The literature has suggested that addiction treatment programs are not addressing the unique recovery needs of gays and lesbians. This qualitative study examined gay men's and lesbian women's experiences with addiction treatment and recovery. Ten themes emerged to define their experiences. These themes are described, along with implications for mental health counselors working with this population.
Mental health professionals have long considered the gay and lesbian population to be at-risk with respect to alcohol and other drug addiction. In an extensive review of the literature, Hughes and Eliason (2002) concluded that this risk continues despite declines in actual levels of use in this population. There is also evidence to suggest that gay men and lesbian women do show differences from the general population in patterns and consequences of use (e.g., McKirnan & Peterson, 1989; Skinner & Otis, 1996). Bux (1996) reviewed the literature on prevalence rates of problem drinking among gays and lesbians and concluded that lesbian women and gay men are less likely to abstain from alcohol use than the general population, that lesbian women seem likely to be at higher risk than heterosexual women for problems related to drinking, that gay men's risk for alcohol related problems is comparable to that of heterosexual men, and that the latter is due to recent declines in use.
There is also some evidence that the gay and lesbian population may experience substance use and addiction in ways that are uniquely related to their sexual orientation (Cheng, 2003). In a study of lesbian women and gay men in recovery, participants reported that conflict related to sexual orientation was a major contributing factor to their alcoholism (Millinger & Young, 1990). Furthermore, alcohol and other drugs can become a mechanism for coping with social stigma and internalized homophobia (Cabaj, 1996; Cheng, 2003; Ratner, 1993) This is exacerbated by the fact that the gay bar is one of the most accessible routes into the lesbian and gay community for individuals coming out or exploring their sexual identity (Cheng; Gay and Lesbian Medical Association, 2001).
Despite these culturally specific experiences with substance use and abuse, the limited information available suggests that treatment providers often lack the knowledge or inclination to address them. For example, Hellman, Stanton, Lee, Tytun, and Vachon (1989) studied government funded treatment facilities in New York City. They reported a lack of information and training in working with gay and lesbian clients, a reluctance to refer clients to other clinicians who might have specialized training, and frequent failure to address issues related to sexual orientation. This is consistent with Ratner's (1993) report that 53% of the clients who entered the Pride Institute, an inpatient treatment center targeting the gay and lesbian population, had previously participated in inpatient treatment elsewhere where sexual orientation was never addressed. More recently, Eliason (2000) found that substance abuse counselors lacked information about critical aspects of gays' and lesbians' experiences and that, although many of the counselors surveyed had "tolerant or accepting attitudes" (p. 323), a large percentage had "negative or ambivalent attitudes" (p. 323). Matthews, Selvidge, and Fisher (2005) found that the organizational climate in substance abuse treatment facilities predicted the degree to which individual counselors practiced in ways that were affirmative with gay, lesbian, and bisexual clients. The more affirmative the organizational climate, the more counselors reported affirmative attitudes and behaviors in working with this population.
The question of culturally specific treatment is one that has been raised in the multicultural counseling literature for the past couple of decades. Sue and his colleagues have presented a competence-based theory of multicultural counseling, arguing that there are certain competencies that counselors who practice cross-culturally need to develop to work successfully with clients whose backgrounds are different from their own (Ponterotto, Fuertes, & Chen, 2000; Sue, Arredondo & McDavis, 1992; Sue et al. …