SAN FRANCISCO – To help sexual minorities with addiction, physicians need to consider factors ranging from details in their waiting rooms to the attitudes of their patients and themselves.
Not all treatment providers are comfortable with patients' sexual diversity (see box). Physicians who are uncomfortable treating GLBT patients and other sexual minorities either can obtain education and experience to desensitize themselves, overcome prejudices and become more accepting, or they can refer these patients to other providers who might better meet the patients' needs, Dr. Penelope P. Ziegler suggested.
Those who are comfortable treating sexual minorities still have extra work to do. They can ensure their offices or treatment programs let patients know it's “okay” to be a sexual minority by including art work or literature relevant to sexual minority cultures and by designing intake forms so that same-sex relationships or diverse sexual identities can be reported.
When treating sexual minorities, it's essential to know the developmental stages of “coming out,” said Dr. Ziegler, medical director of Virginia Health Practitioners Intervention Program, Richmond.
Patients can start addiction treatment at any of the six stages of self-discovery of sexual orientation. The stages start with an individual's confusion about sexual identity to comparison (accepting the possibility of being gay, lesbian, and so on), followed by tolerance of a sexual identity, then acceptance, pride, and finally synthesis of the identity into the patient's life.
Similarly, there's a continuum of sensitivity to sexual minorities in addiction treatment programs, she added. Some are actively antigay, especially some faith-based programs, whereas others are traditional heterosexist programs. Then there are the GLBT-naive programs that assume everyone there is heterosexual, which sends a message that no one should be queer. Better programs are tolerant, and then sensitive, and finally affirming of GLBT patients, Dr. Ziegler said.
“Everyone in the addiction field needs to have some training to overcome heterosexism, shock, and revulsion toward sexual minorities,” she believes. It's important to reinforce boundaries for practitioners and patients so that value judgments aren't verbalized and attempts to direct behavioral changes are based on patient need, not the practitioner's values.
Residential treatment programs should examine any heterosexist rules dealing with roommates and address any homophobia being acted out in the community, she suggested. In group therapy, the treatment leader should know whether a sexual minority patient is “out” to the other members, and know how to interrupt heterosexist or homophobic behavior.
In individual therapy, besides addressing the patient's stage of self-awareness of sexual identity as it relates to addiction recovery, the provider should consider specific risks or triggers for relapse that might be related to the patient's sexual identity. Social settings such as clubs and bars or sexual practices that commonly involve drug use increase the risk of relapse.
In 12-step recovery groups, facilitators need to put extra thought into whether a sexual minority individual may do better with a sponsor of the same or opposite sex, gay or straight, and whether some gay 12-step meetings may or may not be better than “regular” meetings for some.
Support groups or treatment programs designed specifically for sexual minorities have advantages and disadvantages, and aren't available everywhere, but mainstream programs can take steps to enhance the treatment experience for GLBT patients, Dr. Ziegler said.
Try adding a “special interest” group with regular group therapy sessions, she suggested. Develop contacts in the GLBT community to find people in addiction recovery to act as volunteer sponsors. Provide in-service training to all staff so that all can help GLBT patients. “It is not cool to have a designated queer on your staff” to be the only one doing this work, commented Dr. Ziegler, who said she has no pertinent conflicts of interest.
All staff should be trained to help GLBT patients. 'It is not cool to have a designated queer on your staff' to do this work.
Source DR. ZIEGLER
An Acronym for Sexual Minorities
The ingredients of the sexual minorities “alphabet soup”–GLBTQQAAi2S–include the following:
Gay: Males attracted to males.
Lesbian: Females attracted to females.
Bisexual: People attracted to both sexes.
Transgender: People whose gender identity does not match their birth sex.
Queer: An all-encompassing term for orientations other that heterosexual.
Questioning: Individuals who are exploring sexual orientation or identity.
Asexual: Not sexual.
Allies: Important to sexual minorities.
intersex: People born with ambiguous genitalia. (The intersex community chose the lower-case “i.”)
2-Spirit people: Native American or indigenous Canadian term for gays and lesbians.