1. Gay Lesbian Bisexual & Transgender
Issues for
Substance Abuse
Treatment

2. Agenda Review Objectives Introductions Review of terms Homophobia
Myths/Facts
Alcohol & Substance Abuse
“Coming Out Process
What we CAN do!
Wrap-up: Take aways, evaluations, certificates
Created by Amy Shanahan, MS CASAC

3. Objectives
Sensitize participants to the biases that interfere with the treatment process
Offer tools/interventions for working with gay, lesbian, bisexual and transgender people in treatment
Raise awareness of personal biases
Created by Amy Shanahan, MS CASAC

4. Introduction Name Identify yourself as being gay, lesbian.
Why did you choose this training?
What do you hope to get out of the training?
Make list of expectations.
Created by Amy Shanahan, MS CASAC

5. Terminology
Sexual orientation – includes sexual attraction; sexual behavior; sexual fantasies; emotional, social and lifestyle preferences; and self-identification
Heterosexual – “straight”, sexual and romantic feelings that are mostly for the opposite gender
Homosexual – “gay” sexual and romantic feelings that are mostly for the same gender
Lesbian – A woman who is homosexual.
These terms have different meanings in different cultures.
NOTE: being “MOSTLY” attractive. Sexual orientation, in my opinion, falls on a continuum. On one end is exclusively heterosexual; the other end exclusively heterosexual. Many fall between, i.e. a gay man may find a woman attractive.
Created by Amy Shanahan, MS CASAC

6. Terminology
Bisexual – “bi”, sexual and romantic feelings are for both genders.
Transgender – umbrella term including drag queens and kings, bi-genders, cross dressers, transgenderists and transsexuals.
Transvestites – people who like to dress like members of the opposite sex.
Transsexuals – people who feel that their anatomical sex does not match the gender with which they identify.

7. Terminology
Bi-gender – people who define themselves as having the behavioral, cultural or psychological characteristics associated with both the male and female genders
Transgenderist – someone who is gender variant or transgresses gender norms as part of their lifestyle or identity.
Heterosexism – a prejudice denying, ignoring, denigrating or stigmatizing any form of homosexual expression.
Homophobia – fear or loathing of gay men and lesbians. (Antigay bias is another phrase meaning the same).

8. Homophobia Acculturated Internalized Socialization Family Schools
Religious institutions
Youth groups
Television portrayal
Internalized
Accepting acculturated messages
Believing these messages to be true
Internalizing them
Acculturated - Outliers are newsworthy.
Homophobia, judgments, and prejudice
The counselor must be able to recognize and be able to process counter-transference issues related to counselor homophobia, judgments, and prejudices.
Process the client’s possible internalized homophobia.
Look for common denominators as well as differences as an aid to limit over-generalizing about gays and lesbians (both within their own sub-culture and as part of the “general population”), but recognize that there are distinct differences that influence their alcoholism.
Process the client’s experience with homophobia, judgments, prejudice that may have left wounds that have not healed.
Created by Amy Shanahan, MS CASAC

9. Write down the first things that come to mind.
Find a partner.
Take a few minutes to discuss things that come to mind when you think of gay, lesbian, bisexual or transgender.
Write down the first things that come to mind.
After a few minutes, ask participants to share some of the word or phrases and write them on newsprint. Move to the next slide to discuss some myths.
Created by Amy Shanahan, MS CASAC

10. Myths Feminine vs. Masculine Acting out husband and wife roles
GLBT are bad influence on children.
GLBT shouldn’t be parents.
GLBT don’t want long-term relationships.
There are some truths to stereotypes. Children that are molested are 100 times more likely to be molested by straight men (Jefferson report). Mainstream majority refuse to allow sanctioning of commitment but 40-6-% men are in steady relationships; 45-80% women are in committed relationships. Studies suggest that the only difference with glbt parents is that they spend greater effort to provide opposite sex role models. (Many gay parents CHOOSE to be so).
Created by Amy Shanahan, MS CASAC

