|
Article Excerpt
The literature has suggested that addiction treatment programs are not addressing the unique recovery needs of gays and lesbians. This qualitative study examined gay men's and lesbian women's experiences with addiction treatment and recovery. Ten themes emerged to define their experiences. These themes are described, along with implications for mental health counselors working with this population.
**********
Mental health professionals have long considered the gay and lesbian population to be at-risk with respect to alcohol and other drug addiction. In an extensive review of the literature, Hughes and Eliason (2002) concluded that this risk continues despite declines in actual levels of use in this population. There is also evidence to suggest that gay men and lesbian women do show differences from the general population in patterns and consequences of use (e.g., McKirnan & Peterson, 1989; Skinner & Otis, 1996). Bux (1996) reviewed the literature on prevalence rates of problem drinking among gays and lesbians and concluded that lesbian women and gay men are less likely to abstain from alcohol use than the general population, that lesbian women seem likely to be at higher risk than heterosexual women for problems related to drinking, that gay men's risk for alcohol related problems is comparable to that of heterosexual men, and that the latter is due to recent declines in use.
There is also some evidence that the gay and lesbian population may experience substance use and addiction in ways that are uniquely related to their sexual orientation (Cheng, 2003). In a study of lesbian women and gay men in recovery, participants reported that conflict related to sexual orientation was a major contributing factor to their alcoholism (Millinger & Young, 1990). Furthermore, alcohol and other drugs can become a mechanism for coping with social stigma and internalized homophobia (Cabaj, 1996; Cheng, 2003; Ratner, 1993) This is exacerbated by the fact that the gay bar is one of the most accessible routes into the lesbian and gay community for individuals coming out or exploring their sexual identity (Cheng; Gay and Lesbian Medical Association, 2001).
Despite these culturally specific experiences with substance use and abuse, the limited information available suggests that treatment providers often lack the knowledge or inclination to address them. For example, Hellman, Stanton, Lee, Tytun, and Vachon (1989) studied government funded treatment facilities in New York City. They reported a lack of information and training in working with gay and lesbian clients, a reluctance to refer clients to other clinicians who might have specialized training, and frequent failure to address issues related to sexual orientation. This is consistent with Ratner's (1993) report that 53% of the clients who entered the Pride Institute, an inpatient treatment center targeting the gay and lesbian population, had previously participated in inpatient treatment elsewhere where sexual orientation was never addressed. More recently, Eliason (2000) found that substance abuse counselors lacked information about critical aspects of gays' and lesbians' experiences and that, although many of the counselors surveyed had "tolerant or accepting attitudes" (p. 323), a large percentage had "negative or ambivalent attitudes" (p. 323). Matthews, Selvidge, and Fisher (2005) found that the organizational climate in substance abuse treatment facilities predicted the degree to which individual counselors practiced in ways that were affirmative with gay, lesbian, and bisexual clients. The more affirmative the organizational climate, the more counselors reported affirmative attitudes and behaviors in working with this population.
The question of culturally specific treatment is one that has been raised in the multicultural counseling literature for the past couple of decades. Sue and his colleagues have presented a competence-based theory of multicultural counseling, arguing that there are certain competencies that counselors who practice cross-culturally need to develop to work successfully with clients whose backgrounds are different from their own (Ponterotto, Fuertes, & Chen, 2000; Sue, Arredondo & McDavis, 1992; Sue et al., 1982; Sue, Ivey, & Pedersen, 1996). This theory is based on the premise that traditional theories of counseling are culture-bound and reflective of the European and American cultures familiar to their developers. Sue and his colleagues argued that counselors need to develop awareness, knowledge, and skills appropriate for the client's culture when working with clients who do not share the counselor's cultural background. Although Sue and his colleagues focused their work on cultural differences based on race and ethnicity, other scholars (e.g., Croteau, Talbot, Lance, & Evans, 2002; Haldeman & Buhrke, 2003; Pope, 1995) have argued that other aspects of culture such as sexual orientation are also important.
The purpose of the present study was to gain a better understanding of the experiences of gay and lesbian individuals in treatment for drug and alcohol addiction. We were particularly interested in gay and lesbian recovering individuals' perspectives on what was and what was not facilitative of recovery, as well as the ways in which mental health professionals in addiction treatment facilities are or are not addressing the unique recovery needs of gay and lesbian clients. Drawing on multicultural theory, we were interested in participants' perspectives on how important, if at all, it was for treatment programs to address issues related to sexual orientation.
METHOD
Procedures
Participants were recruited through a variety of sources likely to reach the gay, lesbian, bisexual community and/or the recovery community. This included posting recruitment announcements on listservs and sending flyers to gay and lesbian community or health centers, as well as to Alcoholics Anonymous (AA) groups. It also included an announcement at the end of a related quantitative Internet study, inviting participants of that study to participate in this study.
Individuals who responded to the announcement received a Letter of Informed Consent, which described the study in more detail and allowed them to formally indicate their consent to participate, along with a Background Questionnaire, which gathered contact and demographic information. Once the first author received the signed consent form and background questionnaire, one of us contacted the participant to schedule an interview.
We conducted semi-structured interviews via telephone, which were audiotaped with participants' knowledge and permission. A series of open-ended prompt questions were used to initiate discussion and to ensure a common protocol among interviewers; however, participants were encouraged to add or expand upon topics that seemed important to them. The prompt questions are listed in the Appendix. Interviews lasted about an hour. A professional transcriptionist transcribed the audiotapes. Prior to analysis, an individual not connected with the research team compared the transcripts to the audiotapes to verify the accuracy of the transcriptions. In addition, we sent each participant a copy of the transcript for his or her interview to verify that the transcript was correct and accurately represented his or her thoughts. Where indicated, changes were made to the transcriptions. The study was approved by the university's Office for Regulatory Compliance.
Participants
As is characteristic in qualitative research, we used purposive sampling procedures (Creswell, 1998; Jones, 2002). Criteria for participation were that participants self-identify as gay, lesbian, or bisexual and as being in recovery from alcoholism and/or other drug addiction for at least one year. The one-year minimum for sobriety was chosen to ensure that length of sobriety was long enough that participation in the study would not likely jeopardize recovery and also to allow enough recovery time to be able to reflect on the process. The initial working plan developed by the research team was to include only those individuals who had attended at least one formal treatment program (inpatient, outpatient, or intensive outpatient/partial hospitalization). The recruitment announcement specifically mentioned an interest in treatment experiences. This plan was revised when several individuals indicated that their treatment experience had been exclusively through 12-step programs but they believed they had something to contribute. Since qualitative research is an emergent process based on interaction between researchers and participants (Armino & Hultgren, 2002; Jones, 2002), the decision was made to include 12-step programs in the definition of treatment experience. Given that many, if not most, treatment programs include active involvement with 12-step programs as an integral part of the treatment experience, this seemed consistent with the overall purpose of the study.
A total of 23 individuals responded to the recruitment announcement. Twelve people returned the signed and completed consent and background information; however, two of them failed to respond to repeated attempts to schedule an interview. This left a final sample of 10 participants, six women and four men. All of the women identified themselves as "lesbian" or "dyke;" all of the men identified themselves as "gay" or...
|
