1. Effects on Services: Alcohol Treatment Services Please make a note if you think any of the points raised are relevant to your service

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 2002 Alcohol Concern : only 7% of users of 450 alcohol treatment agencies in UK LGB b Alcohol Concern, 2013: no publications and nothing on website about LGBTs and alcohol misuse despite research which identifies it as a problem: gone backwards!

8. Feedback b Were any points relevant to your service? b Write on flip chart b Who will take responsibility for feeding back to your management? (both good and bad)

9. Preventing suicide in England 2012 b LGBTs one of groups identified for whom a tailored approach to their mental health is necessary if suicide risk is to be reduced b Staff in health and care services, education and voluntary sector need to be aware of higher rates of mental distress, substance misuse, suicidal behaviour and ideation and self harm amongst LGBTs

10. NHS Training video b What do you want from the NHS?