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ALCOHOLISM AND ADDICTION IN HOMOSEXUALS
ETIOLOGY, PREVALENCE & TREATMENT
Roy Young, J.D., M.S.W., C.S.W.[1]
There is a good deal of alcoholism and addiction in the gay community, but newer studies suggest that the incidence among younger homosexuals may be no greater than in the population at large. This article suggests that gay liberation in the 1970's may have spared male homosexuals now under 30 some of the misunderstanding, discrimination and hatred that drove older homosexuals to drink and drugs. It also suggests that older homosexuals may abuse drink and drugs to dull the pain of aging in an especially youth-oriented, beauty-driven homosexual culture.[2]This article discusses some of the treatment issues specific to homosexuals who abuse alcohol and drugs, and suggests the use of gay special-interest 12-Step groups to assist in treating internalized homophobia and in making some of the lifestyle changes beneficial to homosexuals in recovery .
Substance abuse[3] is endemic in the homosexual[4] communities in the United States. Although the etiology of abuse in any given individual can be complex, there are certain themes which are frequently seen in the gay or lesbian addict, and require specialized treatment in recovery. Awareness of these special risk factors increases the chances of successfully treating a lesbian or gay addict. The author has chosen this topic because he is both homosexual and in long-term recovery from alcoholism.
Etiology
American Psychiatric Association (1994) (the DSM-IV) lucidly groups all addiction to and abuse of substances into a single chapter: Substance Related Disorders. There is no single theory which accounts for why some people abuse substances and others don't (Straussner, 1993), but the presenting picture is essentially the same regardless of the substance.
In all probability, addiction (like so much mental illness) has a multifactorial etiology. Thus it must be viewed in a biopsychosocial framework. Straussner (1993) concludes that,
It may be best to view substance abuse as a multivariate syndrome in which multiple patterns of dysfunctional substance abuse occur in various types of people with multiple prognoses requiring a variety of interventions (p. 11).
Here are some of the predisposing factors:
1. the possibility of a biochemical or genetic factor in intergenerational transmission;
2. familial factors such as early separation from one or both parents early in life; inadequate parenting during childhood; physical or sexual abuse, or growing up in a family with multigenerational abuse of substances;
3. all of the psychological theories posit psychological factors in the development of addiction. For all the "insight" provided by these theories, none of them leads to any more effective intervention than the others. In fact, those willing to be straightforward on this subject admit that psychotherapy of any ilk is largely ineffective in treating active addiction. If the proof of the pudding is in the eating, it is then apparent that the following classic psychological bromides are wrong and/or irrelevant:
The addict uses the substance:
as a substitute for unacceptable sexual or aggressive drives, as a substitute for the primal addiction to masturbation, or as a defense against homosexuality;
as the result of a fixation in and a regression to the oral stage of development;
in response to an underlying neurosis based on the conflict between dependence and anger, or
as slow suicide (Straussner, 1993).[5]
Other more modern theoretical perspectives focus equally ineffectively on poor ego development, pathological narcissism, or a deficiency in the sense of self (Straussner, 1993).
More useful theories for treating an individual in later-stage recovery[6] suggested that,
the addict attempts to medicate emotional problems such as depression, anxiety and anger;
express dependency needs;
compensate for feelings of inferiority and powerlessness, or
relate to such things as low frustration tolerance, high level of impulsivity, or the inability to endure even low-level anxiety (Straussner, 1993).
Learning and behavioral theorists see addiction as a conditioned response; it produces a pleasurable high (perhaps very pleasurable in some, making them more willing to accept the negative consequences of indulgence) or relieves pain (as suggested above). Because children raised by addicted non-biological parents are at a higher risk of alcoholism than children raised by non-addicted non-biological parents, expectancy, modeling, imitation and identification may also predispose to substance abuse (Straussner, 1993).
4. environmental and cultural factors in general can play a role in the etiology of addiction, such as:
availability of the substance (e.g., many soldiers became addicted to heroin in Vietnam because of [1] the high stress of war, and [2] the availability of the substance, but upon return to civilian life a large proportion of them ceased to have problems with drugs and alcohol);
lack of rewarding alternatives in life (e.g., lack of decent living conditions or opportunity to earn an income, as might be experienced by persons living in a minority ghetto),
influence of mass media, or
social or peer acceptance of use of the substance.
Finally, regardless of the theory of addiction or the predisposition of the person to addiction, almost anyone who takes a mood-altering substance in large quantity for a long enough time will experience physical and/or psychological dependence (Straussner, 1993).
Etiology of alcoholism in homosexuals
People with a homosexual orientation are, of course, subject to all of the multiple risk factors for addiction discussed above. They also have some psychosocial predisposing factors common to all hated minorities, and some unique to the homosexual population. There are many different types of alcoholics; there are many different types of homosexuals, and there are even more types of alcoholic homosexuals (Nardi, 1982).
