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Bureau of Domestic and Sexual Violence Prevention
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- Addiction and the Lesbian, Gay, Bisexual, or Transgendered Individual
- Research on alcohol and drug addiction in the gay, lesbian, bisexual, or transgendered (LGBT) community is limited by a number of factors. Early research tended to concentrate on samples drawn from almost exclusively male patients of psychoanalysts and psychotherapists. The focus of the studies was often directed less toward treatment of alcoholism or addiction than toward "curing" homosexuality. Subsequent studies have focused on samples of people who are identified as gay because they are patrons of gay bars (Fifield, 1975). The fact that in each of these groups rates of drug and alcohol use tended to be higher for what should have been obvious reasons skewed the resulting data.
- A review of LGB incidence studies (Bickelhaupt, 1995) notes one ambitious 1991 study of 748 gay, lesbian and bisexual individuals in the San Francisco area using a lengthy survey tool, which included a 209-item AOD use survey over a two-month period. "Distribution," the author notes, "was accomplished using a gayllesbian monthly newspaper, bookstores, businesses, organizations, service agencies, personal networks of LAGSAP (Lesbian and Gay Substance Abuse Planning Group), and field workers. In addition, there were interviews with targeted populations, including people of color, youth, and homeless or low-income people." The study found that nearly one third (31 %) of gay and bisexual men reported using alcohol and/or drugs at the highest risk level (suggesting dependency) and another 1 1 % reported patterns of drinkingldrug use labeled "problematic."
- Alcohol was recognized as the drug of choice for gaylbi men (75%) and lesbianlbi women (66%). Forty percent of male and 30 percent of female respondents indicated use of more than one drug, and twice as many men as women (1 0% vs. 5.5%) used alcohol daily (Kelly, 1991, cited in Bickelhaupt). This example illustrates a major methodological problem of studies like this in that a largely self-selected sample was used that included only men and women who were to at least some level "out," or publicly identified as gay or lesbian. Useful as this information is, the fact remains that there has been little research that recognizes the fact that most gay men and lesbians historically have not publicly acknowledged their orientation; this voiceless majority consequently has been overlooked in most studies. No such extensive studies have been done of the transgendered population, and Bickelhaupt notes that in several studies, because of small sample size or apparent "mixed membership," the bisexual component studied was either dropped or not reported in the final data.
"Bar Culture" in LGBT Communities
One of the factors complicating the recognition and treatment of addiction in the LGBT community is the fact that bars do tend to be social centers in the community. For people who may be subject to hostility, violence, or arrest for making incorrect guesses or assumptions about another person's orientation, it is important to have a place where LGBT identity can safely be assumed. That place has usually been the gay and/or lesbian bar. In larger communities, this is less true now than it may have been previously, but it is still the case for many LGBT people. In some locales such venues are the only places where LGBT people can be relatively free of harassment and ridicule, although in some communities even these havens are subject to law enforcement and regulatory discrimination. It may be true for some people that the only gay men or lesbians they know are people whom they have met in gay or lesbian bars.
Several researchers, (notably Kus, 1988) have suggested that there is evidence that the etiology and incidence of alcoholism in gay men, at least, is unrelated to gay bars, noting that most gay alcoholics interviewed point out that they began drinking (and may have begun problematic drinking) before they ever patronized a gay bar. In larger communities, 12-step and other groups with a specific focus on gay men, lesbians, or the LGBT community in general have become well established alternatives for those recovering from addiction. In the Chicago area there are now two social organizations for recovering people that provide social and recreational activities in addition to self-help groups. Rural LGBT people in recovery may have less formal networks within AA, NA and other groups, but for many LGBT people, bars will continue to be part of their social life in sobriety. Treatment centers that do not serve large numbers of LGBT clients may be ill-equipped to prepare them for dealing with this aspect of their recovery.
