For gay, lesbian, bisexual and transgender addicts and alcoholics, finding a facility that meets their needs — recovery from drugs and alcohol while also serving as an LGBT-friendly addiction treatment center — can be a challenge.
Most drug and alcohol rehabs, like Cornerstone of Recovery — located near Knoxville, Tennessee — tend to promote recovery as an equal-opportunity life-changing position for anyone, regardless of age, race, sexual orientation or economic status. In many ways, that reflects the nature of 12 Step recovery programs: The focus is on the diseases of addiction and alcoholism, and everything else follows.
Such a concept sounds simple on the surface, and for good reason: Many principles and suggestions of 12 Step recovery involve breaking the process down into simple steps best left uncomplicated by the polluted thinking of addicts and alcoholics whose reason and judgment are still clouded by drugs and alcohol. However, for sexual minorities, drug and alcohol abuse is often inextricably tied to their sexuality.
“The way I was raised — in a small Tennessee town with all of the stereotypes about being gay — it didn’t really promote a safe place to be yourself,” says Chris Brewster, assistant director of Extended Care at Cornerstone of Recovery. “The reason I’m an alcoholic is because I was born an alcoholic. I have that alcoholic (predisposition). But because of where I was raised, I needed to change the way I felt about myself, and drinking and drugs allowed me to do that.
“I think with being gay, where you come from can be a huge factor. If your sexuality doesn’t develop in a proper, supportive way, what happened with me is a prime example of what can fuel addiction or alcoholism — meaning it’s not the reason for it, but it can be a contributing factor.”
LGBT-friendly addiction treatment: Startling statistics
Those contributing factors, according to national statistics, serve to underscore a need for LGBT-friendly addiction treatment more than ever. The disparities, consistent surveys demonstrate, between LGBT populations and their straight counterparts when it comes to alcohol and drug use aren’t just stark — they’re alarming. Consider:
- According to the 2018 National Survey on Drug Use and Health [1], 14.8 million people met the criteria for an alcohol use disorder, the scientific term for alcoholism. Given a nationwide population of 327.2 million people at the time, that comes out to roughly 4.5 percent of all Americans. For addiction (substance use disorder), 8.1 million Americans qualified for such a diagnosis — or 2.4 percent of the population.
- However, according to the Center for American Progress [2], “twenty-five percent of gay and transgender people abuse alcohol.”
- “LGBTQ people also have a greater likelihood than non-LGBTQ people of experiencing (substance use disorder) in their lifetime, and they often enter treatment with more severe SUDs,” according to the National Institute on Drug Abuse [3].
- Abuse of alcohol, drugs and tobacco combined is 2 to 4 times higher in the LGBT community than in the general population, according to NAADAC, the Association for Addiction Professionals [4].
- “Mental and Behavioral Health professionals working with the LGBT population receive more than their share of phone calls from distraught parents and colleagues, each reporting their alarm at the lack of concern (and the general absence of compassion) involving treatment programs that do not accommodate the needs of this group,” according to Manny Rodriguez, writing for the LGBT publication The Advocate [5].
How, then, does a drug and alcohol treatment facility meet the needs of the LGBT community while maintaining focus on the over-arching mission of sobriety? According to Logan Mahan, it’s not as much about crafting a specific approach to meet those needs as it is creating a culture that embraces acceptance and diversity while ensuring the safety and comfort of sexual minorities. Mahan, himself a gay man, recently transitioned out of his position as a full-time therapist in Cornerstone’s Recovery Renewal Program, and will now lead Cornerstone’s soon-to-launch LGBT support group while also working at Trailhead Treatment Center, a local counseling office specializing in men’s mental health.
“From the conversations I’ve had with the gay and bisexual men I’ve worked with at Cornerstone of Recovery, they have a very positive experience here,” Mahan says. “We had a guy who came through who said that he felt more accepted here and had more healing here than he did at an exclusively LGBT treatment facility he was previously at elsewhere in the country. This is anecdotal, of course, but for this patient at least, it was important to recover in a place where he could connect with people like himself and challenge some of the fears he may have had of being an out gay man around straight men.
