With teens who have tree substance abuse problems, school psychologists may be able to intervene on an individual level, by being aware of substance abuse issues in this population, noting when particular students appear to have problems or deterioration in school performance, and providing assessments and referrals for treatment.
Treatment must build on traditional substance abuse treatment models and incorporate appropriate focus on issues specific to this population (Cabaj, 1996). D'Augelli (1996) suggested seven critical areas in mental health treatment for lesbian, gay, and bisexual youth. They include stress connected with management of their lesbian/gay/bisexual identity; peer relationship disruptions; the decision to disclose to family and the consequences of disclosure; emotional reactions to developing close relationships; being isolated from gay-affirming situations; discrimination, harassment, and violence due to sexual orientation; and anxieties about sexuality, especially HIV. Treatment with this population may be difficult; the issues facing lesbian, gay, and bisexual youth are complex. For example, complicating factors include difficulty with family, unavailability of gay-friendly treatment centers or therapists, religious beliefs, and anti-gay violence and harassment (Ratner, 1993).
Successful treatment begins with a thorough assessment, which should include questioning about many factors unique to lesbians, gay men, and bisexuals. For example, it is important to understand experiences with homophobia and heterosexism, the "coming out" experience, the social support network, religious beliefs, relationship with the family of origin, history of romantic and sexual relationships, and current relationships (Ratner, 1993). Thus, the psychologist may query the youth about the reactions of others (friends, parents, teachers) to their disclosure about their sexual orientation, their daily experience with peers, school personnel, and family regarding their sexual orientation (i.e., is it ignored, are they teased), their same-sex relationship history, and their support network.
Other important factors to assess include signals of inappropriate use, such as difficulties with social life, legal problems, and school or employment difficulties (Faltz, 1992). Warning signs include deteriorating academic performance, increasing interpersonal difficulties (e.g., fights at school), suspensions or expulsions, excessive absences, and threats of dropping out of school. Finally, patterns of use and preferred substances should be thoroughly assessed (e.g., using substances only with a certain group of friends vs. using alone; experiencing blackouts).
Involvement with groups such as Alcoholics Anonymous or Narcotics Anonymous can be beneficial to the recovery process (Anderson, 1996). Some groups may specifically state that they are gay-friendly or may be exclusively for sexual minority persons. Furthermore, many of these groups include a system in which a new member is provided with a sponsor. It is important to consider the sponsor choice carefully, including considering whether to have a sponsor of the same or other gender and whether to have a sponsor of the same sexual orientation (Ratner, 1993). No research on the efficacy of exclusively sexual minority groups or the sexual orientation of the sponsor with sexual minority youth has been conducted, however.
Countertransference issues also are important. If the therapist also is lesbian or gay, minimization of the client's substance abuse may be easier if the pattern of abuse is similar to others within the therapist's social circle. Similarly, idealization of the client may occur (Faltz, 1992). Alternatively, a therapist's negative attitudes toward lesbians and gay men may cloud treatment. Therapists may assume that the client's sexual orientation is the cause of the substance abuse problem (Faltz, 1992) and inappropriately focus on changing sexual orientation as a therapeutic goal (Committee on Lesbian and Gay Concerns, 1991).
Programs to address the needs of youth who have dropped out of school also are important. Several programs have been developed to reintegrate sexual minority youth who have dropped out of high school back into the school setting (e.g., the Hetrick Martin Institute in New York City, Project 10 in San Francisco).
School has an important role in the lives of teenagers, and gay, lesbian, bisexual, transgender, and questioning youth are no exception. Thus, school psychologists can have a pivotal role in the prevention, detection, and treatment of substance abuse problems in this population. By providing support for gay, lesbian, and bisexual organizations at school, they may help alleviate the isolation and loneliness common to these teens. By being aware of the prevalence of substance abuse among gay, lesbian, and bisexual teens, they may be able to detect problems when they start or when they begin to interfere with schoolwork and appropriate development. However, it is important that school psychologists not assume that all lesbian, gay, bisexual, and transgender youth are substance abusers. Finally, they may contribute a critical service in providing treatment to teens who do experience substance abuse problems.
- Jordan, Karen M., Substance Abuse Among Gay, Lesbian, Bisexual, Transgender, and Questioning Adolescents, School Psychology Review, 2000, Vol. 29, Issue 2.
Reflection Exercise #11
The preceding section contained information
about substance abuse intervention with gay, lesbian, bisexual, and questioning adolescents. Write
three case study examples regarding how you might use the content of this section
in your practice.
What are seven critical areas in mental health substance abuse treatment for lesbian, gay, and bisexual youth? Record the letter of the correct answer