LESBIANS, GAY MEN AND ALCOHOL

RESOURCE LIST

Several research projects, mainly from the U.S.A., suggest that a third of lesbians and gay men have alcohol problems. Indeed, some findings suggest that lesbians appear to have a worse problem than either heterosexual women, gay men or heterosexual men.

We are about twenty years behind the U.S.A. with regard to research, our understanding of alcohol misuse among lesbians and gay men and provision. However, recent research in Britain suggests that many lesbians have a serious alcohol problem: Bridget (1994) found that 50% of the twenty isolated lesbians interviewed had serious drink problems; Creith (1993, personal communication) found that, of the 326 lesbians who completed her survey, 37.3% drank over the recommended levels for women and Bloor (DYKENOSIS, Issue 3, March 1995) found that 49% of the 120 lesbians who took part in her survey drank more than the recommended sensible limit for women.

The purpose of this Resource List is to

a) make the problem visible, and

b) support those who want to do something about it.

All of the academic articles referred to in this list can be obtained by completing a request form at your local library. It will cost about 50p and take about a month but you should then receive a photocopy of the relevant article.

This Resource List has been up-dated and published with the help of Comic Relief; it was originally produced with help from the Alcohol Education and Research Council.

ACADEMIC ABSTRACTS

THE PSYCHOLOGICAL RELATIONS BETWEEN SEXUALITY AND ALCOHOLISM, KARL ABRAHAM, INTERNATIONAL JOURNAL OF PSYCHOANALYSIS, 1926, VOL 7, P2-10.

ALCOHOL ABUSE AMONG LESBIANS: A DESCRIPTIVE STUDY, DEBORAH L. DIAMOND, SHARON C. WILSNACK, JOURNAL OF HOMOSEXUALITY, 1978, VOL 4(2), P123-142.

Intensive interviews with 10 lesbian alcohol abusers revealed strong dependency needs, low self-esteem, and a high incidence of depression. Drinking increased power-related behaviors, enhanced self-esteem, and for many subjects increased feelings of depression. The findings suggest that lesbians with alcohol problems need (a) therapists who will accept their sexual orientation and (b) treatment that will help them increase their sense of power and self-esteem without alcohol.

ALCOHOL PROBLEMS IN SEVERAL MIDWESTERN HOMOSEXUAL COMMUNITIES, LEANDER J. LOHRENZ, JOHN C. CONNELLY, LOLAFAYE COYNE, KEITH E. SPARE, JOURNAL OF STUDIES ON ALCOHOL, 1978, VOL 39(11), P1959-1963.

According to their scores in the Michigan Alcoholism Screening Test, close to one-third of the homosexual men in four urban areas of Kansas were alcoholics.

HALLUCINOGENIC DEPENDENCY DURING ADOLESCENCE AS A DEFENSE AGAINST HOMOSEXUAL FANTASIES: A REENACTMENT OF THE FIRST SEPARATION-INDIVIDUATION PHASE IN THE COURSE OF TREATMENT, R.M. GONZALEZ, JOURNAL OF YOUTH AND ADOLESCENCE, 1979, VOL 8(1), P63-71.

ALCOHOLISM AND SELF-ESTEEM AMONG WOMEN WITH A FEMALE SEX OBJECT PREFERENCE, MARTHA JANE HAVEN, DISSERTATION ABSTRACTS INTERNATIONAL, 1981, VOL 42(05), P2058B.

ALCOHOL AND THE LESBIAN COMMUNITY: CHANGING PATTERNS OF AWARENESS, PATRICIA HASTINGS, DRINKING PRACT. SURV. 1982, VOL 18, P3-7.

DRINKING PATTERNS IN HOMOSEXUAL AND HETEROSEXUAL WOMEN, COLLINS E. LEWIS, MARCEL T. SAGHIR, ELI ROBINS, JOURNAL OF CLINICAL PSYCHIATRY, 1982, VOL 43(7), P277-279.

The lifetime prevalence of heavy and problem drinking was found to be significantly higher in a sample of homosexual women (N = 57) compared to a demographically matched sample of heterosexual women (N = 43). This prevalence of excessive drinking is not explained by personality traits, psychiatric diagnosis, gender identity, history of frequenting gay bars, or family history of alcoholism.

ALCOHOL TREATMENT AND THE NON-TRADITIONAL "FAMILY" STRUCTURES OF GAYS AND LESBIANS, PETER M. NARDI, JOURNAL OF ALCOHOL AND DRUG EDUCATION, 1982, VOL 27, P83-89.

As attention to the family aspects of alcoholism and treatment increases, several salient issues emerge for the gay and lesbian population. Most of the literature and many of the programs devoted to the problem drinker's family emphasize the role of the spouse and children in the alcoholic's recovery. For many lesbian and gay alcoholics, however, such traditional family systems are not as common. Since so little is known about "co-alcoholism" and alternative family structures among the gay population, relatively little attention is devoted to these topics in alcoholism treatment and prevention programs.

Therefore, this paper will focus on the various family systems in which gay and lesbian people exist and how these relate to drinking behavior and its treatment and prevention. A sociological perspective is used, emphasizing the values, norms, and meanings held about drinking by gay and lesbian people. This allows us to view the subject from within, rather than imposing definitions and structures from outside the subculture. Instead of asking how gay people's lifestyles deviate from the norm, we can discuss how gay people define their experiences and roles. Their issues, their perspectives, and their values are the important dimensions. How they interpret their social role relationships with various "families" and integrate these relationships into their lifestyle become the topics of analysis.

JOURNAL OF HOMOSEXUALITY, 1982, VOL 7(4): ALCOHOLISM & HOMOSEXUALITY, INCLUDES:

INTRODUCTION: ALCOHOLISM AND THE HOMOSEXUAL COMMUNITY, THOMAS O ZIEBOLD, JOHN E. MONGEON, P3-7.

ALCOHOLISM AND HOMOSEXUALITY: A THEORETICAL PERSPECTIVE, PETER M. NARDI,
P9-25.

Although causal relationships between homosexuality and alcoholism have not been established, the myths and assumptions surrounding this issue are numerous. Much of the available literature on the subject is from a psychoanalytic perspective, emphasizing latent homosexuality as a cause of alcoholism. Very little is from the perspective of gay and lesbian populations. This paper analyzes the assumptions underlying the biological and genetic approaches, learning theory, psychoanalytic perspectives and sociological models as they relate to alcoholism and homosexuality.

WHO SHOULD BE DOING WHAT ABOUT THE GAY ALCOHOLIC? TRICIA A. ZIGRANG, P27-35.

Treatment options for the homosexual alcoholic are examined with the conclusion that increased education for staff about the particular needs of homosexual alcoholics and development of specialized services in existing treatment facilities are high priorities. A description of the format of in-service training provided for one agency staff and the results of the training are presented. Finally, directions for future research in the area of homosexual alcoholism are suggested.

THE TIES THAT BIND: STRATEGIES FOR COUNSELING THE GAY MALE CO-ALCOHOLIC, SCOTT WHITNEY, P37-41.

Within the gay male subculture, strong pressures strengthen the ties between the gay male alcoholic and emotionally significant other persons in his life. This article is an attempt to describe a theoretical model for viewing co-addiction with a more specific discussion of how this model applies to gay male relationships. The brief theoretical discussion is followed by a discussion of common presenting complaints of gay co-alcoholics and a more detailed treatment of counseling strategies, from initial contact to participation in support programs, that have proven effective in an outpatient setting.

COUNSELING THE HOMOSEXUAL ALCOHOLIC, RONNIE W. COLCHER, P.43-51.

The author summarizes her clinical experience with 75 homosexual alcoholics, 47 male and 28 female, of diverse backgrounds. Similarities and differences in treating homosexual and heterosexual alcoholics are presented. A summary of recommendations for the counselor working with homosexual alcoholics is included.

SPECIFIC APPROACHES AND TECHNIQUES IN THE TREATMENT OF GAY MALE ALCOHOL ABUSERS, TOM MILLS SMITH, P53-69.