Common to all hated minorities is the damage done to self-image by the internalization of that hatred. Erikson (1959) asserts that it is impossible for any member of a hated minority to escape that internalized hatred.[7]
Homosexuals are subject to unique stressors, as well. Starting in youth, sometimes as early as school age, sometimes before the homosexual himself[8] is aware of any sexual orientation, he learns some of the dangers of being homosexual:[9] public derision ("Joey is a fagot!"), discrimination ("We don't want a queer on the baseball teem"), and physical harm ("Hit the sissy again!"). The child may be rejected by her family implicitly (Mother overheard: "I'd rather my daughter be dead than be one of those lez-bines.") or explicitly (Father overheard: "You are a homo, you are not my son. Get out of my house.") (Savin-Williams, 1994). In later life he will face discrimination in the workplace and the possibility (only today less prevalent) of arrest and imprisonment for "unnatural acts." Rosario, Hunter & Rotheram-Borus (1992) note,
. . . the experience of being gay or bisexual in our society overwhelms any potential differences in social categories involving age, ethnicity, race, social class or geographical region of the country (p. 19).
The homosexual is unique among minorities in facing hatred and discrimination in that she usually has no role model, no positive example in her family, no loving parent who has gone through the same experience, to support her in her pain. Those discriminated against because they are (for instance) Jewish or African-American usually have families or communities for which this is a common problem. But gay youths are all too often rejected even by their families (Savin-Williams, 1994) and too seldom have yet found their supportive peers and communities.
Facing this external view of herself, no wonder that the homosexual internalizes this hatred and has difficulty with accepting her identity, building self-esteem, and expressing her sexuality. About 65% of all homosexuals seek therapy and give as a reason depression which is a result of adjusting to their homosexuality; of these, 50% started therapy between the ages of 18-21 (Diamond-Friedman, 1990).
In turn, these difficulties lead some to increase their consumption of alcohol or other drugs to aid in the coming-out process, or to medicate the anxiety or depression associated with concealing their identity or facing rejection from family and friends, discrimination in employment and housing, physical assault, arrest or imprisonment.
Colcher (1982) hypothesizes that homosexuals use substances to dull the pain of feeling "different and alone," to reduce "sexual inhibitions" relating to internalized homophobia, and to reduce the stress of the keen competition for good-looking sexual partners.
Nardi (1982) hypothesizes that homosexuals are more at risk of drinking to the point of addiction because the gay life style often revolves (or revolved in 1982) around gay bars, which have a history of permissiveness and protectiveness:
The absence of significant subculturally valued alternatives to drinking settings . . . contributes to the dependency on alcohol as an acceptable solution to feelings of anxiety, alienation and low self-esteem (p. 21).
ALCOHOLISM AND ADDICTION IN HOMOSEXUALS
ETIOLOGY, PREVALENCE & TREATMENT
Roy Young, J.D., M.S.W., C.S.W.[1]
There is a good deal of alcoholism and addiction in the gay community, but newer studies suggest that the incidence among younger homosexuals may be no greater than in the population at large. This article suggests that gay liberation in the 1970's may have spared male homosexuals now under 30 some of the misunderstanding, discrimination and hatred that drove older homosexuals to drink and drugs. It also suggests that older homosexuals may abuse drink and drugs to dull the pain of aging in an especially youth-oriented, beauty-driven homosexual culture.[2]This article discusses some of the treatment issues specific to homosexuals who abuse alcohol and drugs, and suggests the use of gay special-interest 12-Step groups to assist in treating internalized homophobia and in making some of the lifestyle changes beneficial to homosexuals in recovery .
Substance abuse[3] is endemic in the homosexual[4] communities in the United States. Although the etiology of abuse in any given individual can be complex, there are certain themes which are frequently seen in the gay or lesbian addict, and require specialized treatment in recovery. Awareness of these special risk factors increases the chances of successfully treating a lesbian or gay addict. The author has chosen this topic because he is both homosexual and in long-term recovery from alcoholism.
Etiology
American Psychiatric Association (1994) (the DSM-IV) lucidly groups all addiction to and abuse of substances into a single chapter: Substance Related Disorders. There is no single theory which accounts for why some people abuse substances and others don't (Straussner, 1993), but the presenting picture is essentially the same regardless of the substance.
In all probability, addiction (like so much mental illness) has a multifactorial etiology. Thus it must be viewed in a biopsychosocial framework. Straussner (1993) concludes that,
It may be best to view substance abuse as a multivariate syndrome in which multiple patterns of dysfunctional substance abuse occur in various types of people with multiple prognoses requiring a variety of interventions (p. 11).
Here are some of the predisposing factors:
1. the possibility of a biochemical or genetic factor in intergenerational transmission;
2. familial factors such as early separation from one or both parents early in life; inadequate parenting during childhood; physical or sexual abuse, or growing up in a family with multigenerational abuse of substances;
3. all of the psychological theories posit psychological factors in the development of addiction. For all the "insight" provided by these theories, none of them leads to any more effective intervention than the others. In fact, those willing to be straightforward on this subject admit that psychotherapy of any ilk is largely ineffective in treating active addiction. If the proof of the pudding is in the eating, it is then apparent that the following classic psychological bromides are wrong and/or irrelevant:
The addict uses the substance:
as a substitute for unacceptable sexual or aggressive drives, as a substitute for the primal addiction to masturbation, or as a defense against homosexuality;
as the result of a fixation in and a regression to the oral stage of development;
in response to an underlying neurosis based on the conflict between dependence and anger, or
as slow suicide (Straussner, 1993).[5]
Other more modern theoretical perspectives focus equally ineffectively on poor ego development, pathological narcissism, or a deficiency in the sense of self (Straussner, 1993).
