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Clinician’s Guide
Modules 5, 7, 8, 9, 10, 11, 6, 12, 13
First Edition
A Provider’s Introduction to
Substance Abuse for Lesbian,
Gay, Bisexual, and
Transgender Individuals
First Edition
Unifying science, education and services to transform lives.
Learning Objectives
Understand the coming out process
Counselor Tasks:
1. Facilitate client discussion of hiding LGBT feelings from others
2. Explore emotional costs of hiding/denying one's sexuality
3. Discuss how the client has tried to fit in and at what cost
4. Examine negative feelings of self-blame, feeling bad or sick,
and the effect of shaming messages on client
5. Foster client's ability to be out
Counselor Tasks:
Tasks
1. Facilitate client's self-concept and self-efficacy
2. Identify and change negative messages to affirmations
3. Recognize and release residual shame
4. Develop a positive affirming spirituality
5. Integrate public and private identities
6. Build a support network, connect to community
A Provider’s Introduction to
Substance Abuse for Lesbian,
Gay, Bisexual, and
Transgender Individuals
First Edition
Clinical Issues With Lesbians
Unifying science, education and services to transform lives.
Learning Objectives
- Learn myths,
stereotypes, and facts
- Understand clinical
issues for lesbians in
treatment
- Learn effective
counselor interventions
A Provider’s Introduction to
Substance Abuse for Lesbian,
Gay, Bisexual, and
Transgender Individuals
First Edition
Clinical Issues With Gay
Male Clients
Unifying science, education and services to transform lives.
Learning Objectives
Understand social,
cultural, psychological,
and developmental issues
Understand implications
for treatment
2. Internalized homophobia
A Provider’s Introduction to
Substance Abuse for Lesbian,
Gay, Bisexual, and
Transgender Individuals
First Edition
Clinical Issues With Bisexuals
Unifying science, education and services to transform lives.
Learning Objectives
Learn psychosocial
issues
Understand implications
for treatment
The contemporary
understanding is that
bisexuality, affectional,
romantic and sexual
attraction toward same
gender and other gender
individuals, is a sexual
orientation in and of itself
and distinct from
heterosexuality and
homosexuality.
homosexuality
Power Point Slide # 9-2, n30
Continuous Bisexuality:
Bisexuality Bisexual identity is formed early in
one’s life and remains intact across the lifespan.
Sequential Bisexuality:
Bisexuality Desire is experienced by bisexuals
as sexual attractions to same-sex or opposite-sex partners at
different times during their lives.
Concurrent Bisexuality:
Bisexuality Bisexuals express sexual desire
toward men and women at the same time.
A. Sexual Attraction to
B. Sexual Behavior with
C. Sexual Fantasies about
D. Emotional Preference for
E. Social Preference for
F. Self-Identification as
G. LGBT/Heterosexual Lifestyle Power Point Slide #9-7, n 35
A Provider’s Introduction to Substance Abuse for LGBT Individuals Module 1 Overview
Module 10
Clinical Issues with
Transgender Individuals
Unifying science, education and service to transform lives
A Provider’s Introduction to
Substance Abuse for Lesbian,
Gay, Bisexual, and
Transgender Individuals
First Edition
Clinical Issues
With Transgender Individuals
Unifying science, education and services to transform lives.
Learning Objectives
Understand “transgender”
Be familiar with research & data
Be aware of clinical issues
Understand treatment implications
Transsexuals
Cross-dressers
1. Issues about
appearance, "passing"
and body image
2. History of hiding or 5. Hormone therapy and
suppressing gender
identity use or injection history
3. Lack of family and social 6. Stigma and
support discrimination
4. Isolation and lack of
connection to positive, 7. Employment problems
proactive transgender
community resources 8. Relationship/child
custody issues
DO’S
Use the proper pronouns based on client’s self-identity
when talking to/about transgender individuals.
Get clinical supervision if they have issues or feelings
about working with transgender individuals.
