Substance Use Disorders in Lesbian, Gay, Bisexual, and Transgender Clients: Assessment and Treatment.
Article Type: Book review
Subject: Books (Book reviews)
Author: Henderson, Donna C.
Pub Date: 10/01/2011
Publication: Name: Social Work Publisher: National Association of Social Workers Audience: Academic Format: Magazine/Journal Subject: Sociology and social work Copyright: COPYRIGHT 2011 National Association of Social Workers ISSN: 0037-8046
Issue: Date: Oct, 2011 Source Volume: 56 Source Issue: 4
Topic: NamedWork: Substance Use Disorders in Lesbian, Gay, Bisexual, and Transgender Clients: Assessment and Treatment (Nonfiction work)
Persons: Reviewee: Anderson, Sandra C.
Accession Number: 274026004
Full Text: Substance Use Disorders in Lesbian, Gay, Bisexual, and Transgender Clients: Assessment and Treatment. Sandra C. Anderson. New York: Columbia University Press, 2009, 284 pages. ISBN: 978-0-231-14275-5. $32.50 paperback.

In her introduction to this long-awaited and essential text on the subject, Sandra Anderson notes that although most lesbian, gay, bisexual, and transgender (LGBT) individuals "are well adjusted and do not suffer from substance use disorders" (p. 2), most studies to date have substantiated a higher prevalence of substance use disorders within this combined population than in the general population. Anderson goes on to posit that

When substances are used to manage the heightened social anxiety particular to the search for partners among members of LGBT groups, Anderson notes, the risks and consequences of use are also magnified. For example, although LGBT individuals experience all the consequences inherent in substance use and dependence in the general population, the higher than average rates of smoking among these individuals contribute to higher rates of various cancers and of lung and heart disease. In addition, the empirical evidence is clear that unsafe sex among HIV-positive gay and bisexual men increases with their use of substances, in turn increasing rates of HIV.

Still, despite the prevalence and often-grave secondary health consequences of substance use disorders in LGBT groups, effective treatment that responds to their complex and unique needs and challenges has remained both underresearched and little-examined in the clinical literature.

Anderson's comprehensive and engaging text goes a long way toward filling this significant gap in the contemporary treatment literature, and it represents a valuable resource to clinicians and scholars alike. Exhaustively researched, Substance Use Disorders in Lesbian, Gay, Bisexual, and Transgender Clients is, paradoxically, an energizing and exceptionally practical read. In concise and lucid prose, Anderson diligently examines and clearly presents the multiple and interlocking psychosocial issues and challenges crucial to understanding and effectively treating LGBT individuals.

Topics covered are at once wide-ranging and quite specifically considered, and along the way Anderson does a laudable job of consistently interrogating biases that a less rigorous writer might have ignored. As an example, treatment chapters include nuanced and thought-provoking consideration of the advantages (understanding and empathy) and potential pitfalls (overidentification and other countertransference risks) of LGBT clinicians treating LGBT clients as well as discussion of the blind spots and biases that can interfere with straight clinicians' ability to effectively treat these individuals.

Collectively, the chapters devoted to treatment are especially rich, including as they do separate chapters on treatment related to specific drugs; practice with individuals; practice with couples, families, and groups; and intervention models (including approaches and strategies that can actually compromise treatment outcome). In the chapter on "Issues Related to Diversity;' for example, Anderson points out that although Alcoholics Anonymous (AA) and other 12-step groups have been invaluable to many LGBT users, "for LGBT clients who have been victimized by homo/transphobic religious teachings, it may be impossible to accept A.A.'s emphasis on powerlessness and surrendering to a 'Higher Power.'" (p. 146). In the chapter devoted to intervention models, Anderson notes further that 12-step groups' suggestions that recovering individuals avoid old friends who drink or use "may mean staying away from the only comfortable and safe social outlets available" (p. 158).

On the basis of her thorough analysis of the treatment literature for empirically supported methods of effective treatment, Anderson presents persuasive evidence supporting the effectiveness of motivational interviewing in practice with individuals and the use of other, specific evidence-based practices with couples, families, and groups, illustrating recommendations with extensive case examples.

For its comprehensive and rigorous analysis of the complex issues of

gender identity and sexual orientation alone, Anderson's invaluable volume should be on the reading list of every health and mental health professional. For those working with LGBT clients with substance use-related problems, it offers both sound general guidance and specific, practical recommendations for effectively responding to the complex needs and challenges of this underserved group.

Donna C. Henderson

Monmouth, OR
the connection between sexual orientation and
   substance use disorders is often mediated by
   internalized homo/bi/transphobia, which can
   result in profound feelings of shame, depression,
   and self-hatred. Substances can then become
   part of a person's coping system. Stress resulting
   from lack of validation and victimization puts
   many LGBT individuals at risk for substance
   use disorders. (p. 2)
Gale Copyright: Copyright 2011 Gale, Cengage Learning. All rights reserved.