More useful theories for treating an individual in later-stage recovery[6] suggested that,
the addict attempts to medicate emotional problems such as depression, anxiety and anger;
express dependency needs;
compensate for feelings of inferiority and powerlessness, or
relate to such things as low frustration tolerance, high level of impulsivity, or the inability to endure even low-level anxiety (Straussner, 1993).
Learning and behavioral theorists see addiction as a conditioned response; it produces a pleasurable high (perhaps very pleasurable in some, making them more willing to accept the negative consequences of indulgence) or relieves pain (as suggested above). Because children raised by addicted non-biological parents are at a higher risk of alcoholism than children raised by non-addicted non-biological parents, expectancy, modeling, imitation and identification may also predispose to substance abuse (Straussner, 1993).
4. environmental and cultural factors in general can play a role in the etiology of addiction, such as:
availability of the substance (e.g., many soldiers became addicted to heroin in Vietnam because of [1] the high stress of war, and [2] the availability of the substance, but upon return to civilian life a large proportion of them ceased to have problems with drugs and alcohol);
lack of rewarding alternatives in life (e.g., lack of decent living conditions or opportunity to earn an income, as might be experienced by persons living in a minority ghetto),
influence of mass media, or
social or peer acceptance of use of the substance.
Finally, regardless of the theory of addiction or the predisposition of the person to addiction, almost anyone who takes a mood-altering substance in large quantity for a long enough time will experience physical and/or psychological dependence (Straussner, 1993).
Etiology of alcoholism in homosexuals
People with a homosexual orientation are, of course, subject to all of the multiple risk factors for addiction discussed above. They also have some psychosocial predisposing factors common to all hated minorities, and some unique to the homosexual population. There are many different types of alcoholics; there are many different types of homosexuals, and there are even more types of alcoholic homosexuals (Nardi, 1982).
Common to all hated minorities is the damage done to self-image by the internalization of that hatred. Erikson (1959) asserts that it is impossible for any member of a hated minority to escape that internalized hatred.[7]
Homosexuals are subject to unique stressors, as well. Starting in youth, sometimes as early as school age, sometimes before the homosexual himself[8] is aware of any sexual orientation, he learns some of the dangers of being homosexual:[9] public derision ("Joey is a fagot!"), discrimination ("We don't want a queer on the baseball teem"), and physical harm ("Hit the sissy again!"). The child may be rejected by her family implicitly (Mother overheard: "I'd rather my daughter be dead than be one of those lez-bines.") or explicitly (Father overheard: "You are a homo, you are not my son. Get out of my house.") (Savin-Williams, 1994). In later life he will face discrimination in the workplace and the possibility (only today less prevalent) of arrest and imprisonment for "unnatural acts." Rosario, Hunter & Rotheram-Borus (1992) note,
. . . the experience of being gay or bisexual in our society overwhelms any potential differences in social categories involving age, ethnicity, race, social class or geographical region of the country (p. 19).
The homosexual is unique among minorities in facing hatred and discrimination in that she usually has no role model, no positive example in her family, no loving parent who has gone through the same experience, to support her in her pain. Those discriminated against because they are (for instance) Jewish or African-American usually have families or communities for which this is a common problem. But gay youths are all too often rejected even by their families (Savin-Williams, 1994) and too seldom have yet found their supportive peers and communities.
Facing this external view of herself, no wonder that the homosexual internalizes this hatred and has difficulty with accepting her identity, building self-esteem, and expressing her sexuality. About 65% of all homosexuals seek therapy and give as a reason depression which is a result of adjusting to their homosexuality; of these, 50% started therapy between the ages of 18-21 (Diamond-Friedman, 1990).
In turn, these difficulties lead some to increase their consumption of alcohol or other drugs to aid in the coming-out process, or to medicate the anxiety or depression associated with concealing their identity or facing rejection from family and friends, discrimination in employment and housing, physical assault, arrest or imprisonment.
Colcher (1982) hypothesizes that homosexuals use substances to dull the pain of feeling "different and alone," to reduce "sexual inhibitions" relating to internalized homophobia, and to reduce the stress of the keen competition for good-looking sexual partners.
Nardi (1982) hypothesizes that homosexuals are more at risk of drinking to the point of addiction because the gay life style often revolves (or revolved in 1982) around gay bars, which have a history of permissiveness and protectiveness:
The absence of significant subculturally valued alternatives to drinking settings . . . contributes to the dependency on alcohol as an acceptable solution to feelings of anxiety, alienation and low self-esteem (p. 21).