An extended discussion of specific therapeutic approaches and techniques with homosexual male alcohol abusers, including dealing with low self-esteem, sober sex, getting high, getting "far out" sexually, double lives, second rate relationships, social bonding, and aging. In this paper, the bias of treatment approaches is toward individualized, interpersonal, holistic eclecticism: a combination of responsibility building therapy, awareness therapy, medical and neurophysiological approaches, strategic therapy, utilization of altered states of consciousness, and attitudinal change therapy.

A GAY-IDENTIFIED ALCOHOL TREATMENT PROGRAM: A FOLLOW-UP STUDY, ROSANNE DRISCOLL, P 71-80.

The Homophile Alcohol Treatment Service (HATS) is an urban Boston out-patient clinic. A survey to assess program effectiveness, reported here, demonstrates that HATS has been able to promote less harmful drinking behaviors in its clients and to educate clients about alcohol-related health hazards. Issues around reaction to gay clients in nongay treatment agencies, accessibility of services, and survey problems in the gay community are discussed with their implications for improving services like HATS.

ALCOHOLICS ANONYMOUS AND THE GAY ALCOHOLIC, WILLIAM E. BITTLE, P81-88.

Although the number of homosexual alcoholic men and women has been estimated to be proportionately three times greater than the number of alcoholics in the general population, their participation in Alcoholics Anonymous is not consistent with this proportional representation. It is proposed that there are a number of characteristics of AA, as it is presented in meetings, which discourage participation by gay people. These characteristics are reviewed, and suggestions are made for providing homosexual alcoholics with support and with the tools for reasonably secure sobriety.

PREVENTING ALCOHOL ABUSE IN THE GAY COMMUNITY: TOWARD A THEORY AND MODEL, JOHN E MONGEON, THOMAS O. ZIEBOLD,
P89-99.

Urban gay communities present unique populations for a comprehensive prevention program. They are well defined, bounded communities with rapid internal communication, can be considered "at risk" for alcoholism, and are traditionally "underserved" for prevention and treatment. Models of alcoholism epidemiology elucidate critical factors relevant to the urban gay population, and indigenous gay organizations afford effective means of implementing a program. The model presented in this paper is based upon current research about successful prevention programs and uses accepted strategies tailored to the specific characteristics of the urban gay community. The basic premise of the model is that community self help is the most effective approach to alcohol and drug abuse prevention.

WORKING TOGETHER: THE NATIONAL ASSOCIATION OF GAY ALCOHOLISM PROFESSIONALS, EMILY B. McNALLY, DANA G. FINNEGAN,
P101-103.

This article briefly describes the formation of the National Association of Gay Alcoholism Professionals (NAGAP). It then discusses the need for education, information, and advocacy that prompted the development of NAGAP's goals. There are four primary goals: (1) creating and fostering a network for support and communication among gay and lesbian alcoholism professionals; (2) educating those who work with gay/lesbian alcoholics; (3) raising the gay and lesbian communities' consciousness about alcoholism; and (4) improving treatment for gay/lesbian alcoholics, partly through advocacy. NAGAP's ultimate goal is to serve as a national "voice of conscience for the whole alcoholism field."

HOMOSEXUALITY AS A CAUSE OF ALCOHOLISM: A HISTORICAL REVIEW, S. ISRAELSTAM, S. LAMBERT, THE INTERNATIONAL JOURNAL OF THE ADDICTIONS, 1983, VOL 18(8), P1085-1107.

THE ROLE OF DRUGS IN ADOLESCENT SUICIDE ATTEMPTS, PATRICK C. MCKENRY, CARL L. TISHLER, COLEEN KELLEY, SUICIDE AND LIFE-THREATENING BEHAVIOR, 1983, VOL 13(3), P166-175.

Drug histories of 46 adolescent suicide attempters and their parents are described. In addition, these attempters and their parents are compared with a group of non-attempters and their parents on selected measures of drug use. Findings indicate that adolescent drug use is closely related to and perhaps symptomatic of suicidal behaviors and overall pathology. The relationship between adolescent suicidal behaviors and parental drug use is unclear because of the discrepancy between parent-adolescent responses.

HOMOSEXUAL RECOVERING ALCOHOLICS, A DESCRIPTIVE STUDY, EDWARD J. SAUNDERS, ALCOHOL HEALTH AND RESEARCH WORLD, 1983/84, WINTER, P18-22.

WOMEN, ALCOHOL, AND SEXUALITY, STEPHANIE S. COVINGTON, JANET KOHEN, ADVANCES IN ALCOHOL AND SUBSTANCE ABUSE, 1984, VOL 4(1), P41-56.

Neither women's sexuality nor their alcohol use has been studied until recently. Research on the relationship between the two has been even more neglected. While the literature has acknowledged that sexual dysfunction and abuse may coexist with women's alcoholism, the possibility that these may predate or lead to excessive alcohol use has not been investigated. This study explores sexual experience, dysfunction, and abuse among 35 alcoholic women and their paired nonalcoholic counterparts. Results suggest that both dysfunction and abuse may precede as well as accompany alcoholism. The findings indicate that issues of sexuality should be included in recovery programs for women because alcohol and sexual experience are linked in most of these alcoholic women's lives.

SPECIAL ISSUES AFFECTING THE TREATMENT OF GAY MALE AND LESBIAN ALCOHOLICS, DANA G. FINNEGAN, DAVID COOK, ALCOHOLISM TREATMENT QUARTERLY, 1984, VOL 1, P85-98.

HOMOSEXUALITY AND ALCOHOLISM: SOCIAL AND DEVELOPMENTAL PERSPECTIVES, MARTA ANN ZEHNER, JOYCE LEWIS, HOMOSEXUALITY AND SOCIAL WORK, JOURNAL OF SOCIAL WORK AND HUMAN SEXUALITY, 1984, VOL 2(2/3), P75-89.

"Among the gay and lesbian population probably 20%-30% are alcoholic, twice to three times as large a percentage as in the general population." Thus, there is compelling reason to examine the relationship between homosexuality and alcoholism. That is the primary purpose of this article.

The article is divided into three areas: a general description and definition of alcoholism as a problem in our society; special issues for gays and lesbians and their vulnerability to alcoholism; services for alcoholics generally and services geared specifically to lesbian and gay alcoholics.

WORKING WITH LESBIAN ALCOHOLICS, SANDRA C. ANDERSON, DONNA C. HENDERSON, SOCIAL WORK, 1985, VOL 30, P518-525.

Alcoholism is a widespread but neglected problem in the lesbian community. The authors describe the myths and realities of lesbian experience and suggest treatment strategies that address the special problems and needs of lesbian alcoholics. This article reviews the literature and discusses the need to overcome homophobia among social workers and in agencies.

HOMOSEXUALITY AND ALCOHOL: OBSERVATIONS AND RESEARCH AFTER THE PSYCHOANALYTIC ERA, S. ISRAELSTAM, S. LAMBERT, THE INTERNATIONAL JOURNAL OF THE ADDICTIONS, 1986, VOL 21(4/5) P509-537.

There is very little literature in the area of homosexuals and alcohol but since the 1960s some work on the alcohol use of homosexuals has begun to surface. Most studies focus on the male but there are some studies of lesbians. The gay bar seems to be the best starting point for such studies as it is so central to gay society. How sex, drugs, and acquired immune deficiency relate to alcohol use are discussed. Ideas relating to intervention into the alcohol problems of gays are put forward.

JOURNAL OF CHEMICAL DEPENDENCY TREATMENT, SPECIAL ISSUE: CHEMICAL DEPENDENCY AND INTIMACY DYSFUNCTION, 1987, VOL 1(1), INCLUDES:

CHEMICAL DEPENDENCY AND INTIMACY DYSFUNCTION: INEXTRICABLY BOUND, ELI COLEMAN, 13-26.

Despite the fact that chemical dependency and intimacy dysfunction are inextricably bound, intimacy concerns are rarely addressed in the diagnosis, treatment or aftercare of the chemically dependent person or his or her family members. This article is intended to provide information which will help professionals recognize the connection between intimacy concerns and the drug abuse and dependency problems of their clients - and consequently, help them improve the treatment and rehabilitation of those clients.

CHILD PHYSICAL AND SEXUAL ABUSE AMONG CHEMICALLY DEPENDENT INDIVIDUALS, ELI COLEMAN, P27-38.

