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Basics Revisited: Providing Affirmative Treatment for LGBT Clients

July 12, 2014
by Craig Sloane, LCSW, CASAC, CSAT Candidate
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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.

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"NALGAP: The Association of Lesbian, Gay, Bisexual, Transgender Addiction Professionals and...