual individuals are at increased risk for substance abuse, they seem to be at least using and abusing chemicals at rates comparable to those of heterosexual men and women.

Bux (1996) stressed the importance of recognizing the unique needs of gay men and lesbians who may be experiencing addiction, even if prevalence rates do not suggest that they are at higher risk for problems related to abuse. Likewise, a number of authors (Beatty et al., 1999; Bux, 1996; Cabaj, 1996; Paul et al., 1991; Schaefer, Evans, & Coleman, 1987; Ubell & Sumberg, 1992) have offered specific suggestions for chemical dependency treatment that is sensitive to these unique issues. Many of these suggestions echo general recommendations for counseling gay men, lesbians, and bisexual (GLB) individuals (e.g., Eldridge & Barnett, 1991; Garnets, Hancock, Cochran, Goodchilds, & Peplau, 1991). These include such practices as adapting paperwork to allow clients the opportunity to indicate that they are GLB and to allow them to accurately identify the nature of intimate relationships (i.e., choice of life partner in addition to single, married, etc.); offering educational activities, groups, and outreach programs that are targeted toward this population; providing books and other literature specific to GLB individuals in waiting rooms and offices; and demonstrating attitudes that are not only tolerant but are affirming of GLB people. In addition, there are elements specific to addiction treatment such as familiarity with gay Alcoholics Anonymous and Narcotics Anonymous groups; assistance in connecting with sponsors who are lesbian, gay, or bisexual and recovering; staff members who are knowledgeable about the unique issues of addicted GLB people described above; understanding and assistance in striking a balance between an often very real need for secrecy regarding sexual orientation and the equally important need for honesty as part of a recovery program (and the importance of this discussion occurring in a setting in which it is safe for the individual to be fully open); and family programs that incorporate expanded definitions of family and recognize the complexities of relationships with families of origin around issues related to sexual orientation. The presence of openly GLB staff to serve as role models is also mentioned frequently. In addition, Bux (1996) stressed that it is important to be able to recognize that not all issues facing this population pertain to sexual orientation and that it is necessary to be able to differentiate when they do and when they do not.

Although there is growing literature that discusses the unique concerns of GLB alcoholics and addicts, as well as the importance of an affirmative approach toward working with this population, there remains a question as to the extent to which addictions counselors are indeed doing this. Early reports (Bittle, 1982; Driscoll, 1982; Zigrang, 1982), largely anecdotal, addressed the lack of responsiveness of traditional substance abuse treatment programs to the gay, lesbian (and bisexual) population and the reluctance of this population to use them. …