Article

Substance Abuse Treatment Providers' Explicit and Implicit Attitudes Regarding Sexual Minorities

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Abstract

Lesbian, gay, bisexual, and transgender (LGBT) individuals have been found to have elevated rates of substance use disorders when compared with heterosexuals. However, little is known about the challenges a sexual minority might face in presenting for substance use treatment. In this study, treatment providers' attitudes toward LGBT individuals were assessed among a sample of 46 substance abuse treatment counselors who provide publicly funded treatment. Participants completed both explicit measures of heterosexist bias and an implicit measure designed to assess for biases that exist at an automatic, uncontrolled level. Results indicate that treatment counselors' negative biases regarding LGBT individuals were stronger for heterosexual counselors and for those with few LGBT friends. However, biases among this sample were significantly less than in comparison samples. Findings were also related to a newly developed measure of cultural competence in working with LGBT substance users. Implications for provision of appropriate services and recommendations to treatment agencies are discussed.

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... Prior studies have examined healthcare providers' explicit biases regarding sexual minorities, including those of social workers (Berkman and Zinberg 1997;Logie et al. 2007), psychologists (Hayes and Erkis 2000), psychiatric nurses (Smith 1993), and physicians (Téllez et al. 1999). Recent research has described both the explicit and implicit attitudes of substance abuse treatment providers (Cochran et al. 2007), first year medical students (Burke et al. 2015), physicians, nurses, mental health providers, and other non-diagnostic providers (Sabin et al. 2015). Genetic counselors represent a group of healthcare professionals whose attitudes have yet to be characterized, yet data on genetic counselors' and genetic counseling students' implicit and explicit attitudes toward homosexuality would be of value for a number of reasons. ...
... and (iii) a majority of participants will express support for the implementation of genetic counseling curricula addressing LGBT issues (Cochran et al. 2007;Glessner et al. 2012;Sabin et al. 2009Sabin et al. , 2015. ...
... Self-reported sexual orientation was found to have a significant effect on D score, such that participants who identified as bisexual or homosexual/gay/lesbian demonstrated significantly weaker biases than participants who identified as heterosexual/ straight. Previous studies have also found that heterosexual substance abuse treatment providers (Cochran et al. 2007), physicians, nurses, mental health providers, and other non-diagnostic providers (Sabin et al. 2015) typically hold more negative implicit attitudes toward gay men and lesbian women than sexual minority healthcare providers. Similar trends of implicit bias favoring ones' ...
Article
Members of the lesbian, gay, and bisexual (LGB) community experience significant health disparities. Widespread preferences for heterosexual over homosexual people among healthcare providers are believed to contribute to this inequity, making recognition (and ultimately reduction) of healthcare providers’ sexual prejudices of import. The present study sought to characterize North American genetic counselors’ and genetic counseling students’ implicit and explicit attitudes toward homosexuality. During January 2017, 575 participants completed a Web-based survey and Sexuality Implicit Association Test (SIAT). A majority of participants (60.2%) harbored implicit preferences for heterosexual over homosexual people. Mean implicit attitude score (0.24) indicated a slight automatic preference for heterosexual over homosexual people, while mean explicit attitude score (0.033) indicated no preference for either group. Although participants’ implicit and explicit attitudes were positively correlated (p < 0.001), there was greater implicit bias for heterosexual over homosexual people than suggested by explicit attitude scores (p < 0.001). Implicit attitudes differed across self-reported sexual orientation (p < 0.001), but not across gender, race, or genetic counseling specialty. Education has been demonstrated to be moderately effective at reducing sexual prejudices, and almost all participants (95.8%) indicated that they would support the implementation of genetic counseling curricula addressing lesbian, gay, bisexual, and transgender (LGBT) issues. The study’s combined findings suggest that North American genetic counselors and genetic counseling students support, and may benefit from, the implementation of genetic counseling curricula addressing LGBT issues.
... 31---33 In-group membership and in-group favoritism are a basic component of human nature, 34 and psychologists believe that modern discrimination may be the result of "in-group" favoritism, rather than overt hostility. 35 Little research has been published about health care providers' implicit attitudes toward members of sexual minority groups. We found no studies of physicians', nurses', dentists', or other providers' implicit attitudes toward lesbian women and gay men. ...
... 32,38 Similar weak implicit sexual orientation preferences may indicate one potential benefit of diversity in the health workforce. In health care systems and organizations that employ LGB professionals, "in-group" favoritism, which advantages people through acts of favoritism, rather than overt hostility, 35 may help reduce discrimination in health care toward lesbian and gay people. ...
... For health care organizations that aim to serve these populations, these data suggest an opportunity to examine methods likely to mitigate implicit biases, such as eliminating discretion from decision-making, use of clinical guidelines, awareness of personal bias as self-caution, organizational policies that promote objective decision-making, and inclusion of counterstereotypical experiences in educational programs. 35,71 It is possible that these methods may improve patient---provider communication, patient trust and satisfaction, continuity and timeliness of care, and other areas that can maximize quality of care for all. j ...
Article
We examined providers' implicit and explicit attitudes toward lesbian and gay people by provider gender, sexual identity, and race/ethnicity. We examined attitudes toward heterosexual people versus lesbian and gay people in Implicit Association Test takers: 2338 medical doctors, 5379 nurses, 8531 mental health providers, 2735 other treatment providers, and 214 110 nonproviders in the United States and internationally between May 2006 and December 2012. We characterized the sample with descriptive statistics and calculated Cohen d, a standardized effect size measure, with 95% confidence intervals. Among heterosexual providers, implicit preferences always favored heterosexual people over lesbian and gay people. Implicit preferences for heterosexual women were weaker than implicit preferences for heterosexual men. Heterosexual nurses held the strongest implicit preference for heterosexual men over gay men (Cohen d = 1.30; 95% confidence interval = 1.28, 1.32 among female nurses; Cohen d = 1.38; 95% confidence interval = 1.32, 1.44 among male nurses). Among all groups, explicit preferences for heterosexual versus lesbian and gay people were weaker than implicit preferences. Implicit preferences for heterosexual people versus lesbian and gay people are pervasive among heterosexual health care providers. Future research should investigate how implicit sexual prejudice affects care. (Am J Public Health. Published online ahead of print July 16, 2015: e1-e11. doi:10.2105/AJPH.2015.302631).
... This type of environment could impact the affirmative attitudes and behaviors that counselors need to have when treating gay, lesbian, bisexual, and transgendered clients (Matthews, Selvidge, & Fisher, 2005). Research has also indicated that heterosexual substance abuse counselors endorsed negative, implicate biases toward gay and lesbian individuals (Cochran, Peavy, & Cauce, 2007a). Furthermore, "both male and female gay/bisexual substance abuse clients have reported feeling less connected, less therapeutically supported, and less satisfied with treatment then heterosexual counterparts" (Senreich, 2010, p. 161). ...
... In fact, substance abuse treatment programs and practitioners may not be familiar with or sensitive to trans issues, leaving the addiction needs of transpeople unmet (Lombardi, 2007). In studies that have been targeting the LGBTQ perspective, the transgendered voice is often underrepresented (Cochran et al., 2007a). Additionally, "transgender individuals may experience the most stress [of other LGB groups] given that the coming out process may include a redefinition of the self as a gender different from one's biological sex" (Cochran et al., 2007a, p. 66). ...
Article
A focus on consistent use of technological mechanisms for entertainment and communication practice appears commonplace for the adolescents of today. Counseling practitioners may view these practices as less valuable than the traditional art of face to face communication practiced in earlier decades. The value adolescents place on technological means may create implications for counseling practice regarding rapport, goal setting, and empathy. These authors discuss the digital native phenomenon and perspective, along with implications and suggestions for counseling practice in a digital native world.
... Studies suggest that clinicians, like those in the general population, hold negative implicit biases regarding lesbian, gay, bisexual, transgender, queer, intersex, and all sexual and gender minority (SGM) people. [8][9][10][11][12][13][14] Clinician implicit bias against stigmatized groups has been shown to adversely affect patient-clinician interactions, clinical decisions, and patient perceptions of care. Through these pathways, implicit bias may negatively influence patient outcomes. ...
... Studies using the IAT have consistently indicated that heterosexual healthcare professionals of diverse ages and races/ethnicities prefer heterosexual people over lesbian/gay people. [8][9][10][11][12][13][14] This preference exists even among those who do not express explicit bias toward sexual minorities. 11 The IAT does not yet have a test for gender identity bias, and we are unaware of research that has looked at implicit bias and gender identity. ...
Article
Background Implicit bias is an ingrained, unconscious cultural stereotype that can negatively affect a person’s interactions with members of stigmatized groups, including sexual and gender minorities (SGM). Clinician implicit biases may negatively impact the quality of patient care. Objective and Methods This article uses four case scenarios to illustrate how implicit bias among psychiatrists and other clinicians can affect patient-clinician communication and diminish the quality of health care provided to SGM people. We offer strategies for clinicians to recognize, challenge, and address implicit bias. Discussion Through continuing education, self-reflection and practice, psychiatrists and other clinicians can improve communication and foster more affirming care experiences for their SGM patients, with the ultimate goal of addressing and ultimately eliminating SGM health disparities.
... Of the 46 substance abuse treatment counselors, ten of whom identified as sexual minorities and four marked other, gay men scored as having the most positive attitudes toward sexual minorities, lesbians; heterosexual men and then heterosexual women counselors followed (Cochran, Peavy & Cauce, 2007). ...
... Two other independent variables that show similar statistically significant correlations within the research and with the MHS -G in this study were sexual orientation and knowing more different types of sexual minorities (gay, lesbian, and/or bisexual) as well as knowing ones in different categories such as student, co-worker, self, or other. Teachers who reported being non-heterosexual showed less homonegativity than their heterosexual counterparts, which is consistent with past research (Banse, et al., 2001;Cochran, et al., 2007). Teachers who knew more types of sexual minorities as well as ones in more different categories showed a more positive attitude toward nonheterosexuals. ...