11. Facts 3-11% of the total population is homosexual
Gay people come out at various points in life.
80% of GLBT have experienced verbal bashing, 40% have been threatened with violence and 17% have been attacked.
% take into account that many homosexuals won’t participate in offering their status.
Unlike other minority groups, glbt parents do not share in their minority status…glbt rarely able to turn to family for support (and often make their own family within the community).
There are no laws outlawing prejudice against glbt in employment, housing, etc.
Created by Amy Shanahan, MS CASAC

12. Alcohol & Substance Abuse
30 % GLBT abuse drugs and alcohol.
Discrimination, homophobia & violence contribute to substance use & abuse.
Bars – are safe places to socialize.
Social attitudes contribute to lower self esteem, increased anxiety, depression and isolation.
Studies are considered to be flawed due to the number of participants found mainly in bars.
Clinicians should be aware that there may be two set of trauma for a glbt client: the typical stigma that comes with addiction plus the trauma that occurs in family, community and in religious institutions. There is minimal legal protection for housing, employment, and custody concerns.
Created by Amy Shanahan, MS CASAC

13. “Coming Out” Process This process is unique for each person.
Several stages have been identified by Cass (1979).
Providers should consider which stage the client is in when developing treatment plans.
Process may be white, Western, middle class biased.
Other cultures may not experience the same process. Some cultures view coming out as selling out (to the values of that culture) and may lead to an additional level of shame.
Some may not experience such a process and others who never intend on acknowledging homosexual thoughts/behaviors.
Stages: identity confusion, comparison, tolerance, acceptance, pride and identity synthesis.
It is important to recognize a client’s comfort level with his or her feelings about his or her sexual identity and treat the client accordingly. (Use example of recommending a glbt group to a client…she was “out” to some and seemed comfortable, but did not want to be identified with the larger group due to not being out in her religious circles.)
Process the client’s self-identity as a man/woman and their associated feelings of maleness/femaleness respectively.
Explore the client’s tendency toward androgyny and un-differentiation.
Explore the client’s feelings about his/her own sex-role behavior and develop awareness of the constricting sex-role stereotypes.
Created by Amy Shanahan, MS CASAC

14. Stages of “Coming Out” Process
Identity Confusion – recognized thought/behaviors as homosexual and usually finds this unacceptable.
Identity Comparison – feels positive about being different, accepts behavior but rejects identity.
Identity Tolerance – seeks out meeting other GLBT through groups, bars, etc. Building sense of community (positive and negative).
Identity Confusion –
Identity comparison
Identity Tolerance –
Created by Amy Shanahan, MS CASAC

15. Stages of “Coming Out” Process
Identity Acceptance – increased anger toward anti-gay society, greater self-acceptance.
Identity Pride – immersed in GLBT subculture, less interaction with heterosexuals. Views world as divided as “gay” or “not gay.”
Identity Synthesis – recognizes supportive heterosexual others. Sexual identity is still important but not a primary factor.
Identity Acceptance –
Identity Pride –
Identity Synthesis –
Exercise – Find someone you don’t know. One clinician, one client. (The client will be role playing a specific stage.) Take 10 min. to begin a clinical discussion. Clinician to see if you can i.d. what stage and act accordingly.
After 10 min. Client to take 3 min. to describe what the experience was like. Switch and clinician respond and share what it was like.
LEADER debrief with whole group: 1. What did you like about what happened? 2. What didn’t you like about what happened? 3. What would you have done differently? 4. What would you do more of?
Created by Amy Shanahan, MS CASAC

16. Treatment Consideration
GLBT struggle with self acceptance (internalized homophobia).
GLBT live in genuine fear.
GLBT sometimes “identify with the aggressor” and cast out fringes within their own sub group.
GLBT are continually bombarded with negative messages and socially accepted violence. Lack of self acceptance must be fully understood to provide good treatment. GLBT deny differences because they want to be seen like everyone else.
Created by Amy Shanahan, MS CASAC

