1. Copyright Alcohol Medical Scholars Program1 Alcohol Abuse and Dependence in Gay and Lesbian Populations Marty H. Hoiness M.D. Acting Instructor Department of Psychiatry & Behavioral Sciences University of Washington School of Medicine Harborview Medical Center

2. Copyright Alcohol Medical Scholars Program2 Alcohol Abuse and Dependence in Gay and Lesbian Populations FPrevalence Estimates FReasons for Possible Increased Prevalence FSubstance Abuse/Dependence and HIV FTreatment Recommendations

3. Copyright Alcohol Medical Scholars Program3 Prevalence Estimated to be approximately 30% in men True prevalence unknown Most studies have methodological errors Most studies have found greater prevalence compared to heterosexuals

4. Copyright Alcohol Medical Scholars Program4 Etiology of Increased Prevalence Biological Factors Societal / Cultural Factors Psychological Factors

5. Copyright Alcohol Medical Scholars Program5 Biological Factors Growing evidence that substance abuse / dependence and homosexuality have some genetic component

6. Copyright Alcohol Medical Scholars Program6 Societal / Cultural Factors Stigmata of homosexuality Homosexual culture is often focused around alcohol use with few alcohol-free social outlets Alcohol use allows individuals to experience their sexuality regardless of acceptance

7. Copyright Alcohol Medical Scholars Program7 Psychological Factors Internalized homophobia may cause psychological distress Many gay individuals have their first sexual experience under the influence of alcohol Self acceptance of homosexuality may be important in the treatment of alcohol abuse / dependence

8. Copyright Alcohol Medical Scholars Program8 Current Treatment Programs Less than 5% of individuals in treatment programs self-identified as homosexual Issues of gay and lesbian clients are rarely addressed in treatment programs Drug and alcohol programs report that they have relatively little knowledge of the special needs of gay and lesbian clients

9. Copyright Alcohol Medical Scholars Program9 HIV and Alcohol Alcohol intoxication may increase risky sexual behavior Men who don’t drink during sex are three times more likely to engage in safer sex Association between risky sex and alcohol has not been replicated in all studies

10. Copyright Alcohol Medical Scholars Program10 HIV and Alcohol Alcohol abuse / dependence leads to difficulties with adherence to HIV therapies Alcohol may increase the progression of HIV infection through immune suppression

11. Copyright Alcohol Medical Scholars Program11 Alcohol Problems in Lesbians Very few studies documenting prevalence Society focuses on men and neglects issues of women Few lesbian specific treatment centers

12. Copyright Alcohol Medical Scholars Program12 Alcoholics Anonymous Most cities have gay/lesbian AA meetings Clients may need to be reminded that AA is not specifically focused on religion Extending the powerlessness over alcohol concept to being powerless over being gay may be helpful

13. Copyright Alcohol Medical Scholars Program13 Recommendations Screen gay and lesbian clients for alcohol abuse and dependence Gay and lesbian individuals should be referred to gay and lesbian specific treatment centers Treatment should focus on acceptance of homosexuality

14. Copyright Alcohol Medical Scholars Program14 Summary Prevalence of alcohol problems may be elevated in gay and lesbian populations Multiple possible etiologies Current treatment program rarely address gay and lesbian issues

15. Copyright Alcohol Medical Scholars Program15 Summary HIV risk taking behaviors may be associated with alcohol use Lesbian clients may have special needs Treatment centers should address gay and lesbian issues