Degrees of LGBT Sensitivity Special Assessment Questions

In formulating a treatment plan for LGBT individuals with a substance abuse problem, some additional factors may need to be assessed. Following are a sample.

• Determine the individual’s comfort with being an LGBT person. Evaluate the person’s comfort level with his or her sexuality and expression of sexual feelings. If the person is a transgender individual, determine his or her level of comfort with, and acceptance of, that identity.

• If appropriate, determine the stage where the individual is in the coming-out process (whether as a gay, lesbian, bisexual, or transgender person). Learn about his or her experience and the consequences of coming out.

• Determine the extent of the individual’s support and social network, including whether there are any current relationships or past relationships and the individual’s relationship with his or her family of origin.

• Determine whether there are any health factors of concern, including the individual’s HIV status.

The substance abuse counselor can ask the same questions about alcohol or drug use as he or she uses for non-LGBT individuals. Specific information about the patterns of, and situations involved in, the use of alcohol and drugs by LGBT individuals can be helpful in planning treatment and preventing relapse. For example:

• Look at the most recent alcohol and drug use: Was it with family, friends, a significant other, a lover, or a date? With work colleagues? Where was it? At a circuit party? Alone? At a sex club or bathhouse? At a lesbian, gay, bisexual, or transgender bar or at a straight bar?

• Is there current or past intravenous or injection drug use? If so, what drugs are used? Are amphetamines (speed, crystal, crank) used? Are amphetamines used to enhance sexual intensity?

• What is the frequency of the alcohol and drug use? Does it correlate with the socializing?

• What is the drug of choice—the drug the client enjoys or seeks most? What does it seem to do or accomplish? Provide relaxation? Provide freedom from guilt? Enhance sexual behavior?

• If the client has a significant other, does that person believe there is a problem? Does he or she have his or her own substance abuse problems? Has the client had legal problems due to his or her use of alcohol and drugs, including driving under the influence? Has the client ever had legal problems related to sexual behavior or police harassment?

• Has the client ever been attacked or assaulted (gay bashed) because he or she was thought to be an LGBT person?

• Has the client had social problems or lost partners, family, or friends because of alcohol and drug use? Has there been domestic violence? Was it by a same-sex lover?

• Has the client had treatment in the past for substance abuse? If so, was his or her sexual orientation or sexuality discussed?

• What is the longest time the client did without alcohol and drug use, and what allowed that to happen?