Article
Research has shown that lesbian, gay, and bisexual youth have increased rates of physical and mental health problems primarily due to the chronic stress incurred by the levels of prejudice and isolation experienced in their environment, especially in Southern States. Teachers are the most available and sought after adults by sexual minority students, helping them to mitigate such toxic environments. In this study, the aim was to examine the relationship between implicit and explicit attitudes of homonegativity and the moderating role of motivation to control prejudiced reactions among teachers in Southern states. Additional information was gathered about the teachers’ school environment in regard to protective factors that were or were not in place for sexual minority students and possible resources that they perceived would be helpful in establishing a more positive environment for these students. Correlations were found between the Implicit Association Test (IAT), Modern Homonegativity Scale (MHS), and the Internal (IMS) and External (EMS) Motivation to Respond without Prejudice measure among other variables. Further, information was obtained that verified that the majority of these schools lacked needed protective factors to help sexual minority students navigate their environment safely.
... This type of environment could impact the affirmative attitudes and behaviors that counselors need to have when treating gay, lesbian, bisexual, and transgendered clients (Matthews, Selvidge, & Fisher, 2005). Research has also indicated that heterosexual substance abuse counselors endorsed negative, implicate biases toward gay and lesbian individuals (Cochran, Peavy, & Cauce, 2007a). Furthermore, "both male and female gay/bisexual substance abuse clients have reported feeling less connected, less therapeutically supported, and less satisfied with treatment then heterosexual counterparts" (Senreich, 2010, p. 161). ...
... In fact, substance abuse treatment programs and practitioners may not be familiar with or sensitive to trans issues, leaving the addiction needs of transpeople unmet (Lombardi, 2007). In studies that have been targeting the LGBTQ perspective, the transgendered voice is often underrepresented (Cochran et al., 2007a). Additionally, "transgender individuals may experience the most stress [of other LGB groups] given that the coming out process may include a redefinition of the self as a gender different from one's biological sex" (Cochran et al., 2007a, p. 66). ...
Article
Full-text available
Group work has been a staple of substance abuse treatment for many decades. This article overviews how several different types of therapeutic groups are helpful treatment modalities for lesbian, gay, bisexual, transgendered, and queer clients (LGBTQ) who struggle with substance abuse disorders. This article discusses particular issues facing the LGBTQ community regarding substance abuse and addresses how several different types of groups can benefit this population. Additionally, suggestions and resources for counselors working with this population are offered.
... On the other hand, "explicit biases" are self-reported associations and attitudes consciously held by an individual. In recent years, research has focused on the role of healthcare provider bias as a contributor to unequal treatment plans and health disparities (Smedley et al. 2003;Cochran et al. 2007;Dovidio and Fiske 2012;Sabin and Greenwald 2012;Chapman et al. 2013;Hall et al. 2015;Phelan et al. 2015;van Ryn et al. 2015). ...
... Few studies have focused on the magnitude and impact of provider bias on LGBTQI þ health (Cochran et al. 2007;Sabin et al. 2015). It has been well documented that implicit preference for straight people is pervasive among straight providers regardless of field of specialty (Sabin et al. 2015). ...
Article
Full-text available
Purpose: This study assessed the: (1) effect of an LGBTQI + health equity curriculum (eQuality) on implicit attitudes among first (M1) and second year (M2) medical students and (2) utility of dedicated time to explore implicit bias. Method: Implicit biases were assessed at baseline using implicit association tests (IAT) for all M2s and a random sample of first years (M1A). These students were then debriefed on strategies to mitigate bias. Following eQuality, all M1 and M2s completed post-intervention IATs. The remaining first years (M1B) were then debriefed. Paired sample t-tests assessed differences between pre/post. Independent sample t-tests assessed differences in post-IATs between M1 groups. Results: IATs indicated preferences for “Straight,” “White,” and “Thin” at both pre and post. M2s demonstrated statistically significant improvements pre to post for sexuality (p = 0.01) and race (p = 0.03). There were significant differences in post-intervention IAT scores between M1As who received the IAT and debriefing prior to eQuality and M1Bs for sexuality (p = 0.002) and race (p = 0.046). There were no significant changes for weight. Conclusion: eQuality reduced implicit preference for “Straight” and “White.” Differences in M1 post-intervention IAT scores between groups suggest dedicating time to debrief implicit attitudes enhances bias mitigation.
... However, within high-resource regions, SGM people may be more concentrated in cities that have fewer resources (Lee et al., 2018), indicating that treatment availability may continue to be a concern for SGM people even if improvements are made in regional facility availability. SGM people also often report sexual orientationbased stigma from treatment providers when seeking substance use treatment (Cochran, Peavy, and Cauce, 2007;Drabble and Eliason, 2012;Lyons et al., 2015;Scheer et al., 2022aScheer et al., ,2022b. Thus, in addition to considering logistical availability and accessibility concerns, it is important to address other potential barriers, such as substance use treatment providers' abilities to provide SGM-affirming care. ...
Article
Background Syndemics (i.e., multiple, co-occurring, and synergistic conditions) contribute to elevated substance use among sexual and gender minority (SGM) people relative to heterosexual, cisgender people. Research suggests that syndemic-informed and SGM-tailored treatments are effective in substance use treatment among SGM people. However, few studies have examined 1) the proportion of substance use treatment facilities offering syndemic-informed, SGM-tailored treatment programming; and 2) the availability and accessibility of syndemic-informed, SGM-tailored treatment programs across the U.S. Methods We used the 2020 National Survey of Substance Abuse Treatment Services (N-SSATS) dataset to perform a latent class analysis examining whether substance use treatment facilities’ tailored treatment programs cluster together to form distinct classes indicating whether facilities offer syndemic-informed and SGM-tailored programming. We then used multinomial logistic regression to examine associations between class membership and facility availability and accessibility. Results Analyses revealed four classes of substance use treatment facilities’ tailored programs. Facilities with syndemic-informed and SGM-tailored treatment programs compared to facilities with no tailored programs were more likely to be in the Northeast compared to the Midwest and South; to offer payment assistance versus not offer payment assistance; and to be private, for-profit facilities versus public or non-profit facilities. Conclusions This study’s findings identify the need for more facilities with syndemic-informed and SGM-tailored treatment, particularly in the Midwestern and Southern U.S. regions. Facilities offering syndemic-informed and SGM-tailored treatment might present accessibility barriers for low-income SGM people, as they were more likely to be private, for-profit facilities; however, they were more likely to offer payment assistance.
... Canada have an ethical obligation to be competent in interventions and to promote social justice and empowerment among marginalized and oppressed groups, including lesbian, gay, bisexual, and transgender (LGBT) individuals (Canadian Association of Social Workers[CASW], 2005; National Association of Social Workers[NASW], 1999). Yet, homophobia and heterosexism are well documented among health and human service practitioners (Berkman &amp; Zinberg, 1997;Cochran, Peavy, &amp; Cauce, 2007;Harris, Nightengale, &amp; Owen, 1995;Krieglstein, 2003;Peterson, 1996;Swank &amp; Raiz, 2008). These negative attitudes among social work practitioners have been attributed in part to the lack of LGBT content in professional social work education (Bergh &amp; Crisp, 2004;Longres &amp; Fredriksen, 2000;Morrow &amp; Messinger, 2006). ...
Article
Full-text available
This article presents findings from the first national surveys of United States and English-speaking Canadian MSW social work faculty examining their support of curriculum content on sexual orientation and gender identity. Faculty in either country are generally supportive of including LGBT content but report significantly more support for content on LGBT populations as compared to the types of oppression experienced. Significant predictors of support for LGBT content include being female, younger, non-White/non-European, having positive LGBT social attitudes, and the availability of resources on transgender-related issues. The findings suggest that faculty development should address the social attitudes among faculty as well as integrate gender identity into diversity discourse in social work education.
... LGBT persons who are in need of treatment for SUDs face several substantial dilemmas: (a) a lack of culturally relevant trained staff and specialists, (b) staff members and clients who will attempt to impose their own ideological beliefs on them, (c) programs that do not address issues related to sexual identity or gender expression, and (d) programs that do not address issues related to traumatic childhood experiences (Cochran et al. 2007). In a survey of substance abuse treatment providers' attitudes and knowledge about LGBT clients, ATTC (n.d.) found half had no education about lesbian, gay, and bisexual persons, and 80 % had no education regarding transgender persons. ...
Article
Substance use disorders (SUDs) and mental health problems frequently co-occur. SUDs are one of the most common psychiatric diagnoses in older adults. The purpose of this chapter is to discuss SUDs among LGBT elders. Information is presented on the scope of SUDs, prevalence and patterns of use, SUDs and aging comorbidity, assessment, diagnosis, and treatment of LGBT elders. This chapter provides the reader with a baseline for understanding issues that impact and influence LGBT elders’ substance use. There is no suggestion that LGBT status is synonymous with addiction or mental illness disorders. Thus, the chapter explores the extent to which SUDs exist among LGBT elders.
... For example, let us consider oppression and prejudice toward sexual minorities. Counselors and counselor educators operate in a heteronormative culture (Montgomery & Stewart, 2012), wherein even the most well-intentioned counselors who identify as affirming toward sexual minorities have internalized heterosexism and may hold implicit bias against persons who identify as LGB (Boysen, Vogel, & Madon, 2006;Cochran, Peavy, & Cauce, 2007;Smith, 2009). Boysen (2010) suggested that heterosexism has been downloaded into one's phenomenological software without one's consent. ...
