Basics Revisited: Providing Affirmative Treatment for LGBT Clients

In order to execute our mission to provide education in delivering evidence based addiction treatment for lesbian, gay, bisexual and transgender (LGBT) clients, the National Association of Lesbian, Gay, Bisexual and Transgender Addiction Professionals and their Allies (NALGAP) created an LGBT track at the annual NCAD conference.  At these and other presentations I have observed that regardless of the specific topic, many of the same questions arise over and over again.  In this blog post I will answer some of the most common questions from my perspective.

1.  Addiction is addiction, so LGBT clients should be treated the same as everyone else, right?

Yes, addiction is addiction.  And no, LGBT clients should not be "treated differently" or receive "special treatment" in the general sense.  However, there are cultural issues that need to be taken into consideration when developing programming for LGBT clients.  Becoming familiar with LGBT identity development, definitions of affirmative language used by and for LGBT individuals and some of the basics of the distinct cultural aspects of lesbian, gay, bisexual and transgender people is critical in providing competent care.  In the same way that we have done a good job developing gender and age specific treatment we also need to develop LGBT specific and affirmative treatment.  Remember, one of the most prohibitive barriers of access to care for LGBT people is that of perceived safety.  LGBT clients won't access care unless they can be sure they will feel comfortable bringing their whole selves to treatment, including their sexual orientation and gender identity.  Some clients will need to be referred to a LGBT specific treatment center in order to feel completely safe.  However many clients will thrive in a mainstream treatment center that has worked hard to provide LGBT affirmative treatment.

2. How can I expect to attract and admit LGBT clients to our treatment program when I know it will make the other clients uncomfortable?

This question is a very common one.  At its root is fear.  A treatment center that is committed to providing LGBT affirmative care would instead ask, "How can I inspire and educate my clients to treat ALL the members of our treatment community with dignity and respect?"  One of the tasks of addiction recovery treatment is to prepare our clients to attain their maximum potential while living "life on life's terms."  In recovery our clients will encounter all types of people including those with differences based on race, class, sex, gender identity, sexual orientation and more.  Many treatment programs include a psycho-educational component that teaches clients about how societal stigma associated with alcoholism and drug addiction has negatively impacted their lives.  We also help them process those effects and develop strategies to cope with stigma in their recovery.  In the same way, I believe we have an ethical responsibility to educate our clients about diversity, tolerance and acceptance of self and others. With this in mind we need to provide education and counseling about diversity, including present and potential diversity in their treatment groups.  While we inform new clients during orientation that one of the rules of the program is to treat each other with dignity and respect regardless of their differences, we often leave differences of sexual orientation and gender identity off the list.  By including these identities in the discussion, you're off to a good start.

3. Where should I house transgender clients in my residential treatment program?  Which gender group should the transgender client at my outpatient facility attend?

Plain and simple:  People who identify as female live in women's housing and attend women's treatment groups, people who identify as male live in men's housing and attend men's treatment groups.  The exception would be if a transgender person feels they will be more comfortable in the house or group that aligns with their gender assigned at birth.  This choice is sometimes made when the transgender client is in the early stages of transitioning.  If you're not sure how a client identifies their gender, check the intake form, especially if it was self-administered.  Or ask them, "How do you identify your sex or gender?", "What pronouns do you prefer to be used when being addressed?"  If their chosen name is different from the name on their ID card ask them, "What name would you like to be called?" Transgender individuals may or may not choose to have gender reassignment surgery.  The choice they make regarding surgery does not reflect how they identify their sex or express their gender and should not impact which housing or treatment group to which they are assigned.  The biggest mistake would be making this decision based on the client's genitalia, which does not always align with their gender identity.  There are multiple reasons that some transgender people choose not to have surgery, ranging from personal choice, financial considerations and access to healthcare.  If you're concerned that placing a transgender person in the house or group that corresponds to their gender identity will be disturbing to your other clients, see question #2 above.

4.  My program is faith-based. How can we provide competent care to LGBT clients if some of our staff and clients have been taught that homosexuality is wrong?

This is a tough one!  As much as I believe that we have a responsibility to inspire tolerance of diversity, some environments will just not be in the best interest of some clients, including LGBTs.  If the worldview and culture of a particular treatment community includes a belief system that would not be conducive to affirmative treatment of LGBT clients, they must be referred to a treatment center in which they can thrive.  Knowing when to admit a client and when the client would be better served at another facility is an integral part of provider competence.  If you find yourself in this situation, utilize the resources available to find a more appropriate referral.  If you decide that you would rather change the culture of your program to be LGBT affirmative, see question #5 below.

5.  How can the staff of my treatment program learn more about LGBT affirmative addiction treatment?

The evidenced based manual "A Provider's Introduction to Substance Abuse Treatment for Lesbian, Gay, Bisexual, and Transgender Individuals" was developed in 2001 by SAMHSA and is available for free on their website.  Several NALGAP members participated in its development.  In addition, the Prarielands ATTC has developed an extensive training curriculum based on the aforementioned publication.  These and other resources are available on NALGAPs website: www.nalgap.org.  NALGAP provides information, training, networking and advocacy, and support for addiction professionals and can be a good starting place to get connected to resources in your community.

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Author Bio:

Craig Sloane, LCSW, CASAC, CSAT Candidate is in full time private practice in New York City.  He is a practitioner, supervisor and workshop facilitator in the fields of mental health, substance use disorders, HIV/AIDS, and LGBT issues.  Among his practice specialties is working with addictive disorders in the LGBT communities.  He has a special interest in working with gay men experiencing the interaction of crystal meth addiction and sexual compulsivity, a topic on which he has presented nationally.  Craig is the recipient of the 2012 Emerging Social Work Leader award from the National Association of Social Workers NYC Chapter. 

Email:  newleafnyc@gmail.com

Website: www.new-leaf-counseling.com