LGBT Addiction Treatment Availability: Changes and Challenges (BOOK REVIEW)

A book review of “Fundamentals of LGBT Substance Use Disorders” outlining the LGBT-specific risk factors for substance use as well as treatment challenges for these populations since the late 70s until the present day.

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We need a new vision for treating LGBT addiction

Substance use in the LGBT population comes with many stereotypes, such as:

  • gay men combine club drugs and sex
  • lesbians are embittered alcoholics
  • bisexuals use psychoactive substances to deal with confusion
  • transgender people exchange sex for money and drugs

The book “Fundamentals of LGBT Substance Use Disorders: Multiple Identities, Multiple Challenges” by Michael Shelton offers us a new vision. A more compassionate, up-to-date vision … and a deeper understanding of the real needs of the LGBT community in addiction treatment. In fact, Shelton shows the ways substance abuse risk factors, addiction root causes, and treatment are far more complex for LGBT individuals than stereotypes suggest.

Fundamentals of LGBT Substance Use Disorders covers the many changes and challenges in the LGBT addiction and mental health fields. We think the book is truly fundamental, in that clinicians working in the LGBT community MUST HAVE THIS BOOK in their libraries. It features:

  • empirical literature
  • historical research
  • case studies
  • analysis
  • future suggestions

…all aimed at the development of matching affirmative treatment services to the population’s specific needs. Most importantly, the book is written in a very easy-to-comprehend manner, despite the complexity of the topics it covers.

Continue reading to learn more about why this book matters. Then, feel free to leave your questions about LGBT addiction recovery in the comments section at the end of the page. We try to respond to all real life questions personally and promptly.

LGBT addiction research and views in the past

At the beginning of the book we get introduced to LGBT substance use disorders and the changes that have occurred in our view of the community’s substance use since the middle of the 70s. This is the time when homosexuality was removed from the DSM and LGBT substance use studies first began to research and promote the physical and mental health of gay men and lesbians.

It was also thought that LGBT people used psychoactive substances as a coping mechanism for the shame they feel as a result of their identity – a view that was, of course, dismissed due to the acknowledgement of other contributing factors. This book digs deep into the LGBT-specific risk factors for substance abuse that accompany general addiction risk factors that are universal for all individuals.

LGBT-specific risk factors that increase a person’s likelihood of abusing psychoactive substances and developing an addiction problem can include:

  • microagressive behaviors
  • minority stress (including internalized heterosexism)
  • navigation of the coming-out process
  • the deeply-rooted nature of LGBT culture in bars and clubs

Addiction treatment for LGBT substance use

Before the 70s, anyone who was in need of LGBT addiction treatment would receive therapies that were directed towards changing homosexual thoughts with heterosexual feelings, thoughts and behaviors. We have come a long way since then, but LGBT-specific treatment programs still have room to progress.

Today, LGBT people can receive the same interventions as the general population, they can be provided with appropriate pharmaceutical and psychological treatments, and be referred to adequate self-help groups. However, cultural competence in addressing LGBT addiction is of utmost importance and plays a significant role in constributing to treatment success stories. LGBT-centered clinical environments can help these populations:

  1. Reduce fear of discrimination
  2. Increase motivation for accepting and accessing treatment
  3. Overcome shame, minority stress, and the damage of heterosexism
  4. Heal trauma that is related to sexual orientation and a direct cause for addiction
  5. Prevent re-traumatization during and after the treatment process
  6. Develop pride and feelings of inclusiveness

Are Lesbian, Gay, Bisexual, and Transgender substance use patterns different?

Yes. Sexuality and substance abuse have many different approaches.

From Chapter 4 to Chapter 7, the book covers substance use behaviors separately for the Lesbian, Gay, Bisexual, and Transgender populations. Which is enlightening and super informative!

The author fist addressees substance use patterns in trans and bisexual people, firstly because of the common negligence by researchers, and because the dangerous degree of substance abuse patterns in these populations. Transgender individuals have a highly problematic substance abuse and treatment experiences. Not only was substance use in trans people not studied until the late 90s, even in today’s times treatment providers often have little-to-no information for working with members of this group.

In contrast, bisexual individuals have a whole different minority stress experiences,that often may arise from lesbians and gay men and their unacceptance of bisexuals as being emotionally, romantically and physically attracted to both genders. In this section, the author also examines substance use by straight (heterosexual) men who have sex with other men (SMSM).

Additionally, lesbians face a whole set of challenges that arise from the combined risk of their sexuality and gender status. Lesbians are more likely to abuse tobacco, alcohol and illicit drugs compared to heterosexual women, but they are also more likely to seek treatment. However, the lack of research on female substance use in general means they encounter a treatment system developed for adult men.

Gay men and substance abuse have been the subject of most research done in the past and to this day. Risk factors for this population include the popularity of meth and other club drugs use, minority stress, childhood sexual abuse, other co-occurring disorders, eating and body image disorders, the association of sexual activity and HIV transmission, etc. All these factors are considered in this book, and should be taken into consideration in the treatment process.

Why we recommend “Fundamentals of LGBT SUDs”

This book is for anyone interested in learning more about LGBT substance use and treatment from its early beginnings. Here is why “Fundamentals of LGBT Substance Use Disorders” is a revolutionary book:

1. It points out that there is no stereotypical LGBT person.
2. To understand each individual, his/her substance use, and the appropriate course of interventions and treatment approaches, many factors need to be considered, such as:

  • race
  • ethnicity
  • age
  • family connections
  • living location

3. A number of LGBT-specific risk factors for substance use and addiction need to be taken into consideration. Each set of risk factors is different for each population under the LGBT umbrella.

4. The growing recognition of health disparities shows that culturally competent treatment is necessary.

5. The book also digs into other important aspects of LGBT substance use, risk factors, and treatment needs:

  • research on LGBT youths’ behavioral health
  • substance use by LGBT elders – the fastest growing demographic in the community
  • the impact of substance use on family members and couples, including gay-parented families and families with an LGBT member
  • research on the legal system because the numbers of LGBT individuals in jails and prisons are far higher than the number of
  • heterosexual and gender-conforming populations
  • research on LGBT people who live in rural areas

LGBT substance use disorders questions

Are you interested in learning more? You can purchase Fundamentals of LGBT Substance Use Disorders: Multiple Identities, Multiple Challenges by Michael Shelton on Amazon.

We welcome you to post any questions you have related to LGBT substance use and treatment in the comments section below. We appreciate your feedback and try to provide personal and prompt response to all legitimate inquiries.

About the author
Lee Weber is a published author, medical writer, and woman in long-term recovery from addiction. Her latest book, The Definitive Guide to Addiction Interventions is set to reach university bookstores in early 2019.
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