Alcohol Abuse and Dependence in Gay and Lesbian Populations

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					Alcohol Abuse and Dependence
in Gay and Lesbian Populations

           Marty H. Hoiness M.D.

                  Acting Instructor
  Department of Psychiatry & Behavioral Sciences
   University of Washington School of Medicine
            Harborview Medical Center



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Alcohol Abuse and Dependence
in Gay and Lesbian Populations

  Prevalence Estimates

  Reasons for Possible Increased Prevalence

  Substance Abuse/Dependence and HIV

  Treatment Recommendations


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              Prevalence
• Estimated to be approximately 30% in
  men

• True prevalence unknown

• Most studies have methodological errors

• Most studies have found greater
  prevalence compared to heterosexuals

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Etiology of Increased
     Prevalence

• Biological Factors

• Societal / Cultural Factors

• Psychological Factors



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      Biological Factors

• Growing evidence that substance
  abuse / dependence and
  homosexuality have some genetic
  component




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   Societal / Cultural Factors

• Stigmata of homosexuality

• Homosexual culture is often focused
  around alcohol use with few alcohol-free
  social outlets

• Alcohol use allows individuals to
  experience their sexuality regardless of
  acceptance

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      Psychological Factors
• Internalized homophobia may cause
  psychological distress
• Many gay individuals have their first
  sexual experience under the influence of
  alcohol
• Self acceptance of homosexuality may
  be important in the treatment of alcohol
  abuse / dependence
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  Current Treatment Programs
• Less than 5% of individuals in treatment
  programs self-identified as homosexual

• Issues of gay and lesbian clients are rarely
  addressed in treatment programs

• Drug and alcohol programs report that they
  have relatively little knowledge of the
  special needs of gay and lesbian clients
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           HIV and Alcohol
• Alcohol intoxication may increase risky sexual
  behavior

• Men who don’t drink during sex are three
  times more likely to engage in safer sex

• Association between risky sex and alcohol
  has not been replicated in all studies



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         HIV and Alcohol

• Alcohol abuse / dependence leads to
  difficulties with adherence to HIV
  therapies

• Alcohol may increase the progression of
  HIV infection through immune
  suppression


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Alcohol Problems in Lesbians


• Very few studies documenting
  prevalence

• Society focuses on men and neglects
  issues of women

• Few lesbian specific treatment centers

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     Alcoholics Anonymous

• Most cities have gay/lesbian AA
  meetings
• Clients may need to be reminded that
  AA is not specifically focused on religion
• Extending the powerlessness over
  alcohol concept to being powerless over
  being gay may be helpful
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        Recommendations
• Screen gay and lesbian clients for
  alcohol abuse and dependence

• Gay and lesbian individuals should be
  referred to gay and lesbian specific
  treatment centers

• Treatment should focus on acceptance
  of homosexuality
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               Summary

• Prevalence of alcohol problems may
  be elevated in gay and lesbian
  populations
• Multiple possible etiologies
• Current treatment program rarely
  address gay and lesbian issues

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               Summary

• HIV risk taking behaviors may be
  associated with alcohol use
• Lesbian clients may have special
  needs
• Treatment centers should address gay
  and lesbian issues

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posted:4/12/2008
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