WI Bureau of Mental Health and Substance Abuse
Weston M. Edwards, PhD
Weston M Edwards, PHD LP
• PhD from UMN, Counseling Psychology
• Research in the area of Measuring Sexual Health
• Licensed Psychologist, MN Board of Psychology
Pride Institute, Director of Program Development
• Enhancing current programming
• Development of residential sexual compulsivity program
Sexual Health Institute
• Private practice
• Instructor in the School of Psychology
Instructor in the Mental Health Counseling Program
• Currently teaching Diagnosis and Assessment
Introduction to basic sexology regarding LGBT
Understand how behavioral psychology and
twelve-step traditions can be used concurrently
to produce optimal treatment results
Understand the effects of societal heterosexism
on substance use in their LGBT patients
be able to identify common co-occurring
compulsive behaviors that present in LGBT
Brief Review of Current research
Selected approaches to treating
why a LGBTQ treatment
program is important.
While this article does not suggest that all homosexuals
are child molesters, the overwhelming evidence finds
that "mainstream" gay activists and publications
regularly flirt–indeed promote–the notion of pederasty
(sex between adults and children of the same sex). 295-
Again, this is not an attempt to turn the "guilt by
association“ tactics of gay activists on them–it would be
defamatory to imply that homosexuals in general are
the moral equivalent of serial killers. Nonetheless,
evidence strongly suggests that there is a
disproportionately high rate of violent sex crimes
among male homosexuals (pg 333).
Article posted to the SASH listserv, March 19, 2008 by Judith Riesman.
We simply do not know. We have best
estimates of population
• Kinsey’s 10% (1950’s) having same sex behavior –,
• Michael’s meta-analysis (1996) showed 10% male
and 5% female
self-identify as GL (therefore, today’s estimate is 7-8% being
• CDC studies in 2002
Self-identification of men at 11% and women at 3%.
Lifetime behavior for men at 54% and women at 11%
• Bockting studies of HIV risk in 2003 indicate 6%
may be high due to studies sexual behavior focus
behavior and identity
• identity as a process – when does one identify?
• behavior separate from identity (MSM through
more recent aversion to labels (ex. – queer, bi-
reluctance to disclose – stigma and discrimination
convenience sampling that biases results
Models of Coming out
• Cass (1978) Intrapersonal 6 stages
• Coleman (1982) Psychosocial 5 stages
Getting stuck in process
• addictive behaviors
• Mental Health Concerns
Higher rates of addiction/use.
• Research studies suggest that, when compared to the general
population, lesbian, gay and bisexual (LGB) individuals are likely to
use drugs and alcohol, have higher rates of substance abuse, are less
likely to abstain from substance use, and more likely to continue heavy
drinking into later life (Center for Substance Abuse Treatment, 2001).
• 23-35% higher in LGBT (>3x hetero)
• relapse is more frequent in LGBT
• periods of sobriety between relapses are shorter for LGBT
LGBT social reliance on bars / drinking events
struggles with “God” and spiritual messages of 12-Step groups
multiple minority lables (women, ethnic minorities, etc.)
lack of support (family abandonment, lack of affirming 12-step groups)
co-occurring with compulsive sexual behavior
co-occurring mental health issues.
Much energy is current being focused.
• NSDUH data estimate approximately 5.2 million people had COD in
2005 (SAMHSA, 2006).
Depending on the survey, some estimates are up to 10
• Because the treatment of COD is a relatively new field, there has not
been time for the development and testing of a large number of
Evidence Based Protocols.
Substance Abuse and Mental Health Services Administration, and Center for Mental Health Services Center for
Substance Abuse Treatment. (2007) Understanding Evidence-Based Practices for Co-Occurring Disorders. COCE
Overview Paper 5. DHHS Publication No. (SMA) 07-4278. Rockville, MD:.
Principle 2. An integrated system of mental health and
addiction services that emphasizes continuity and quality.
Principle 5. The system of care must reflect the importance
of the partnership between science and service, and
support both the application of evidence- and consensus-
Principle 6. Behavioral health systems must collaborate.
