Gay, lesbian, bisexual, transgendered, and intersex individuals

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There is a lack of research into the impact of comorbidity on gay, lesbian, bisexual, transgendered, and intersex (GLBTI) communities in Australia [1075]. On the whole, there is evidence that GLBTI individuals experience comorbid AOD and mental health disorders at rates higher than heterosexual individuals [1076]. However, only five peer-reviewed studies of GLBTI individuals with a heterosexual comparison group have examined comorbidity of mental health and AOD use [1077], all of which found higher rates of comorbidity in the GLBTI sample relative to the heterosexual sample [1078-1082]. Across studies, the evidence indicates that GLBTI people are approximately between three and six times more likely to have a comorbid AOD and mental health disorder than their heterosexual counterparts, and are at particularly increased risk of suicidal ideation and suicide attempts, and multiple disorders [1077].

Fundamentally, treatment for GLBTI individuals is the same as for any other client group and should focus on the specific needs of the client [402]. GLBTI clients represent a diverse group of people from varying backgrounds; thus, like all other clients, a holistic view should be adopted considering all aspects of the client’s presentation. While all GLBTI clients are different, it is important to be aware of the context in which GLBTI clients’ problems may develop. For instance, the development of a same-sex attracted identity usually occurs within a context of stigma and internal pressure [1083]. This can produce feelings of shame, isolation, guilt, lying, maladaptive sexual patterns, and loss of social support among other things, all increasing the risk of mental health and substance use problems. Thus, comorbidity among GLBTI individuals is likely to be a consequence of being in a minority group within the community, rather than being same-sex attracted. Ritter and colleagues [1077] identified several key features for working with GLBTI clients that are associated with positive outcomes:

  • A welcoming, non-judgemental, and respectful environment.
  • An accepting and affirming approach to the client’s GLBTI status.
  • Appropriate use of culturally sensitive language.
  • Staff awareness of GLBTI support services.
  • Appropriate education and training for staff.
  • Presence of GLBTI staff and positive GLBTI role models.
  • A high regard for confidentiality around personal information.
  • Affirmation of non-traditional family networks.
  • Teaching the client strategies for dealing with stigma, discrimination, and stress.

Sexuality and related issues require sensitive exploration and may require the AOD worker to assist the client with safety, support, accommodation, harm reduction, and education needs that may arise. It is important to consider and use professional judgement in raising and discussing issues of sexual orientation; for instance [1084]:

  • How comfortable is the person with his/her sexuality and with talking about it with others?
  • Has he/she told family/friends? How have these people reacted (or how will they)?
  • Is it his/her decision to tell someone or is he/she being forced?
  • How much support does he/she have?
  • Is he/she financially, physically, or emotionally independent?

Engagement is fundamentally important as well as confidentiality issues. AOD workers should also be aware that, for some clients (especially young clients), issues surrounding gender and sexual orientation may be a principal concern and may demand increased attention during treatment.