Numerous studies have documented the correlation between various forms of child physical abuse and/or neglect, sexual abuse, other sex offending behavior and chemical abuse and/or dependency. In treating any of these disorders, professionals should be aware of the high risk of interrelatedness of these factors and that in addition to addressing relevant factors, the underlying dynamics of intimacy dysfunction, shame, and boundary inadequacy need to be treated.

MARITAL AND RELATIONSHIP PROBLEMS AMONG CHEMICALLY DEPENDENT AND CODEPENDENT RELATIONSHIPS, ELI COLEMAN, P39-59.

There is a growing awareness that the marital and relationship problems must be addressed and worked upon if the chemically dependent person is going to maintain his or her sobriety. The involvement of the spouse or partner is important because of the family system dynamics that caused, perpetuated, and/or enabled the chemical dependency needs to be addressed and all involved need some treatment. Recognizing the source of marital or relationship discord is helpful in determining the chemically dependent and codependent couple's needs in terms of aftercare or therapy needed to resolve these conficts. This article reviews the common problems encountered by many chemically dependent and codependent couples: codependency, sexual identity conflicts, violence in their relationship, confusion in roles, communication difficulties, unhealthy sexual and intimacy attitudes and values and sexual dysfunctions. Essentially, the chemically dependent or codependent couple is experiencing intimacy dysfunction and is often lacking in intimacy skills. These skills need to be learned in order for them to experience intimacy and to feel more complete in their sobriety.

SHAME, INTIMACY, AND SEXUALITY, JEFFREY A. BROWN, P61-74.

This paper examines the interrelationship between shame and problems with intimacy and sexuality. It posits the view that these problems are the manifestations primarily of difficulties in identification and differentiation in the developmental process and of the influence of culture and religion. The author recommends that intervention focus on the six developmental tasks proposed by Kaufman (1980) and concludes that treatment will succeed to the extent that interpersonal bridging, balance of identification/differentiation, and transference occur in the therapeutic relationship.

ASSESSMENT OF BOUNDARY INADEQUACY IN CHEMICALLY DEPENDENT INDIVIDUALS AND FAMILIES, PHILIP COLGAN, P75-90.

Interpersonal boundary inadequacy has been highly correlated with chemical dependence in both individuals and families. Accurate assessment of patterns of boundary inadequacy appears integral to the successful recovery process of chemically dependent people. This paper presents a conceptual approach for skillful assessment of boundary inadequacy.

WOMEN, SEXUALITY AND THE PROCESS OF RECOVERY, SUSAN SCHAEFER, SUE EVANS, P91-120.

This paper discusses the importance of addressing sexuality issues in the treatment of chemically dependent women. It summarizes the research which has correlated chemical dependency in women to such areas as: sexual dissatisfaction/dysfunction, sex role conflicts, intimacy and interpersonal relationships, sexual orientation issues and sexual abuse/incest. Four primary factors impacting the relationhsip between women's sexuality and recovery will be explored including: social influences, physical correlates, psychological components and spiritual aspects. This paper draws on existing research, the authors' clinical experience, and information provided to the authors by the self-reports of 100 chemically dependent women who were extensively surveyed. This paper should be viewed as both an invitation to others for further research into these relationships, as well as a challenge to alcoholism and mental health professionals to incorporate more aspects of sexuality work into the individual treatment plans and overall treatment programs for their recovering women clients.

SEXUAL ORIENTATION CONCERNS AMONG CHEMICALLY DEPENDENT INDIVIDUALS, SUSAN SCHAEFER, SUE EVANS, ELI COLEMAN, P121-140.

The rates of alcoholism among the gay/lesbian and bisexual population has been estimated to be three times that of the general public. The socio-political influences that produce higher rates of alcoholism are reviewed. Specific issues in the treatment of chemically dependent men and women are defined and specific suggestions to address sexual orientation issues in treatment and the recovery process are made.

INCEST AND CHEMICALLY DEPENDENT WOMEN: TREATMENT IMPLICATIONS, SUE EVANS, SUSAN SCHAEFER, P141-173.

This paper summarizes research which documents the correlation between chemical dependency and incest. It provides a conceptual framework for addressing incest on a continuum consisting of psychological precursors, covert incest and overt incest. The incest continuum which is described goes beyond mere legal definitions of incest and offers a definition of incest which the authors feels is more clinically meaningful and one which has implications for prevention, intervention, and treatment. This paper includes an assessment tool which the authors designed and have modified based on their clinical work and related research with incest victims. Recommendations for working with incest victims are outlined, and an annotated bibliography is provided as a resource for both human service professionals and their clients who wish to explore the topic further.

SEXUAL COMPULSIVITY: DEFINITION, ETIOLOGY, AND TREATMENT CONSIDERATIONS, ELI COLEMAN, P189-204.

While no consensus on the definition or method of assessing sexual compulsivity exists, there is a growing realization that certain sexual behavior patterns could become the agent for compulsive disorders. This paper reviews the controversy over definition and conceptualization and offers a hypothesized definition of sexual compulsivity, etiology and treatment methodology. One high risk group for developing sexually compulsive behavior patterns is chemically dependent individuals and their family members. The reasons for this higher incidence rate among this group are explained and professionals are urged to look for symptoms of sexual compulsivity and look for treatment opportunities as simply treating the chemical dependence or codependence will rarely alter this symptomology.

TREATMENT OF DEPENDENCY DISORDERS IN MEN: TOWARD A BALANCE OF IDENTITY AND INTIMACY, PHILIP COLGAN, P205-227.

In many male clients struggling with issues of dependency there are often dysfunctional patterns of recognizing, expressing, and satisfying needs for human contact. This paper presents a conceptual framework of dependency disorders as an organizing principle for understanding such patterns. The discussion will be directed toward the etiology of the patterns, their behavioral manifestations, and effective treatment strategies.

TREATING INTIMACY DYSFUNCTIONS IN DYADIC RELATIONSHIPS AMONG CHEMICALLY DEPENDENT AND CODEPENDENT CLIENTS, SONDRA SMALLEY, ELI COLEMAN, P229-243.

When treating intimacy dysfunctions in chemically dependent and codependent relationships, the therapist must focus on resolution of the codependency patterns in order to be successful. Codependency patterns contain several traits (characteristics) or a single state (a fundamental relationship). This paper describes a treatment method which addresses the intimacy dysfunctions among dyadic relationships that display codependency traits. Through three stages of treatment, the therapist can help clients see patterns of their relationships, learn that these patterns are learned and can be unlearned, and that the individual can gain personal power and inner resources. The results of this therapeutic approach leads to healthy intimacy expression based upon individuation of the clients rather than on compulsive codependent patterns.

TOWARD A HEALTHY SEXUAL LIFESTYLE POST CHEMICAL DEPENDENCY TREATMENT, SANDRA L. NOHRE, P245-260.

Treatment of and recovery from chemical dependency surfaces numerous problems in relationships and sexual functioning. These problems will be discussed. The author believes that freedom from chemicals must be accompanied by the re-awakening of the physical senses and emotional responses. Sexual therapy can be an effective therapeutic approach. In reviewing the role of sexual therapy, this paper introduces a definition of sexuality. The journey toward a healthy sexual lifestyle for the chemically dependent person is an exploration through the areas of self-esteem, self-responsibility, communication, touching and intimacy. Awareness of one's personal values and attitudes are primarily essential to a healthy recovery.

INTIMACY, AGING AND CHEMICAL DEPENDENCY, JOHN BRANTNER, P261-268.

SOCIAL SUPPORTS AND LESBIAN ALCOHOLICS, R. SCHILIT, W.M. CLARK, E.A. SHALLENBERGER, AFFILLIA, 1988, VOL 3(2), P27-40.

The purpose of the study discussed in this article was to investigate the relationship between social support and alcoholism among lesbians. Fifteen lesbian alcoholics and 15 lesbian nonalcoholics were administered a questionnaire covering their childhood and adolescent history, social support systems, history of drinking, and demographic information. The findings suggested that the alcoholic lesbians' current support systems were not as disrupted as had been anticipated. However, the alcoholic lesbians more often reported having had a less supportive childhood and adolescence, feeling unloved and unwanted, experiencing conflict with adults in their families, and having had a parent with a drinking problem. The implications of these findings for treatment are discussed.

