31 Jan, 2007
GLBT Addiction Treatment Philosophies and Recovery Issues
Posted by: jhutt In: Drug Addiction
Addiction Treatment and Drug Rehab
Addiction treatment approaches, says McCabe, can range from gay-tolerant, gay-affirmative, gay-sensitive, gay-avoidant, gay-intolerant, or even abusive. The variety of GLBT addiction treatment possibilities begs the questions: Is it possible to get adequate addiction treatment without addressing issues of sexual orientation, and can closeted individuals truly explore their drug addictions in a meaningful way? Many experts suggest that if it’s not impossible, it’s at least more challenging. Amico is convinced that issues concerning one’s sexual identity more often than not must be addressed. He notes that clients typically go to heterosexist treatment centers and programs that are well-meaning but not informed about GLBT issues. “If the programs are gay-naive and clients don’t feel comfortable or safe, they won’t talk about their real issues. They relapse until finally someone helps them figure out what the real issues are.”
Addiction treatment programs, says McCabe, may be tolerant yet not inclusive. Sexual orientation may be seen to have no relevance to addiction and thus is not discussed. “That’s almost impossible to do,” he adds, “because homosexuality integrates into all components of our lives, not just our intimate relationships.” Another addiction treatment model, he claims, may be sensitive to, but not affirming of, the role of sexuality. In this, issues of orientation are neither stressed nor repressed, but no special attention is paid to them. A truly gay-affirmative addiction treatment program, however, he explains, will have openly gay staff people, a statement in the policy or mission of sensitivity toward GLBT individuals, cultural sensitivity training for staff, and surroundings and materials that are sensitive to GLBT issues. Amico adds that staff should be trained to ask questions that are appropriate to gender and sexual orientation. The addiction treatment programs, furthermore, should offer a gay sensitivity or coming-out group that explores issues related to coming out at various stages of life. The needs, McCabe says, will be different for people in different situations, stages of life, and stages of coming out.
Some clients, says McCabe, are not going to come out, and clinicians need to respect that choice. However, he says, “they’ll need to develop coping strategies to deal with some of the related stressors of living a closeted life, such as fear of disclosure or discovery, conflict within the family or in the work site, and integrating a clean and sober social life with being closeted.”
“Addiction is addiction, and you can get addiction treatment anywhere,” says Amico. “But I train counselors that people need to be free to talk about all areas of their lives.” Agosta agrees: “If a person is in addiction treatment with a therapist, it’s completely counterproductive if they’re not able to be out to the therapist.” One’s sexual identity, she says, affects so many different areas of a person’s life and can cause a great deal of stress and pressure. “You can’t really get to the root of things unless you understand the whole picture,” says Agosta. Otherwise, she says, “it’s like putting a bandage on a huge infection.”
“I believe that people need to be in an open, honest addiction treatment setting where disclosure is neither prohibited nor required but is allowed to be the client’s choice,” says Stolz. Furthermore, he says that not everyone needs to be in a gay program. “People can get perfectly good addiction treatment in mainstream drug rehab programs if they can be open and honest, although such programs are hard to find. While not everyone needs a gay addiction treatment program, what they do need is good addiction treatment where they can be themselves.”
Being GLBT-Affirming
“A lot of social workers think that just because they feel that they don’t have any prejudices that they can be empathetic with the client,” says Agosta. Therapists who want to work with GLBT clients, she suggests, “need to broaden their own personal lives in terms of having a diverse group of friends, acquaintances, and contacts.” To be effective as a therapist, she says, you must be somewhat familiar with the GLBT subculture, which isn’t something you can get from a book or conference. Social workers, in addition to attending continuing education programs, can learn a great deal simply by going out into the community, talking, and opening themselves up to learning more about the culture. For example, says Agosta, visiting community centers or attending meetings of Parents, Families, and Friends of Lesbians and Gays is helpful.
Amico says it’s also important to indicate that your practice is gay-affirming. For example, make sure that your intake forms show that you’re open to GLBT clients. “If the only options for marital status on your forms are married, single, divorced, or widowed, the gay or lesbian person that’s in a relationship may think gay and lesbian isn’t spoken here,” he says. “They have no category to check off and do not feel included.” Similarly, says Agosta, intake forms ask if a client is male or female. “There are plenty of clients out there that do not identify as either male or female,” she says. “They’re transgendered or they’re questioning or they choose not to label themselves.” GLBT clients, she asserts, are continually facing the assumption that everyone is straight. In that atmosphere, she says, clients, especially those with a lot of internalized homophobia, won’t be forthcoming because they have too much shame.
Also, an office environment can either welcome or discourage GLBT clients. Amico shares an office with two straight therapists whose clients are largely straight. Yet, placed in the waiting room are gay newspapers and magazines that let people know it is a safe place. “An office can have artwork or symbols such as pink triangles or rainbows, for example, and it lets clients know that ‘gay is spoken here,’” says Amico. These gestures, says Agosta, such as displaying a Human Rights Campaign equality symbol, are welcome signs that let clients feel the therapist is someone they can be honest with and are important in making clients feel more comfortable about disclosing. In the absence of an accepting atmosphere, Amico says, clients will not feel safe and will not reveal. Clients who have difficulties finding a comfortable and accepting addiction treatment or therapy atmosphere, he says, can look for a gay addiction treatment program or request a gay-friendly addiction therapist from their insurance company. “Many of the major managed care companies today have counselors who will self-identity either as gay or lesbian or at least indicate that they specialize in dealing with GLBT clients,” says Amico.
On one point the experts agree. If you have any doubt about your ability to work effectively with the GLBT client in addiction and recovery work, it’s crucial to refer the client to someone more accepting or experienced. “One of the underlying factors of being a social worker is understanding the therapeutic use of self,” says Stolz. “If you know that you’re not very good with this population, then you either need to work on that or not work with the population. If the therapists sense that their beliefs could get in the way, that they’re not adequately trained, or that they’re in any way conflicted with respect to GLBT issues, it would be damaging if they didn’t refer the client to more receptive or knowledgeable professionals.”
To locate a gay friendly addiction treatment program you can call the national addiction treatment helpline at 1-800-99-DETOX or click on www.recoveryconnection.org.