Allow transgender clients to continue the use of hormones
when they are prescribed. Advocate that the transgender
client using “street” hormones get immediate medical care
and legally prescribed hormones.
Take required training on transgender issues.
DO’S
Find out the sexual orientation of all clients.
DON’TS
Don’t call someone who identifies as a female “he or him” or call
someone who identifies as male “she or her”.
Don’t project transphobia onto the transgender client or share
transphobic comments with other staff members or clients.
Never make the transgender client choose between hormones and
treatment and recovery.
Don’t make the transgender client educate the staff.
Don’t assume transgender women or men are gay.
Don’t make transgender individuals living as females use male
facilities or transgender individuals living as males use female
facilities.
Never allow staff members or clients to make transphobic comments
or put transgender clients at risk for physical or sexual abuse or
harassment.
A Provider’s Introduction to
Substance Abuse for Lesbian,
Gay, Bisexual, and
Transgender Individuals
First Edition
CLINICAL ISSUES WITH YOUTH
Unifying science, education and services to transform lives.
Learning Objectives
Identity Studies**
A Provider’s Introduction to
Substance Abuse for Lesbian,
Gay, Bisexual, and
Transgender Individuals
First Edition
Families of Origin
and Families of Choice
Unifying science, education and services to transform lives.
Learning Objectives
Understand families of
origin versus families of
choice
Understand family-related
relapse triggers
Be able to develop
interventions for families
of choice in treatment
What were the rules of the Was anyone else in the family
family system? acknowledged to be or
suspected of being a lesbian,
Was there a history of gay, bisexual, or transgender
physical, emotional, spiritual, individual?
or sexual trauma?
How did the family respond to
other individuals coming out or
Were all family members being identified as LGBT
expected to behave or evolve individuals?
in a certain way?
A Provider’s Introduction to
Substance Abuse for Lesbian,
Gay, Bisexual, and
Transgender Individuals
First Edition
Related Health Issues
Unifying science, education and services to transform lives.
Learning Objectives
FALSE
Lesbians are at Lesbians may be at increased
risk for HPV infection and,
lower risk for hence, cervical cancer,
breast and depending on their sexual
practices.
cervical cancer Lesbians typically see
than heterosexual healthcare providers less
frequently than do
women. heterosexual women, and,
thus, may not undergo
sufficient screening.
TRUE
Gay men are at Hepatitis A and B can be
transmitted through
higher risk sexual contact.
for hepatitis A Hepatitis B and C can be
transmitted through
and B, and, in sexual contact and/or
some cases, sharing needles.
hepatitis C.
FALSE
There is a In recent San Francisco
relatively low study HIV prevalence
prevalence of HIV among MTF persons was
35% and 65% among
infection among African-American MTFs.
male-to-female Other recent studies of
transgender transgender health risks
persons. in urban areas around the
country show similar
results.
FALSE
Gay men tend Recent and
to smoke less representative studies
than among gay men have
heterosexual indicated strikingly
higher rates of
men. smoking among gay
men than in the
general male
population.
Power Point Slide # 12-6, n26
A Provider’s Introduction to Substance Abuse for LGBT Individuals Module 1 Overview
True Or False
Unifying science, education and services to transform lives.
FALSE
Even when men who
Gay and bisexual have sex with men
men are at higher refrain from
risk for HIV but unprotected anal sex,
lower risk for they may engage in
gonorrhea and other activities such
chlamydia. as unprotected oral
sex that increases
risk for both
gonorrhea and
chlamydia.
Power Point Slide # 12-7, n27
Ron
How would you proceed
with the assessment?
A Provider’s Introduction to
Substance Abuse for Lesbian,
Gay, Bisexual, and
Transgender Individuals
First Edition
Counselor Competence in
Treating LGBT Clients
Unifying science, education and services to transform lives.
Learning Objectives:
Andrea
David
Rita Greg Amber
Power Point Slide # 13-4, n36
A Provider’s Introduction to Substance Abuse for LGBT Individuals Module 1 Overview