LESBIAN ALCOHOL AND SUBSTANCE ABUSE, DEE MOSBACHER, PSYCHIATRIC ANNALS 1988, VOL 18, P47-50.

Health professionals treating lesbian alcohol and substance abusers are often handicapped by a scarcity of accurate information on the topic. In this article the literature on lesbian alcohol and substance abuse is reviewed. Issues pertaining to treatment and topics for future investigation are also discussed.

ALCOHOLISM AND NON-ACCEPTANCE OF GAY SELF: THE CRITICAL LINK, ROBERT J. KUS, JOURNAL OF HOMOSEXUALITY, 1988, VOL 15(1/2), P.25-41.

As part of a larger research project designed to generate grounded theory on the nature of gay sobriety, this study was designed to explore the etiology of alcoholism among gay American men and how etiology is related to gay bars or non-acceptance of gay self or both. In-depth interviews were conducted in Seattle, Iowa City, Chicago, and Oklahoma City with 20 gay recovering alcoholic men, each of whom had at least one year of sobriety. It was found that: (a) Gay bars were totally unrelated to the etiology in any of the informants, yet most thought that this gay bar ethnotheory could explain why there was a high incidence of alcoholism in the gay community; (b) none of the men saw being gay as a positive thing before sobriety, yet many didn't realize their non-acceptance until after sobriety was chosen; (c) accepting being gay as a positive aspect of self occurred only after sobriety was chosen and lived; and (d) not accepting being gay as a positive thing may therefore explain the etiology and thus the high incidence of alcoholism among gay American men.

A COMPARISON OF ALCOHOL AND DRUG USE PATTERNS OF HOMOSEXUAL AND HETEROSEXUAL MEN: THE SAN FRANCISCO MEN'S HEALTH STUDY, RON STALL, JAMES WILEY, DRUG AND ALCOHOL DEPENDENCE, VOL 22, 1988, P63-73.

Very high prevalence rates for problem drinking and/or alcoholism have been estimated for homosexual male populations. Populations characterized by high prevalence rates for problematic drug or alcohol use are of special interest since study of such groups may help to provide insights regarding the processes associated with problematic substance use. However, prevalence estimates for problematic substance use within gay male populations have most typically relied on convenience samples and generally contain an over-representation of bar patrons. This study reports data from a large scale random household sample of homosexual and heterosexual men who live in an urban district of San Francisco, California. Few differences were noted in the drinking patterns of these men, although important differences were found in the prevalence of drug use over a 6-month period. Differences in the prevalence of at least weekly drug use were comparatively minor, however. Health policy implications of these findings are discussed.

STRESS, EXPECTANCIES, AND VULNERABILITY TO SUBSTANCE ABUSE: A TEST OF A MODEL AMONG HOMOSEXUAL MEN, DAVID J. MCKIRNAN AND PEGGY L. PETERSON, JOURNAL OF ABNORMAL PSYCHOLOGY, 1988, VOL 97(4), P461-466.

We hypothesize that specific attitudes or expectancies make people vulnerable to responding to stress via alcohol or drugs. This "stress-vulnerability" model was tested among homosexual men, who show elevated rates of substance abuse and have culturally specific stressors and vulnerability. Tension reduction expectancies of alcohol effects had a substantial effect on alcohol and marijuana/drug abuse, as did the use of bars as a social resource. Two stress variables - negative affectivity and discrimination attributable to sexual orientation - also had significant, though more moderate effects. Interactions of the vulnerability measures with the stress variables had significant effects on substance abuse beyond the main effects, supporting the central hypothesis. In a second analysis both simple consumption levels and "high-risk" styles of alcohol or drug use predicted alcohol or drug problems better among vulnerable than among nonvulnerable respondents. These findings strongly supported a general stress-vulnerability model of substance abuse and illustrated several important risk factors in homosexual culture.

THE IMPACT OF AIDS ON A GAY COMMUNITY: CHANGES IN SEXUAL BEHAVIOR, SUBSTANC USE, AND MENTAL HEALTH, JOHN L. MARTIN, LAURA DEAN, MARC GARCIA AND WILLIAM HALL, AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY, 1989, VOL 17(3), P269-293.

This report describes progress made to date on a study of the impact of the AIDS epidemic on the gay community of New York City. Using a model of the life stress process described by Barbara Dohrenwend and her colleagues, the AIDS epidemic was conceptualized as a community stressor resulting in two key stress-inducing events: death of loved ones due to AIDS and potential illness and death of oneself due to infection with human immunodeficiency virus (HIV). It was hypothesized that these stressors would be significantly related to three domains of health outcomes: sexual behavior, drug and alcohol use, and psychological distress. Descriptive trends over time are provided for both the health outcome variables and the stressor variables. Cross-sectional analyses for 3 years of data provide evidence in support of the main hypothesis. The implications of these findings are discussed from the standpoints of methodology, public health, and the psychology of stress processes in community settings.

PSYCHOSOCIAL AND CULTURAL FACTORS IN ALCOHOL AND DRUG ABUSE: AN ANALYSIS OF A HOMOSEXUAL COMMUNITY, DAVID J. MCKIRNAN AND PEGGY L. PETERSON, ADDICTIVE BEHAVIORS, 1989, VOL 14, P555-563.

Homosexual men and women may be at risk for alcohol and drug abuse due to psychosocial variables such as drinking styles, stress, or the cultural importance of bars. The study of psychosocial variables in homosexual culture may help us understand how they operate generally. This paper describes the findings of a large (n = 3400) survey of homosexual population. The core hypothesis was that stress and other psychosocial variables have their primary effects among people made vulnerable to substance abuse by individual expectancies and/or cultural values. Tension reduction expectancies of alcohol effects had substantial effects on alcohol and drug abuse, as did the use of bars as a social resource, a vulnerability variable more specific to urban homosexual culture. Further, stress affected alcohol-drug problems only among people who were "vulnerable" via expectancies and values, and both high risk styles of substance use and simple consumption levels had much stronger effects on problems among vulnerable respondents, thus supporting the stress-vulnerability perspective. Individual differences in social role status was related to alcohol and drug problems, and may explain differences between homosexual and general populations.

ALCOHOLISM, CHEMICAL DEPENDENCY AND THE LESBIAN CLIENT, KATHLEEN O'HALLERAN GLAUS, WOMEN AND THERAPY, 1989, VOL 8, P131-144.

The alcoholic or chemically dependent lesbian carries a double stigma in a society intent on denying the existence of both lesbianism and alcoholism or chemical dependency in women. In view of this, it should not be surprising that a review of the research literature concerned with the alcoholic or chemically dependent lesbian yields so little. The purpose of this review is to summarize what is known, present issues that are unique to the alcoholic or chemically dependent lesbian and provide recommendations for future work.

ALCOHOL AND DRUG USE AMONG HOMOSEXUAL MEN AND WOMEN: EPIDEMIOLOGY AND POPULATION CHARACTERISTICS, DAVID J. MCKIRNAN, PEGGY L. PETERSON,
ADDICTIVE BEHAVIORS, 1989, VOL 14, P545-553.

Homosexual men and women have been described as at high risk for alcohol and drug abuse, due to psychosocial variables such as stress levels or the cultural importance of bar settings. However, there are few actual data in this regard. This paper presents the findings of a large (n = 3400) survey of a homosexual population regarding population characteristics and patterns of alcohol and drug use. Psychosocial variables that may account for substance use patterns both generally and in this population are discussed in an accompanying paper. Substantially higher proportions of the homosexual sample used alcohol, marijuana, or cocaine than was the case in the general population. Contrary to other reports, this was not accompanied by higher rates of heavy use, although homosexuals did show higher rates of alcohol problems. In the general population women consume less drugs and alcohol than do men, and substance use substantially declines with age. Neither of these patterns were found for the homosexual sample, thus creating overall higher rates of substance abuse. This may reflect differences between homosexuals and the general population in their adherence to sex-role stereotypes and age-related social role changes, as well as culturally specific stressors and vulnerability to substance use.

TREATMENT OF HOMOSEXUAL ALCOHOLICS IN GOVERNMENT-FUNDED AGENCIES: PROVIDER TRAINING AND ATTITUDES, R.E. HELLMAN, M. STANTON, J. LEE, A. TYTUN, R. VACHON.
HOSPITAL-COMMUNITY-PSYCHIATRY, 1989, VOL 40(11), P1163-1168.

