If a client is identified as either a batterer or a survivor of interpersonal violence, he or she should be referred to a support group, to a batterers’ intervention program, and for ongoing consultation with an expert in the treatment of domestic violence (CSAT, 1997c). Exactly how to refer survivors depends on the situation. If immediate danger is present, suspend the interview. The provider should be familiar with deescalation methods and have established links with other treatment providers and police (CSAT, 1997c). The practitioner should be aware of available resources with expertise in interpersonal violence and LGBT issues.
Past trauma has been associated with subsequent substance abuse. For many in the LGBT community, trauma not only results from childhood physical and sexual abuse but also from internalized homophobia, cultural heterosexism, and gay bashing. It is important for the practitioner to consider these issues as LGBT clients move toward abstinence because they can be powerful relapse triggers.
Just as substance abuse does not cause or excuse violent interpersonal behavior, HIV infection does not cause battering. Unfortunately, many in the LGBT community who are assaulted by their HIV-infected partners blame the stress of HIV infection for the violent behavior (Letellier, 1996). Treatment providers should not collude in this denial of responsibility and should consider the comorbidity of HIV infection, interpersonal violence, and substance abuse in planning assessments and interventions.
The treatment for both substance abuse and interpersonal violence should be conducted concurrently. The fundamental goal of treatment for both is to create, nurture, and strengthen the individual’s capacity to maintain intimate relationships that are free of violence (Byrne, 1996) and substance abuse.
The skills used in assessing substance abuse are useful for assessing interpersonal violence, regardless of the client’s sexual orientation. A practitioner is likely to encounter the same defensive strategies (e.g., denial, defensiveness, blame). Assessment and intervention strategies do not require new theoretical approaches or skills. However, the practitioner must consider the safety of the victim and perhaps the practitioner’s own safety when intervening. The same competencies and approaches can be used with LGBT individuals. Successful treatment outcomes for LGBT individuals depend on creating an open and trusting atmosphere, taking care not to make hetereosexist assumptions, and having an understanding of the importance of confidentiality and disclosure issues. Working with LGBT individuals requires a thorough knowledge of the effects of cultural heterosexism on the LGBT client and the use of existing empirically derived practice skills.