Clinical Issues With Substance-Abusing Lesbians

Too little is written on the incidence, prevalence, and patterns of substance use among lesbians. Many formal studies have generalized from gay males to lesbians, whereas others have used unreliable sampling methods. In the literature that is available, certain risk factors are noted repeatedly, such as:

• The reliance of many lesbians upon women’s bars for socializing and peer support

• The interaction of sexism, stress, and substance use

• Issues related to coming out such as alienation from loved ones upon revealing one’s lesbianism, the emotional dissonance of “passing” as heterosexual, and the use of substances to reduce the anxiety of these conflicts

• The interaction of trauma (discriminatory experiences, physical or sexual assault because of one’s lesbianism) and substance use.

The traumas that lesbians may have suffered need to be recognized and understood as integral parts of their behavior, outlook, and emotional makeup. For example, the research findings of the National Lesbian Health Care Survey (Bradford, Ryan & Rothblum, 1994) reported that 21 percent of lesbians had been sexually abused as children and 15 percent as adults. (However, it is a myth that being sexually abused makes a woman a lesbian. That is false, even though some lesbians believe the myth.) For every lesbian client, the trauma of alcohol and drug abuse is added to the negative effects of homophobia and heterosexism. Finally, there may be other traumas, such as being African American or Latina in a prejudiced society. Attention to trauma issues may, therefore, be a key part of the overall recovery process of the substance-abusing lesbian.

In their 1997 review, Hughes and Wilsnack note some general patterns in lesbians’ use of alcohol, including:

• Fewer lesbians than heterosexual women abstain from alcohol

• Rates of reported alcohol problems are higher for lesbians than for heterosexual women.

• Drinking, heavy drinking, and problem drinking among lesbians show less decline with age than among heterosexual women.

Along with addressing the above concerns, counselors will find lesbian clients with a variety of issues as women and as homosexual persons. The roles partners and children play in the clients’ use of alcohol and drugs and recovery are particularly important (see chapters 2 and 6), as are confidentiality and legal concerns (see chapter 3).