Alcoholism treatment providers in 36 government-funded agencies in New York City were surveyed for information about their training for and attitudes toward the treatment of homosexual patients. The 164 respondents had limited knowledge about how to evaluate and treat homosexual alcoholics and frequently did not discuss sexual orientation with their clients even though they considered it important. The training and supervision of most providers in the treatment of alcoholic homosexual clients was substandard or nonexistent. About half of the providers believed that treatment programs would benefit from having openly gay staff and felt that being openly gay carried little professional risk. Respondents also reported that development of programs for homosexual alcoholics had little priority in their facilites. Many believed that homosexual alcoholics are less likely to seek help and may have more difficulty achieving sobriety.

ALCOHOLISM IN LESBIANS: DEVELOPMENTAL, SYMBOLIC INTERACTIONIST, AND CRITICAL PERSPECTIVES, JOANNE M. HALL,
HEALTH CARE FOR WOMEN INTERNATIONAL, 1990, VOL 11(1), P89-107.

Alcoholism is a significant health concern for lesbian women, with an incidence rate perhaps three times that of the general population. The relationships among the development of alcoholism in women, the experience of stigmatisation, and the complex facets of lesbian identity and lesbian community are explored. This exploration provides for a more comprehensive and critical analysis of alcoholism in lesbians. As a phenomenon of women's health, alcoholism is examined using the perspectives of developmental theory, symbolic interactionism, and critical theory. The author offers insights and implications for health care, research, and theory building.

ALCOHOLISM RECOVERY IN LESBIAN WOMEN: A THEORY IN DEVELOPMENT, JOANNE M. HALL, SCHOLARLY INQUIRY FOR NURSING PRACTICE: AN INTERNATIONAL JOURNAL, 1990, VOL 4(2), P109-122.

Utilizing the modified practice-theory strategy for theory building, a provisional theoretical model was developed to describe alcoholism recovery in lesbian women. Assumptions are acknowledged, key concepts are identified, and propositions are formulated for the purpose of generating nursing knowledge about a significant health problem in this aggregate of women. The theory's implications for nursing research, practice, and further theory development are discussed.

SUBSTANCE USE AS A CORRELATE OF VIOLENCE IN INTIMATE LESBIAN RELATIONSHIPS, REBECCA SCHILIT, GWAT-YONG LIE, MARILYN MONTAGNE, JOURNAL OF HOMOSEXUALITY, 1990, VOL 19(3), P51-65.

This article examines the problem of domestic violence as related to substance abuse in lesbian relationships. One hundred and four self-identified lesbians responded to a 70-item mail survey. Thirty-nine reported a past or present abusive relationship. Sixty-four percent reported alcohol or drugs were involved prior to or during incidents of battering. Respondents' frequency of drinking significantly correlated with committing abusive acts as well as with being the victim of abusive acts. Efforts must be initiated to improve the delivery of human services to lesbian batterers and victims and to encourage cooperation and cross-fertilization between practitioners from the domestic violence and substance abuse fields.

A MULTIVARIANT MODEL OF ALCOHOLISM SPECIFIC TO GAY-LESBIAN POPULATIONS, CASSANDRA DIAMOND-FRIEDMAN, ALCOHOLISM TREATMENT QUARTERLY, 1990, VOL 7(2), P111-117.

This paper focuses on the link between alcoholism and the gay and lesbian populations. The special needs of gay/lesbian alcoholics are presented through the literature reviews using a multivariant approach containing specific psychodynamic and socio-cultural models, which will offer a framework for helping gays/lesbians deal with lifestyle and alcoholism issues simultaneously.

ALCOHOL AND OTHER DRUG ABUSE IN A GAY/LESBIAN POPULATION: RELATED TO VICTIMIZATION? JOSEPH H. NEISEN, HILARY SANDALL, JOURNAL OF PSYCHOLOGY & HUMAN SEXUALITY, 1990, VOL 3(1), P151-168.

The prevalence of sexual abuse in recovering chemically dependent lesbians and gay men was studied by a retrospective chart review of inpatients at Pride Institute, a center designed to provide treatment for chemical dependency in this population. Nearly 50% of the 201 inpatients studied reported being sexually abused. The researchers postulate that comprehensive chemical dependency treatment programs must recognize and support their clients' need to address sexual abuse in order to prevent relapse and to improve their general emotional well-being. Most treatment centers are reluctant to address sexuality and its problems. Pride Institute maintains a sharp focus on the homosexual culture and staff are sensitive to any difficulties with sexuality, ranging from society's disapproval of a minority lifestyle to overt rape and assault. As a consequence, clients are open to discussion of these problems and staff are able to collect data confirming the extent and nature of sexual abuse in this population. The researchers reviewed this data and placed it in the context of the recent documentation of the long-term effects of childhood sexual abuse.

TWELVE STEP PROGRAMS: A LESBIAN FEMINIST CRITIQUE, BETTE S. TALLEN, NWSA JOURNAL, 1990, VOL 2(3), P390-407.

LESBIAN ALCOHOLISM: DEVELOPMENT OF A CONSTRUCT, CHRISTINE L. SAULNIER, AFFILIA, 1991, VOL 6(3), P66-84.

This article reviews the development of concern for lesbian alcohol problems. It draws on social constructionism as a theoretical backdrop to describe lesbian alcoholism as the intersection of the construction of several other categories: lesbians, the alcoholism movement, women alcoholics, and gay alcoholics. It is unclear how well Alcoholics Anonymous (AA) and other 12-step programs popular in both the mainstream and lesbian communities, meet the needs of women. The utility and political implications for lesbians of such programs as AA and the forms that alcohol intervention for lesbians should take are questioned. A possible trend away from use of 12-step programs is reviewed.

FAMILY TREATMENT WITH CHEMICALLY DEPENDENT GAY MEN AND LESBIANS, MICHAEL SHERNOFF, DANA FINNEGAN, JOURNAL OF CHEMICAL DEPENDENCY TREATMENT, 1991, VOL 4(1), P121-135.

This article will examine three issues: (1) the context within which family treatment of chemically dependent gay men and lesbians takes place; (2) the concepts which underlie any understanding of how to provide quality treatment to them; and (3) examples of practical approaches to providing such treatment.

GAY AND ALCOHOLIC, EPIDEMIOLOGIC AND CLINICAL ISSUES, JAY P. PAUL, RON STALL & KIM A. BLOOMFIELD, ALCOHOL HEALTH & RESEARCH WORLD, 1991, VOL 15(2), P151-160.

Although the rate of alcohol abuse in the gay community cannot be stated conclusively, it is clear that a substantial portion of gays, lesbians, and bisexuals drink probematically. The literature has demonstrated a need to address issues specific to the gay community in alcoholism treatment, and supports the notion of gay-specific treatment groups and programs.

INVISIBLE WOMEN IN INVISIBLE PLACES: LESBIANS, LESBIAN BARS, AND THE SOCIAL PRODUCTION OF PEOPLE/ENVIRONMENT RELATIONSHIPS, MAXINE WOLFE, ARCHITECTURE AND COMPORTMENT/ARCHITECTURE AND BEHAVIOR, 1992, VOL 8(2), P137-158.

HOW DO LESBIAN WOMEN DEVELOP SERENITY? S. DEEVEY, L.J. WALL, HEALTH CARE WOMEN INTERNATIONAL, 1992, VOL 13(2), P199-208.

This article considers how lesbian women recover from alcoholism and develop serenity in the context of a homophobic society. We review what is known about the incidence and lethality of alcoholism in lesbian women. We critique Finnegan and McNally's (1987) five-stage conceptual framework of lesbian and alcoholic identity development, which is based on the disease model of recovery. We present our own model, based on our own recovery experiences. The Deevey-Wall model describes factors that may determine how shaming social environments may affect drinking behavior and recovery in lesbian women. In conclusion, we explain Wall's theory of self-hate as a survival mechanism in traumatically hostile environments.

AN EXPLORATION OF LESBIANS' IMAGES OF RECOVERY FROM ALCOHOL PROBLEMS, J.M. HALL, HEALTH CARE WOMEN INTERNATIONAL, 1992, VOL 13(2), P181-198.

