In the last few decades, American culture has an increase awareness of the sexual minority community. The civil-rights battle for marriage equality has been in the public radar in recent years. Many GLBT individuals are moving ‘out of the closet’. The visibility of the sexual minority is rapidly increasing. Most people have known someone who self indentifies as GLBT. Both the layperson and the professional often misunderstand or stereotype the GLBT community:
This community is more of an identity-based political construction and may be said to comprise all nonexclusively heterosexual people (Hawley & Mostade, 1998) and gender nonconformists. This is an enormously rich, complex, and varied community of diverse culture, ethnicity, gender, sex, age, ability, religion, class and national origin not easily reduced to brief generalizations and therapeutic heuristics (Mostade, 2006).
Researchers are becoming more aware of the GLBT related stress. Symptoms of these stressors are “victimization, ridicule, external and internalized homophobia” (Rosario et al., 2008, p. 1003). Being a member of an “often despised minority” can be a stessor (Eliason & Hughes, 2004, p. 627). The family disapproval or the “loss of family of origin” is also common (Eliason & Hughes, 2004, p. 627). The years when an individual begin to ‘come out’ publically about their sexual identity, typically in their late teens or early twenties, can be highly stressful (Parks & Hughes, 2008).
Researchers have theorized a link between ‘coming-out’ related stressors to increase of substance misuse (Marshal et al., 2008; Rosario et al., 2008; Parks & Hughes, 2007; Logan, 2006; Hutchins, 2006). Logan (2006) draws a connection between lesbian substance abuse and homoprejudice in society. Yet Chemical Dependency Professionals are unaware of specific needs and culture of the GLBT community (Eliason & Hughes, 2004; Matthews et al., 2006). Additional research is needed to further comprehend the GLBT individual in recovery from substance abuse.
My research question has several parts. First, does the GLBT community have higher rates for chemical misuse than heterosexuals? If so, why? Is Human Service professionals, chemical dependency professionals and mental health counselors able to address the unique needs of the GLBT client?
Terms Defined
It is important to note various terms used in the paper. GLBT stands for gay, lesbian, bisexual and transgender; at times a Q (for Queer) may be added. Same-sex attracted and same-sex experience may be used when the individual does not self identify as GLBT. Butch is a woman “who is perceived to have, behaviors, appearance, or other characteristics considered masculine by sociality” (Rosario et al., 2008, p. 1013). Femme women “identifies as having, or who is perceived to have, behavior, appearance or other characteristics considered feminine by society” (Rosario et al., 2008, p. 1013). Transgender is a blanket “term used to describe people whose appearance or behavior does not conform to the cultural norm for their presumed sex/gender; it also includes intersexual people and cross-dressers” (Mostade, 2006, p. 303).
The terms substance use/misuse and substance dependency/addiction are two separate terms. I will not use them interchangeably in this paper. An individual can use substances without being addicted to them. The diagnostic criteria from the DSM-IV-TR (2000, pp 114-115) recognizes substance abuse
“as chemical usage less than a year with recurrent substance use resulting in a failure to fulfill major role obligations; physical hazardous; and continued substance use despite having persistent of recurrent social or interpersonal problems caused or exacerbated by the effect of the substances. [Or] symptoms have never met the criteria for Substance Dependence
Substance Dependency is classically defined as an individual with tolerance, unsuccessful attempts to decrease usage, and withdrawal (DSM-IV-TR, 2000). It should also be noted that the loss of activities due to the substance use and significant preoccupation with the substance is other diagnostic criteria for chemical dependency (DSM-IV-TR, 2000).
Substance Use Trends in GLBT Communities
Lesbians and gays portray unique consequences of use and patterns of overall chemical use, Matthews et al. (2006) summarizes (McKirnan & Peterson, 1989; Skinner & Otis, 1996). Compared to the general population, gays and lesbians are less likely to “abstain from alcohol use” (Matthews et al., 2006, p. 111). Lesbians are more likely develop “problems related to drinking” then their heterosexual counterparts (Matthews et al., 2006, p. 112). Surprising, both heterosexual and gay males share the same risk to develop “problems related to drinking” (Matthews et al., 2006, p. 112).
Rosario et al. (2008) found rats of substance abuse were higher in butch identified lesbians than their femme counterparts. Marijuana and tobacco abuse, large quantities of alcohol use is reported by Rosario et al (2008) to be higher. Substance use has been largely associated with more “masculine behaviors” by society (Rosario et al., 2008, p. 1003). Butch identified women may face higher rates of “gay-related stressors” (Rosario et al., 2008, p. 1003). “Gay related stressors” can be public ridicule, victimization, and homophobia.