Article
Full-text available
The authors write a rejoinder to Sells and Hagedorn's () article, “CACREP Accreditation, Ethics, and the Affirmation of Both Religious and Sexual Identities: A Response to Smith and Okech,” which supports Smith and Okech's () assertion that a dialogue examining the Council for Accreditation of Counseling and Related Educational Programs' accreditation practices pertaining to counseling programs in institutions that disaffirm/disallow diverse sexual orientation is germane. The authors articulate the common ground they share with Sells and Hagedorn while also highlighting areas of dissension. © 2016 by the American Counseling Association. All rights reserved.
... The literature shows that academic training is associated with use of evidence-based practices (Aarons, 2005;Borntrager et al., 2009;Cochran, Peavy, & Cauce, 2007). Practitioners with a high school level of education reported using EBIs to a lesser extent than those with a college or graduate level of education. ...
Article
Full-text available
Health and social service practitioners have not readily incorporated research-based behavioral interventions in HIV prevention practice due to lack of awareness, lack of training, and challenges translating research findings into practice. Practitioners’ involvement in research is associated with their willingness to use research to guide practice. Likewise practitioners’ personal and organizational characteristics have been shown to be associated with use of research findings in practice. Factors associated with practitioners’ use of evidence-based interventions (EBIs) in HIV prevention, however are not well understood. While research involvement has been recommended to help practitioners overcome barriers to the use of EBIs, the types of research involvement that result in practitioners’ actual use of EBIs is not known. This is partly because most studies are either qualitative or quantitative and ignore the voices of practitioners, which can be best unearthed with qualitative research followed by survey research including larger numbers of participants. By using a mixed methods approach, this study fills this gap by showing associations between practitioners’ and organizational characteristics, specific areas of research involvement, and practitioners’ use of EBIs. The use of mixed methods was extremely helpful to integrate in-depth qualitative interview data from practitioners across 10 community-based agencies providing social and health services, with cross-sectional survey data from practitioners across 24 agencies in New York City. We used a sequential approach for data collection and a concurrent approach for data analysis, content analysis of in-depth interviews, and multivariate linear regression analysis. Practitioners who performed research tasks/procedures similar to their professional duties as well as their level of education, knowledge about EBIs, and their agency capacity were all positively associated with HIV evidence–based interventions. Training practitioners in research, engaging practitioners in research tasks that resemble their professional practices, and capacity building within organizations to foster academic-research partnerships could optimize practitioners’ use of EBIs.
... Eliason (2001) reaffirmed the notion that counselors may even attempt to treat their LGBT clients as they would their cisgender, heterosexual clients and, in doing so, would leave the individuals' sexual and gender identity and societal stigma invisible and unacknowledged. Finally, it is important to be ever mindful of how the counselor's attitude toward a client can affect the therapeutic process and ultimately the recovery of the client (Cochran, Peavy, & Cauce, 2007). Transgender clients may be highly susceptible to the level of acceptance they perceive from their counselor and will benefit greatly from a safe therapeutic relationship. ...
Article
Transgender individuals entering treatment for substance use disorders (SUDs) have unique needs and issues related to their gender identity. This article provides a lens for viewing trans-clients and demonstrates the need for trans-competent counseling through the use of a case study.
... This literature has examined past experiences, barriers, acceptability, and associations of attending treatment. 6,37,39,62,[65][66][67][68][69][70][71][72] Important considerations from this research have emerged for future substance use intervention design. Numerous barriers for transgender individuals seeking treatment have been found that should be addressed when designing substance use programs, including unknowledgeable personnel in substance use treatments on trans-specific realities and experiences, treatment providers having negative attitudes toward transgender individuals, victimization (e.g., verbal, physical, and sexual abuse by other clients and staff), discrimination (e.g., being required to wear only clothes judged to be appropriate for their birth sex), and little formal education for staff regarding the needs of transgender people. ...
Article
Full-text available
Persons who are transgender (i.e., individuals who are assigned one sex at birth, but who do not identify with that sex) are at elevated risk for developing problematic substance use. Recent studies indicate that transgender persons have high rates of alcohol use, illicit drug use, and nonmedical use of prescription drugs and evince more severe misuse of these substances compared with nontransgender individuals. Despite the high rates of substance use among transgender persons and the multiple conceptual and narrative recommendations for substance use treatments, there is a lack of consensus or awareness of empirically tested interventions and programs effective for this population. Thus, it is critical to examine current substance use interventions for transgender individuals to identify gaps in the field and to immediately put forth efforts to reduce problematic substance use. This systematic review is the first to attempt a comprehensive identification and synthesis of the available evidence on interventions for reducing problematic substance use among transgender persons. Reflective of the state of the field regarding transgender care for substance use, we found a deficiency of studies to include in this systematic review (n=2). Perhaps the most important conclusion of this review is that well-designed, theoretically informed culturally sensitive research focused on developing and rigorously testing interventions for substance use among transgender individuals is alarmingly scarce. This review discusses barriers to intervention design and synthesizes treatment recommendations for future work.
... However, students in this study did report feeling more prepared to practice with LGBT populations when there was implicit program support for LGBTQ students, explicit inclusion of content in courses, and when such topics were handled well during classroom and field discussions alike . Cochran, Peavy, and Cauce (2007) found that substance use counselors in the field showed fewer homophobic beliefs than undergraduate students sampled in the 1998 study by Raja and Stokes (1998), yet there was still a 'considerable range in the attitudes held by these counselors, ' (p. 201). ...
Article
Full-text available
Trends in the field of service among those with alcohol and other drug addictions highlight the urgent need for schools of social work to effectively train students to serve clients with substance use disorders, and have cultural humility to effectively serve disproportionately affected LGBT consumers. Online surveys and interviews examined perceptions of graduate social work students and alumni in a certified alcohol and drug counselor program, along with several service providers within an urban setting in the US. Results indicated that students and alumni did not feel adequately prepared through coursework to practice with LGBT populations affected by substance use, while feeling more clinically competent to practice with LGB individuals, than with transgender consumers. Similar findings related to unique differences associated with perceptions of faculty support, along with field preparedness to practice with LGB individuals when compared to transgender individuals. Service providers noted an overall commitment and to serve LGBT consumers as well as positive perceptions of students and alumni to do the same. Implications examine the role of faculty in addressing challenges related to preparation of social work students to practice with LGBT consumers affected by substance use disorders, along with suggestions for curricular changes, and ongoing field trainings.
... computed total scale scores for one or more factors of LGBT prejudice (the remaining five [17.2%] instruments appear to have been analyzed one item at a time). Four (16.7%) of these 24 scales did not provide any evidence of scale score reliability (Cochran, Peavey, & Cauce, 2007;Gandy, McCarter, & Portwood, 2013;Johnson & Federman, 2014;Sanchez et al. 2006). Additionally, while a Cronbach's alpha coefficient was provided for a 2- To illustrate: for the item, "Homosexuality (sex between men or between women) is an illness," the authors issued a numeric value of 1 if the participant's score on the five-point Likert scale provided was a three or higher. ...
Article
Prejudice and discrimination against LGBT individuals is widespread and has been shown to have negative consequences for sexual and gender minority persons’ physical and psychological well-being. A recent and problematic trend in the literature is to compositely measure prejudice toward and discrimination against LGBT persons. As such, a review of the psychometric properties of scales assessing, in a combinatory fashion, negative attitudes and/or behaviours toward LGBT persons is warranted. In the current study, 32 scales were identified and their psychometric properties were evaluated. Most of the scales reviewed did not provide sufficient information regarding item development and refinement, scale dimensionality, scale score reliability, or validity. Properties of the reviewed scales are summarized and recommendations for better measurement practice are articulated.
... Previous studies have suggested a range of strategies to enhance an LGBT individual's access to health services. Initiatives should involve education of staff on LGBT issues (Cochran, Peavy, & Cauce, 2007), establishment of specialist services for LGBT in place of generalist services (Senreich, 2010), inclusion of sexual orientation and more flexible gender options on intake forms (Eliason & Hughes, 2004), and the development by services of LGBTsensitive policies and programs (Leonard et al., 2008). Spector and Pinto (2011) recommend counselors and clinicians working in the alcohol and drug sector improve awareness and understanding of how dominant cultural beliefs and counter transference can impact the therapeutic relationship and treatment, for example substance use and HIV prevention. ...
Article
Background: Lesbian, gay, bisexual, and transgender (LGBT) populations are more likely to misuse alcohol and other drugs (AOD), compared to the general population. However, LGBT engagement with AOD treatment is often precluded by insensitivity and misunderstanding of LGBT issues. These treatment barriers may be a consequence of either worker attitudes, organizational factors or a combination of both. Few studies have compared service context as an impediment to AOD treatment. Objectives: This pilot study sought to examine and compare staff attitudes, knowledge and awareness of LGBT issues in two state-wide AOD services within Australia. One organization was a government service, whilst the other was faith based. Methods: A cross-sectional study of a convenience sample (N = 130) of workers employed in a state-wide government AOD service (n = 65), and a state-wide non-government service (n = 65) was conducted. Participants self-completed a questionnaire comprising tools previously used to assess staff attitudes, knowledge and awareness of LGBT issues. Results: Few significant differences in attitudes and awareness of LGBT issues between government and non-government respondents were found. Nearly all respondents were supportive of LGBT persons irrespective of organizational context, with a small number of negative views. Although most respondents demonstrated awareness of organizational policies and practices relating to LGBT clients, many were "unsure" or "neutral" of what these might be. Conclusion: It is confirming that the majority of staff report supportive attitudes towards LGBT clients. Findings suggest that organizations need to continue to take leadership to strengthen organizational training and capacity to deliver LGBT friendly AOD treatment practices.
