LGBT and Alcohol Abuse
An accepted notion within the rehabilitation community is that satisfaction with one’s sexuality is highly correlated with productivity and social adjustment. Despite this notion, the topic of sexuality has not received a great deal of attention within the rehabilitation literature. For example, a review of the Journal of Applied Rehabilitation Counseling, Journal of Rehabilitation, and Rehabilitation Counseling Bulletin during the past 10 years reveals that few empirical articles or discussion papers have been published about human sexuality. One theme that emerged in our literature review is that issues concerning homosexuality have been virtually ignored within the drug rehabilitation field. In fact, to our knowledge, there is only one article that examines the needs of clients with disabilities who are gay. This article by McAllan and Ditillo outlines myths, terminology, and practical suggestions for rehabilitation practitioners to work more effectively with gay clients. The intent of the present article is to examine specific issues with respect to alcohol treatment of gay men and lesbians.
The “Hidden Minority”
It is estimated that between 10% and 15% of the general population is homosexual. Despite this statistic, lesbians and gay men have often been referred to as a “hidden minority”. Such invisibility has been attributed to a variety of factors which include a reluctance on the part of gay men and lesbians to openly acknowledge their homosexuality; lack of awareness, knowledge, and sensitivity of helping professionals who work with homosexuals; and the negative stigma associated with being gay or lesbian Strong religious doctrine and legal repercussions against same-sex behavior have also contributed to the need for people to remain hidden. In addition, disclosure of one’s sexual orientation can lead to isolation, ostracism, and even physical abuse.
Alcoholism is the one disability that affects gay people at a much higher rate than heterosexuals. Kus (1990) stated that between 20% and 33% of the gay and lesbian population has an identified drinking problem. Other researchers believe that between 18% and 38% of gay men and 27% to 35% of lesbians are either alcohol abusers or alcoholics. This percentage exceeds the general population at large which has an estimated alcoholism rate of between 10% to 12%. In reviewing these statistics about gay men and lesbians, it is important to keep in mind that there are a number of methodological constraints with such research including small sample sizes, non-random groups, and lack of a representative sample Despite these flaws, though, “all of the studies show a remarkable consistency in their findings … that 28 to 32 percent of lesbians and gay men are at high risk or are alcoholic” (Finnegan & McNally, 1989, p. 129). Based on these statistics, it is safe to say that alcoholism is the number one health issue for gay men and lesbians.
Possible Reasons for Increased Alcohol Use Among Gay Men and Lesbians
The difference in alcoholism rates between gay and non-gay populations has been attributed to a number of environmental factors. One factor is that alcohol serves as a method of coping with internal homophobia. Anderson and Henderson (1985) believe that socio-cultural pressure is the soundest explanation as to why alcoholism rates differ between gay and non-gay populations. Overt societal stigmatization of gay men and lesbians can lead to low self-esteem, anxiety, depression, and powerlessness. As such, alcohol may serve as one way to cope with these negative feelings.
A second reason for increased alcohol use/abuse by gay men and lesbians is the fact that legitimate socialization is often limited to bars or parties serving alcohol. Gay bars promote the use of alcohol in much the same way that nongay bars endorse alcohol use in the heterosexual culture. The major difference between the two, however, is that heterosexual have a greater range of social outlets from which to choose without fear of recrimination.
A third reason that may explain the higher incidence rate is that alcohol use may help the individual during the “coming out” process. As the individual struggles with the decision to “tell or not to tell”, an increasing amount of stress can occur. Using alcohol provides one way to relieve such stress. Alcohol can also be used to help people lower their inhibitions as a way to engage in same-sex sexual activities they may not feel comfortable performing if they are sober. Making the decision to “come out” requires an acknowledgment to oneself, to other gay people, and then to everyone else that you are gay or lesbian. As such, “coming out” represents an on-going, gradual process of acknowledging one’s sexuality over time. It is important to remember that gay men and lesbians must make a choice about whether to “come out” every time they meet someone new. The process of “coming out” to non gay people may be the most difficult for gay men and lesbians who enter alcoholism treatment. It is important to respect a person’s decision if they choose not to “come out” in treatment because of legitimate fears of oppression or possible retaliation.