“There’s already a sense of isolation in addiction and alcoholism for everyone, but for gay and bisexual men, there’s often both a longing for and a fear of connecting with other men. Sexual minority men, in my experience, want to connect with other men but often feel that if they’re fully open and honest, they’ll be rejected. So if you can give them the experience of sharing about their sexuality and being accepted in the context of that, it’s deeply healing for them, or at least that has been my experience.”
Navigating and unraveling addiction, shame and sexuality
That was Chris Brewster’s experience as well — only as a patient, when he came through Cornerstone of Recovery in 2005. At the time, he knew he was gay, but he had never taken ownership of the term, he said.
“It was never talked about within my family, and until I was at Cornerstone, I don’t think the words had ever come out of my mouth,” he said. “I remember when I first came to treatment, during the assessment process, one (counselor) was asking me all of the questions on one of the intake questionnaires, and one of the questions was, ‘What is your sexual preference?’
“I didn’t say anything, and she could tell I was shocked. I remember her saying, ‘If you don’t want to answer that, you don’t have to,’ so I just left it blank. I remember trying to connect being gay with being an alcoholic — why that had anything to do with why I needed treatment for alcohol.”
During his time in residential inpatient treatment, he kept his sexuality to himself, but the program itself began to ease his sense of isolation. From the beginning, he said, staff members at Cornerstone made him feel welcomed and safe, and while he was the only gay man in the adult residential program at the time, there were two Black patients that opened his eyes to the fact that addiction and alcoholism — and by proxy, recovery — aren’t discriminatory.
“I got to thinking about the difficulties of being a minority in treatment, and pretty quickly, I knew I was in a safe place, no matter what I was,” he said. “The staff here helped me realize that I was doing the best thing I’d probably ever done for myself, and my fears started to subside.”
After completing residential care, Brewster’s treatment team recommended he extended his stay by enrolling in the Intensive Outpatient Program and staying in Cornerstone’s Sober Living community. Because of Cornerstone’s history and reputation as a provider of treatment for the railroad industry, that meant living with and attending groups with a large population of railroad employees — a stereotypically masculine group of patients. As a gay man, Brewster was uneasy at first, he said — and that’s typically the reaction of many of the gay men that Mahan has worked with.
However, with time, trust and the guidance of the Cornerstone therapeutic staff, something transformational often happens when those two populations come together, Mahan added.
“A lot of the basics of what we do in a 12 Step program are effective, especially in addressing social isolation,” Mahan said. “We want these patients to know that they are unique as an LGBT person, and that they need to have spaces to process that, but they also need spaces to understand how they are like other alcoholics and addicts, and those other addicts and alcoholics need to have experiences where they can relate to you.
“At our best, we give LGBT individuals an opportunity to see the ways their experiences are similar to their straight, cisgender counterparts, and this is especially true in terms of masculinity for gay men. A gay man can bring with him a lot of assumptions and fears about sexuality and masculinity when he walks into a group of tough railroaders, but what we see is that when a gay man gets vulnerable and starts talking about his sexuality and the ways he may have felt rejected or scorned by men in his life, it opens up the floor for these straight men to talk about how they weren’t accepted or loved by their dads, or how they felt less than because they were never good at sports or good with women.
“For gay and straight men alike, trying to live up to society’s standards and stereotypes around masculinity can be soul-crushing and painful,” Mahan added. “When gay men and straight men realize they share some of the same wounds, they may also realize they can share in the same healing.”
LGBT-friendly addiction treatment: An oasis of acceptance, for patients and employees
In that respect, it levels the playing field, in a sense: It demonstrates to both populations that they have more in common than they do different, both in terms of their experiences and in their potential for recovery. That, added Extended Care Counselor Susan Mullaly, is what will stay with both populations after treatment is complete.
“One thing people don’t understand about treatment is that we share our soul stuff,” Mullaly said. “Five years from now, the people with you in treatment aren’t going to remember (your sexuality) at all. They’re going to remember who you were as a person and how you helped them as a fellow addict or alcoholic.”
