[nandm]

Below is an article that I found regarding recovery resources and how they relate to the GLBT community. I found it interested although I do not agree with all the findings. What are your thoughts? What do you agree or disagree with? Do you feel that the needs of recovering GLBT's are being met? How can these needs be better met?

I agree with the majority of the article except for the comment regarding AA "AA is based on Christianity". The principles and steps of AA are about spirituality rather than religion. There are people who represent all religions as well as athiests that find the program of AA useful to them. I do not consider myself a Christian yet the program of AA has been lifechanging for me. Without it I would probably have continued my slow suicide of alcoholism. I can not really comment much on treatment centers as I did not go through a treatment center to get sober but I did find the information to be accurate from what I have heard of treatment centers.

I am looking forward to hearing your responses.

3.3 Why Most Current Drug/Alcohol Services are Unhelpful

3.3.1 U.S.A.

Most services, including alcohol treatment agencies, are geared towards serving a white, heterosexual, male, clientel. Unless great effort has been put into awareness training, developing knowledge about the experiences and circumstances of minority groups, and the establishment of programmes to deal with the special needs of different groups of oppressed people, services will simply perpetuate institutional discrimination. U.S. researchers Lohrenz et al (1978) found that 37% of homosexuals experienced discrimination from alcohol agency staff while Fifield, De Crescenzo & Latham (1975) discovered that 75% of homosexuals who are recovering from a drink problem believe that mainstream agencies are not geared to treating homosexuals and do not provide an accepting and supportive environment.

Because of discrimination homosexuals are less likely to attend alcohol dependency treatment centres unless, that is, they are 'passing.' In this case, if the worker 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, programs will be doing a service to no one. Their 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.

Shernoff & Finnegan (1991) discuss the case of a lesbian who is hiding her sexuality, then stress:

It is the responsibility of each counselor to take the lead in this area the same way 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 offense 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: American surveys, referred to by Hellman et al (1989), reveal a list of complaints about mainstream provision ranging from

• heterosexual bias in treatment and evaluation (including either focussing 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 misuse,
• lesbians and gays felt discomfort in the mainly heterosexual environment of agencies and were fearful of being viewed as pathological or stereotyped.

Neisen & Sandall (1990) worked at a programme designed to offer treatment to chemically dependent lesbians and gays. They list their clients' experiences of non-gay provision, 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 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 services were not happy having their partner attend a family programme.

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

• the majority of detoxification and rehabilitation programmes were insensitive to issues of sexual orientation and did not, generally, encourage its disclosure;
• homophobia limits the success of recovery and 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 treatment services which address lesbian social issues and provide lesbian counsellors (Hall,1986, 1990, 1992, 1993, 1994; Morales & Graves, 1983).

Inclusion of families in treatment programmes 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 unacceptance of families which is one of the main reasons why homosexuals are vulnerable to alcohol and drug misuse.

Lesbians and gays often replace their family of origin with an extended family of lesbian and gay friends, many of whom will also have alcohol/drug problems. Rofes (1989) points out: "The inability of the traditional networks which people use to support their recovery from alcoholism - family, church, school, employers - are closed to many gay people."

Alcoholics Anonymous (AA) is one of the main support agencies which helps people with alcohol problems. However, because AA is Christian based and Christianity - along with other religions - is particularly responsible for society's homophobia, it will be inappropriate for many lesbians and gays. Hawkins (1976) notes that closet homosexuals will attend heterosexual-oriented AA groups and that "It can easily be seen that this would produce some detrimental effects, considering the fact that the acknowledged key to sobriety is an open and honest relationship with one's peers." At the same time, lesbians and gays in the U.S.A. founded Alcoholics Together (AT), a lesbian and gay version of AA, in 1970 and since then there have been 100's of groups formed across the States. Clearly this is fulfilling a desperate need but some people have reservations about the relevance of AA to lesbians and gays (Bittle, 1982; Tallen, 1990; Hall, 1992).

3.3.2 Britain

Utilising the Hellman et al (1989) questionnaire, Bridget (1994) surveyed workers in 38 Alcohol Services in the North West of England for details about their knowledge, training and attitudes towards the treatment of lesbian clients. She found

• more than half of the 121 respondents never discussed sexual orientation with their clients,
• only a handful had had training and supervision in relation to lesbian clients,
• the majority had little knowledge about the treatment and evaluation of lesbian alcohol misusers,
• 84% felt able to treat lesbian clients,
• 67% said they would like training on these issues.

Bridget concluded: "there appeared to be no special provision for lesbians within mainstream services in the North West. The general belief seems to be that lesbians are the same as everyone else and should be treated the same."

In the 1991-92 Alcohol Directory (Alcohol Concern), 120 agencies said they welcomed LGB people (this response was based on equal opportunities policy statements). In the 1998/99 Alcohol Directory 17 agencies state that they make specific provision for LGB people; this reflects a more realistic picture in response to a revised criteria under which agencies were asked about specific provision.