LGBT-Specific Treatment Options
Treatment options for the LGBT person have been less carefully thought out and less available than those from which heterosexual clients choose. In a recent edition of a directory published for the LGBT community in Illinois' largest city, there are 35 listings for "Counseling and Psychotherapy." Only two mention addiction specifically and one of those is a Chicago unit of an addiction treatment program specifically designed for LGBT people. A third program refers to "compulsive behaviors." (Out!, 2002- 2003). Another guide offers a separate specific "Addiction Recovery" section; it fails to list the LGBT-specific program but does include information about contacting LGBT 12-step groups and organizations such as Rational RecoveryTM (Alternative Phonebook, 2002-2003).
On the whole, people in the LGBT community tend to be wary of mental health and substance abuse treatment because of the homophobic assumptions and practices which have been characteristic in the past (and which continue to be a problem in some institutions and settings). Moreover, the "peer group" from whom LGBT people must seek support in treatment and in 12-Step and other self-help groups may reflect the generally homophobic attitudes of the larger culture, and may pose problems for the gay man or lesbian who is seeking sobriety. The encouragement of self-acceptance, which generally characterizes addiction treatment, has often hit a snag when a client discloses same-sex sexual attraction.
While the incidence of LGBT alcoholism and drug addiction may have been overstated in some studies there is certainly no reason to believe that overall rates of addiction and substance abuse in the LGBT community are any lower than in the general community. Other research has shown that addiction to or abuse of substances "occurs over time and progresses - or not - according to an intricate process that involves the larger socio-cultural system; the individual's age, life stage, and social role within that system; the demands and opportunities of the individual's more immediate social environment; and the unique pattern of neurobiological vulnerability and protection that his or her genetic endowment provides" (National Institute on Alcohol and Alcoholism, 2000).
Even assuming a similar distribution in the LGBT community of whatever factors may predispose people to addiction for genetic or biological reasons, the use of alcohol and other drugs to medicate negative feeling states resulting from homophobia (both external and internalized) is likely to be higher in this population. Thus, it seems likely that those with such predisposing factors will be more likely to show symptoms of the disease, and to do so earlier.
Violence in and Lesbian Gay Relationships
What we know about same-gender relationship violence is limited. According to a fact sheet distributed by the Wingspan Domestic Violence Project in Tucson, AZ, this is because:
- Same-gender relationships are often not considered to be viable partnerships or families.
- In many states (Illinois is an exception'), domestic violence law only protects partners of the opposite sex. Other types of domestic violence legislation, such as mandatory arrest, no-drop clauses, state prosecution and mandates for abusers or victims to attend programs that address domestic violence, may not apply to samegender relationships.
- 'IDVA [750 ILCS 60/103(6)] lists "persons who have or have had a dating or engagement relationship." Illinois courts have interpreted this to include same sex partners.
- Fear of continued victimization by law enforcement, criminal justice, and social service helpers keeps LGBT people from seeking assistance, support, and safety.
- Limited or non-existent officially sanctioned programs and resources further isolate same-gender victims and offer few intervention opportunities for perpetrators in domestic violence situations.
- Many LGBT people lead double lives in which it would be a threat to job, status, family role, safety, and security to be open about their sexual or gender identity. When help is needed, fear of exposure may prevent them from taking action to stop the cycle of violence.
- With a few exceptions, the LGBT community generally avoids, denies, and ignores relationship violence. Victims and perpetrators are left without resources within their identified communities (Wingspan Domestic Violence Project).
There is evidence that battering occurs in gay and lesbian domestic partnerships at roughly the same rate as in heterosexual marriages or domestic relationships. One of the first studies of domestic violence in lesbian relationships found that 25 percent of those surveyed reported abuse in their committed relationships (Brand & Kidd). A 1990 study determined that 47 percent of lesbian couples had experienced repeated acts of violence. Of these couples, 10 percent to 20 percent experienced severe violence, defined as: two or more incidents of physical violence, including beating, strangulation, hitting, forced sex, mutilation or threats with a weapon (Coleman, 1990).
