Center of Excellence
for Lesbian, Gay, Bisexual and Transgendered Persons Substance Abuse
Treatment Provider Survey Results
Nearly 250 substance abuse counselors from Iowa completed a survey
of attitudes and knowledge regarding LGBT clients. The counselors
were predominately white (93%), well-educated (over 30% had some
graduate education or master's degree), and heterosexual (93%).
They ranged in age from 19 to 62. About 90% lived in rural areas
of Iowa. Half of the sample reported they had no education about
lesbian, gay, and bisexual people in their training, and 80% had
no education regarding transgendered clients.
Most
of the counselors in the study had worked with lesbian, gay or bisexual
clients in the past year (over 50%), although few has worked with
transgendered person (only 20%). However, the majority reported
that they lacked information about many of the important issues
that affect their LGBT clients. For example, the following percent
of the counselors reported that they had little or no knowledge
regarding:
1.
Legal issues of LGBT people (73%)
2.
Domestic partnership (69%)
3.
Family Issues (54%)
4.
Internalized homophobia (48%)
5.
Coping strategies of LGBT people (37%)
Many
were unaware of the issues of transgendered clients. Only 20% had
ever worked with a transgendered client and 70% said that they were
unfamiliar with the issues that a transgendered client might have.
Many
counselors in this study said that they needed training in these
areas to be more effective with all clients. It is vital for relapse
prevention and for aftercare planing to be aware of the potential
stresses in the client's life related to their sexual or gender
identity with the issues that a transgendered client might have.
Many
counselors in this study said that they needed training in these
areas to be more effective with all clients. It is vital for relapse
prevention and for aftercare planning to be aware of the potential
stresses in the client's life related to their sexual or gender
identity.
Attitudes
of Substance Abuse Counselors
Attitudes
of counselors can have a profound influence on their clients. Counselors
in this study were mixed in their attitudes toward LGBT people.
About one-fourth of the sample had positive attitudes about LGBT
people as a group, and about one-quarter had decidedly negative
attitudes. The remaining 5% had ambivalent attitudes.
However,
there was a difference in attitudes about lesbian, gay, bisexual
and transgendered clients, with the largest percent negative attitudes
aimed at transgendered clients.
The
following percent of the sample had negative attitudes:
1.
Lesbians (19%)
2.
Gay Men (24%)
3.
Bisexuals (24%)
4.
Transgendered people (34%)
Religious
beliefs were a strong predictor of negative attitudes, with those
believing that all people are to be accepting of other's sexuality
having the most positive attitudes.
Comments
From Substance Abuse Counselor
The
last item in the survey asked counselors to suggest ways that LGBT
people might differ in treatment from heterosexual clients. Some
of the responses are included below:
If
they aren't honest about themselves they cannot concentrate in
treatment because they are busy covering up their tracks so no
one will think they are homosexual.
The
sexuality should be kept to the mental health counselor.
When
identified as LGBT that may be the focus of the other group members
this can cause less positive outcomes for all.
Human
beings are human beings. You treat the whole person and there
should be no problem.
All
LGBT patients we have had have been abuse victims so multiple
issues to deal with.
Alcohol
and drugs appear to go with the homosexual experience.
Gays
and lesbians may believe that they have to have their social outlet
in bars.
Pride
issues can cloud honesty about what needs to be dealt with in
treatment. It's sort of a false pride to hide the pain phenomenon.
I
disapprove of their lifestyle but I treat them with dignity.
Since
it is generally politically correct to unconditionally accept
the client's sexual choice...we ignore or overlook emotional issues
that may be contributing to the client's substance abuse. The
shame, guilt, inability to cope with society, and not being able
to reconcile with God, not having repented the sin.
Treatment
is usually a microcosm of the society. They feel or hide the shame
and disapproval. In treatment, though, one is so vulnerable that
disapproval by the group can interfere or prevent recovery on
that environment. It is imperative that counselors grasp that.
They
don't want to look at their gender preference as a result of a
gene imbalance.
Spending
a lot of time as a self-enlisted spokesperson for the LGBT population.
This immediately alienates all involved.
Implications
for Treatment
Several
dilemmas are faced by LGBT clients: if they come out they face possible
rejection and alienation. If they do not come out, they are labeled
as untruthful. If they point out their differences from heterosexual
clients, they are asking for special privileges or jeopardizing
other client's recovery, but if they accept generic treatment, their
own recovery is jeopardized. Finally, they are likely to encounter
a few staff and clients who will impose their own religious beliefs
on them. These beliefs are often taken from biblical passages that
many bible scholars believe have been misinterpreted, or that are
taken out of the historical and social context in which they were
written. The U.S. was built upon a foundation of division of church
and state and clients in substance abuse treatment have the right
to treatment free of imposition of staff or peer's religious beliefs.
LGBT
people also deserve equal access to treatment, which does not mean
equal treatment. Not all clients benefit from exactly the same treatment
programs and goal. Attention to individual issues is key for our
diverse client populations. Some LGBT people need programs that
deal with issues related to their sexuality, such as dealing with
feelings of guilt. However, many LGBT people have already dealt
with those issues and their substance abuse stems from other types
of problems, such as childhood sexual abuse experiences. Pay attention
to the individual and do not base treatment on stereotypes about
a group.
The
positive finding was that 25-50% of substance abuse counselors had
clearly positive attitudes about LGBT clients. The counselors with
ambivalent attitudes may just lack information or experience with
LGBT clients. However, the counselors with negative attitudes may
adversely affect the recovery of many clients. Please take advantage
of continuing education and workshop opportunities to learn more
about LGBT clients.
