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NCAD Spotlight: Understanding LGBTQ Inclusive vs. LGBTQ Affirmative Treatment Programs

July 29, 2019

In 1979, the National Association of Lesbian and Gay Alcoholism Professionals (NALGAP) was formed with three goals in mind:

  • Advocate for good non-homophobic treatment for lesbians and gays suffering from alcoholism and other drug addiction
  • Educate gay and lesbian health professionals about alcoholism/addiction
  • Provide support and communication network for gay and lesbian professionals and other interested people

Now in its 40th year, the association has evolved. Under a new name—NALGAP, The Association of Lesbian, Gay, Bisexual, Transgender Addiction Professionals and Their Allies—the association’s mission has expanded “to confront all forms of oppression and discriminatory practices in the delivery of services to all people and to advocate for programs and services that affirm all genders and sexual orientations. NALGAP provides information, training, networking, and advocacy about addiction and related problems, and support for those engaged in the health professions, individuals in recovery, and others concerned about the health of gender and sexual minorities,” NALGAP board president Philip T. McCabe, CSW, CAS, DRCC, tells Addiction Professional.

At the upcoming NCAD East, Aug. 15-18 in Baltimore, McCabe will be among the presenters of a two-part session on the mental, physical, sexual and spiritual aspects of recovery for LGBTQ individuals. Ahead of the conference, he spoke with Addiction Professional by email on LGBTQ-friendly treatment programs, the differences between programs that live out the mission of being LGBTQ-friendly and those with empty marketing rhetoric, and LGBTQ inclusive vs LGBTQ affirmative treatment.

(Editor’s note: This interview has been edited for length and clarity.)

We hear the phrase “LGBTQ-friendly treatment program” in various programs’ marketing efforts. What does that term mean to you?

As the president of NALGAP, The Association of Lesbian, Gay, Bisexual, Transgender Addiction Professionals and Their Allies, I appreciate having the opportunity to hold this conversation. This a great question to start with, because honestly it can be confusing. “LGBTQ friendly” speaks of the difference between clinical practices and marketing efforts. It’s a welcoming acknowledgement of a program’s outreach to the LGBTQ communities. Just like a hotel saying, “pet friendly,” it’s helpful if traveling with a pet knowing I can secure lodging. As a consumer or potential guest. I also have to investigate whether there are restrictions about pets when making a reservation.

For a program to market they are “LGBTQ friendly,” I consider they want LGBTQ clients to feel comfortable in their program and know they are welcome. It does not provide me insight into what type of clinical services are being offered. What accommodations or considerations are offered for someone who is transgender, non-binary or gender non-conforming? Going beyond lodging and physical needs, what clinical services are provided to address the needs of LGBTQ clients?

How do programs truly live out the mission of being LGBTQ-friendly vs. those with empty marketing rhetoric?

There can be a variety of ways to achieve this. Marketing should not be the only consideration, however for some programs it is a beginning. Let’s begin with how to create a more welcoming environment.

According to the National LGBT Health Education Center, there are various ways an organization can demonstrate affirmation for LGBT individuals:

  • Health education or marketing materials should show images of same-sex couples or families
  • LGBT-specific signs, stickers and brochures should be displayed in our organization
  • Community bulletin boards should include postings for LGBT people
  • Waiting areas should have reading materials (newsletters, magazines) appealing to LGBT people
  • Provide restrooms that conforms to all genders

Intake forms that recognize LGBTQ individuals make an organization more visible as an ally to all members of the LGBT community. Intake and enrollment forms should specifically indicate sexual orientation and gender identities reflective of that individual. Ask clients which name and pronouns they use, and assure that all staff and clients respect the person’s gender identity. Include corrective action when a client is misgendered.

Can you explain the difference between LGBTQ inclusive and affirmative treatment?

I first want to discuss the many challenges on establishing best practices for LGBTQ clients. For many years, programs basically could say whatever they liked with no accountability. Looking at an early study from 2007, this became obvious. The researchers made telephone contact with 854 substance abuse treatment agencies promoting themselves as having specialized programs for LGBTs in the National Survey of Substance Abuse Treatment Services. Each facility was presented with the same question: ““Hi, I am calling because your agency is listed in the SAMHSA directory as one that provides special programs or groups for gays and lesbians, and I am interested specifically in what those programs are. Could you tell me more about them?”

The results? Although all 854 agencies had indicated they provided LGBT-specific services, at the time of the phone contact:

  • 605 (70.8%) acknowledged no specialized programs existed
  • 16 of the agencies (1.9%) reported they had offered those services in the past but no longer did so
  • 79 (9.3%) programs described themselves as “non-discriminating” (Sample response: “We offer the same thing we offer straight people…we don’t discriminate.”)
  • 34 (4%) as “accepting” (Sample response: “We don’t have special services for gays and lesbians, we just allow them in our groups.”)
  • Only 62 (7.3%) of agencies indicated specialized LGBT programming and almost half were in New York and California
  • 62 programs in the entire country offer specialize treatment for LGBT of the 854 programs who listed themselves as having services available

This continues to be a major concern for NALGAP. We have set a goal to develop the NALGAP Centers of Excellence, which will assess the level of clinical services, programming and policy considerations, including HR equality policies for LGBTQ employees. Our overall goal is to help programs interested in providing evidence-based and documented services for LGBTQ clients. We can no longer consider that a program has a rainbow flag on their website or brochure to be an indication of appropriate services.

The terms “inclusive” and “affirmative” are not necessarily interchangeable. Providing services that include and recognize sexual minorities is important. Inclusive is a necessary step to incorporate the awareness of LGBTQ often being left out when discussing representation of client services. This can include didactic lectures, and discussions with clients. LGBTQ clients and staff are recognized and respected in an inclusive program. A LGBTQ affirmative program will move beyond this recognition. The core issues of trauma, violence, family of origin, family of choice, discrimination, harassment, improved health, heterosexism and transphobia are addressed in all levels of care. The celebration of the LGBTQ experience and acknowledgement of the diversities of communities are an intricate component of an LGBTQ affirmative program. This needs to include affirming the support of IGBTQ staff, board of directors, volunteers, community leaders and others who play a role in the recovery process.

NALGAP will continue to provide training and other resources for addiction professionals. It should not be the responsibility of one or two staff who are LGBTQ or allies to be the only ones able to address the concerns of LGBTQ clients. All staff need to be trained not just on the clinical skills, but awareness of how LGBTQ individuals experience life in recovery after treatment. How they live, create families, work, socialize and love needs to be respected and affirmed. As NALGAP initiates the Center of Excellence matrix to help program identify where they are currently in providing services, the primary intention will be to help them to establish policy and initiatives for continual quality improvement and the ability to get to positive health outcomes for LGBTQ clients.

Can you share an example of a common mistake you see even well-intentioned clinicians make when working with LGBTQ clients?

We also have witnessed, as confirmed by research, that some programs list themselves as providing LGBTQ services, yet when asked what those services include, they reply with “we treat all clients the same.” That is no longer an acceptable response when asked to describe how agencies are meeting the needs of LGBTQ clients.

Join clinicians and executives at NCAD East, Aug. 15-18 in Baltimore, and work to improve and refine patient care as well as develop sustainable and successful treatment organizations.

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