More recently, a study of gay and bisexual men indicated that 2 in 5 of these men who have sex with men experienced abuse in intimate partner relationships (Greenwood, 2002). The Gender, Violence and Resource Access survey of transgender and intersex (defined as those who "naturally, [that is, without any medical intervention] develop primary or secondary sex characteristics that do not fit neatly into society's definitions of male or female") individuals determined that half of respondents had been raped or assaulted by a romantic partner. The study goes on to note that only a little less than 213 of transgendered or intersex individuals who reported rape or assault (or a bit less than 113 of the whole sample) described themselves as survivors of domestic violence (Courvant and Cook-Daniels, 1998).
Chicago-based Horizons Community Services is the only Illinois program reporting statistics on LGBT domestic violence to the National Coalition of Anti-Violence Programs, which publishes an annual report on LGBT domestic violence across the nation.
In the NCAVP's report on LGBT domestic violence in 2002, Horizons reported 74 new cases. These reports break down as follows:
Horizons 2002 Report to NCAVP
|Questioning or Unsure
Months with the highest incidence were January (12), August (14) and December (1 0). Months with the fewest reports were February and September with two each, and April and May, with three each.1 Clearly, these numbers cannot be considered fully representative of the incidence of domestic violence in Chicago, Illinois' largest LGBT community, as they do not include LGBT victims served by other agencies and governmental units or unreported incidents. It seems important to note the obvious: that when appropriate, LGBT-specific services are available, many LBGT victims use them.
1 "Lesbian, Gay Bisexual and Transgender Violence in 2002: A Report of the National Coalition of Anti-Violence Programs (2002 Preliminary Edition) 02003, Adapted from Appendix A (Data Chart).
Homophobia, Misogyny and Violence
Rigid conceptions of gender roles and attributes play a significant part in the dynamics of domestic violence. The expectation of male privilege is grounded in a belief that men are superior to women and that men have rights with regard to women which are not reciprocal. One of the effects of this attitude is to make male identity, and specifically heterosexual male identity, the norm. To be anything else is to be "less than."
In a sexist society it is not surprising that boys who find themselves attracted to other males, and wish the attraction reciprocated, may begin to internalize the gender role expectations that surround them and assume characteristics that the social framework characterizes as "feminine." Similarly, girls who are attracted to women may take on characteristics that might be seen as "masculine." Misogyny's relationship to homophobia can be inferred from the fact that adults generally see a girl who is considered a "tomboy" as "cute" far longer than they do a boy who is considered a "sissy."
The threat to male privilege implied by homosexuality is that gender roles and their attendant privileges are not immutable ("if he can give his up, perhaps mine can be taken away"). If, as a man, I view women as sex objects in ways that depersonalize them, I am likely to respond with anger and fear to the thought that another man might regard me in the same way. If, as a man, I am defensive of male privilege, I may well feel threatened when confronted by another man who appears to have voluntarily surrendered that privilege. If I believe that being the object of a man's sexual interest is one of the things that defines the female and makes her "less than," then the attention of such a man is even more threatening to me.
Lesbians get less attention from the heterosexist position. The sexual attraction of one woman for another becomes useful in providing a label for women who reject or are indifferent to a particular man's advances. Whereas male-male sex is seen as repulsive and shameful, female-female sexual activity is seen as titillating or merely strange. Thus lesbians tend to become less visible, and are discounted by being trivialized (Nelson, 1988).
Homophobia and Men Who Batter
In many kinds of behavioral intervention or therapy with men, it is necessary to address homophobia as an isolating factor. Men in substance abuse treatment, for example, often need to confront homophobia as a factor that makes it more difficult for them to selfdisclose in groups of men or to confide fully in a sponsor. Many men come to realize that homophobia has made it difficult for them to seek and appreciate support from other men, including fathers and male siblings.
In intervention with men who batter, however, homophobia and its relationship to misogyny play a more crucial role, and confrontation of homophobia is often a difficult and volatile aspect of the intervention process. Placing gay men in intervention groups designed for heterosexual males makes them uniquely vulnerable. They may become targets for the fear, discomfort and hostility which men in the group often experience as men's assumptions about maleness and masculinity are challenged.