... The importance of having such a wealth of literature to support counselors' work with sexual and gender minority populations cannot be overstated. Persons who identify as LGBT experience higher rates of suicide (Haas et al., 2010;Hatzenbuehler, 2011), homelessness (Cochran, Stewart, Ginzler, & Cauce, 2002;Keuroghlian, Shtasel, & Bassuk, 2014), mental illness (Kidd, Howison, Pilling, Ross, & McKenzie, 2016), sexually transmitted infections (Wolitski & Fenton, 2011), bullying (Abreu, Black, Mosley, & Fedewa, 2016;Earnshaw, Bogart, Poteat, Reisner, & Schuster, 2016), and discrimination from health providers (Cochran, Peavy, & Cauce, 2007;Jaffee, Shires, & Stroumsa, 2016;Sabin, Riskind, & Nosek, 2015). ...
Article
Despite the counseling field adopting holistic health and developmental frameworks, sexual health is often absent or underrepresented in these discussions. Via content analysis, the authors examined publications in three counseling journals to assess the current state of the sexuality literature in the field. Almost half (46.6%) of publications are on the topic of sexual identity. There are notable gaps in the literature on topics related to anatomy/physiology, sexual functioning, and pleasure/sexual lifestyle. Implications for counselors and counselor training are discussed.
... Although research surrounding the importance of prevention related to alcohol and substance use among sexual minority individuals continues to emerge (Goldbach, Tanner-Smith, Bagwell, & Dunlap, 2014;McCabe, Hughes, Bostwick, West, & Boyd, 2009), there is limited literature related to affirming prevention, treatment, and care for transgender people (Glynn & van Den Berg, 2017;Heck, Flentje, & Cochran, 2013) and assessment of using SBIRT among such populations. However, there is an emerging body of research examining the role of SBIRT and substance use among young sexual minority women (Corte, Matthews, Stein, & Lee, 2016) as well as practitioner and student preparedness for practice with gender and sexual minorities affected by substance use (Cochran, Peavy, & Cauce, 2007;Dentato, Kelly, Lloyd, & Busch, 2018;Gates & Sniatecki, 2016). A unique opportunity remains for research that modifies and tests the efficacy of using the SBIRT model with transgender young adults, as well as other gender and sexual minority populations. ...
Article
Full-text available
Transgender young adults are at higher risk for alcohol and substance use that could lead to other health and mental health complications. Utilization of the Screening, Brief Intervention, and Referral to Treatment (SBIRT) model might be effective to identify members of this minority community at risk for alcohol and substance use, provide early interventions for those not meeting diagnostic criteria, and link them to care. A tailored, peer-based approach to universal screening with SBIRT could offer affirming experiences for transgender young adults to openly discuss substance use within unique practice settings such as the house/ball community. In addition to examining health and mental health challenges faced by transgender young adults, implications for the field of social work practice, research, and education are discussed related to utilization of SBIRT with this minority population, along with providing a relevant case scenario.
... 35 There is an urgent need for treatment providers to be educated about gender and the needs of the transgender client, to overcome the stigma and discrimination that currently prevents engagement with these services. [74][75][76][77][78][79][80] Specialist services for transgender people who use drugs and/or specialist interventions in nonspecialist settings may be indicated. However, a recent systematic review highlighted that these appear to be lacking. ...
Article
Purpose The purpose of this study was to compare five gender groups (cisgender women, cisgender men, transgender women, transgender men, people with non-binary/other identities) on measures of use of and dependence on seven substances. Methods A two-stage approach to assessing gender allowed 126,648 participants from the 2018 Global Drug Survey to be classified to one of these five gender groups. Participants were asked to disclose use of each substance in the preceding 12 months. The Alcohol Use Disorder Identification Test and the Severity of Dependence Scale were used to assess dependence. Multivariable logistic regression generated odds ratios to measure the association between gender and each substance use/dependence outcome, with cisgender women as the reference group. Results The sample comprised 43,331 cisgender women, 81,607 cisgender men, 215 transgender women, 254 transgender men, and 1,241 people with non-binary/other identities. Relative to cisgender women, non-binary/other participants reported greater odds of last 12-month use of all substances (adjusted odds ratio (AOR)=1.66-2.93), except alcohol (lower odds; AOR=0.42), and greater odds of dependence on cannabis (AOR=2.39), 3,4-methylenedioxymethamphetamine (MDMA; AOR=1.64) and alcohol (AOR=3.28), adjusting only for age (all p<0.05). Conclusion Transgender 2018 Global Drug Survey respondents, particularly those with non-binary/other identities, had greater odds of reporting most substance use outcomes than cisgender women. These findings suggest a nuanced approach to gender reporting in surveys and treatment centres is required to understand the needs of transgender people who use substances.
... Researchers have documented ways in which traditional treatment programs often fall short with regards to the treatment of LGBT individuals. Relative to their heterosexual and cisgender counterparts, LGBT people who utilized conventional treatment services reported comparatively lower levels of satisfaction with care (Senreich, 2009), inconsistencies in counselor education regarding experiences with sexual minorities (Eliason & Hughes, 2004), and unfavorable attitudes of substance use counselors, including negative biases toward LGBTQ individuals (Cochran, Peavy, & Cauce, 2007). These experiences likely contribute to sexual and gender minorities in traditional treatment programs exhibiting lower completion rates because of unmet needs (Senreich, 2009). ...
Article
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This paper examines the factors that are associated with the availability of tailored programs for LGBT clients in substance use disorder (SUD) treatment facilities in the U.S. from 2008 to 2018. Associations were determined by using pooled odds ratios overtime from multivariable logistic regression modeling utilizing the 2008–2018 data from the U.S. National Survey of Substance Abuse Treatment Services (N-SSATS). In 2018, roughly one in five facilities had LGBT-specific programs; an increase of three-fold from 2008 to 2018. SUD treatment facilities that had other programs tailored for specific subpopulations, in the West, private for-profit, or owned by the federal government were more likely to have LGBT-specific programs. While the percentage of facilities offering LGBT programs increased three-fold from 2008 to 2018, differences in the characteristics of SUD treatment facilities that offer such programs remain. Eliminating these variabilities could expand tailored programs for LGBT clients in SUD treatment facilities in the U.S. and subsequently improve care quality for LGBTQ clients.
... Asimismo, el uso excesivo de alcohol y drogas que en nuestro estudio fue más alto entre participantes no identificados como gay, coincide con otro estudio reciente en América Latina (31). Los datos destacan la necesidad de implementar programas de tratamiento y prevención de abuso de sustancias adaptadas a las poblaciones HSH, ya que pueden ser reacios a participar en programas existentes por temor a ser discriminados o no entendidos por sus prácticas u orientación sexual (32)(33)(34). En este sentido, estudios previos han indicado que las intervenciones diseñadas específicamente para ellos resultan más efectivas por abarcar aspectos específicos de la comunidad gay (35). ...
Article
This article summarizes published findings from Project LINKS. A total of 500 men who have sex with men were recruited through Respondent Driven Sampling into this study on factors associated with HIV infection. Among participants, 24.5 % identified as gay, 36.2 % as bisexual, 21.9 % as heterosexual, and 17.4 % as "other"; 33 % reported having sex with men, women, and transgender women during the prior two months. Prevalence of HIV, Hepatitis B, and syphilis was 17.3 %, 22.9 %, and 20.5 %, respectively; rates were significantly higher among participants who only had male sex partners. Over two-thirds of participants reported unprotected anal or vaginal intercourse during the prior two months, and 52 %had never been tested for HIV. Twenty-five percent reported heavy drinking, and 34 % reported poly-drug use during the past two months. Eighteen percent of participants reported a sexual experience prior to the age of thirteen with a partner who was at least four years older. Acceptability of microbicides and HIV home testing was high.
... Several studies examined attitudes against homosexuality and transgender individuals and related factors. Many studies used standardized scales, such as the Attitudes Toward Lesbian and Gay Men (ATLG) Scale, 21,23,26,27 the Attitudes Toward Homosexuality Questionnaire (ATHQ), 14,31 the Index of Homophobia, 24 the Homophobic Scale, 25 the Modern Homophobic Scale, 29 the Modern Homonegativity Scale, 35 and the Affect Adjective Checklist. 41 The most frequently examined correlations between demographic variables and attitudes across all studies were gender, 25,29,42 religion, 23,26,29,35 occupation, 23,45 knowledge level, 26,27,31,43 sexual orientation, 26,42,45 and education level. ...
Article
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The present systematic review aimed to determine discrimination experiences of sexual and gender minority (SGM) individuals and attitudes toward SGM among health care staff in health care settings. Following PRISMA guidelines, the review was conducted in 3 databases (PubMed, Cochrane Library, Science Direct) using keywords of sexual and gender minority, including “gay,” “lesbian,” “bisexual,” “transgender,” “LGB,” “LGBT,” “health care discrimination,” “stigma,” “homophobia,” “transphobia,” and “attitudes of healthcare professionals” from May to September 2016. Predetermined inclusion criteria were selected. Thirty quantitative studies were eligible for inclusion in this review. Discriminative behaviors experienced by SGM individuals were stigma, denial or refusal of health care, and verbal or physical abuse. Knowledge and educational levels, beliefs, and religion of health care providers affected their attitudes toward SGM patients and their homophobia level. These findings revealed that health care providers needed more education about SGM issues, and SGM-friendly policies should be created for improving health care for SGM individuals.
... Further, surveys have demonstrated that only 5% of substance misuse service providers have formal education about the needs of trans clients and service providers have often made the incorrect assumption that "all transgender people are gay." Therefore, poor care likely results from a lack of knowledge among nonspecialist services providers (Cochran, Peavy, & Cauce, 2007;Eliason, 2000;Rachlin, Green, & Lombardi, 2008). ...
