(Because I am posting this online where anyone can access it, I have decided to take the actual name of the organization I work for out of the paper. I have replaced the name of the agency with the title: "The Organization")
I plan to design an anti-oppression project that combats institutional heterosexism at an Alcohol & Drug Recovery Organization, where I am employed. Gregory Herek, a psychologist who has conducted a great deal of research on negativity and stigma directed toward LGBT people, has defined heterosexism as “the ideological system that denies, denigrates, and stigmatizes any non-heterosexual form of behavior, identity, relationships, or community” (1995, p. 321). The organization cites their function on their website as: “Founded in 1973, The Organization is a private non-profit corporation located in Connecticut, providing high quality substance abuse treatment and recovery-supportive services. We operate a number of facilities, offering a wide range of services to help our clients achieve and maintain a life free of the destructive effects of chemical dependency.” (http://www.ct.org/mission.html). I argue that this organization is not effectively offering the wide range of services it claims to provide, because it operates as a heterosexist institution on account of the lack of training for the staff who serves this identity group, the absence of services provided to recognize this population’s presence, and address their unique needs. To eliminate heterosexism at The Organization, the corporation must incorporate training for the staff to increase sensitivity and awareness of LGBT clients and their concerns, add LGBT issues to quality improvement programs, and network with other LGBT community health care and treatment providers.
Studies indicate that, when compared with the general population, LGBT people are more likely to use alcohol and drugs, have higher rates of substance abuse, are less likely to abstain from use, and are more likely to continue heavy drinking into later life. (SAMHSA, 2001). As a case manager at their transitional residential facility, and a former clinician at their outpatient facility where I worked as an intern for a number of months; I have had experience working with a number of clients who identify themselves as a member of the LGBT community, and self-disclose personal histories that include an inability to remain clean and sober. After only working for this agency for one year and managing a number of LGBT self-identified clients, I have become increasingly aware of this identity group and how underrepresented it is in the agency. With little to offer them except the same services and treatment that is being provided to heterosexual clients, I have been forced to confront the fact that LGBT clients are in need of recognition and specialized care.
LGBT individuals face concerns related to substance use and abuse that are specific to their situation as sexual minorities. Connue R. Matthews and Mart M.D. Selvidge (2005) mention a number of concerns in their study titled “Lesbian, Gay, and Bisexual Clients’ Experiences in Treatment for Addiction” which include the process of identity formation and coming out, the stress of being part of a stigmatized minority group, and external homophobia that often leads to internal self-hatred. Estrangement from family and friends, lack of recognition of intimate relationships, social isolation and alienation, spiritual distress, and concerns related to sexual expression that are particularly applicable to this population. I would argue that The organization is falling short of fulfilling their mission statement which commits to: “Maintaining an array of comprehensive and integrated services which support the restoration of lives and the principles of recovery” (http://www.ct.org/mission.html). It is impossible for LGBT clients to practice principles of recovery and lead restored lives because they are not provided with comprehensive and integrated services that address their distinctive problems and provide them with relative principals for their recovery. The Organization also commits as a provider to following principles which include: “Services, to be effective, must be accessible, welcoming, empathic, hopeful, culturally-competent, comprehensive, continuous, integrated, responsive, and tailored to the need of the individual.”( http://www.ct.org/mission.html). Yet, this agency neglects to provide any services that are tailored for LGBT clients that are responsive of their needs. Services and treatment that address these client’s spiritual distress, external homophobia, estrangement from family, etc. are completely absent let alone short of welcoming or accessible. It is therefore apparent that The Organization has been perpetuating a heterosexist ideal since 1973 by failing to recognize a prevalent identity group within their client population when creating, implementing, and developing services and staff development in line with their principles and mission statement. If the agency had considered LGBT clients in their facilities then their agency declaration would have been false, this proves that this population has remained invisible to this organization, and as a result denied them access to services and specialized treatment that would result in better outcome possibilities for their recovery.
The Organization is not the only substance abuse treatment and recovery supportive service provider that fails to serve LGBT clients effectively. In a study of government-funded treatment facilities in New York City, (Hellman, Stanton, Lee, Tytun, and Vachon, 1989) found evidence that there was some insensitivity toward this population. Participants in their study reported a lack of information and training in working with LGB clients. They also indicated that counselors frequently failed to address issues related to sexual orientation and were not inclined to refer these clients to other clinicians who might have specialized training. Ratner (1993) reported that 53% of clients entering the Pride Institute, an inpatient treatment facility for lesbian, gay, and bisexual addicts, reported previous inpatient treatment experiences that did not address sexual orientation. Seventy-four percent of the clients in treatment at the Pride Institute for at least five days were abstinent from alcohol and 67% were abstinent from other drugs at 14-month follow up (Ratner, Kosten, & McLellan, 1991, as cited in Cabaj, 1997). As a full time employee and one that has had experience working in more than one facility in the corporation, I can attest to the lack of specialized training that I and my colleagues have had to adequately address issues pertinent to LGBT clients. This study in addition to my experiences and observations as an employed member of the agency reveals the importance of improving The Organization's ability to work successfully with this population.