Perhaps related to homophobia is the antipathy or discomfort with transgendered people that is sometimes referred to as transphobia. During focus groups, providers who serve the transgendered community pointed out that reporting of domestic violence among transgendered clients is frequent in private conversations but rare in official reports. One provider reported that a number of transgendered sex workers have reported frequent abuse by clients or procurers but state that reporting to the police has only resulted in ridicule or harassment. Additionally, they report confronting confusion or uncertainty when they approach some social service agencies for assistance.
The consistent message that transgendered people give when asked about what would help is that agencies and individuals in the helping professions should first respect the gender identity of the person seeking help, period. Service providers' "ifs, ands, and buts," as one person put it, that are often appended to offers of assistance make transgendered people feel both unsafe and unwelcome because they send a message that providers are not knowledgeable about or comfortable with them because they challenge the conventional understanding of gender. Service providers need to educate their staff about transgendered people, establish policies and procedures that respect the identity of transgendered people, and make appropriate and respectful accommodation when required. Providers must recognize that a transgendered individual who receives gender-inappropriate treatment may be likely to reject the treatment for the same reasons that would cause any other individual to resent or fail to identify with such treatment.
LGBT People of Color
Lesbians, gay men and transgendered individuals who are people of color experience what has been called "double trouble": they must deal with the effects not only of racism, but also of homophobia. For lesbians of color, this becomes a triple threat, as the effects of sexism must also be considered. People of color must deal with racism in the gay and lesbian community, whose emerging culture remains heavily dominated by white men and women. At the same time, in struggling against racism, they must deal with the fear of homophobic retaliation in addition to their other vulnerabilities. These factors increase the isolation of the lesbian of color particularly, but also of the gay or transgendered person of color. The person of color who embraces a lesbian, gay, bisexual or transgendered identity is subject not only to homophobic attack, as are whites, but also to racist attacks, which are not a concern for whites (Kanuha, 1990).
Few resources are available for intervention in violent LGBT relationships. It is obvious that gay men would not be safe in an intervention group that was predominantly composed of heterosexual men. Of course, no woman should be included in a group for men who batter. In many communities, this makes group treatment of gay and lesbian batterers impossible, because it is unlikely that a sufficient number of gay men or lesbians to form an effective group would present for intervention at any one time. In Chicago, the largest social service agency that serves the lesbian and gay community is currently referring identified perpetrators to individual therapy with selected psychotherapists. This is certainly not recognized as the intervention of choice.
One private practice in the Loop area is willing to provide group intervention but has not yet received enough referrals to begin a group. At this writing one agency is planning to begin a group intervention for gay and bi men in the fall of 2005 and for lesbians and bi women in early 2006 (West Side Domestic Abuse Project, Chicago). They are also engaged in discussions with other service providers who primarily serve the LGBT community in Chicago to assure the necessary matrix of ancillary services for an accountable intervention group. In discussing this issue with various service providers, the authors found that several partner abuse intervention groups for women in various areas of the state report that some lesbian perpetrators have been successfully integrated into women's intervention groups. Other counselors working with lesbians who have been identified as perpetrators have reported that some clients make it very clear that they would not be comfortable in groups of heterosexual women. To date, no groups specifically for lesbian perpetrators exist in the state, and no partner abuse intervention groups for bisexual or transgendered men or women are available.
Lesbian victims of domestic violence report a wide variety of responses from shelters and other domestic violence providers. A particular shelter's commitment to providing safe refuge for lesbian women may depend on the attitudes of individual staff members and volunteers, and may change as personnel change. Focus groups of persons active in the LGBT shelter movement and the battered women's movement in Chicago described incidents of lesbians coming into shelter reporting that they had been denied shelter by staff at a local shelter who felt their presence would be "disruptive" to the milieu of the shelter. Most shelters in Illinois have no policy that would exclude a woman simply because she is lesbian, but staff sensitivity and willingness to confront homophobia on the part of other residents varies considerably.
