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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