I propose to begin a committee at the agency which will help organize strategies to improve The Organization's ability to provide adequate treatment and services to LGBT clients. I will send an agency wide e-mail in order to recruit committee members and I will require bi-weekly meeting attendance from them. The goals of the committee will focus on staff development and training, community networking, and quality improvement tactics. The committee will be expected to become a member of The Association of Lesbian, Gay, Bisexual and Transgender Addiction Professionals and Their Allies (NALGAP) which cite on their website that their goals are: “to create alliances with LGBTQ and other professional organizations to ensure that issues specific to LGBTQ tobacco, alcohol, and drug abusing and addicted clients are addressed and to ensure that LGBTQ clients receive respectful and culturally competent services; and to ensure that the chemical dependency field create a safe and supportive atmosphere for staff members an clients who may be lesbian, gay, bisexual or transgender” (http://www.nalgap.org/). The membership will yield services and activities that include a web site with current information and new events, involvement in national education, training, and consultation, referrals to treatment, and a clearinghouse on LBTQ substance abuse. Becoming a member of this organization will allow The Organization to become part of a national movement toward more affirmative practices for LGBT clients. Membership will also increase The Organization's validity and fulfill the agency’s commitment listed in its vision statement to being an innovator in the design and implementation of additional services as partnerships in the community and with those in recovery indicate are necessary (http://www.ct.org/mission.html).
Staff development and training is crucial to improving care and treatment for LGBT clients. Substance Abuse and Mental Health Services Administration (SAMHSA) produced A Provider’s Introduction to Substance Abuse Treatment for Lesbian, Gay, Bisexual, and Transgender Individuals (2001) which explains that few programs are LGBT affirmative, they do not actively promote self-acceptance of an LGBT identity as a key part of recovery. LGBT affirmative programs affirm LGBT individuals’ sexual orientation, gender identity, and choices; validate their values and beliefs; and acknowledge that sexual orientation develops at an early age. An LGBT-affirmative program, the Pride Institute, released data showing a very successful treatment rate when acknowledging one’s sexual orientation is considered a key factor in recovery (Ratner, Kosten & McLellan, 1991). At a 14-month follow up with verified reports, 74 percent of all patients treated 5 or more days abstained from alcohol use continuously, and 67 percent abstained from all drugs. It is not only important that the staff become aware of LGBT clients and their issues but that they become affirmative treatment and care providers, able to adequately encourage their client’s best chance at success in recovery.
Additionally, strategies for staff training and development at The Organization may include requiring staff attendance at trainings provided by The Department of Mental Health Services (DMHAS) that address how to work effectively with LGBT clients. DMHAS trainings are provided at no cost to employees and are offered on a recurring basis which could allow for all employees to attend. The committee may also collaborate with Jessica Parker, the director of agency training at The Organization to negotiate using a part of the training budget to recruit experts in the field to provide on campus training for staff to develop LGBT affirmative practices. Additionally, a negotiation may take place for funds to be allocated to the gathering of LGBT treatment provider tools such as the SAMSHA guide or NALGAP’s recommendation of “A Provider’s Introduction to Substance Abuse Treatment for Lesbian, Gay, Bisexual and Transgendered Individuals: Training Guide” (2001) developed by The University of Iowa and also supported by SAMSHA. These tools can be used in the treatment facilities in the agency by the clinicians, and yield an adequate surplus of material for the creation of LGBT specific treatment group and individual sessions. It would be the committees’ responsibility to organize and implement these efforts.
It is necessary for The Organization to create linkages and network with local LGBT community services, and use appropriate referral sources and resources for LGBT clients. In order to fulfill this goal it will be the responsibility of the committee to:
• Research LGBT specific NA and AA meetings in Hartford County.
• Recruit self-identified LGBT folks in recovery who are willing to speak at agency 12-step meetings and serve as guest speakers during intensive outpatient sessions.
• Encourage self-identified LGBT employees to serve on the committee.
• Research local outpatient facilities that offer LGBT affirmative treatment.
• Stay updated on local LGBT and PFLAG tailored political, activist, health, recovery, and social events; and advertise them by posting flyers throughout the agency.
• Provide pamphlets and post flyers advertising local LGBT specific services inside all of the agency buildings.
• Visit other agencies that identify themselves as providing LGBT affirmative treatment to gather ideas and additional resources.