Although an LGBT shelter movement has begun in Chicago, it has not yet progressed to the point where clients can be offered specific LGBT-friendly shelter. This movement hopes in the future to be able to offer shelter in homes, much like the early work of the battered women's movement, and eventually a brick-and-mortar shelter for LGBT victim-survivors of domestic violence. Several shelters around the state will provide emergency assistance (usually in the form of vouchers for hotel or motel accommodations) to gay male victims of domestic violence. At present, there are no active support groups for gay, lesbian, bisexual or transgendered victims of domestic violence in any agency in Chicago or elsewhere in the state. Several agencies have tried to develop these with limited success in the past.
Concerns specific to LGBT identity also reduce the willingness of people affected by the problem to seek help. Anecdotal evidence is strong that such services, if they existed, would be used by only a small fraction of the LGBT community. Barriers to greater participation include the following:
- Fears of being 'buted or exposed as homosexual. In Illinois, it has only been since early 2005 that gay, lesbian, bisexual or transgendered persons are protected by law from being discharged from or refused employment, evicted from or refused housing, and denied any public accommodation simply because of the person's sexual orientation. In fact, such discrimination is also legal on the basis of perceived or suspected orientation. (This protection does not exist in all states.) Despite this new legal protection, there may be less-formal kinds of discrimination (ostracism by family, co-workers or religious community, for example) that may discourage the victim from acknowledging his or her abuse.
- Low expectations of official response. Many LGBT persons have experienced insults, harassment, and ridicule from police and other governmental authorities, and do not expect serious attention to their needs, including their needs for protection from violence. Many fear that taking action will result in retaliation by the perpetrator that will go unhindered by any official sanction.
- Concerns about HIV status and about having that status revealed. For those who are impacted by HIV, abusers may exploit fear that negative consequences from employers, family, friends and acquaintances, landlords and others in the community may result from disclosure of that status.
- Fear of other homophobic or heterosexist responses. Both battered gay men and lesbians who batter challenge the assumptions that underlie the provision of services to both victims and perpetrators. Internalized homophobia leads many in the LGBT community to deny or minimize the existence of the problem, and disbelief, ridicule or rationalization often greets discussion of the problem.
Working With LGBT Domestic Violence Survivors (Adapted from a document prepared by Horizons Community Services, Chicago)
- Whether on the phone or in person, do not assume that every victim you come in contact with is heterosexual. Be sensitive to word choices ("lover" or "partner" or even "roommate" as opposed to "boyfriend/girlfriend" or "husband/wife." Be aware of your own use of pronouns from the initial contact with any victim; do not assign a gender to their partner until they do. Practice use of non-gender-specific language.
- Do not pressure the victim to file a report or follow up on legal action. Know that this is a difficult and risky choice for the victim (to be involved in the legal system), especially if they/their partner are not "out." If the victim does choose to take legal action, work with them on anticipating the reactions of family, friends, employers, etc. Know what protections exist or do not exist for them.
- Take special care in finding out what support systems exist in a victim's life. Acknowledge that some victims may not have the support of their original family members. Do not assume that a victim has an "LGBT community" to which they can turn for support. Acknowledge that many of their friends may align with the abuser and not want to get involved. Provide the victim with information and referrals and let them know that they are not alone and that they are welcome in your program.
- Respect their individuality and don't expect them to conform to stereotypes or your ideas of what LGBT people are like. Don't assume that just because they're in a relationship with someone now that they've never been with other genders in the past. Don't assume that they or their partners are childless. Don't assume that they are politically active, a feminist, not a churchgoer, etc.
- Advocate for them in situations where others may be insensitive or unsupportive: police, doctors, landlords, etc.
- Know the counseling, medical and legal resources available in the LGBT community in order to make appropriate referrals, but don't assume that just because they are LGBT that they will want an LGBT attorney, therapist or doctor.
- If an LGBT victim asks to speak to an LGBT advocate and none are available, do your best to convey your knowledge and sensitivity to their needs and concerns, but do not automatically pass LGBT clients off to an LGBT counselor.
Working With LGBT Abusers
Most of the same things apply to working with abusers, but there are several other issues that partner abuse intervention professionals should keep in mind, whether they are starting a group for abusers or working with an abuser in individual sessions.