The author's purposes in this article are to explore the images lesbians use to describe their recovery from alcohol problems and to derive from this exercise relevant implications for health care. Lesbians' experiences in recovery are particularly significant because of growing concerns about the prevalences of alcohol problems among lesbians, the vulnerability of lesbians as an aggregate, and the cultural trend away from substance use in lesbian communities. Images of recovery are the descriptions that people offer about their healing from alcohol problems. They are the frameworks by which problem drinkers interpret the meanings of their experiences and determine which aspects of their lives are most pertinent to their recovery efforts. The images persons use to represent their progress and the difficulties they encounter in recovery also provide important bases for developing relevant resources, therapeutic techniques, and social support. Excerpts from an ongoing ethnographic interview study about the recovery experiences of lesbians with alcohol problems illustrate the diversity of recovery images that are characteristic of this population.

JOURNAL OF CHEMICAL DEPENDENCY TREATMENT, 1992, VOL 5(1) SPECIAL ISSUE: LESBIANS AND GAY MEN: CHEMICAL DEPENDENCY TREATMENT ISSUES (THIS HAS ALSO BEEN PUBLISHED AS LESBIANS AND GAY MEN: CHEMICAL DEPENDENCY TREATMENT ISSUES, DAVA L. WEINSTEIN EDITOR, HARRINGTON PARK PRESS, 1992), INCLUDES:

HEALING ADDICTION AND HOMOPHOBIA: REFLECTIONS ON EMPOWERMENT AND LIBERATION, C. HEYWARD, P5-18.

HETEROSEXUAL THERAPISTS TREATING HOMOSEXUAL ADDICTED CLIENTS, V. UBELL, D. SUMBERG, P19-34.

SUBSTANCE ABUSE AND AIDS: REPORT FROM THE FRONT LINES (THE IMPACT ON PROFESSIONALS), M. SHERNOFF, E. SPRINGER, P35-48.

SPIRITUALITY IN EVERYDAY LIFE: EXPERIENCES OF GAY MEN OF ALCOHOLICS ANONYMOUS, R.J. KUS, P49-66.

CHEMICAL DEPENDENCY IN GAY AND LESBIAN YOUTH, F. SHIFRIN, M. SOLIS, P67-76.

DOUBLE TROUBLE: LESBIANS EMERGING FROM ALCOHOLIC FAMILIES, B.P. ROTHBERG, D.M. KIDDER, P77-92.

LESBIAN RECOVERING ALCOHOLICS: A QUALITATIVE STUDY OF IDENTITY TRANSFORMATION - A REPORT ON RESEARCH AND APPLICATIONS TO TREATMENT, E.B. MCNALLY, D.G. FINNEGAN, P93-104.

DUAL DIAGNOSIS ISSUES WITH HOMOSEXUAL PERSONS, R.E. HELLMAN,
P105-118.

PLANNING AN EXPERIENTIAL WEEKEND WORKSHOP FOR LESBIANS AND GAY MALES IN RECOVERY, M. PICUCCI,
P119-140.

APPLICATION OF FAMILY THERAPY CONCEPTS IN THE TREATMENT OF LESBIANS AND GAY MEN, D.L. WEINSTEIN, P141-155.

A COMPARISON OF WOMEN SEEKING DRUG AND ALCOHOL TREATMENT IN A SPECIALIST WOMEN'S AND TWO TRADITIONAL MIXED-SEX TREATMENT SERVICES, JAN COPELAND & WAYNE HALL, BRITISH JOURNAL OF ADDICTION, 1992, VOL 87, P1293-1302.

The paucity of research on the treatment needs of women with substance abuse problems has been a serious impediment to the development of empirically validated treatment services. Women continue to be seriously under-represented as research subjects and clients of treatment services. This study compares the characteristics of 80 women attending a specialist women's treatment service with those of eighty women attending two traditional mixed-sex treatment agencies. Women attending a gender-sensitive service were significantly more likely to have dependent children, to be lesbian, to have a maternal history for drug or alcohol problems and to have suffered sexual abuse in childhood. These results suggest that gender-sensitive treatment services may be recruiting women who might not otherwise have sought treatment for their substance dependence problems.

A COMPARISON OF PREDICTORS OF TREATMENT DROP-OUT OF WOMEN SEEKING DRUG AND ALCOHOL TREATMENT IN A SPECIALIST WOMEN'S AND TWO TRADITIONAL MIXED-SEX TREATMENT SERVICES, JAN COPELAND & WAYNE HALL, BRITISH JOURNAL OF ADDICTION, 1992, VOL 87, P883-890.

The problem of high levels of client drop-out in drug and alcohol treatment is frequently reported in the literature. In the course of conducting an evaluation of a specialist women's treatment service, the inadequacy of the data on women-specific predictors of treatment drop-out was highlighted. Using a retrospective design, the characteristics of 160 women who left treatment less than 5 days after admission were compared to the 160 women who stayed longer than 5 days and were enrolled in the evaluation study. The findings of this study suggested that women who were employed, had a history of sexual assault (especially in adulthood), nominated alcohol as their drug of choice, were not married, older than 25 years of age and had demonstrated a sympathy with the agency's treatment philosophy were less likely to drop-out of treatment. In addition, for lesbian women, women with a history of sexual assault in childhood, and those with dependent children, attendance at a specialist women's service reduced the incidence of treatment drop-out.

LESBIANS AND ALCOHOL: PATTERNS AND PARADOXES IN MEDICAL NOTIONS AND LESBIANS' BELIEFS, J.M. HALL, JOURNAL OF PSYCHOACTIVE DRUGS, 1993, VOL 25(2), P109-119.

There is growing awareness in the lesbian community about the prevalence of alcohol problems, and the meanings and values attached to alcohol use are currently undergoing change. Little research has focused on lesbians' life experiences and alcohol use practices, although in earlier decades a number of medical theories linked lesbianism with alcohol problems as copathologies. More recent theories from the social sciences also linked lesbianism with alcohol problems, but on the basis of sociocultural dynamics and consequent negative self-images. This article compares and contrasts medical theories about lesbians and alcohol with lesbians' own ideas about alcohol use and alcohol problems. Mutually reinforcing themes in medical views and lesbians' experiences are identified. The analysis clarifies what is at stake in the current debates about alcohol, alcohol problems and recovery experiences in the lesbian community, and offers suggestions for research, theory, and practice regarding this significant health issue.

A COMPARISON OF ALCOHOL CONSUMPTION BETWEEN LESBIANS AND HETEROSEXUAL WOMEN IN AN URBAN POPULATION, K. BLOOMFIELD, DRUG AND ALCOHOL DEPENDENCE, 1993, VOL 33, P257-269.

An elevated rate of alcohol problems is believed to exist in the gay and lesbian community. However, prevalence estimates suggesting this have generally been based on convenience samples which have over-represented bar patrons and clinical sources. Recent epidemiological studies examining risk factors for AIDS have gathered information on alcohol consumption as well as sexual orientation. Data based on improved sampling methods are now available for estimating drinking rates of lesbians and gay men. This study compares the drinking patterns of heterosexual women and lesbian/bisexual women who were recruited through a random sampling design in San Francisco, CA. Contrary to previous research, no statistically significant differences in alcohol consumption and drinking patterns between these two groups were found.

ALCOHOL AND OTHER DRUG USE IN FEMALE MEDICAL STUDENTS: A COMPARISON OF LESBIANS AND HETEROSEXUALS, D. MOSBACHER, JOURNAL OF GAY & LESBIAN PSYCHOTHERAPY, 1993, VOL 2(1), P37-48.

Three hundred eight women medical students were surveyed concerning alcohol and other drug use and abuse. At high risk for alcohol abuse were 18.2% of lesbians versus 4.2% of heterosexuals; at high risk for other drug abuse were 6.1% of lesbians versus 1.2% of heterosexuals. The top two drugs of choice for both lesbian and heterosexual medical students were amphetamines and barbiturates. The increased stress of homophobia is suggested as a contributing factor to the higher prevalence of alcohol and other drug abuse among lesbian medical students.

