Dual Diagnosis Treatment Services are Ineffective for the GLBT Population in a Drug Rehab

Most drug rehab services, including alcohol treatment programs, are geared towards serving a white, heterosexual, male, client. Unless great effort has been put into awareness training, developing knowledge about the experiences and circumstances of minority groups, and the establishment of programs to deal with the special needs of different groups of oppressed people, services will simply perpetuate institutional discrimination.

Gay Alcohol Treatment Programs Not Adequate

U.S. researchers Lohrenz et al (1978) found that 37% of homosexuals experienced discrimination from alcohol treatment program staff while Fifield, De Crescenzo & Latham (1975) discovered that 75% of homosexuals who are recovering from alcoholism believe that mainstream drug rehab and alcohol rehab program are not geared to treating homosexuals and do not provide an accepting and supportive environment. Because of discrimination homosexuals are less likely to attend an alcohol treatment program and drug addiction treatment program unless, that is, they are 'passing.' In this case, if the clinician does not bring up the subject, one of the major causes of their problems will be ignored. Rofes (1989) says: By ignoring the special problems that a lesbian alcoholic, for example, presents, an alcohol treatment program will be doing a service to no one. Their alcoholism treatment of the individual will be less than adequate and may tend to intensify the woman's feelings of isolation and 'difference.' Only by bringing the issue into the open and addressing the woman's lesbianism as an aspect of her life which she needs to feel positively about, will the program be truly effective.

Avoiding Coming Out

Shernoff & Finnegan (1991) discuss the case of a lesbian who is hiding her sexuality, then stress: It is the responsibility of each alcoholism treatment counselor to take the lead in this area the same way alcohol treatment counselors routinely question early family history, dynamics of shame, denial and spirituality. By omitting questions about sexual orientation, or the more subtle questions about sexual or affectional feelings or fantasies for a person of the same sex, the counselor is not obtaining information about all the possible contributing factors for achieving and maintaining sobriety. While Hellman et al (1989) note: Therapists may fear causing anxiety by asking patients about sexual orientation because of discomfort with the subject. However, this questioning can be essential in helping to overcome the secrecy and denial that are hall marks of the struggle with both alcoholism and homosexuality. Of course, if a worker is ignorant about homosexuality s/he is likely to make the situation worse:

Problems Faced In Gay Alcohol Treatment Programs

American surveys, referred to by Hellman et al (1989), reveal a list of complaints about mainstream provision ranging from

? heterosexual bias in alcoholism treatment and evaluation (including either focusing primarily on sexual orientation when inappropriate or ignoring important factors linked with sexuality)

? ignorance about lesbian/gay issues and discomfort at approaching matters of sexuality

? ignorance about the inter-relation of homosexuality and alcohol abuse

. Neisen & Sandall (1990) worked at a program designed to offer alcohol treatment to chemically dependent lesbians and gays. They list their clients' experiences of non-gay drug rehab or non gay alcohol rehab, which include:

difficulty in being open about their sexual orientation due to fear of staff/client harassment,? staff telling them it wasn't acceptable to discuss sexual orientation

some were forced to disclose their sexual orientation

as soon as their sexuality was known, some were discharged

some said that after disclosure the alcohol treatment they received was different due to an atmosphere of condemnation

some feared that if their sexual orientation was known about this would receive more emphasis than their chemical dependency

some addiction treatment programs were not happy having their partner attend a family program.

Citing Morales & Graves (1983) and Hellman, Stanton, Lee, Tytun and Vachon (1989), O'Hanlan (1996) notes:

? the majority of detox and drug rehabilitation and alcohol rehab programs were insensitive to issues of sexual orientation and did not, generally, encourage its disclosure

? homophobia limits the success of recovery and alcohol treatment for lesbian substance abusers (Hall, 1990; de Monteflores, 1986)

? failure to acknowledge sexual orientation makes relapse more likely (Cabaj, 1992)

? lesbians were more likely to attend alcohol treatment program services which address lesbian social issues and provide lesbian counsellors (Hall,1986, 1990, 1992, 1993, 1994; Morales & Graves, 1983).

Family Treatment In Gay Alcohol Treatment Programs

Inclusion of families in addiction treatment and alcohol rehab program is now an acceptable way of supporting those coming off alcohol dependency (Nardi, 1982; Shernoff & Finnegan, 1991). This would be problematic for the homosexual client, partly because many will have been rejected by their families and those families who do not reject their offspring rarely want to discuss anything connected with homosexuality. Yet it is the ignorance and lack of acceptance of families which is one of the main reasons why homosexuals are vulnerable to alcohol abuse and drug abuse. Alcoholism treatment does work!

A gay alcohol treatment program, drug rehab or gay friendly dual diagnosis treatment program, can be found at a web site located at www.lakeviewhealth.com or you can call the dual diagnosis national helpline at 1-800-511-9225 to locate a dual diagnosis treatment program in your local area.

Jonathan Huttner is a principal with Lakeview Health Systems, which treats drug addiction and alcohol addiction in a gay friendly environment. Lakeview also operates a nationally recognized dual diagnosis treatment program.