As a gay woman working under the Cornerstone of Recovery umbrella, Mullaly is part of a large number of gay and lesbian employees who make the facility an LGBT-friendly addiction treatment center. That often comes as a surprise to LGBT individuals who come to Cornerstone for drug and alcohol treatment from across the country.
“We get phone calls all the time (from LGBT individuals struggling with drugs and alcohol) — ‘Is it OK for someone like me to come to treatment in East Tennessee?’” said Brian O’Hearn, associate director of the Aviation Program at Cornerstone of Recovery. “My response is always, ‘Absolutely yes. You’ll find that this part of East Tennessee is incredibly inclusive.’ I tell them that while you’re here in a residential setting, the counselors are tuned in to the LGBT community, and they ensure there’s a van going to Sober Pride (LGBT-specific Alcoholics Anonymous) meetings on Tuesdays and Fridays.”
The diversity of the staff at Cornerstone, O’Hearn added, serves as the rising tide does to lift all boats: It increases awareness on the part of heterosexual counselors and therapists as well, and in treatment team meetings where patient needs are discussed, the suggestion to reach out to LGBT patients about attending Sober Pride, or joining one of the facility’s forthcoming LGBT-centric therapy groups, often comes from straight staff members who are sensitive to the needs of sexual minority patients.
“I think part of it is that we have so many LGBT staff,” Mahan added. “I have had instances where, as a gay man, I got pulled in with patients who weren’t specifically assigned to me, but because other staff members felt that patient would connect better with me on a specific issue. Just as it’s so important for our patients to be able to connect with staff members that are also in recovery, giving our LGBT patients the opportunity to connect with LGBT staff members can be comforting and grounding — especially LGBT staff members in recovery.
“I don’t think there’s a replacement for that, and luckily, Cornerstone has a good deal of opportunity for those kinds of connections.”
Addiction, sexuality and the intersection of identity
Such diversity only serves to better assist members of the therapeutic team in meeting the challenges to recovery that the LGBT population faces. Some of those challenges include addressing the reasons substance abuse rates are so high for those individuals. According to the Center for American Progress [2], three primary factors serve as the drivers to those higher numbers:
- Stress “that comes from social prejudice and discriminatory laws in areas of daily life such as employment, relationship recognition, and health care.”
- “A lack of cultural competency in the health care system discourages gay and transgender people from seeking treatment for substance abuse, and — if they do seek help — often leads to inappropriate or irrelevant services.”
- Marketing efforts by alcohol companies, specifically, but also by illicit drug operations to target LGBT bars and clubs as “safe spaces for socializing (that) increase easy access” to the substances with which these individuals develop a problem.
In the late 1970s, when Mullaly was taking her first tentative steps toward sobriety (she got sober for good in 1982), gay establishments were the only place that LGBT individuals could congregate socially without fear of prejudice or even violence. For O’Hearn, it was the social experience around his sexuality that contributed to his drug use. His family, he said, knew he was gay, and it was never an issue — but to meet, socialize with and date individuals who shared his sexuality? Clubs, bars and parties were the center of his world.
For Brewster, it was the stress associated with their sexuality that was a contributing factor to his addiction … but he found an enormous amount of relief when, after transferring to Extended Care, he claimed his sexuality for the first time.
“Other than a group of my immediate friends who knew I was gay, I hadn’t talked about my sexuality, and I had a lot of fear about going up and living in an environment with a lot of men — especially railroad men!” he said. “Finally, I felt like it was time to be honest — not that I was dishonest or had lied, but that I wasn’t being my true, genuine self. So I told them in an organized group that I wanted them to know I was a gay man.
“And I was absolutely, 100 percent, totally accepted. It was like a wall came down. My fears totally dissipated, and those guys loved me for who I was, my spirit and my contributions to the community. Through doing that, I learned what it means to be true to yourself.”
And helping clients be true to themselves can often take many forms. Although there are rules in place against discriminatory, derogatory, hurtful or insulting language on the part of patients — one of many rules of conduct that make Cornerstone a premier LGBT-friendly addiction treatment center — recovery from drugs and alcohol is an emotional process. Those undergoing it are often spiritually stunted and emotionally raw. Personalities can clash, words can be exchanged and prejudice can rear its ugly head.