WHAT REALLY WORKED? A CASE ANALYSIS AND DISCUSSION OF CONFRONTATIONAL INTERVENTION FOR SUBSTANCE ABUSE IN MARGINALIZED WOMEN, JOANNE M. HALL, ARCHIVES OF PSYCHIATRIC NURSING, 1993, VOL VII(6), DEC, P322-327.

Confrontations, including ultimatums and withdrawal of services, are used by health care providers to break down denial in substance abusers. This case analysis and discussion looks at the ramifications of confrontation for marginalized women and asks questions about the ethics and efficacy of this approach for substance abusers in general. Nursing is starting to include substance abuse as a substantive area of knowledge and practice. It is suggested in this article that nurses should not uncritically adopt the current orthodoxy about this problem, but view it anew from our own unique, comprehensive perspective.

PATTERNS OF ALCOHOL AND DRUG USE AMONG WOMEN: FOCUS ON SPECIAL POPULATIONS, TONDA L. HUGHES, MARILYN L. FOX, CLINICAL ISSUES IN PERINATAL WOMEN'S HEALTH NURSING, 1993, VOL 4(2), P203-212.

Despite the growing national concern about the effect of the use of alcohol and other drugs on the health and productivity of men and women, relatively little is known about alcohol and other drug (AOD) problems in women. Because of this lack of research and the stigma associated with women who are alcoholic or drug addicted, AOD problems among women are less likely to be recognized and addressed. This article reviews patterns and consequences of AOD use among a number of special populations of women. Information about risk factors and assessment and screening are included to assist the nurse in the identification, counseling, and referral of women with AOD related problems.

SEXUAL RISK FOR HIV TRANSMISSION AMONG GAY/BISEXUAL MEN IN SUBSTANCE-ABUSE TREATMENT, JAY P. PAUL, RON STALL, FRANK DAVIS, AIDS EDUCATION AND PREVENTION, 1993, VOL 5(1), P11-24.

A sample of San Francisco gay/bisexual men in substance-abuse treatment (N = 314) was compared to the San Francisco Men's Health Study (SFMHS) cohort to compare levels of sexual behaviors that are high-risk for HIV transmission. Quantitative data were supplemented by analysis of transcripts of focus group discussions with gay men in treatment at the same agency. Sexual risk for HIV infection was significantly higher for gay/bisexual men in substance-abuse treatment than among the community-based (SFMHS) sample of gay/bisexual men. Among those entering outpatient alcohol/drug treatment, 21% reported unprotected insertive anal sex, 23% reported unprotected receptive anal sex, and 32% reported unprotected insertive and/or receptive anal sex during the previous 6 months. Substance abusers in focus groups identified a number of factors that made it difficult to reduce their sexual risk behavior, including the perceived disinhibiting effects of alcohol and other drugs, learned patterns of association between substance use and sex (especially methamphetamine use and anal sex), low self-esteem, lack of assertiveness and negotiating skills, and perceived powerlessness.

CORRELATES OF SEXUAL RISK-TAKING AMONG GAY MALE SUBSTANCE ABUSERS, JAY P. PAUL, RON D. STALL, G. MICHAEL CROSBY, DONALD C. BARRETT, LORAINE T. MIDANIK, ADDICTION, 1994, VOL 89, P971-983.

This paper examines sexual risk-taking within a sample of sexually active gay and bisexual men entering substance abuse treatment (n = 383), and identifies correlates of unprotected anal sex within this group. Sexual risk-taking was high, with 55% of these men engaging in anal intercourse without a condom within a 90-day period. Correlates of unprotected anal sex varied somewhat when looking at unprotected anal sex with a primary partner only and with non-primary partners; substance use variables (number of drugs used, use of inhalant nitrites or stimulant drugs with sex, length of time since use of alcohol/drugs, loss of control problems associated with alcohol/drug use) appear to play more of a role in unprotected anal sex with non-primary partners. Overall, logistic regression analyses indicated that sexual risk was greater for those who were more sexually active, enjoyed unprotected anal sex with withdrawal prior to ejaculation, did not approve of sex outside of a love relationship, and identified themselves as more risky. In addition, those who reported more social problems due to substance use had fewer expectations that substance use increased risk, had been HIV-tested, and used reappraisal/problem-solving coping strategies showed greater risk with a primary partner only. Sexual risk with non-primary partners was greater for those who used more drugs, reported more difficulty avoiding high-risk sex when aroused and were HIV+. The paper discusses the implications of these findings for the design of sexual risk-reduction interventions.


HIGH RISK SEXUAL BEHAVIOR AND ALCOHOL CONSUMPTION AMONG BAR-GOING GAY MEN, MELISSA J. PERRY, LAURA J. SOLOMON, RICHARD A. WINETT, JEFFREY A. KELLY, ROGER A. ROFFMAN, LAURIE L. DESIDERATO, SETH C. KALICHMAN, KATHLEEN J. KIKKEMA, ANN D. NORMAN, BRIAN SHORT, L. YVONNE STEVENSON, AIDS, 1994, VOL 8, P1321-1324.

Objectives: To determine whether alcohol use prior to sexual behavior influenced the occurrence of unprotected anal intercourse among bar-going gay men.

Methods: Anonymous AIDS behavioral risk surveys were administered to men entering gay bars in 16 cities on three nights in February 1993 in six states in the United States.

Results: Of the 1519 men who completed the survey, 85% were current alcohol drinkers. Men who had unprotected anal intercourse after consuming alcohol drank more and reported more incidents of unprotected anal intercourse than men who had unprotected anal intercourse but not after drinking. Overall, unprotected anal intercourse occurred less frequently after alcohol consumption than without prior consumption.

Conclusions: This study found that heavy alcohol use and frequent high-risk sexual behavior occurred among the same individuals. However, we found no evidence for a causal link between alcohol use and unprotected sexual behavior in this sample of bar-going gay men.


LEVELS OF HIV TESTING AND LOW VALIDITY OF SELF-REPORTED TEST RESULTS AMONG ALCOHOLICS AND DRUG USERS, CHRISTINA P. LINDAN, ANDREW L. AVINS, WILLIAM J. WOODS, ESTHER S. HUDES, WAYNE CLARK, STEPHEN B. HULLEY, AIDS, 1994, VOL 8(11), P1149-1155.

Objectives: To evaluate HIV testing behavior, validity of self-reported serostatus, and intention to test among alcoholics and drug users entering treatment.

Design: Longitudinal cohort study.

Methods: A total of 952 clients voluntarily entering three outpatient and two inpatient public alcohol treatment centers in San Francisco were enrolled. Seventy-six per cent were men, 50% black, 81% had used both alcohol and drugs during the last year, 43% had injected drugs and 9% of the men were homosexual. Subjects completed an interviewer-administered questionnaire and blindly-linked HIV-antibody test at entry and after 1 year (81% follow-up).

Results: Fifty-seven per cent of subjects reported that they had previously sought HIV testing. Factors associated with HIV testing included homosexual contact, injecting drug use, having a partner who had been tested, and using condoms. Hispanics were the least likely of all ethnic groups to report testing. Of 60 subjects with HIV antibodies, 47 (78%) said they had already been tested; however, 19 (40%) inaccurately reported that their serostatus was negative and another four (9%) had not collected their test results. Blacks were much more likely than other groups to misreport or be unaware of their HIV status. Only half of the 68% who said they planned to be tested during the following year did so. Five (42%) out of 12 HIV-positive individuals who were unaware of, or misreported their serostatus at baseline, and who sought another HIV test during the follow-up year continued to report themselves as uninfected.

Conclusions: A large proportion of clients attending public alcohol treatment centers report having been HIV tested, much greater than that observed in other populations. However, misreporting of HIV test results was very common among seropositive subjects. Alcohol and drug treatment programs for this high-risk population should include interventions to optimize use of HIV testing for prevention and treatment, and improve understanding of test results.

RESEARCH ON LESBIANS AND ALCOHOL, GAPS AND IMPLICATIONS, TONDA L. HUGHES, SHARON C. WILSNACK, ALCOHOL, HEALTH & RESEARCH WORLD, 1994, VOL 18(3), P202-205.

A FEMINIST APPROACH TO SUBSTANCE ABUSE TREATMENT AND SERVICE DELIVERY, ANN A. ABBOTT, SOCIAL WORK IN HEALTH CARE, 1994, VOL 19(314), P67-83.

