1. Foundations of Addictions Counseling, 3/E David Capuzzi & Mark D. Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Chapter 19 Lesbian, Gay, Bisexual, and Transgender Affirmative Addictions Treatment Updated by Melinda Haley, Walden University

2. Introduction to LGBT Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Sexual orientation Gender identity Gender expression Cisgender Heterosexism Homoprejudice Transprejudice

3. Addiction Among LGBT People Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Very little research Estimated that 28-35% of gay men/lesbians have engaged in some form of recreational drug usage LGB youth also more likely abuse alcohol, tobacco than heterosexual peers LGBT-affirmative therapies

4. Common Terms for LGBT People Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Stigma of diagnosis “Homosexual” GID is classified as a mental disorder Identify transgender identity as a medical condition Evolving terminology Counselor should have knowledge of terms and definitions Sexual orientation, gender, and queer

5. Common Myths About LGBT People Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Bisexuals are “confused” Gay men seen as sexual predators Lesbians ‘trying to be men’ LGBT people want to recruit heterosexuals Choice of LGBT LGBT as a mental disorder

6. Coming Out, Cultural Differences, and Addiction Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Process of sexual/gender identity Coming-out models Counselors need to address to assess what stage of sexual identity development a client is in.

7. Coming Out, Cultural Differences and Addiction Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Four Stages 1. Identification 2. Cognitive changes 3. Acceptance 4. Action Different cultural groups may have different coming-out processes Racism

8. Case Scenario: Asim Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Asim, 36-year old Muslim of South Asian heritage Abusing Alcohol/marijuana Started 3 years ago after end of difficult relationship Changes the subject when questioned about the relationship Asks if it is possible to be attracted to both men and women How do you honor both cultural and sexual identities? How do you help Asim to share more about past relationship and sexual orientation Cultural issues that may bring strengths to Asim’s treatment

9. LGBT-Affirmative Addiction Treatment and Assessment Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved “Hidden minority” Variations across LGBT communities Transgender Gay men Lesbian women Bisexual people Queer or questioning youth

10. LGBT-Specific Assessment of Addiction Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Clinical Assessment Relationship building Strong therapeutic alliance Trust is important Assessments laden with heterosexual bias Relaxed manner of questioning about sexual orientation Beware of bias in assessment instruments

11. Affirmative Language Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Be aware of relevant terms. Sex plays the same role in all our lives, regardless of sexual orientation. Coming out is a complex process that happens over a lifetime. Be sensitive and affirming of the name and terms a transgendered person uses to describe himself or herself.

12. LGBT-Specific Treatment of Addiction Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Integrate sexual identity issues into treatment as appropriate Treatment plans created collaboratively Factors Life stage Coming-out process Available support Client’s comfort with identity Career, finances, health, for example

13. Modality Issues Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Individual therapy Couples and family counseling Invite partners to attend treatment “Chosen” families (close friends) Therapeutic community settings Guidance in where and when to come out Care in inpatient settings Standards and education for non-LGBT clients

14. Recovery Support Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Boundaries for healthy, safe recovery meetings Valuable coping recovery skills Sponsorship, relaxation, meditation, and journaling Role playing social settings that are potential triggers

15. Relapse Prevention Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Help clients identify triggers, ways to counteract Common relapse precursors Coming-out issues Low self-esteem, internalized homonegativity Verbal and physical attacks Grief/loss associated with HIV/AIDS Prevention plans Resilience strategies

16. Role of Addictions Counselors Working with LGBT Clients Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Follow best-practice guidelines Counselors can have powerful impact on lives of LGBT clients Important principles Create a safe environment Affirmative messages LGBT magazines in the waiting room Display “Safe Zone” sticker on front door

17. The Pride Institute Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Begin recovery where you can “be yourself” Appropriate addictions treatment Individual and group counseling Positive recovery outcomes Safety and freedom from homophobia

18. How to Be an Advocate for LGBT- Affirmative Treatment Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Social advocacy on behalf of LGBT Social justice (5 th force in counseling) Incorporate affirmative counseling Advocating for culturally relevant addiction treatment Move beyond traditional counseling

19. Useful Web Sites Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Association for LGBT Issues in Counseling http://algbtic.org http://algbtic.org National Gay and Lesbian Task Force http://www.thetaskforce.org http://www.thetaskforce.org PFLAG http://www.pflag.orghttp://www.pflag.org