In the book titled: Social Work Practice with Lesbian, Gay, and Transgender People author Gerald P. Mallon (1998) capitalizes on the importance of promoting community building with LGBT individuals. He states that it decreases the feelings of isolation and alienation by promoting pride and empowerment. He goes on to further emphasize that these changes are essential for individuals who have been trivialized and marginalized by mainstream society, isolated from one another, and often rejected by heterosexual and/or non-transgender family and friends. Mallon also cites that social support has been associated with factors of mental health, as those with less support and more isolation have more mental health problems (Ayala & Coleman, 2000; Turner, Hays, & Coates, 1993; p.316). Connecting clients with services that are tailored to their needs, helping them become involved in LGBT affirming activities, connecting them to leaders in their identity group, and with other self-identified LGBT people in recovery will greatly improve their chances of prolonged abstinence and success.
Once the committee is created and The Organization as an agency becomes responsible for recognizing and adequately serving its LGBT clients, it will be necessary to monitor how well treatment and care is being provided to them. SAMSHA’s treatment provider guide dedicates a chapter to quality improvement which offers suggestions on how to incorporate an evaluation of substance abuse services for lesbian, gay, bisexual, and transgender clients. Using this guide it will be the responsibility of the committee to:
• Create client satisfaction survey’s based on already existing models such as the one offered in the SAMSHA treatment provider guide.
• Determine how the surveys should be distributed and collected with respect to client confidentiality.
• Evaluate the surveys, determine factors and processes that impact satisfaction, and identify priorities for improvement.
• Keep surveys on record and monitor changes over time.
• Determine an appropriate approach to collecting baseline information on percentage of LGBT clients using the facility to analyze average percentage of LGBT client’s represented in the agency, and increasing or decreasing readmissions.
These quality improvement tactics are essential to measuring the processes and outcomes of implementing LGBT services and care. It will also confirm the necessity of budget use for the committee as the need for LGBT services and care becomes realized through concrete qualitative and quantitative data produced by these efforts. These strategies will also be useful in determining how successful LGBT affirmative practices in the agency are as well as how they can be further improved.
I plan to request a meeting with the Chief operating officer (COO) of The Organization to propose this plan for eradicating heterosexism at The Organization. With his approval I will be able to launch my efforts immediately and begin recruiting for the committee. I trust that once the COO is confronted with contradictions in the agency’s mission statement and principles pertaining to LGBT clients, that a desire to address this conflict will warrant support for the project. If approval to launch such efforts is denied, and treatment services and care for LGBT clients continues to be ignored, I will contact the media and express my disappointments. The agency will then be confronted publicly for their inadequacy and will be forced to address their heterosexist practices. As a social worker, I refuse to cooperate in the oppression of any identity group, and feel responsible for creating empowering change in the lives of those who are not receiving the care and services they deserve.
References
Cabaj, R. P. (1997). Gays, Lesbians, and Bisexuals. In J. H. Lowinson, P. Ruiz, R. B.
Millman, & J. G. Langrod (Eds.), Substance abuse: A comprehensive textbook
(pp. 725-733). Baltimore, MD: Williams and Wilkins.
Harper, Gary W. (2007). A Journey Toward Liberation: Confronting Heterosexism and the
Oppression of Lesbian, Gay, Bisexual, and Transgendered People. Journal of Gay & Lesbian Psychotherapy, 11(3), 99-119. doi: 10.1300/J236v11n03_06
Hellman, R. E., Stanton, M., Lee, J., Tytun, A.,& Vachon, R. (1989). Treatment of homosexual
alcoholics in government-funded agencies: Provider training and attitudes.
Hospital and Community Psychiatry, 40, 1163-1168.
Herek, G.M. (1995). Psychological heterosexism in the United States. In A.R. D'Augelli & C.J.
Patterson (Eds.) Lesbian, gay, and bisexual identities across the lifespan: Psychological perspectives (pp. 321-346). Oxford University Press.
Mallon, Gerald P. (1998). Social Work Practice with Lesbian, Gay, and Transgender People.
New York: The Haworth Press, Inc.
Mathews, Connie R & Selvidge, Mary M.D. (2005). Lesbian, Gay, and Bisexual Clients
Experiences in Treatment for Addiction. Journal of Lesbian Studies, 9 (3), 79-90. Retrieved from: http://newperspectivesforyou.com/LGB_TxtmntExper.pdf
Substance Abuse and Mental Health Services Administration. (2001). A Provider’s Introduction
to Substance Abuse Treatment for Lesbian, Gay, Bisexual, and Transgender Individuals. Retrieved from Substance Abuse and Mental Health Services Administration website: http://kap.samhsa.gov/products/manuals/pdfs/lgbt.pdf
