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Article Excerpt
In this article, the author analyzes the issues and standards facing mental health counselors (MHCs) when working with lesbians and gay men who have substance abuse problems. In order to provide professional and affirmative services to clients from this population, it is critical for MHCs to understand the social and historical context of the lives of lesbians and gay men. Therefore, some of the major factors that contribute to substance abuse problems in the gay community are explored. Finally, guidelines regarding legal protections for this population are provided.
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According to reports, more than 16.6 million people aged 12 or older have problems with substance abuse or substance dependency in the United States (U.S. Department of Health and Human Services, 2002). According to the Diagnostic and Statistical Manual of Mental Disorders (4th ed.), substance abuse is a maladaptive pattern of using alcohol or other drugs that results in significant adverse consequences such as problems at home, school, or work place; placing oneself in dangerous situations; legal troubles; or deteriorating interpersonal relationships (American Psychiatric Association, 2000). Despite the growing acceptability of gay men and lesbians over the past three decades, sensitivity to the mental health service needs of this population is still lacking (Benshoff & Janikowski, 2000; Hellman, Stanton, Lee, Tytun, & Vachon, 1989). Cabaj (1996) indicates professionals that help in substance abuse treatment centers may often lack knowledge about lesbian and gay issues and be unaware that they have clients who are lesbians or gay men. Although it has become known that lesbians and gay men have a higher rate of substance abuse compared to that of the general population, studies show that only about 1% of the clients in traditional substance abuse treatment programs identify themselves as being a lesbian, gay man, or another sexual minority such as bisexual, transgender, or transvestite (Hellman et al.). It is speculated that many lesbians and gay men are not comfortable with the idea of sharing the secret of their sexual orientation with their counselors or their fellow clients in the mainstream treatment agencies (Pride Institute, 1997). The reason behind this secrecy might be their fears of not being supported by their counselors and worries about being harassed by their fellow clients once their sexual orientation becomes known. After all, mental health counselors (MHCs) are usually trained to deal with clients' substance abuse issues, but they may not have received multicultural education on issues related to clients with a nonheterosexual orientation (Eldridge & Barnett, 1991). The purpose of this paper is to highlight information on (a) factors that contribute to substance abuse problems among the lesbian and gay male population and (b) professional standards that pertain to MHCs when addressing substance abuse problems with clients who are lesbians or gay men.
FACTORS CONTRIBUTING TO LESBIANS' AND GAY MEN'S SUBSTANCE ABUSE PROBLEMS
There is no single explanation why some people develop substance abuse problems and others do not (Mendelson & Mello, 1985). Rathbone-McCuan and Stokke (1997) stated that substance abuse has "a complex etiology which includes genetic/biochemical, psychological, and social/environmental factors interacting to create a probable cause-effect equation" (p. 170). This complexetiology approach has been helpful to many MHCs who work with clients with substance abuse concerns (Steven-Smith & Smith, 1998). From the environmental and psychosocial perspectives, there are several explanations for the high rate of substance abuse within the gay community including effects of the gay bar scene, internalization of society's homophobia and nonacceptance of self, the experience of childhood sexual abuse (CSA), the effects of HIV/AIDS, and painful coming-out experiences (Kus, 1988; McKirnan & Peterson, 1989).
Gay Bar Scene
Traditionally, the gay bar scene has been regarded as a key risk factor for substance abuse problems among the gay community (Steven-Smith & Smith, 1998; Weinberg, 1994). For many individuals who are gay, gay bars have functioned as a haven for them to meet new friends and sex partners. Also it is a place which is free from the stigma and prejudice of a largely homophobic society (Benshoff & Janikowski, 2000; Hooker, 1967). Cohler and Galatzer-Levy (1996) state: "Among young gay men and lesbians, the bar represents an important opportunity for affirming one's identity, being together with others like oneself, meeting friends, and enjoying music and dancing" (p. 209).That is, the attraction of the bar is not merely alcohol, illicit drugs, or sex; it is a place where a person can feel normal. Cabaj (1996) indicates that the role models for some young people who are coming-out may be those individuals using alcohol and other drugs whom they met at parties or in bars. In addition, Weinberg (1994) suggests that pressures experienced by gay men in a bar setting derived from a number of different sources which include the use of alcohol to facilitate cruising, the expectations of friendship groups, and a variety of inducements provided by bar management. Another study conducted by Mattison, Ross, Wolfson, Franklin, & HNRC group (2001) indicates that 50% of their gay male subjects who attended the gay circuit parties reported using alcohol, Esctasy, and Special K within the past 12 months.
Homophobia
Homophobia is defined as the irrational fear of people and things related to lesbians and gay men (Weinberg, 1972). There are two kinds of homophobia, externalized and internalized. Externalized homophobia comes from the heterosexual community who dislike or fear homosexuals. Conversely, internalized homophobia comes from within the lesbian or gay man. From an early age, most lesbians and gay men internalize society's ideology of sex and gender roles. As a result of these ideal expectations, they usually experience a certain degree of negative feelings about themselves when they are aware of their same sex attractions (Herek, 1996). Studies show that homophobia is one...
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