Even those moments, Mahan pointed out, can be teachable ones.
“If some patient has made a derogatory comment, and the LGBT individual is thinking about confronting them and telling them how hurtful it was, I’m going to say to them right off the bat: ‘That is your decision. We will create a safe space, but you have to deal with the consequences — and recognize the potential benefits,’” he said. “There are risks of opening up and telling a fellow patient that you’re gay or bisexual in order to help them understand how what they said is hurtful, but it can also be cathartic and healing for all parties involved. Ultimately, it’s about creating a safe space in which to do that.”
LGBT-friendly addiction treatment and the 12 Steps
Safe spaces in LGBT-friendly addiction treatment centers aren’t to be confused with those in 12 Step recovery, although they do share similarities. In fact, the Third Tradition of Alcoholics Anonymous stems from “Year Two” of A.A.’s existence, according to the publication “Twelve Steps and Twelve Traditions” [6]. A struggling alcoholic showed up at one of A.A.’s fledgling meetings: “Will you let me join your group? Since I am the victim of another addiction even worse stigmatized than alcoholism, you may not want me among you. Or will you?” Group discussion veered from paranoia over “what trouble” the individual would “brew” to the primary purpose of A.A.: to focus solely on alcoholism.
Finally, someone pointed out: “‘What we are really afraid of,’ he said, ‘is our reputation. We are much more afraid of what people might say than the trouble this strange alcoholic might bring. As we’ve been talking, five short words have been running through my mind. Something keeps repeating to me, “What would the Master do?”’” And so the Third Tradition was born: “The only requirement for A.A. membership is a desire to stop drinking.”
As blogger Jason Schwartz points out [7], “The approach in those early days seemed to be, ‘the only thing we care about is that you’re an alcoholic.’ The unfortunate corollary to this was social pressure to not discuss one’s sexual identity (Unless, of course, you were heterosexual.) or stay in the closet. To be fair, this was still very progressive for the time and they took the same approach to many other ‘problems other than alcohol.’”
Those attitudes persisted into the 1970s, at least in East Tennessee: While there were gay 12 Step clubhouses in major cities around the country by that point, in the rural South, Mullaly remembers, old-timers were rigidly inflexible when it came to any discussion of sexuality. Over the past several decades, that’s slowly dissipated, but recovering LGBT people have also found greater options in 2020, from Sober Pride meetings to other recovery programs, like Recovery Dharma or Refuge Recovery.
By the same token, Mahan pointed out, sometimes members of the LGBT community with deeply internalized shame seek to apply the 12 Steps to their sexuality.
“I had a patient once who got into the 12 Steps, and learned about change and change through acceptance, then asked if it was possible to apply this to his sexuality — ‘Can I change this?’” Mahan said. “Then we have to have a conversation about the differences between sexuality and addiction.”
Some of that, Mahan points out, can be a holdover from the tenets of Christianity that are embedded in 12 Step recovery. Although most 12 Step organizations go to great pains to claim spirituality rather than religion, the use of “God” in the literature can carry with it certain connotations that play into religious shame and fundamentalist condemnation of homosexuality. And that, Mahan said, can unfortunately cause some members of the LGBT community to see their sexuality as a manifestation of spiritual failing that can and should be “cured.”
“Sexuality is different than a substance — we don’t need substances, but we need intimacy, and we all need love,” he said. “And accepting what gender you love and finding ways to explore that in a way that is safe and doesn’t perpetuate shame is a sensitive but very important process for the gay and bisexual men I work with. And even LGBT individuals who recognize the distinction between addiction and sexuality can be fearful of stepping into a recovery environment where they think sexuality is going to be treated in the same way that they treat their substance abuse issues.
“At the end of the day, Cornerstone believes in an abstinence-based approached to drugs and alcohol. But for my part, I want to be crystal clear that the conversation around understanding sexuality is very different and far more nuanced. Sobriety can be a great place for sexual minority patients to start working through the sexual shame of their past and start to uncover the expression of sexy and love that is healthy, fulfilling and authentic for them.”