The gay bar has played an historical role in the GLBT communities. The gay bar has been the cornerstone of gay culture and activism for decades (Hutchins, 2006; Logan, 2006; Matthews et al., 2006). Men could safely socialize without fear of judgment or punishment. In some communities across the nation the gay bar is the only public GLBT safe. Some urban, younger gay men are active in the “circuit party” scene. “Circuit parties” is dance parties where gay man drink heavy and when crystal meth use is “a significant part of life” (Hutchins, 2006, p. 271). The likelihood of at-risk sexual behavior at “circuit parties” is well established (Hutchins, 2006). Hutchins (2006), p. 271 recognizes that substance use can increase feelings of “isolation, depression and alienation.”
GLBT Youth
GLB ‘at-risk’ youth are “on average, 190% higher than heterosexual youth” to use mind altering substances, according to a meta-analysis study conducted by Marshal et al. (2008, p. 546). This study also found that bisexual adolescents were 340% more likely than heterosexual youth abuse substances (Marshal et al., 2008, p. 546). Women in this study where 400% more likely to use mind altering substances (Marshal et al., 2008, p. 546).
Lesbian, bisexual, same-sex attracted and same-sex experience young women have higher rates of tobacco, marijuana, and alcohol miss-use than young, heterosexual females (Rosario et al, 2008). Rosario et al. (2008, p. 1002) found “even after controlling for age, sexual identity, and social desirability, young butch women reported using marijuana more frequently than young femme women.” The research findings conclude that “gender atypicality as a potential risk factor for substance use” (Rosario et al., 2008, p. 1011).
‘Coming-out’ Process and Identity Development Stages
Various studies conclude that substance use in GLBT youth and adults is a coping mechanism for the ‘coming-out’ process (Eliason & Hughes, 2004; Matthews et al., 2006; Parks & Hughes; 2007). The ‘coming-out’ process is self-realization stages which someone internalizes sexual orientation and communication publically to various degrees about their sexual minority status. Each ‘coming-out’ experience is unique to the individual. “Modest yet robust association with alcohol consumption-related problems” were linked to sexual identity disclosure (both in level and age of disclosure) in Chicago-area lesbians (Eliason & Hughes, 2007, p. 375). Younger women in early stages of ‘coming-out’ show to be at higher risk for “negative alcohol use outcomes” (Eliason & Hughes, 2007, p. 375).
Hutchins (2006) recognizes six developmental stages of ‘coming-out’ process for gay or bisexual men. It is important to note that an individual may forever remain on one developmental stage for his life, or may process through all of the stages. The first developmental stage is identity confusion (Hutchins, 2006, p. 273): “the individual may focus on sexual behavior and not make a distinction between sexual behavior and sexual orientation.” The lower stages are marked with shame and guilt toward their sexual orientation. This person will disassociate his homosexual attraction, and sexual behavior. The next stage from identity confusion is identity comparison (Hutchins, 2006, p. 276). At this stage, the man begins to explore that he is in fact gay or bisexual. It is typical that he may fear “social alienation” from his society, peers, and family (Hutchins, 2006, p. 276). Identity comparison individual may still try to “pass as straight” male; social anxiety is high (Hutchins, 2006, p. 276. Hutchins (2006) warms the risk of substance abuse is high during this developmental stage.
The third development stage is identity tolerance (Hutchins, 2006). This individual may begin to social within the GLBT community and general movement away from social isolation of the previous stages. If the contact with the GLBT community is positive or negative, according to Hutchins (2006, p. 278), it increases or decreases a “positive sense of self.” It is extremely important for the individual to be social connected to others to progress further to the next stages of his identity development. Geographic isolation from a strong GLBT or gay-positive community can negative impact on development stages
The fourth stage of identity development is acceptance (Hutchins, 2006, p. 281). A man on this stage will no longer just tolerate his sexual orientation but accepts it. Acceptant individual may have more contact within the GLBT community. Hutchins (2006, p. 281) surprisingly states that urban communities as a whole are moving toward gay acceptance. Identity acceptance may move into identity pride.
Identity pride development stage “occurs when accepting the philosophy of full legitimatization, the person become immersed in the gay subculture and has less and less to do with heterosexual others” (Hutchins, 2006, p. 283). The abandonment of hiding his homosexuality from the greater community is a common in this development stage. A “we/they framework” may develop in response to homophobic events. The final identity stage is identity synthesis (Hutchins, 2006). This stage is seen to marked by awareness of the trap of the “we/they framework”; and a decrease intensity of anger directed to the heterosexual community.
