In “Fundamentals of LGBT Substance Use Disorders,” the new book released by Columbia University Press-distributed LGBTQ publisher Harrington Park Press, Philadelphia clinician Michael Shelton sums up what is known about the prevalence of LGBTQ substance abuse and treatment, and emphasises the importance of affirmative therapy practices—counselling that supports and embraces client sexual identity.
The book looks at not only how lesbians, gay men, bisexuals, and transgender individuals differ in their susceptibility to substance abuse, but stresses that treatment programs must consider many additional factors, including race, ethnicity, age, family relations, and place of residence in order to succeed.
Michael Shelton’s “Fundamentals of LGBT Substance Use Disorders,” continues the work began by Dana G. Finnegan and Emily B. McNally, the married lesbian professional counselling couple widely considered two unsung pioneering heroes of LGBTQ substance abuse research and counselling.
The book is the first new comprehensive resource for LGBTQ substance abuse counsellors to be released since a free government-funded guide was released by SAMHSA (Substance Abuse and Mental Health Services Administration) fifteen years ago, in 2001.
While there have been significant LGBTQ cultural victories since the study of LGBTQ substance use began, there remains a dearth of counsellors specifically trained in LGBTQ issues.
“Fundamentals of LGBTQ Substance Use Disorders” is at once an introduction, textbook, and handbook for LGBTQ-focused and general substance-use disorder counsellors, offering optimum care guidelines, current terminology and sobering facts about substance abuse—most strikingly regarding those who identify as bisexual. The following are a few key terms and factoids from the book.
What to Look for in Effective LGBTQ Substance Abuse Treatment
LGBTQ people face barriers to entering treatment and challenges while in a treatment setting—ranging from prejudicial and discriminatory treatment from staff and peers to “therapeutic neutrality” (being prescribed the same treatment regardless of gender or sexual identity). Below is a short list of key requirements LGBTQ people should look for when seeking effective substance abuse treatment.
- LGBTQ-specific programs are available.
- Treatment embraces “affirmative therapy” (see below)
- Facility operates as a safe place for LGBTQ patients. Just one bad experience with a staff member or even a random person working in the same building is enough to destroy a clinic’s effectiveness and reputation in the LGBTQ community.
- LGBT employees on staff: A clinic or program with no LGBTQ employees is a red flag and does not bode well for LGBTQ patient success.
What are “Affirmative Therapy,” “Trauma Informed Care,” and “Cultural Competency”? Three Terms You Need to Know When Seeking LGBTQ Counselling
- “Affirmative Therapy” recognises, embraces and supports an individual’s self-identity, and operates on the tenet that sexual orientation is not the problem for an LGBTQ person but societal heterosexism is. (Hello!)
- “Trauma Informed Care” takes into account the distress and suffering that may have led to substance abuse and the need to seek treatment.
- “Cultural Competency” entails an understanding and respect for LGBTQ cultural differences and experiences by providing an inclusive, safe environment that cannot exist in a program that claims therapeutic neutrality (treating LGBTQ patients and non-LGBTQ patients the same).
It’s Not Me, It’s You. Heterosexism and 7 other Terms You May Have Experienced, but Not Known Are a Thing
- Minority Stress: Stress caused by just being a member of a minority, mostly due to everything on this list.
- Microaggressions: Brief and commonplace verbal and behavioural indignities made towards LGBTQ people, which are considered more damaging than overt expressions of bigotry precisely because they are small, and therefore often ignored or downplayed, leading the victim to feel self-doubt rather than justifiably angry, and isolated rather than supported. In three bitter flavours: microassuaults (verbal attacks or avoidant behaviour: slurs, bullying, hate speech), microinsults(rudeness and insensitivity that demeans a person’s heritage or identity: “forgetting” to use trans person’s preferred name or gender pronoun or name), microinvalidations (interactions that exclude, negate, or nullify a person’s thoughts or feelings: straight folks stating or implying that minority stress does not exist. “We are all human beings.”)
- Social Stigma: Extreme disapproval of a person or group based on stereotypes to segregate them from society. Think HB2, Ted Cruz, One Million Moms, Trump.
- Stigma Consciousness: The chronic expectation to be stereotyped by others.
- Stereotype Threat: The fear of being seen through the lens of a negative stereotype or of doing something that would inadvertently confirm that stereotype. The MTV short film “America Male” is good, though exaggerated example.
- Heteronormativity: The belief that hetero is not only bettero, but is the only normal sexual orientation.
- Heterosexism: The enforcement of heteronormativity. Works just like the other negative isms – racism, sexism – the expression of heteronormativity through discrimination.
- Implicit Bias: Even if you feel you are not biased, you are. Assuming the Latina is a maid, the black man in the hoodie is a thug, or all gay men are diseased. Think you’re not biased? Take this test.
Five Not-So-Fun Facts about LGBTQ Substance Abuse
- Bisexuals make up the largest single population in the LGBTQ community, are the most troubled and most susceptible to substance abuse issues, yet they remain the least researched and understood. The odds of substance use for bisexual youth were 340% higher than for heterosexual youth.
- Two-thirds of LGBTQ people experience at least one of three forms of discrimination (sexual orientation, gender, and race). Substance abuse is four times greater among those who experience all three types of discrimination, than those who experience none.
- LGBTQ men and women demonstrate a smaller decline (or none at all) in substance use as they age, in contrast to heterosexuals, who typically reduce or end their substance use as they get older.
- Baby boomers represent the fastest growing group in need of substance abuse care.
- Most gay men and lesbian women do not have a substance use issue, although their risk is elevated in comparison to that of heterosexuals. •