Article
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Introduction Transgender (trans) people experience stressors related to their minority status which have been associated with increased rates of psychoactive substance use and related harm. Despite this, there is a paucity of evidence relating to the treatment needs of trans people who use psychoactive substances, beyond a small body of literature describing a culture of transphobic hostility in general substance misuse services. This paper aims to describe and compare psychoactive substance misuse help-seeking among trans and cisgender (cis) participants from a large multi-national cross-sectional survey. Methods Over 180,000 participants, recruited from the world's largest annual survey of drug use - the Global Drug Survey - during 2018 and 2019, reported use of a range of psychoactive substances in the preceding 12 months. Five gender groups (118,157 cis men, 64,319 cis women, 369 trans men, 353 trans women and 1857 non-binary people) were compared on items relating to the desire to use less psychoactive substances and the need to seek help to achieve this. Results Trans respondents (n = 1710) to GDS 2018 were significantly more likely to report use of illicit substances (OR = 1.66–2.93) and dependence on cannabis (OR = 2.39) and alcohol (OR = 3.28). In the combined GDS 2018 and 2019 dataset, there were no significant differences between trans (n = 2579) and cis (n = 182,476) participants on the desire to reduce substance use. However, among those who did report wanting to use less, trans participants were more likely to want help to achieve this. Conclusion Trans respondents reported a greater need for help with reducing substance use than cis respondents. Given the deficit of specialist services for psychoactive substance users who are trans, there is a need for a more thorough understanding of the barriers and facilitators to their engagement in general substance misuse services. In the interim, substance misuse service providers require education about gender minority status to help meet the needs of trans clients.
... In the absence of any systematic major review of professional training programs, a number of well-conceived small studies suggest that social workers and other health care and medical providers are not adequately equipped to work successfully with LGBT populations because of insufficient training, biased attitudes, or lack of resources. B. K. Cochran, Peavy, and Cauce (2007) found that almost one in five substance abuse counselors did not feel adequately trained to deal with LGBT clients. Others have shown that many social workers and others in the counseling community are biased against LGBT populations or too poorly trained to adequately treat mental health and substance use problems among these groups (Anderson, 1997;DeCresenzo, 1984;Hellman, Stanton, Lee, Tytun, & Vachon, 1989). ...
Article
The impacts of public and private funding of lesbian, gay, bisexual, and transgender (LGBT) health research, the state of integration of LGBT health issues into the academic and professional training programs of health care practitioners, and the larger social reality experienced by LGBT people profoundly affect substance use and substance use disorders in those populations. This analysis uses a social work perspective and considers the current state of research, professional training, and social oppression as they affect the health of LGBT people. Suggestions for action are offered that may improve the health of LGBT peoples and the practice of social work.
... For example, let us consider oppression and prejudice toward sexual minorities. Counselors and counselor educators operate in a heteronormative culture (Montgomery & Stewart, 2012), wherein even the most well-intentioned counselors who identify as affirming toward sexual minorities have internalized heterosexism and may hold implicit bias against persons who identify as LGB (Boysen, Vogel, & Madon, 2006;Cochran, Peavy, & Cauce, 2007;Smith, 2009). Boysen (2010) suggested that heterosexism has been downloaded into one's phenomenological software without one's consent. ...
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The authors write a rejoinder to Sells and Hagedorn’s (2016) article, “CACREP Accreditation, Ethics, and the Affirmation of Both Religious and Sexual Identities: A Response to Smith and Okech,” which supports Smith and Okech’s (2016) assertion that a dialogue examining the Council for Accreditation of Counseling and Related Educational Programs’ accreditation practices pertaining to counseling programs in institutions that disaffirm/disallow diverse sexual orientation is germane. The authors articulate the common ground they share with Sells and Hagedorn while also highlighting areas of dissension.
... For instance, Matthews and colleagues (Matthews, Selvidge, & Fisher, 2005) found that sexual minorities reported that their addiction counselors engaged in supportive and otherwise lesbian, gay, bisexual, and transgender (LGBT)-affirmative behavior with them only some of the time, and Senreich (2009) found that sexual minorities reported lower levels of connection and satisfaction with their substance use treatment than did heterosexuals. Studies have also documented gaps in counselor education regarding the experiences of sexual minorities and negative or ambivalent attitudes held by substance use counselors (Cochran, Peavy, & Cauce, 2007;Eliason, 2000;Eliason & Hughes, 2004). ...
Article
Epidemiologic studies have consistently found elevated rates of alcohol and other substance use among sexual minority women (SMW), and despite calls for “lesbian, gay, bisexual, and transgender (LGBT)-specific” services and culturally tailored interventions, few such services exist. This study involved qualitative interviews with directors from substance use treatment programs (N = 10) about how they addressed the needs of SMW. Strategies implemented primarily focused on creating a safe and welcoming environment for sexual minority clients. Findings highlight challenges involved in meeting the treatment needs of SMW and provide guidance to researchers and service providers on how to improve the quality of care for them.
Chapter
Pride Healing Center (PHC), a trauma-informed specialty clinic for the LGBTQ+ community, opened its doors at Long Island University Post on January 22, 2017. Following the tragic shooting in Orlando at Pulse nightclub and the shift in our political climate, many LGBTQ+ community members were left scared to be themselves and feeling unsafe in their communities. This is when members of the nationally recognized Trauma Response and Research Team at Post decided to act. With the help of local and national experts on trauma and LGBTQ+ cultural competency, student leaders worked to create a space where members of the LGBTQ+ community would feel welcome and their voices would be heard. Each decision from the name to the marketing materials, treatment modalities, and training of clinicians was carefully considered in an effort to ensure both cultural competency and a high level of trauma services. Now in its infancy, Pride Healing Center continues to grow in clientele, community partnerships, and recognition. The PHC continually hears how safe it feels for clients to be themselves in this space. Readers will benefit from a conversation about the creation and development of this clinic, the benefits of trauma-informed treatment for the LGBTQ+ community, and how to take steps toward cultural competency in their own practices.
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This study examines substance use severity, levels of social and health service utilization, and the impact of service utilization on treatment outcomes for sexual minorities versus non-minorities. The sample included 3,094 clients from the National Treatment Improvement Evaluation Study (NTIES). Substance use severity among sexual minorities and non-sexual minorities was similar at treatment entry and at 12 months post-discharge. Differences in social and health service utilization were significant for substance abuse counseling and health services. Significant interactions between sexuality and access services and sexuality and mental health services were also found. Practice and research implications are discussed.
This study describes the relationships between clients' perception of cultural competency of mental health providers and service outcomes. A study was conducted of a public children's mental health program that used a community-based, systems of care approach. Data from a subsample (N = 111) of families with youths (average age 12.3) and primarily African-American (81.5%) were analyzed for this study. Findings demonstrate statistically significant associations between cultural competence of the provider and better overall clinical outcomes including access, participation, satisfaction, and service outcomes. This study provides empirical clinical data that improved cultural competency leads to improved clinical outcomes.
Article
Abstract Given the rise in the aging population and the increased use of health care services, there is a demand for awareness and training that targets underserved populations such as older Lesbian, Gay, Bisexual, and Transgender (LGBT) adults. Older LGBT adults are five times less likely to access health care and social services (King, 2009). Ethically responsible health service delivery is needed to capitalize on the strengths and capabilities of older LGBT adults and is vital for combating existing health disparities. Social workers aim to prevent ongoing gaps in care for older LGBT adults that can lead to negative individual and social consequences.
Article
The experiences of transgender persons have gained increased attention in academic discourse; however, few studies address how significant others, family members, friends, and allies (SOFFAs) process the transition of a loved one. This study seeks to fill this gap with research based on 133 observational hours and fifty interviews. Focusing on three relational identity themes—sexual orientation, social role, and religious identity—the findings suggest that SOFFAs use various intentional and unintentional strategies to negotiate relational identities. Furthermore, reflected appraisals and social stigma mediate the ability of SOFFAS to “undo” and “redo” gender when negotiating their relational identities.
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Recovery housing is a promising way to augment the substance use continuum of care, but we know little about the experiences of members of the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community who live in them or about residences specifically for them. Within the LGBTQ community, gay, bisexual, and other men who have sex with men (MSM) often experience co-occurring syndemic conditions (e.g., trauma, depression, HIV) that present unique recovery challenges. Using qualitative data gathered from residents living in a recovery residence specifically for gay and bisexual men and from community key informants, we examine the experiences of men living in the home and factors that facilitate operating it. Findings highlight the need for residences that can address syndemic burden among gay and bisexual men in recovery and identify programmatic and community-level factors critical to operating residences for this population.
Book
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IOM (Institute of Medicine). 2011. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington, DC: The National Academies Press. A review and report assessing the state of the science on the health status of lesbian, gay, bisexual, and transgender populations; identifying research gaps and opportunities; and outline of a research agenda that will assist NIH in enhancing its research efforts in this area.
Article
Lesbian and bisexual (LB) women exhibit elevated rates of a variety of behaviors (i.e., smoking, excessive caloric intake, physical inactivity, heavy alcohol consumption) that put them at risk for adverse health consequences. Furthermore, LB women experience numerous barriers to obtaining culturally competent health care. In this article we review risk behaviors and health care barriers and we discuss the role of stress as an important contributing factor in LB women's health outcomes. We suggest future research, health care delivery changes, and training improvements that will prepare social workers to effectively address the needs of their LB clients.
