Recommendations for Clinicians

To provide quality care for LGBT clients, treatment providers need to learn about sexual orientation and gender identity and how these are determined. Counselors need to know more about how LGBT individuals learn to acknowledge and accept their sexual orientation, about the stages of coming out, and about how to meet the needs of clients, regardless of sexual orientation. Counselors can help LGBT clients recover from substance abuse and addiction by being empathic, supportive, and nonjudgmental and assisting clients to:

• Integrate their sexual identity

• Become more self-accepting

• Heal from shame resulting from heterosexism, internalized homophobia, and substance abuse.

The counselor should help the recovering LGBT individual connect with a community that will help him or her heal, such as 12-step or other self-help groups, other LGBT individuals in recovery, and the client’s own family of choice. The counselors should learn to provide sensitive support for LGBT clients’ families and partners.

Counselors should remember that LGBT clients may have additional health concerns such as co-occurring mental illnesses, HIV/AIDS, STDs, liver disease, hormone-related issues, and hepatitis B or C. Counselors should screen for other health problems and for domestic violence. Any assessment should be framed with sensitivity.

Counselors must confront their own negative or ambivalent feelings about homosexuality and learn to provide quality care that is sensitive, supportive, and comprehensive.

It is a challenging task to provide services that are appropriate, accessible, cost-effective, and quality driven. The following section includes selected recommendations for achieving this goal.

• Counselors and treatment providers need to re-examine their treatment approaches and take steps to move them to LGBT-sensitive and supportive modalities.

• Internalized homophobia, anti-LGBT bias, and heterosexism may contribute to the use of alcohol and drugs by LGBT individuals. Providers should learn the effects of these negative biases on the LGBT individual and community and how to help LGBT clients affirm themselves and address negative feelings. A better understanding is needed of the interplay between sexual orientation and the socio-cultural context in relation to substance use, abuse, and treatment.

• Treatment providers should learn about substance abuse in the LGBT community. Substance use, especially alcohol, is often an integral part of the LGBT social life and is connected to sexual identity formation, coming out, and self-acceptance processes for many LGBT persons.

• Treatment providers should work at the individual client’s comfort level related to his or her sexual orientation issues and consider how the client’s feelings about his or her sexual orientation affect the client’s recovery.

• All staff and clients should not assume that stereotypes and myths about LGBT individuals are true. Each LGBT individual is unique.