The development stages of identity are not universally accepted (Logan, 2006). Logan (2006, p. 293) cites McCarn and Fassinger (1996) research, which finds that identity development model, ignores “multiple oppressive environments” and “effects of minority statuses”. An identity development may look different for women than a man. Lesbians may be more fluid sexual identity than a gay male. The large amounts of cultural, ethnic and socio-economic diversity within the GLBT community must warrant against too generalize assumptions on identity development (Logan, 2006).
Not all researchers however agree with the connection between identity development, “coming-out” or minority stress model (“Coming-out process”, 2005). A study on 156 New York City youths involved in GLBT campus activities report that “GLB teens rely on alcohol and marijuana to ameliorate social anxiety and boost self-confidence when they first begin to participate in gay-related social and recreational activities” (“Coming-out process”, 2005). The rate of substances use drops with the youth further ongoing involvement in GLBT friendly activities (“Coming-out process”, 2005). Substance abuse rates among gay and heterosexual men are however comparable (Rosario et al., 2008). Ten GLB individuals with long-term recovery from active dependency, reported that they did not view their sexuality as the reason why they were alcoholics or addicts (Matthews et al., 2006). “Being gay or lesbian influenced how they experienced their addiction and their recovery” (Matthews et al., 2006, p. 123).
GLBT Treatment Experiences
American Psychiatric Association removed homosexuality as a deviance behavior since 1972 (Logan, 2006). Yet various researchers agree that current helping professionals are not aware of the specific needs, identity development or culture of the GLBT individual (Eliason & Hughes, 2004; Hutchins, 2006; Logan, 2006; Marshal et al., 2008; Matthews et al., 2006; Mostade, 2006; Rosario et al., 2008). GLBT individuals enter counseling at a “rate two to four times higher than their heterosexual counterparts” Logan (2006, p. 291) quotes Elliott (1993). Mental health provides are often ignorant on external/internal homophobia, family origin issues. (Eliason & Hughes, 2004; Hutchins, 2006; Logan, 2006; Marshal et al., 2008; Matthews et al., 2006; Mostade, 2006; Rosario et al., 2008).
Eliason and Hughes (2004) shockingly found that increase of GLBT experience training, experiences and contacts does not increase the likelihood of GLBT friendly therapeutic environment within the chemical dependency field. The study examined urban (Chicago) and rural (Iowa) treatment centers, and found the rates of homophobic attitudes of the chemical dependency professional were the same between both groups. Even when the urban area professionals had more personal contact and experience working with GLBT clients, and educational training, the urban professionals had high evidence of internal homophobia opinions.
In a small survey-based study on GLB individuals in long-term recovery conducted by Matthews et al. (2006) found that their chemical dependency professionals often ignored issues and lack general cultural awareness of the GLB culture. Partners and ‘family-of-choice’ of GLB patients was often left out from family day events (Matthews et al., 2006). Several interviewees stated the importance of gay-friend twelve-step meetings to their recovery (Matthews, et al., 2006). Many individuals felt like their counselors often did not engage in topics around their sexuality (Matthews, et al., 2006).
Direct Service Recommendations
All reviewed literature provided specific service direct-service recommendations for the chemical dependent GLBT community. Development of substance use prevention material targeted butch-identified women youth (Matthews et al., 2006; Rosario, 2008). Professionals need to be able to provide referrals to local GLBT community programs or agencies (Eliason & Hughes, 2004; Hutchins, 2006; Logan, 2006; Matthews et al., 2006; Roasrio et al., 2008). Increase cultural awareness on the GLBT community was universal recommendation from all reviewed literature.
Increasing the required education level standards of chemical dependency professionals was also an interesting recommendation from Matthews et al (2006). Matthews et al. (2006) and Eliason & Hughes (2004) advise mental health provides to explore their own possible internal homophobias biases. “Be aware of your own attitudes and behaviors with respect to both addiction and sexual orientation” (Matthews et al., 2006, p. 128). The hiring of out chemical dependency professionals was common suggestion from Eliason & Hughes (2004) paper. Professionals should also be aware of current political and legal issues affecting clients.
Conclusion
The literature review provided to be interesting. The rates of substance abuse is higher in lesbian and bisexual women than heterosexual women (Rosario, 2008; Marshal et al., 2008). Rates of substance abuse is equal in both heterosexual and homosexual men (Rosario, 2008). Majority of literature conclude that minority-stress and the identity development is the causes for increase likely of substance use and dependency. If this minority theory is true, wouldn’t GB men have increase rates of substance use? Nonetheless, further research on minority stress model must be completed. It is apparent the limited amount of research on sexual minority experiences in mental health services and chemical dependence treatment. Studies on the transgender population and substance use/abuse seems are almost nonexistent.
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