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Coming-out Issues for LGBTs: Connections to Substance Use and Treatment

April 7, 2014
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Dr. Raven James, author of “Sexuality and Addiction: Making Connections, Enhancing Recovery,” discusses the coming-out process for LGBTs

Coming-out is a joyful and liberating experience or it can be one of the most devastating events LGBTs go through.  Negative responses to coming-out experiences can influence LGBTs to cover up emotional pain through the use of drugs or alcohol.  Consequences of coming-out in loss of familial support or peer relationships can further damage the psyche and contribute to a downward spiral of depression or substance use. 

Coming-out and self-disclosure

Counselors need to understand the coming out process, stages of sexual identity development (Cass, 1979) and how to incorporate these tools in the treatment setting.  Levels on which someone can “come out”include personal, interpersonal, social and public (James, 2012).  Self-disclosure can be one of the greatest challenges facing counselors who work with LGBTs. 

Many LGBTs have faced discrimination and outright rejection and as a result, are reluctant to disclose their sexual orientation in treatment. Some clients have experienced this discrimination and disapproval within the very service institutions that they have turned to for assistance: shelters, social service agencies and substance abuse treatment centers.  These negative experiences can have a lasting impact, making subsequent disclosures less likely and difficult to attain.  A client’s hesitancy to “come out” should be understood as the protective mechanism that it is for the client’s psychological and, in some cases, physical well-being.

Internalized Homophobia

Cheng (2003) highlights internalized homophobia as an explanation for the high rates of substance use and abuse among gays and lesbians, stating “many LGBT people…feel self-hatred”.  The use of mood-altering substances temporarily relieves but then reinforces this self-loathing in the drug withdrawal period…leading to a worsening of self-esteem” (Cabaj, 1996).  It is vital that LGBT clients have access to counselors who accept their sexual orientation.  It is equally important that these clients have treatment that considers and is sensitive to their unique situation as sexual minorities. 

Stages of Coming Out

The personal stage of coming-out is when the person admits to themselves that they are, or might be gay, lesbian, bisexual or transgender.  They may or may not choose to tell another person, and may also keep this information to themselves.  There is no prescribed time limit on this, or other stages.  It can happen across the lifespan and the decision to come out is contingent on a myriad of factors.

In the interpersonal stage, the person tells other people that they are/might be lesbian, gay, bisexual or transgender.  There are no rules on who a person decides to tell.  It is usually someone they feel will not betray their confidence.  In the event the experience is negative, they may go back “into the closet,” choose to not tell other people, or they may continue to seek support.  Supporting and connecting individuals who are coming-out to others is critical to personal acceptance of a healthy sexual identity development.

Social coming-out pertains to the process of the LGBT person developing a group of friends, typically in loose, social settings such as the bar scene.  Online forums can be a mechanism to meet other LGBTs and develop a social network.  Online forums can be particularly helpful for people who live rurally, where coming-out and meeting others could be dangerous.




I appreciate everything about this post except for the all-too-common mistake made my many well-meaning folks to use the catchphrase "LGBT" when they really mean "LGB". There are frequent references to sexual orientation and identity in direct connection to this term throughout the article, without regard for the fact that a transgender person, while potentially ALSO grappling with sexual orientation and identity, is primarily (in their "T" role) grappling with gender identity/expression, and all of the things that accompany coming out as female or male when they've so far been considered the opposite sex.

Hi sparkjen,
While I certainly appreciate your response, using LGBT in this blog is intended to be inclusive of transgender individuals with regard to coming out issues. Gender identity is very different than sexual orientation, yet the coming out process and stigmatization of transgenders is similar to that of LGBs. My intent is to be inclusive, not use a catch-all-phrase. Apologies if you took it the wrong way. My not specifying gender identity in the blog relates to the fact that coming out with our identity (LGB or T) is very different than the experiences of being transgender. Drs. Eli Coleman and Walter Bockting's work on their coming-out model for transgenders follows a similar trajectory to that of the Cass Model. As a sexologist, I appreciate your concern and want to assure you that this particular blog is certainly not indicative of the larger spectrum of sexual and gender identity. Gender identity would actually be an excellent topic for one of our next blogs and I thank you once more for your bringing this to the forefront.

Yours in spirit,

Dr. James...




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

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