1. Inappropriate Mainstream Services

2. Hellman et al 1989 • heterosexual bias in treatment and evaluation (including either focussing primarily on sexual orientation when inappropriate or ignoring important factors linked with sexuality), • ignorance about lesbian/gay issues and discomfort at approaching matters of sexuality, • ignorance about the inter-relation of homosexuality and alcohol misuse, • lesbians and gays felt discomfort in the mainly heterosexual environment of agencies and were fearful of being viewed as pathological or stereotyped.

3. Neisen & Sandall (1990) • difficulty in being open about their sexual orientation due to fear of staff/client harassment, • staff telling them it wasn't acceptable to discuss sexual orientation, • some were forced to disclose their sexual orientation, • as soon as their sexuality was known, some were discharged, • some said that after disclosure the treatment they received was different due to an atmosphere of condemnation, • some feared that if their sexual orientation was known about this would receive more emphasis than their chemical dependency, • some services were not happy having their partner attend a family programme.

4. O’Hanlan (1996) • the majority of detoxification and rehabilitation programmes were insensitive to issues of sexual orientation and did not, generally, encourage its disclosure; • homophobia limits the success of recovery and treatment for lesbian substance abusers (Hall, 1990; de Monteflores, 1986); • failure to acknowledge sexual orientation makes relapse more likely (Cabaj, 1992); • lesbians were more likely to attend treatment services which address lesbian social issues and provide lesbian counsellors (Hall,1986, 1990, 1992, 1993, 1994; Morales & Graves, 1983).

5. Other Issues • Rofes (1989): traditional networks which people use to support recovery: family, church, school, employers, are often closed to LGBs • Hawkins (1976): closet gays attend het-oriented AA groups: detrimental effects as key to sobriety is “open and honest relationship with one’s peers.”

6. Bridget (1994) • more than half of the 121 respondents never discussed sexual orientation with their clients, • only a handful had had training and supervision in relation to lesbian clients, • the majority had little knowledge about the treatment and evaluation of lesbian alcohol misusers, • 84% felt able to treat lesbian clients, • 67% said they would like training on these issues.

7. Mainstream Services in Britain • 1991-1992 Alcohol Directory: 120 agencies welcomed LGB people • 1998-1999 Alcohol Directory: 17 agencies make special provision for LGB people • Alcohol Concern, 2002: only 7% of users of 450 alcohol treatment agencies in UK LGB

8. Specialist/Gay-friendly • DASL • Hungerford Project • Blackpool • Piccadilly Project, Bradford • Others • LGB AAs

9. Making Services Accessible • Acknowledge problem • Conduct training needs assessment • Homophobia awareness training • Policies, procedures • Specialist worker/provision • Publicise service • Links with local LGBT orgs • Evaluate and monitor

10. Pros/Cons of separate provision • Is there a need to debate? Need both • Closet LGBs (most vulnerable) not likely to attend separate LGB therefore crucial mainstream accessible, knowledgeable • Specialist provision (could be within LGB org or alcohol treatment agency)