- Do not assume that size, perceived "masculinity" or "femininity," "butch" or "femme" identification, or perceived body strength or weakness are determinant factors in who is the abuser. Consider other kinds of power differentials including class privilege, economic dominance, age and social status, job security, community ties, and HIV status (positive or negative). The abuser may be taking advantage of any of these.
- If it is not possible to offer the client a counselor or facilitator who is LGBT, or a counselor or facilitator who has had extensive training about and contact with LGBT individuals and their needs, consider referral to an agency or individual that can provide these options. If this is not an option, the counselor or facilitator will need to balance the need to listen to the client's understanding of hislher situation with the need to obtain supervision or consultative assistance from professionals who are familiar with the community and the needs of LGBT clients and their victims.
- If your agency or practice does victim safety checks, consider obtaining assistance from a victim's service program that has experience providing services to LGBT victims.
While there are no easy solutions to this complex group of problems, there are steps communities and institutions can take to continue the work that activists in the LGBT, domestic violence and substance abuse treatment communities have begun.
- Continue to name the problem. Community groups, publications, and institutions within the LGBT community must continue to acknowledge that gay men, lesbians, bisexuals and transgendered people batter their intimate partners.
- Make a commitment to a response. Complex problems such as the incidence of violence in samegender relationships often lead to situations in which nothing is done because so much needs to be done. An individual, a single community, or one institution cannot provide all that is necessary to address this, but each can do something. Programs can examine their attitudes toward LGBT clients, and can provide training designed to increase staff sensitivity, awareness, and knowledge about the particular needs of this community and its members.
- Individual counselors and intervention workers can become knowledgeable about the LGBT community in their area.
- Community organizations and networks that have done so much to begin a coordinated response to intimate partner violence in oppositesex couples can examine the opportunities for outreach to LGBT people, including hiring LGBT staff, recruiting LGBT volunteers, and encouraging participation of LGBT people on their Boards of Directors.
- Encourage research. While there are few resources nationwide for this community, there are some. Further research is clearly needed to better understand the dynamics of samesex domestic violence and the particular challenges it poses to intervention and safety planning efforts. Within programs, there are steps that counselors and advocates can take to increase the effectiveness of their interactions with LGBT clients.
- Service providers should be aware that there is not one monolithic "gay subculture" or "gay lifestyle."
- As with any special population, an effort to be culturally sensitive begins with awareness of one's own attitudes. Advocates and counselors may wish to ask themselves:
- Can I personally believe that gay is just as good as straight?
- Can I personally conceive of a homosexual person living a happy life?
- Do I conceal from myself attitudes of pity, condescension, and moral superiority toward LGBT people, attitudes that may cut me off from full communication with LGBT clients? (Schwartz, 1980).
- Become familiar with the resources available to LGBT clients in your community. For example, in Chicago, many LGBT persons may be unaware that more than 60 gayllesbian or gayllesbian-friendly religious organizations have services on a weekly or more frequent basis (Out! 2002-2003). Many LGBT organizations for civic, political, philanthropic, and community organizing activities exist, which are places to seek friendship and support among people who are not focused on drinking or drug use. Social, athletic, cultural and political organizations for LGBT people are becoming more numerous all the time. Many smaller communities may have some resources for LGBT clients of which the clients are unaware. Horizons in Chicago can serve as a resource, as can organizations such as Equality Illinois and the National Gay and Lesbian Task Force.
- Become familiar with referral sources for treatment such as the Pride Institute, Horizons Community Services and the Howard Brown Health Center, which may be able to suggest additional local resources. Obtain copies of the Pink Pages or Out, which are LGBT "yellow pages" publications issued on a semiannual basis.
- Be aware that there is a growing network of sobriety-based support for LGBT people such as specialinterest A.A. and N.A. groups.
In many states (Illinois is an exception), domestic violence law only protects partners of the opposite sex. Other types of domestic violence legislation, such as mandatory arrest, nodrop clauses, state prosecution and mandates for abusers or victims to attend programs that address domestic violence, may not apply to same-gender relationships.