An Ongoing Challenge: Safe and Respectful Treatment for LGBTs

The Supreme Court handed down two decisive victories to LGBTs on June 26, and, not surprisingly, there are many who are dissatisfied with the Court’s decisions.  While it does seem that the United States has crossed a threshold in regards to LGBT recognition, approval, and support, let us not forget that millions of Americans are not so supportive and even antipathetic to these societal changes.

While researching my books “Gay Men and Substance Abuse” and  “Family Pride: What LGBT Families Should Know about Navigating Home, School, and Safety in Their Neighborhoods” I interviewed LGBTs who reported a backlash in their local communities.  Some felt that in the present climate - in which so much LGBT progress is evident – the need to hunker down and maintain a low profile has never been so necessary.  As addiction professionals we cannot blithely assume that LGBT progress has necessarily occurred in our treatment facilities.  Our colleagues, administrators, support staff, facility staff, and, particularly, our patient population, may not be affirming of LGBTs.   Unless an agency or program was specifically created for LGBT substance abusers we cannot readily infer a facility’s readiness and willingness to accept this population, and the reality is that most LGBTs will receive treatment in general programs and not those specializing in LGBT-specific care.

How then do we begin to determine if a facility – even our own facility - is appropriate for LGBTs?  The National Institute on Drug Abuse formulated five essential questions families should ask when considering prospective treatment programs:[i]

1. Does the program use treatments backed by scientific evidence?
2. Does the program tailor treatment to the needs of each patient?
3. Does the program adapt treatment as the patient's needs change?
4. Is the duration of treatment sufficient?
5. How do 12-step or similar recovery programs fit into drug addiction treatment?

These questions are a great starting point for LGBT substance abusers, but they elude concerns that many LGBTs and their loved ones espouse as essential, particularly those regarding safe and respectful treatment.  I propose then an additional question: Does the facility provide education to all clients regarding language and behaviors that show bias toward LGBT people?  Treatment facilities need to do more than ask clients to read an acknowledgment during orientation that disrespectful behavior is contraindicated; they instead need to clearly inform all prospective clients that:

• The agency is in no way attempting to sway their personal beliefs regarding LGBTs, whether these are affirmative, neutral, uncertain, or fiercely antipathetic.
• Regardless of personal beliefs, LGBTs might be in treatment at the same time as they are.
• All members of a treatment community will be treated with respect, and the milieu is supportive and safe for all members.
• If these requirements are not acceptable to a prospective client, it would be best for him or her to find a more suitable treatment facility.

When a treatment facility voluntarily turns away clients because their anti-LGBT behaviors might negatively impact LGBT members, it is a sign that it is purposefully and proactively working on fashioning a safe and respectful treatment environment.   LGBTs, their loved ones, and allies consider safety and respectful treatment their primary concerns, considerations that supersede the above questions formulated by NIDA.   Certainly people who have negative beliefs about LGBTs can still successfully and therapeutically interact with them as supportive peers.  Indeed, we already recognize that peers with differing beliefs about topics such as abortion, gun control, and religion still work together successfully.  However, when beliefs lead to behaviors such as proselytizing, discrimination, exclusion, and aversive exchanges, LGBTs become victims in treatment rather than collaborators in a positive therapeutic experience.