Principle 9. Empathy, respect, and belief in the individual’s
capacity for recovery are fundamental provider attitudes.
Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment.( 2006)
Overarching Principles To Address the Needs of Persons With Co-Occurring Disorders. COCE Overview Paper 3.
DHHS Publication No. (SMA) 06-4165 Rockville, MD.
Need to have resources for dual diagnosis.
• In MN, Rule 31, Dual Diagnosis
• Chem dep individuals trained in MH and
• MH staff trained in Chem Dep.
Avoidance of an either/or approach.
• (Different from the MN Model)
OUIMETTE P., JEMELKA, R. HALL, J., BRIMNER, K. KRUPSKI, A. & STARK K. (2007) Services to Patients with Dual Diagnoses:
Findings From Washington’s Mental Health Service System Substance Use & Misuse, 42:113–127
12-step approaches/Minnesota Model
Field is very complex.
buprenorphine and other narcotics for opioid addiction
Multiple drugs for other drugs of choice.
Bupropion for the Treatment of Methamphetamine
Dependence.(Elkashef, et al (2008) Neuropsychopharmacology 33:5, 1162-1170)
12 Step tradition
Variations on a theme
A framework for categorizing addiction
versus a treatment approach
Six content areas
3. Emotional/Psychological Issues
4. Treatment Acceptance
5. Relapse potential
6. Recovery Environment.
The Acting Out Cycle
High Risk Situations
Payoffs/Costs Act out
Escape/Avoidance Sexual behavior
Pleasure Other types of behaviors
Step 1 - We admitted we were Step 7 - Humbly asked God to remove our
powerless over our addiction - that shortcomings
our lives had become Step 8 - Made a list of all persons we had
harmed, and became willing to make
amends to them all
Step 2 - Came to believe that a Power Step 9 - Made direct amends to such people
greater than ourselves could restore wherever possible, except when to do so
us to sanity would injure them or others
Step 3 - Made a decision to turn our will Step 10 - Continued to take personal
and our lives over to the care of God inventory and when we were wrong
as we understood God promptly admitted it
Step 11 - Sought through prayer and
Step 4 - Made a searching and fearless
meditation to improve our conscious
moral inventory of ourselves contact with God as we understood God,
Step 5 - Admitted to God, to ourselves praying only for knowledge of God's will
and to another human being the for us and the power to carry that out
exact nature of our wrongs Step 12 - Having had a spiritual awakening as
Step 6 - Were entirely ready to have the result of these steps, we tried to carry
God remove all these defects of this message to other addicts, and to
character practice these principles in all our affairs.
Step 1 - We admitted we were powerless over
our addiction - that our lives had become
Step 2 - Came to believe that a Power greater
than ourselves could restore us to sanity
Step 3 - Made a decision to turn our will and
our lives over to the care of God as we
Step 4 - Made a searching and fearless moral
inventory of ourselves
Step 5 - Admitted to God, to ourselves and to
another human being the exact nature of our
at the underlying human
Attemptto understand the experience
then provide the label.
Minnesota Model Cog. Behavioral Therapy
“Higher Power” Classic Goal Therapy
-what do you want in life?
as part of the cycle.
Home/Group Sponsor Support Network
Making Amends Taking Responsibility for behavior
Fearless Moral Inventory Full disclosure
Ready to ask god to take these defects Motivation for change
Primary aftercare program is a 12-step
Ithink we do our clients a disservice if
we don’t help them understand the
support network they are returning to.
bridge the gap between
SAMSHA has a great resource.
• Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatments (2001) A
Provider’s Introduction to Substance Abuse Treatment for Lesbian, Gay, Bisexual, and Transgender Individuals.
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Rockville, MD
Not every “gay” program is “gay.”
• 70% of providers offering gay identified programming that has
no difference with their “non-gay” programming.
• Outside of New York and California, little “gay” programming
exists. Only 32 programs as of 2003/2004.