Conference Paper
Background and Purpose: Research dating back to the 1970s demonstrates that sexual minorities are at higher risk for developing substance abuse or dependence disorders than their heterosexual counterparts. Though often limited methodologically by lack of representative samples, more recent studies using population-based samples have generally confirmed this link. Far less research has been conducted on treatment utilization and post-treatment outcomes for this population, and it remains unknown whether or not existing comprehensive substance abuse treatment services are effective for sexual minorities. This study will begin to address this gap by comparing the impact of comprehensive services on treatment outcomes for sexual minorities and their non-minority counterparts. Methods: Data from the National Treatment Improvement Evaluation Study (NTIES) was used for this analysis. NTIES is a prospective, cohort study of substance abuse clients and programs, comprised of 3,142 women and men from 78 publicly-funded substance abuse treatment facilities nationwide. The sexual minority sample was comprised of men who have sex with men (MSM) and women who have sex with women (WSW). T-tests were used to compare pre and post-treatment substance abuse rates among those who reported same-sex sexuality and those who did not. Generalized linear mixed modeling was used to determine whether same-sex sexuality moderates the impact of comprehensive services on post-treatment substance abuse. Missing values were specified for these comparisons. Results: Despite similar levels of pre treatment substance abuse severity, sexual minorities were significantly more likely to benefit from the receipt of access services (including transportation and childcare) and substance abuse counseling services than those who did not report same-sex sexuality. Still, sexual minorities evidenced poorer post-treatment outcomes than their peers, as demonstrated by their significantly higher rates of substance abuse at the 12-month follow-up period. Conclusions: This study suggests that the pathway to recovery from substance abuse may differ for those with sexual minority status. While those who reported same-sex sexuality did not differ in pre-treatment substance abuse rates when compared to non-minority peers, sexual minorities benefitted more from services that facilitate access to treatment and from substance abuse counseling. Nonetheless, any benefits conferred by access services and substance abuse counseling services did not offset the poorer post-treatment outcomes among sexual minority respondents. Poor treatment outcomes for sexual minorities suggest that comprehensive substance abuse treatment services may not be adequately addressing needs in this population and that specialized services may be warranted. Funding: This research was supported by grant R01-DA-018741 from the National Institute of Drug Abuse.
Article
Despite many recent advances in rights for sexual and gender minorities in the United States, bias against lesbian, gay, bisexual, and transgender (LGBT) people still exists. In this Commentary, the author briefly reviews disparities with regard to LGBT health, in both health care and medical education, and discusses the implications of Burke and colleagues' study of implicit and explicit biases against lesbian and gay people among heterosexual first-year medical students, published in this issue of Academic Medicine.Emphasis is placed on the ways in which physicians' implicit bias against LGBT people can create a cycle that perpetuates a professional climate reinforcing the bias. The hidden curriculum in academic health centers is discussed as both a cause of this cycle and as a starting point for a research and intervention agenda. The findings from Burke and colleagues' study, as well as other evidence, support raising awareness of LGBT discrimination, increasing exposure to LGBT individuals as colleagues and role models in academic health centers, and modifying medical education curricula as methods to break the cycle of implicit bias in medicine.
Article
We investigated 163 (82.2% female; 73% White; and 91.4% heterosexual) mental health trainees' explicit and implicit attitudes toward heterosexual, lesbian, and gay White couples adopting and raising Black children. Explicit attitudes were assessed with a vignette depicting a Black child in need of a home. Implicit attitudes were assessed with the multifactor implicit association test (IAT) protocol. Explicit data showed that most participants indicated no strong family preference. However, IAT data showed that most trainees had implicit preference, with a moderate preference for lesbian couples over heterosexual couples and a moderate-to-strong preference for lesbian couples over gay couples. The trainees only demonstrated a very weak preference for heterosexual couples over gay couples. Overall, congruence between explicit and implicit is very low. Implications for training are discussed.
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Introduction Lesbian, gay, bisexual, transgender, and queer (LGBTQ) populations experience opioid-related disparities compared to heterosexual and cisgender populations. LGBTQ-specific services are needed within opioid use disorder (OUD) treatment settings to minimize treatment barriers; research on the availability and accessibility of such services is limited. The purpose of the current study was to mimic the experience of an LGBTQ-identified individual searching for LGBTQ-specific OUD treatment services, using the SAMHSA National Directory of Drug and Alcohol Abuse Treatment Facilities - 2018 (Treatment Directory). Methods We contacted treatment facilities listed in the Treatment Directory as providing both medications for OUD (MOUD) and “special programs/groups” for LGBTQ clients within states with the top 20 highest national opioid overdose rates. We used descriptive statistics to characterize the outcome of calls; the overall number of facilities offering LGBTQ-specific services, MOUD, and both LGBTQ-specific services and MOUD; and the availability of both LGBTQ-specific services and MOUD in each state by 100,000 state population and in relation to opioid overdose mortality rates (programs-per-death rate). Results Of the N = 570 treatment facilities contacted, n = 446 (78.25 %) were reached and answered our questions. Of n = 446 reached (all of which advertised both MOUD and LGBTQ-specific services), n = 366 (82.06 %) reported offering MOUD, n = 125 (28.03 %) reported offering special programs or groups for LGBTQ clients, and n = 107 (23.99 %) reported offering both MOUD and LGBTQ-specific services. Apart from Washington, DC, New Mexico, South Carolina, and West Virginia, which did not have any facilities that reported offering both MOUD and LGBTQ-specific services, Illinois had the lowest, and Michigan had the highest programs-per-death rate. Most of the northeastern states on our list (all but New Hampshire) clustered in the top two quarters of programs-per-death rates, while most of southeastern states (all but North Carolina) clustered in the bottom two quarters of programs-per-death rates. Conclusions The lack of LGBTQ-specific OUD treatment services may lead to missed opportunities for supporting LGBTQ people most in need of treatment; such treatment is especially crucial to prevent overdose mortality and improve the health of LGBTQ populations across the United States, particularly in the southeast.
Article
The focus on trans*1 individuals as researcher subjects often problematizes trans* identity, limiting the possibility for trans* individuals to create and co-create bodies of knowledge. Drawing on three years of participatory research in the animal production industry, I discuss the implications of my subjectivity as a trans* man in this particular sett ing and in my research more broadly. Beyond being a self-refl exive exercise, this study seeks to make a number of theoretical and empirical contributions. First, feminist literature discussing one’s subjectivity has largely focused on the dialectical existence between men and women, with litt le room for trans* or gender diverse perspectives. Further, studies that have acknowledged trans* identity have done so in relation to trans* persons as research subjects, with no recognition of their positionality or the possibility of the trans* researcher. This study seeks to change these paradigms by extending current feminist research frameworks on subjectivity to include greater gender diversity.
Article
Through a field experiment set among licensed therapists (N = 425), we found nuanced evidence of heterosexist discrimination at the entry point of mental health services for a fictitious White, presumably gay man seeking counseling. We called therapists in LGB-affirming and LGB-hostile states and left voicemails requesting services. To manipulate perceived sexual orientation, a confederate using the name “Jon” recorded one of three conditions (a) heterosexual-presenting Jon, (b) gay-presenting Jon, and (c) gay-sounding Jon. Analyzes comparing the rate of returned calls for each condition within LGB-affirming versus LGB-hostile states against our referent group, gay-presenting Jon calling mental health professionals in an LGB-affirming region, revealed a number of significant effects. Notably, being perceived as gay in LGB-hostile states significantly decreased the rate of returned calls, with the reverse being true in an LGB-affirming state. The use of “gay-sounding” voice, however, did not appreciably affect these relationships.
Article
Ethnic minority and sexual minority individuals face unique challenges in accessing treatment services. Once treatment is accessed, minority clients face additional problems. Frequently, the prevailing treatment models do not account for minority cultural values and traditional practices, and therapists often are insensitive to cultural differences inherent in their minority clients. Addressing specific issues of relevance to positive outcomes for minority clients is often overlooked or avoided. A long history of minority clients being underserved and understudied has contributed to a general lack of understanding about how to effectively help them therapeutically. However, researchers and treatment professionals are now collaborating with key stakeholders to improve treatment in ethnic minority communities. The new model of community-based participation in the development, implementation, and evaluation of treatment programs holds great promise in improving services to people who have been traditionally disempowered and poorly served in society.
Article
This article characterizes the political ideology of first-year medical students and describes the extent to which their political ideology was associated with attitudes and beliefs related to the care of marginalized patients assessed during their fourth year. Analyses use data fromonline questionnaires administered to 3,756medical students from a stratified random sample of forty-nine medical schools in their first and fourth years of study. The primary measure of political ideology was a five-point scale anchored by "very conservative" and "very liberal." Mixed-effects linear regression was used to test the predictive power of political ideology at year 1 on year 4 outcomes. Among incoming medical students, 47.7% identified as liberal, 33.3% as moderate, and 19.0% as conservative. More conservative ideology was associated at year 4 with greater implicit bias against black and gay individuals, more negative explicit attitudes toward stigmatized groups, lower internal motivation to control racial prejudice, lower levels of trait empathy and empathy toward patients, and lower levels of patientcentered attitudes. Future research is needed to inform and develop interventions to improve care of patients from marginalized groups that are effective for medical students and health care providers across the political spectrum.
Chapter
This chapter examines addiction issues particular to lesbian, gay, bisexual, and transgender (LGBT) people. This includes a description of the available epidemiological data on substance use and addiction in the LGBT community, as well as a discussion about unique psychosocial issues that LGBT people face that increase their risk of substance use, such as stigma, social rejection, discrimination, harassment, HIV, issues specific to adolescents and young adults, internalized homophobia, and transphobia. Because the vast majority of research on substance abuse in the LGBT community is from North America, examples of social settings and substances specific to this LGBT community are used to illustrate how specific drugs can develop a unique appeal to an LGBT community in response to the psychosocial environment and stressors that a specific LGBT community faces. Substances discussed include methylenedioxymethamphetamine (MDMA, ecstasy), methamphetamine, gamma-hydroxybutyrate (GHB), anabolic steroids, and cross-gender hormones. In other LGBT communities, different psychosocial stressors lead to unique substance abuse patterns that must be understood to adequately treat addiction in those populations. General recommendations are made regarding the provision of clinically competent care for cases of LGBT addiction, and common clinical scenarios are discussed. The need for research on substance abuse patterns in LGBT populations is sternly emphasized in order to improve understanding of local patterns of substance abuse and to improve the provision of treatment to those populations.