Understanding, affirmation, acceptance … and recovery
That’s just one example of the sensitivity required on the part of an LGBT-friendly addiction treatment center. And even though marketing materials may promote it as such, it often takes time for LGBT clients to feel safe enough to examine their sexuality in the context of recovery.
“I didn’t know what the experience was going to be coming to treatment, because I had no frame of reference, so immediately the guard went up,” said O’Hearn, who came through Cornerstone as a patient in 2014. “I just kind of kept everything to myself until I saw the diversity within the patient population, but also among the staff, and that’s when my fear subsided and my feeling of acceptance increased.”
As an employee, O’Hearn added, he feels no confinement about being openly gay. As with most organizations, the emphasis on professionalism and decorum level the playing field among gay and straight members of the Cornerstone team, but the openness and comfort level ensures equality.
“The number of staff at Cornerstone who are LGBT, while not staggering, is a pretty big number — and that’s comforting,” he said.
Cornerstone is far from the only options for LGBT-friendly addiction treatment. Members of that specific population who have concerns, however, should never hesitate to ask questions — of Cornerstone, or any prospective facility.
“Talk to people and get an idea of what the atmosphere is like,” Mullaly said. “Ultimately, I think you have to put your medical needs first, but if you go into it with complete honestly and work on dealing with any shame or guilt you may have around your sexuality while you’re working on getting sober, then you can leave whatever baggage you have at the door. A good facility will help you do that.”
There are always places in which any facility can improve: After all, one of the fundamental principles of recovery encourages individuals to “remain teachable” — open to new information and the need to change in order to become better. Organizations, especially a facility that bills itself as an LGBT-friendly addiction treatment center, should do likewise, said Mahan. While he’s no longer a full-time Cornerstone therapist, he’s working to revive a support and processing group for LGBT patients at Cornerstone that will be launched in the near future.
“It’s a group for them to talk about things they may not yet be comfortable talking about in general groups,” he said. “It’s a place to share with people who get it, specifically how this process affects you as a gay man, as a bisexual person, as a lesbian woman, as a trans person. A lot of it is about sex and sexuality elements, which can be sensitive and scary for the patient to share in their primary group. So we’ll help them with those issues as well as offer support and encouragement if they’re considering bringing it to their peers in their general groups.”
It’s another resource that makes Cornerstone a model of alcoholism and addiction treatment — for all populations. For Brewster, who at 58 found comfort later in life than some of the LGBT patients that Cornerstone treats, that’s more than just a comfort: It can be, in a sense, a life saver.
“If they have any shame and guilt over being gay, if they have issues with the God thing or religion, we want to process it with them, to help them just get more comfortable in their own skin with being themselves and being a gay person,” Brewster said. “Ultimately, if you want to come to Cornerstone for treatment, it doesn’t matter who you are, where you come from, what you drive, what color you are, what your sexual preference is, if you’re transgender — if you want a place to go where you’re going to be loved and accepted for who you are, supported from start to finish, find yourself and reap the benefits of recovery while people love on you, this is where you need to come.
“I’ve been here for 14 years, and I’ve never seen anything other than that, ever. That’s what Cornerstone is about.”
SOURCES
[1]: https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHNationalFindingsReport2018/NSDUHNationalFindingsReport2018.pdf
[2]: https://www.americanprogress.org/issues/lgbtq-rights/reports/2012/03/09/11228/why-the-gay-and-transgender-population-experiences-higher-rates-of-substance-use/
[3]: https://www.drugabuse.gov/drug-topics/substance-use-suds-in-lgbtq-populations
[4]: https://www.naadac.org/assets/2416/jeff_zacharias_-_naadac_-_seattle.pdf
[5]: https://www.advocate.com/commentary/2015/9/28/lgbt-addiction-not-same-straight-addiction
[6]: https://www.aa.org/assets/en_US/en_tradition3.pdf
[7]: https://addictionandrecoverynews.wordpress.com/2011/10/20/the-history-of-gay-people-in-aa/