• Only 7.4% could identify what they do that responded to “gay
COCHRAN, B. , PEAVY, M., & ROBOHM J. (2007) Do Specialized Services Exist for
LGBT Individuals Seeking Treatment for Substance Misuse? A Study of Available
Treatment Programs Substance Use & Misuse, 42:161–176DOI:
GLBT Averse (Anti-gay).
• Your sexual orientation is the cause of your
• We have gay people?
• OK, we have gay people, and it’s not an issue.
• We need to do something, but the needs of the
group come first, so don’t talk about it.
• A group/track that integrates the GLBT program
within the larger community.
• All programming is designed to address GLBT
issues within the GLBT culture.
Amico & Neisan (1997), Sharing the Secret:
The need for gay- Specific treatment
The Counselor, May/June 1997, 12-15
Heterosexism/homophobia, both internal and external, are
Isolation and poor self-concept are “natural” reactions to
systemic negative messages.
Healthy Social outlets and forums are often
Bars and clubs become the most available comfortable
social outlets, and in locales where these are unavailable,
isolation can be even greater.
Substance use can serve as an easy relief from negative
feelings and provide a degree of social acceptance.
Barbara & Chairm (2004) Asking About Sexual Orientation During Assessment for Drug and
Alcohol Concerns: A Pilot Study. Journal of Social Work Practice in the Addictions, 4(4), 89-109.
All are related, and often interchangeable.
• Generally negative view of homosexuality
• Only one form of sexual orientation is healthy.
• And the degree to which these thoughts create a
sense of fear
Can be internalized and externalized.
Most of it is Covert Expression
• Do you “mind” seeing a LGBT therapist.
• Assuming a client is “straight.”
Failure to assess
• Using opposite sex language when asking about partners.
• Not exploring/understanding stereotypes and challenging.
• What “caused” your homosexuality?
Avoiding the topic
• Not following up on a topic. How did the date go?
Body image issues
• Kimmel &Mahalik (2006) Body Image Concerns of Gay Men: The Roles of Minority Stress and Conformity
to Masculine Norms. Journal of Consulting and Clinical Psychology 73:6, 1185-1190.
HIV Risk /Status
• Prevalence ~60% of HIV cases are in the MSM
• Incidence (2006) 147 of 237 cases (MDH)
• Queer eye for the Straight Therapist (joekort.com)
• Don’t make assumptions
• How do you self-identify.
• Equally disclose as appropriate/when asked
• Model disclosure/create safety
• Recognize the impact of homophobia/heterosexism.
• Be sensitive to language
• Identify as a gay male versus “Are you gay”
• Sexual orientation versus sexual preference
• Acknowledged your limitations
• Heck, even I don’t know all there is to know about the GLBT community.
• Give yourself permission not to know. Read, ask, seek supervision
• Make a welcoming environment
• Lavender magazine?
• Other magazines?
• Forms that are inclusive
• Party 1/Party 2
Guideline 2. Psychologists are encouraged to recognize how
their attitudes and knowledge about lesbian, gay, and
Guideline 3. Psychologists strive to understand the ways in
which social stigmatization
(i.e., prejudice, discrimination, and violence) poses risks to
the mental health and well-being of lesbian, gay, and
Guideline 4. Psychologists strive to understand how
inaccurate or prejudicial views of homosexuality or
Guideline 5. Psychologists strive to be knowledgeable about
and respect the importance of lesbian, gay, and bisexual
Guideline 8. Psychologists strive to understand how a
person’s homosexual or bisexual orientation may have an
impact on his or her family of origin.
Guideline 9. Psychologists are encouraged to recognize the
particular life issues or challenges experienced by lesbian,
gay, and bisexual members of racial and ethnic minorities
that are related to multiple and often conflicting cultural
norms, values, and beliefs.
Guideline 12. Psychologists consider generational
differences within lesbian, gay, and bisexual populations.
• Pride Institute
14400 Martin Drive
Eden Prairie, MN 55344
• Weston Edwards, Ph.D, LP
(direct/cell) 612 987 4482