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Important mental and physical health disparities exist among lesbian, gay, and bisexual (LGB) individuals in substance abuse treatment. Thus, LGB individuals would benefit from continuity of care within substance abuse treatment that is responsive to their mental and physical health needs. Additional screening, training, outreach, and integration of health care services is warranted in order to meet the needs of LGB individuals in substance use treatment. It is essential that providers offer services that are inclusive of LGB individuals, and that services are provided in a manner that is affirming of LGB individuals and address their unique health care needs. An important step to addressing the unique needs of LGB individuals in substance use treatment is to understand these needs. Our study of over 13,000 San Francisco residents admitted to substance abuse treatment identified differences in mental and physical health care needs of LGB individuals in substance use treatment. We found that LGB individuals were more likely than heterosexual individuals to have co-occurring mental health diagnoses and to be prescribed medications for mental health. Some LGB groups were at higher risk for physical health problems, specifically gay men and bisexual women. Our study highlights the importance of providing either linkage to physical and mental health care or integrated care for LGB individuals in substance use treatment. We provide suggestions for meeting the needs of LGB individuals in substance use treatment settings.
Article
Sexual and gender minority (SGM) individuals include, but are not limited to, those who identify as lesbian, gay, bisexual, transgender, and queer (LGBTQ). LGBTQ individuals are considered a marginalized and at-risk population, facing significant health care inequities when compared with heterosexual and cisgendered (ie, "gender-conforming") populations. They are more likely than heterosexual and cisgendered individuals to experience discrimination, bias, and dissatisfaction with the medical system. This article provides a broad overview of systemic inequalities confronting SGM patients.
Article
We investigated 109 (79.8% female; 76% White, and 83.5% Heterosexual) mental health trainees’ explicit and implicit attitudes towards heterosexual, lesbian, and gay White couples adopting and raising Black children. To determine explicit attitudes, we used a vignette depicting a Black child ready for adoption and three types of equally qualified White families who were headed by a heterosexual couple, gay couple or lesbian couple. The trainees were asked to indicate which type of family that they preferred to adopt the child. To determine implicit attitudes, we used the computer programed latency-based multi-factor implicit association test (IAT) protocol. The IAT data were collected from each participant individually. Explicit data showed that over 80% of the participants indicated no strong preference in terms of which type of family should adopted the child. However, IAT data showed that the trainees implicitly preferred lesbian couples. Overall, the degree of congruence between explicit and implicit was very low. Implications for training were discussed.
Thesis
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When transgender people most need help, many face hostility and inadequate care from their health providers, including psychologists. This hostility is not surprising given widespread lack of familiarity with transgender issues or perspectives amongst clinicians. Even amongst those who hold the stance of openness to the other, most still have considerable difficulty working with transgender clients. Transgender training efforts vary in quality; some even appear to worsen attitudes towards transgender clients. Given these risks, it is crucial that clinical training directors and supervisors evaluate trainees’ abilities to facilitate respectful initial conversations with transgender clients. This project proposed an objective instrument for assessing a mental health clinician, or clinical trainee’s ability to discriminate between helpful and unhelpful responses commonly made in the initial clinical encounters with transgender clients. Development of the instrument is grounded in a combination of theoretical and empirical literature on the topic and is synthesized with the personal and professional experiences of the primary researcher as a transgender person and emerging clinician. This study utilized systematic expert review to examine the validity of this proposed instrument. This dissertation is available in open access at AURA, http://aura.antioch.edu/ and Ohio Link ETD Center, https://etd.ohiolink.edu/etd Keywords: transgender, clinical training, multicultural competency, test development
Article
Using Andersen's behavioural model of health service utilization, we synthesized data from 77 articles addressing mental health service utilization by lesbians, gay men and bisexuals (LGBs) in order to summarize findings and identify directions for future research. LGBs were found to use services more frequently than heterosexuals and display variability in satisfaction with services and treatment outcomes. LGBs present a unique range of predisposing characteristics, enabling resources and needs that predict service use. Our review demonstrates a need for intersectional approaches in LGB mental health services research that address service use among those of multiple marginalized identities, including LGB people of colour, LGB immigrants, Indigenous LGBs and LGB persons with disabilities.
Article
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The authors developed the Modern Homophobia Scale (MHS), a scale that includes measures of attitudes toward lesbians (MHS-L) and attitudes toward gay men (MHS-G). An initial pool of 97 items was generated by the authors based on a review of the literature on homophobia and feedback from several focus groups. Responses to the initial pool of items were factor analyzed. The final versions of the MHS-L and the MHS-G included items reflecting the following factors: Personal Discomfort with lesbians/gay men, Institutional Homophobia toward lesbians/gay men, and the Deviance/Changeability of female/male homosexuality. Although the Personal Discomfort, Institutional, and Deviance/Changeability factors were separable, they were highly correlated and showed little evidence of divergent validity. Reactions to gay, lesbian, and heterosexual characters in written vignettes provided initial support for the validity of the MHS. Both the MHS-L and MHS-G were significantly correlated with the Index of Homophobia and the Attitudes Toward Women Scale. A greater degree of homophobia on the MHS-L and MHS-G was associated with a greater degree of socially desirable responding as measured by the Balanced Inventory of Desirable Responding. Lower levels of homophobia on the MHS-L and MHS-G were associated with having lesbian and gay acquaintances and friends. On the MHS-L, men and women did not differ in their overall level of homophobia toward lesbians, but significant gender differences on MHS-L factor scores were present. Compared to men, women were more supportive of gay men on all three factors of the MHS-G.
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This brief report presents a Multicultural Competency Checklist that can be used by counseling training programs as a pragmatic guide in multicultural program development. The Checklist includes 22 items organized along six major themes: minority representation, curriculum issues, counseling practice and supervision, research considerations, student and faculty competency evaluation, and physical environment. Guidelines for using the Checklist are provided.
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This article reviews the statistical evidence of LGBT violence in the United States and in the world. In the United States the statistics are from Amnesty International and the New York City Gay and Lesbian Anti-Violence Project. Statistics and other information about LGBT violence in other countries of the world come from many different sources. Reasons why this violence exists and international human rights responses are reviewed. The authors argue for a greater role for mental health organizations in the amelioration of prejudice against LGBT people and for more involvement of these organizations in social justice issues around the world. The article concludes with recommendations for future directions.
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This study explored the preference for counselor's sexual orientation among gay and lesbian clients. Recognizing that the perceived reaction of participants to hypothetical situations may be a viable predictor of future choices, respondents were administered a comfort/discomfort index intended to probe a number of potential counseling concerns. Internalized homophobia (Hudson & Ricketts, 1977) and a scale measuring degree of same‐ or opposite‐sex sexual preferences (Kinsey, Pomeroy, Martin, & Gebbhard, 1953) were also investigated in an attempt to account for variance in the comfort/discomfort ratings. Findings indicated that gay men and lesbians tend to prefer gay or lesbian counselors, although a sizable number believe that counselors' sexual orientations do not make a difference. Internalized homophobia was found to predict discomfort in discussing various topics with a counselor of unknown sexual orientation.
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This study is based on interviews with Southern lesbian and gay young adults and survey data from school counselors and prospective teachers living in the South. The essay explores adolescents' perceptions of the beliefs and abilities of school counselors and teachers with regard to issues of homosexuality and the treatment of gay and lesbian students. As a complement and a contrast, it also presents educators' personal beliefs about homosexuality, and how these attitudes are actualized in the schools. One major conclusion is that while school counselors and, to a lesser extent, classroom teachers often expressed the feeling that they should be more proactive and supportive of professionals committed to the welfare of all their students, due to countervailing expressions of high levels of personal justice, ignorance, and fear, the realities of their professional intervention and support were negligible.
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Greenwald, McGhee and Schwartz (1998) described a new method-the Implicit Association Test (IAT)-for unobtrusively measuring racial attitudes. This article assesses the validity of the IAT by investigating whether Greenwald et al.'s implicit racism findings resulted from two confounds present in their studies: differential familiarity and frequency of the words that comprised their target concepts, Experiment I produced large IAT effects when both low and high familiarity words comprised nonsocial target categories (insects and flowers) and demonstrated that the IAT is more sensitive when high familiarity exemplars form the target concepts. in Experiment 2, we obtained large implicit racism effects for both African American and Hispanic racial groups even when the familiarity and frequency of the names that comprised the racial categories were controlled and even though participants described themselves as unprejudiced. Additionally, explicit self-reports of racial attitudes were only weakly related to the IAT measures. These experiments indicate that (a) although familiarity clearly exerts an important influence on the IAT, the use of low familiarity stimuli does not eliminate the sensitivity of the IAT, (b) stimulus familiarity and frequency can not account for the implicit racism effect and (c) stimulus familiarity is an important moderating variable that can influence the sensitivity of implicit attitude measures. We discuss the results in relation to the validity of the Implicit Association Test and theories of implicit social cognition.
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Substance abuse treatment for lesbian, gay and bisexual (LGB) individuals cannot center solely on substance abuse, but must also address the social and psychological aspects of being LGB. This study uses qualitative methods to examine service providers' knowledge and clinical impressions of issues commonly experienced by LGB people with substance use problems. Focus groups and individual interviews were conducted with clinicians experienced in counselling LGB clients. The data were analyzed using NUD*IST qualitative software to derive salient themes presented by the service providers. Eight major themes were identified: openness and disclosure of sexual orientation in substance use treatment; the “coming out” process; societal homophobia; internalized homophobia; family and support systems; bars and social life; body image; and the impact of HIV and AIDS. Examples for each of the major themes are provided.