17. Treatment Issues
GLBT may not attend gay support groups due to repeated victimization.
Because of the small community, clients in treatment may know each other.
Grief and loss issues.
Bisexuals are often pressured to “choose”.
Know resources and make appropriate referrals and recommendations.
Develop real and effective social power.
Develop effective support systems.
Created by Amy Shanahan, MS CASAC

18. What Organizations can Do!
Communicate to all employees that no forms of discrimination will be tolerated.
Make GLBT employees visible in newsletter and communications.
Encourage formulation of GLBT support groups.
Educate employees to refrain from making homophobic jokes and statements.

19. What Organizations can Do!
Reward employees who support an all-inclusive workplace.
Inquire about partners of GLBT co-workers.
Encourage employees to bring harassment complaints to the attention of management.
Do not assume all employees (or customers) are heterosexual.
Select openly GLBT employees to represent the organization at events.

20. What we CAN do! Get informed!
Own up to and identify your own biases and prejudices.
Recognize that being GLBT does not constitute being competent in dealing with the issues.
Understand, if you don’t identify as GLBT, that you can’t really fully understand what it is like.
If you can’t get past the biases, ask not to work with this population. GLBT counselors need to also identify their own defenses. (Nystorm, 1997, reported that 46% of lesbians and gay men in treatment had homophobic therapists, 34% felt that their sexuality was seen as irrelevant, and 7% had therapists who made openly negative comments.
Keep in mind that glbt “come out” in different ways and at different times. Individualized treatment is a must!
Created by Amy Shanahan, MS CASAC

21. What we CAN do! Deal with feeling inadequate.
Role model accepting behaviors for all clients at all times.
Have zero tolerance for prejudice at all times.
Offer GLBT groups.
Just as women cannot fully understand what it is like to be a man (vice/versa). Discuss in supervision. Educate your clients; tolerance and openness is good for all types of prejudices. When you don’t understand, ask.
Created by Amy Shanahan, MS CASAC

22. What we CAN do!
Don’t tell gay jokes and let others know you are offended when they do.
Fully teach GLBT about internalized homophobia.
Don’t push the “coming out” process.
Involve partners (and made families) to treatment.
Understand that sexuality is about feeling physically, spiritually, emotionally, and sexually committed. Process the client’s self-identity as gay/lesbian
Help client develop social skills related to courtship and explore the possibility of “dating anxiety”.
Help client develop relationships and communication skills relevant to committed relationships.
Created by Amy Shanahan, MS CASAC

23. What we CAN do!
Be aware that sex, drugs and alcohol help deal with shame.
Affirm homosexuality as a healthy lifestyle.
Address transgender individuals as they request.
Offer resources.
If a Male to Female transgender may want to be referred by a female name and as “her”.
Created by Amy Shanahan, MS CASAC

24. Final Thoughts . . . Take Aways…Key Learnings Final thoughts
Evaluations
Certificates
Handouts
Make a list of things you will do in the next 6 months re: glbt population.
“I will…”
Examples: I will read, visit web site, have glbt friendly material, train others, not tolerate anti-gay bashing, not work with glbt’s, etc.
Sign your agreement.
Created by Amy Shanahan, MS CASAC

25. “Oh the comfort, the inexpressible comfort, of feeling safe with a person; having neither to weigh thought nor measure words, but to pour them all out just as they are, chaff and grain together, knowing that a faithful hand will take and sift them, keep what is worth keeping, and then, with the breath of kindness, blow the rest away.”
-George Eliot

26. (DHHS Publication No. (SMA) 01-3498)
Resources
A Provider’s Introduction to Substance Abuse Treatment for Lesbian, Gay, Bisexual, and Transgender Individuals
(DHHS Publication No. (SMA) )

27. Websites www.metrokc.gov/health/glbt www.gayhealth.com