With funding from Comic Relief, Lesbian Information Service (LIS), had further copies of the research report (Bridget, 1994) printed, up-dated the Lesbians, Gays and Alcohol Resource List, produced the booklet, "Lesbians and Alcohol Misuse, A Guide for Alcohol Workers" and distributed these to all alcohol treatment agencies in England and Wales (see Welcome to LIS : RESEARCH: Research Statistics: Alcohol; Research Projects: Alcohol Services; Research Library: Alcohol). Working with several alcohol treatment agencies and Alcohol Concern, LIS organised the first national lesbians, gays and alcohol conference in Manchester in 2000 (there had been a previous regional conference in London). Alcohol Concern launched the national network for working with lesbians, gays and alcohol at this conference (as part of their Networking Distant Neighbours scheme). Alcohol Concern then organised a second conference in London in 2001. For further information about these conferences and copies of their NDN newsletter which includes regular up-dates on the Lesbian and Gay Network, visit www.alcoholconcern.org.uk.

Despite these efforts to encourage alcohol treatment agencies to develop services to meet the specific needs of LGB clients, a recent survey by Alcohol Concern discovered that only 7% of the users of the 450 alcohol treatment agencies in the UK were lesbian, gay or bisexual (State of the Nation, Alcohol Concern, 2002). This same survey discovered that whilst alcohol misuse was a greater problem in the north of England, alcohol treatment agencies were more abundant in London and the south of England.

Only a handful of agencies have actually developed services specifically for the lesbian and gay population. Alcohol East, in East London is one; ACAPS in Brixton did have another; the Alcohol and Drug Services Community Alcohol Services in Blackpool have recently set up a support group. The Piccadilly Project in Bradford does not have a specific lesbian/gay project but they are a gay-friendly organisation and have an awareness of LGB issues: one of their staff ran a workshop on lesbians and alcohol misuse at the Women & Alcohol - a cause for concern? conference in Leeds in 2000. All too often, however, provision of services for LGB people is dependent on one individual and if that person leaves the services are no longer provided.

3.3.3 Calderdale

Dashline is the main alcohol treatment agency in Calderdale and until recently provided services for adults and young people. HX1 now provides services for young people.

The ACTION survey, Bridget (1999), included questions about use of services. One young man commented on using Dashline:

I have been about drugs and everything. There was a woman asking really pathetic questions. I only went once and I couldn't be bothered after that. I didn't think they did a right good job at all but that was about a drug issue. They didn't really talk about me being gay.

In the past Dashline have been involved in work on lesbian and gay issues. For example, the manager was part of a multi-agency group assisting Lesbian Information Service to produce the booklet "Lesbians and Alcohol Misuse: A Guide for Alcohol Treatment Agencies" as well as planning the national conference in Manchester. An out gay male worker from Dashline attended the first 'Homophobia from a Multi-Oppression Perspective' module run in Halifax. However, more recent discussions with Dashline to introduce measures developed at Alcohol East in London, which have helped to make it more accessible to lesbian and gay people, have been unsuccessful. These procedures include, for example, anonymous monitoring for sexual orientation, automatically including questions about sexual orientation as part of the assessment process. Alcohol East say that if appropriate services are to be provided it is crucial to know the sexual orientation of the client. Little is known about the HX1 project.

Communities Against Drugs provided GALYIC with a grant to launch a publicity campaign. This consists of a poster designed by an arts project and lesbian and gay youth group in Leicester. It depicts a picture of a young woman looking into a pint glass with the words: Are you coming OUT tonight? Don't get your courage in a bottle. Why not contact GALYIC: 01422.320099. The campaign will run from October 2002 to January 2003.

As with other health issues, first line contacts such as GPs as well as specialist agencies need to be aware of the vulnerability of LGB people to alcohol and drug misuse. The need for training with GPs and other services was highlighted by the response of one of the ACTION participants: A young woman in the survey went to her GP about her drinking problem; she said:

[I came out to my doctor] when I said I had a drink problem about five years ago. Didn't get much response but they did want to help me with my drinking problem. Sent me to see a psychiatrist but I didn't feel it was the right thing for being gay. I didn't open up much as he said it was probably a phase. Talked more about my childhood and asked if I had been abused. Didn't have much information about my sexuality. No link between my sexuality and drinking problem. Didn't get much help at all. Didn't go back. Maybe counselling would have been better not a psychiatrist. I did not seem to get the help I wanted at all.

3.4 Feedback from Workshop

Six people attended this workshop. Feedback included:

• 'Scene' doesn't support friendships
• Hard to contact 'community'
• Promotion of alcohol at gay events
• Sponsorship from alcohol companies
• Services: some provision i.e. AA etc but nearest Bradford and Manchester; Dashline done some homophobia awareness training but limited
• Contact point for Dashline: currently word of mouth, could be included in publicity that they can provide a gay counsellor
• Services for LGBs should be built into provision and not dependent on individual.

3.5 Recommendations

• Establish LGBT Addictions Task Group to include both LGBT individuals and workers from Dashline and other relevant agencies.
• Conduct assessment of needs and services (similar to the Zorro Project in Brighton & Hove, see 6.1.4, only in relation to alcohol and drug use).
• Dashline and other relevant agencies to work with Task Group to develop more LGBT-friendly services.
• Dedicated person to work with LGBT people with alcohol/drugs problems.
• Set up coming off addictions groups for LGBT people.

(excerpt from article titled "Alcohol and drug misuse at http://www.lesbianinformationservice.org/alcohol3.rtf