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Four hundred twenty-five psychologists received vignettes depicting a male client who was either gay or heterosexual and whose source of HIV infection was sexual contact, a blood transfusion, intravenous drug use, or unspecified. Respondents' homophobia and reactions to the client in the vignette were measured. Canonical correlation analyses revealed that therapist attributions of client responsibility for problem cause were predicted by the source of HIV infection and therapist homophobia. In addition, therapists responded with less empathy, attributed less responsibility to the client for solving his problems, assessed the client's functioning to be worse, and were less willing to work with the client when the client's source of HIV infection was other than drugs, when the client was gay, and when therapists were more homophobic. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
assess the status of theory and empirical data on internalized homophobia / a framework adopted from J. Brewer and A. Hunter (1989) is used to evaluate the status of internalized homophobia as a construct / these writers suggest that "for measurements to be useful in building and testing theories, the measures must provide good empirical estimates of the social phenomena about which we theorize" / an important question is how the simplification involved in operationalizing and measuring a phenomenon affects the realism of the resulting theory [begin] with an examination of the conceptual issues involved in the definition, operationalization, and assessment of internalized homophobia / review . . . the empirical work in this area / data on the construct validity of internalized homophobia are presented / [argue] that the construct of internalized homophobia can serve as a central organizing concept for gay and lesbian affirmative psychology (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Thesis (Ph. D.)--Georgia State University, 1998. Includes bibliographical references (leaves 269-282). Photocopy.
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This study is based on interviews with Southern lesbian and gay young adults and survey data from school counselors and prospective teachers living in the South. The essay explores adolescents' perceptions of the beliefs and abilities of school counselors and teachers with regard to issues of homosexuality and the treatment of gay and lesbian students. As a complement and a contrast, it also presents educators' personal beliefs about homosexuality, and how these attitudes are actualized in the schools. One major conclusion is that while school counselors and, to a lesser extent, classroom teachers often expressed the feeling that they should be more proactive and supportive as professionals committed to the welfare of all of their students, due to countervailing expressions of high levels of personal prejudice, ignorance, and fear, the realities of their professional intervention and support were negligible.
Alcoholism treatment providers in 36 government-funded agencies in New York City were surveyed for information about their training for and attitudes toward the treatment of homosexual patients. The 164 respondents had limited knowledge about how to evaluate and treat homosexual alcoholics and frequently did not discuss sexual orientation with their clients even though they considered it important. The training and supervision of most providers in the treatment of alcoholic homosexual clients was substandard or nonexistent. About half of the providers believed that treatment programs would benefit from having openly gay staff and felt that being openly gay carried little professional risk. Respondents also reported that development of programs for homosexual alcoholics had little priority in their facilities. Many believed that homosexual alcoholics are less likely to seek help and may have more difficulty achieving sobriety.
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This paper attempts to refine and state more clearly an operational definition of homophobia. Homophobia is seen as but one dimension among many that collectively refer to the much larger domain of homonegativeism. The paper then presents a new measure of homophobia, called the IHP, and reports the finding of a study designed to validate the new scale. The IHP was found to have a reliability of .90 and good content and factorial validity.
Article
It is recognized that AIDS involves multiple epidemics. As well as an epidemic of HIV, we are experiencing epidemics of fear and of stigmatization, scapegoating and discrimination associated with AIDS. In this paper, we investigate the nature of these reactions and the links between them. In doing so, we identify some of their causes. We likewise investigate counter-reactions, pre-eminent among which is the promotion of concepts of respect for persons and for human rights. We also examine the 'tools' used to elicit and manifest both these reactions and counter-reactions. In all cases, these 'tools' include choice of language--especially in the form of metaphor and rhetoric--and the use of symbolism. We conclude that in order to deal humanely and compassionately with AIDS and persons with AIDS, and, ultimately, to protect society (including, the fundamental principles and rules on which it is based), a primary requirement is to recognize that we are all living with AIDS, whether infected or affected by it; that is, in the context of AIDS, it is imperative that we overcome any divisions into 'them' and 'us'.
Article
Stereotypic and stigmatic attitudes toward homosexuality may interfere both directly and indirectly with the care provided to gay and lesbian patients. The purpose of this study was to measure attitudes toward gays and lesbians and assess homophobia among psychiatric nurses. The demographic characteristics of education, religious identification, and knowledge of gays and lesbians had positive affects on attitudes and homophobia. The Attitudes Towards Gays and Lesbians Scale (ATGLS) developed by the researcher specifically for this study assessed cognitive attitudes and the Index of Homophobia (IHP), developed by Hudson and Ricketts (1980), measured homophobia, the affective response to gays and lesbians.
Article
Research on victimization among oppressed groups such as lesbian and gay people has provided limited insight into its impact on the lives of those who are frequently targeted. This is due in part to small sample sizes and the absence of significant variables known to influence mental well-being. This analysis examines the prevalence and effects of victimization on a large sample (N = 1067) of lesbians and gay men living in a southern state. Multiple regression is used to determine the psychological consequences of victimization as measured by depression. Additional factors thought to contribute, either positively or negatively, to the effect of victimization on mental well-being, i.e., social support, self-esteem, external stress, and internalized homophobia, are also included in the analysis. Results indicate that victimization has a significant positive effect on depression for both lesbians and gay men when controlling for other variables. Self-esteem was found to be the strongest predictor of depression for the entire sample. Social support was found to have a similar effect for lesbians and gay men with partner support and having no support being significant. Gender differences were found for measures of external stress, internalized homophobia, and age.
Article
An implicit association test (IAT) measures differential association of 2 target concepts with an attribute. The 2 concepts appear in a 2-choice task (2-choice task (e.g., flower vs. insect names), and the attribute in a 2nd task (e.g., pleasant vs. unpleasant words for an evaluation attribute). When instructions oblige highly associated categories (e.g., flower + pleasant) to share a response key, performance is faster than when less associated categories (e.g., insect & pleasant) share a key. This performance difference implicitly measures differential association of the 2 concepts with the attribute. In 3 experiments, the IAT was sensitive to (a) near-universal evaluative differences (e.g., flower vs. insect), (b) expected individual differences in evaluative associations (Japanese + pleasant vs. Korean + pleasant for Japanese vs. Korean subjects), and (c) consciously disavowed evaluative differences (Black + pleasant vs. White + pleasant for self-described unprejudiced White subjects).
Article
This study investigated for the first time the relationship between internalized homophobia and shame in gay men. It also briefly re-examined the relationship between internalized homophobia and self-esteem in gay men. A sample of 100 gay men from a variety of sources responded to three questionnaires and a demographic survey. Findings included a significant positive relationship between shame and internalized homophobia and a significant inverse relationship between internalized homophobia and self-esteem. Additional findings included significant correlations between seven variables and internalized homophobia and between six variables and internalized shame.
Article
To better understand the distinguishing characteristics of methamphetamine users versus cocaine users, we conducted a retrospective chart review of the 345 patients admitted to an outpatient stimulant treatment program during 1995--1997. Analyses revealed an increase in methamphetamine patients over the 3-year period, and that these patients were more likely than cocaine patients to be male, Caucasian, and gay or bisexual. Methamphetamine patients were also more likely to be HIV-positive, engage in behaviors such as using and sharing needles that place them at high risk for HIV transmission, have a psychiatric diagnosis, and be on psychiatric medications. The two populations did not differ in treatment adherence, as measured by clinic attendance, drug-free urines, and successful completion of treatment. These findings suggest that highly specialized substance abuse treatments for methamphetamine patients may not be needed. Resources may be directed toward addressing their medical and psychiatric diagnostic issues by providing ancillary services to stimulant treatment programs.
Article
The attitudes of substance abuse counselors can have significant effects on their client's recovery. This study examined the attitudes and knowledge of substance abuse counselors regarding lesbian, gay, bisexual, and transgendered (LGBT) clients. 242 substance abuse counselors in Iowa completed mail-in questionnaires. The counselors reported very little formal education regarding the needs of these clients, and nearly half had negative or ambivalent attitudes. Respondents had the greatest negativity regarding transgendered clients and reported knowing the least about this group. Counselors frequently lacked knowledge about the legal issues of these clients, the concepts of domestic partnership and internalized homophobia, and family issues. Substance abuse counselors require more education about LGBT clients.
Article
This study investigated differences between completers and noncompleters of an intensive outpatient substance abuse treatment program to identify key predictors of attrition. Participants (n = 138) completed a comprehensive intake/assessment package that included the Addiction Severity Index as a precursor to participation in the program. Discriminant function analyses (DFA) suggested that ASI composite scores and severity ratings were not useful predictors. However, analysis of individual items was useful in identifying "red flags" as predictors for treatment attrition. The subsequent DFA identified the following variables as significant predictors: Hispanic ethnicity, absence of a professional skill, shorter time since last hospitalization, cocaine or cannabis use in the last 30 days, total number of family members with drug problems, presence of emotional abuse in last 30 days, concern with family problems, and number of family group meetings that family members attended. These red flags can serve the important function of providing clinicians with enough information to intervene early with patients at risk for treatment dropout.
Internalized homophobia: Conceptual and empirical issues in mea-surement Lesbian and gay psychology: The-ory, research, and clinical applications Homophobia and attitudes toward gay men and lesbians by psy-chiatric nurses
  • A Shidlo
Shidlo, A. (1994). Internalized homophobia: Conceptual and empirical issues in mea-surement. In B. Green and G. M. Herek (Eds.), Lesbian and gay psychology: The-ory, research, and clinical applications. Psychological perspectives on lesbian and gay issues, Vol. 1. (pp. 176-205). Thousand Oaks, CA: Sage. Smith, G. B. (1993). Homophobia and attitudes toward gay men and lesbians by psy-chiatric nurses. Archives of Psychiatric Nursing, 7, 377-384.
Confronting homophobia in health care settings: Guidelines for social work practice
  • A E Messing
  • R Schoenberg
  • R K Stephens
Messing, A. E., Schoenberg, R., & Stephens, R. K. (1984). Confronting homophobia in health care settings: Guidelines for social work practice. Journal of Social Work and Human Sexuality, 2, 65-74.