1. Inappropriate Mainstream Services

2. Hellman et al 1989 b heterosexual bias in treatment and evaluation (including either focussing primarily on sexual orientation when inappropriate or ignoring important factors linked with sexuality), b ignorance about lesbian/gay issues and discomfort at approaching matters of sexuality, b ignorance about the inter-relation of homosexuality and alcohol misuse, b lesbians and gays felt discomfort in the mainly heterosexual environment of agencies and were fearful of being viewed as pathological or stereotyped.

3. Neisen & Sandall (1990) b difficulty in being open about their sexual orientation due to fear of staff/client harassment, b staff telling them it wasn't acceptable to discuss sexual orientation, b some were forced to disclose their sexual orientation, b as soon as their sexuality was known, some were discharged, b some said that after disclosure the treatment they received was different due to an atmosphere of condemnation, b some feared that if their sexual orientation was known about this would receive more emphasis than their chemical dependency, b some services were not happy having their partner attend a family programme.

4. O’Hanlan (1996) b the majority of detoxification and rehabilitation programmes were insensitive to issues of sexual orientation and did not, generally, encourage its disclosure; b homophobia limits the success of recovery and treatment for lesbian substance abusers (Hall, 1990; de Monteflores, 1986); b failure to acknowledge sexual orientation makes relapse more likely (Cabaj, 1992); b lesbians were more likely to attend treatment services which address lesbian social issues and provide lesbian counsellors (Hall,1986, 1990, 1992, 1993, 1994; Morales & Graves, 1983).

5. Other Issues b Rofes (1989): traditional networks which people use to support recovery: family, church, school, employers, are often closed to LGBs b Hawkins (1976): closet gays attend het- oriented AA groups: detrimental effects as key to sobriety is “open and honest relationship with one’s peers.”

6. Bridget (1994) b more than half of the 121 respondents never discussed sexual orientation with their clients, b only a handful had had training and supervision in relation to lesbian clients, b the majority had little knowledge about the treatment and evaluation of lesbian alcohol misusers, b 84% felt able to treat lesbian clients, b 67% said they would like training on these issues.

7. Mainstream Services in Britain b 1991-1992 Alcohol Directory: 120 agencies welcomed LGB people b 1998-1999 Alcohol Directory: 17 agencies make special provision for LGB people b Alcohol Concern, 2002: only 7% of users of 450 alcohol treatment agencies in UK LGB

8. Specialist/Gay-friendly b DASL b Hungerford Project b Blackpool b Piccadilly Project, Bradford b Others b LGB AAs

9. Making Services Accessible b Acknowledge problem b Conduct training needs assessment b Homophobia awareness training b Policies, procedures b Specialist worker/provision b Publicise service b Links with local LGBT orgs b Evaluate and monitor

10. Pros/Cons of separate provision b Is there a need to debate? Need both b Closet LGBs (most vulnerable) not likely to attend separate LGB therefore crucial mainstream accessible, knowledgeable b Specialist provision (could be within LGB org or alcohol treatment agency)