A major concern among service providers and policy makers has been the increase in the number of individuals and families that enter the health care system either using or abusing alcohol and other drugs or suffering from the ramifications of a significant family member's substance abuse. An additional concern involves a lack of adequate understanding of these clients and a lag in the development of appropriate treatment strategies, especially in relation to women (Blume, 1993; Googins, 1984; National Council on Alcoholism an Drug Dependence, 1987). This article pays particular attention to substance use among women; the identification of deficits in current mainstream, treatment efforts, which historically have been developed primarily by male providers for male substance abuses; the advantages and specifics of treatment based on a feminist perspective; and their application to other at-risk populations.

THE PREVALENCE AND DEMOGRAPHIC PREDICTORS OF ILLICIT AND LICIT DRUG USE AMONG LESBIANS AND GAY MEN, WILLIAM F. SKINNER, AMERICAN JOURNAL OF PUBLIC HEALTH, 1994, VOL 84(8), P1307-1310.

Studies on illicit and licit drug use among homosexuals of both sexes have focused primarily on gay men, used limited drug measures, and been conducted in cities known for large homosexual populations. This paper examines (1) the prevalence of 12 illicit and licit drugs by sex and age group and (2) the demographic predictors of past-year frequency of marijuana, alcohol, and cigarette use. Organizational mailing lists were used to collect self-report data on 455 homosexuals living in a southern state. Differences were found between gay men and lesbians in the use of specific substances and in the demographic predictors of drug use.

THE EXPERIENCES OF LESBIANS IN ALCOHOLICS ANONYMOUS, JOANNE M. HALL, WESTERN JOURNAL OF NURSING RESEARCH, 1994, VOL 16(5), P556-576.

A feminist ethnographic study of lesbians' experiences in recovery from alcohol problems was done to understand from their perspectives how they identified alcohol use as problematic, sought help, experienced health care interactions and participation in Alcoholics Anonymous (AA), and maintained recovery. Through community-based purposive sampling in San Francisco, 35 lesbians recovering from alcohol problems participated in semistructured ethnographic interviews of 2 hours duration, which were subsequently interpreted using ethnographic coding, narrative anlaysis, and matrix analysis. A major finding was that participation in AA was fraught with tension in three areas. Each tension was defined by two poles of experience that appear to be in conflict. They were assimilation versus differentiation, authority versus autonomy, and false consciousness versus politicization. These tensions are elaborated and supported by examples from the women's interviews. Nursing implications regarding the role of AA in recovery for marginalized women are discussed.

DIFFERENCES IN ASSESSMENT AND TREATMENT APPROACHES FOR HOMOSEXUAL CLIENTS, IAN MACEWAN, DRUG AND ALCOHOL REVIEW, 1994, VOL 13, P57-62.

This study was undertaken to discover the similarities and the differences in assessment and treatment approaches for heterosexual and for homosexual clients. The purpose of the study was to investigate to what extent sexual orientation is incorporated into treatment plans and what effect this had for treatment outcomes. Responses to nine questions were obtained from 50 self-reporting heterosexual and 50 self-reporting homosexual clients of a range of treatment providers. Differences were found at each stage of assessment and treatment process. There was evidence of sexual orientation not being utilized as a treatment factor. For both groups there was evidence of inadequate significant-other involvement in treatment and post-treatment planning.

HOW LESBIANS RECOGNIZE AND RESPOND TO ALCOHOL PROBLEMS: A THEORETICAL MODEL OF PROBLEMATIZATION, J.M.HALL, ADV. NURSE SCIENCE, 1994, VOL 16(3), P46-63.

To determine how one specific at-risk population problematizes alcohol use and responds to alcohol-related difficulties, findings from an ethnographic interview study of lesbians recovering from alcohol problems were used to develop a theoretical model of problematization. Problematization consists of two phases: recognition and response. Recognition involves problem indicators varying by type (cumulative vs immediate) and source (personal vs environmental). Movement from recognition to response is hindered by perceptual and environmental constraints. Response consists of interrelated processes of construction, interaction, action, and validation. On the basis of validation, problems are reconstructed and new problems are recognized as the cycle continues.

VERBAL AND PHYSICAL ABUSE AS STRESSORS IN THE LIVES OF LESBIAN, GAY MALE, AND BISEXUAL YOUTHS: ASSOCIATIONS WITH SCHOOL PROBLEMS, RUNNING AWAY, SUBSTANCE ABUSE, PROSTITUTION, AND SUICIDE, R.C. SAVIN-WILLIAMS, JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY, 1994, VOL 62(2), P261-269.

A common theme identified in empirical studies and clinical reports of lesbian, gay male, and bisexual youths is the chronic stress that is created by the verbal and physical abuse they receive from peers and adults. This article reviews the verbal and physical abuse that threatens the well-being and physical survival of lesbian, gay male, and bisexual youths. This response to gay male, lesbian and bisexual adolescents by significant others in their environment is often associated with several problematic outcomes, including school-related problems, running away from home, conflict with the law, substance abuse, prostitution, and suicide. Although the causal link between these stressors and outcomes has not been scientifically established, there is suggestive evidence that these outcomes are consequences of verbal and physical harassment.

LESBIANS RECOVERING FROM ALCOHOL PROBLEMS: AN ETHNOGRAPHIC STUDY OF HEALTH CARE EXPERIENCES, JOANNE M. HALL, NURSING RESEARCH, 1994, JULY/AUGUST, P236-244.

The findings of this ethnographic study of 35 San Francisco lesbians in long-term alcohol recovery describe their identification of alcohol problems, help-seeking experiences, and barriers to recovery in health care interactions. Multiple addictions and "core difficulties," such as childhood trauma, were common yet poorly addressed by health care providers. Lesbian clients mistrusted culturally ignorant providers who often inappropriately reversed therapeutic roles. Provider-client conceptual incongruence about alcohol problems often impeded recovery while providers' persuasive styles (paternalistic, maternalistic, confrontational, and influential) were pivotal to recovery. The confrontational approach caused the most problems. It could precipitate crises, be interpreted by the women as social ostracism, and retraumatize those who had histories of childhood trauma. Consensus favored the influential style, characterized by flexibility, negotiation, support, and avoidance of ultimatums. Conclusions challenge the assumptions that alcoholics are manipulative, "in denial," and require coercion to attain and maintain recover.

LESBIAN ALCOHOL AND MARIJUANA USE: CORRELATES OF HIV RISK BEHAVIORS AND ABUSIVE RELATIONSHIPS, SUSANNA M. PERRY, JOURNAL OF PSYCHOACTIVE DRUGS, 1995, VOL 27(4) P413-419.

One hundred fifty-two self-identified lesbian and bisexual women participated in an exploratory study of lesbian health and high-risk sexual behaviors. These women were primarily White, middle class, and college educated. The relationship of alcohol and marijuana use to high-risk sexual behaviors and involvement in past or current abusive experiences was investigated. Having been involved in coercive sexual activities was related to some high-risk sexual activities and alcohol and marijuana use. The women in this sample were engaging in high-risk sexual activities, perhaps because of a lack of HIV-risk perception among lesbians in general, and in this sample in particular. These results demonstrate the need for HIV and safer-sex education even among highly educated women and awareness of the interrelationship between drug use and unsafe sexual activities.

SEXUALITY, SEXUAL ORIENTATION, AND VIOLENCE: PIECES IN THE PUZZLE OF WOMEN'S USE AND ABUSE OF ALCOHOL, TONA L. HUGHES, JEANETTE NORRIS ANNUAL REVIEW OF WOMEN'S HEALTH, 1995, CH. 2 P285-317.

ALCOHOL AND DRUG USE IN HETEROSEXUAL AND HOMOSEXUAL PROSTITUTION, AND ITS RELATION TO PROTECTION BEHAVIOUR, R. DE GRAAF, I. VANWESENBEECK, G. VAN ZESSEN, C.J. STRAVER, J.H. VISSER,
AIDS CARE, 1995, VOL 7(1), P35-47.

To assess the prevalence and effects of alcohol and drug use in heterosexual and homosexual commercial contacts, and the relationship between their use and unsafe sexual behaviour, 127 female prostitutes, 27 male prostitutes, 91 clients of female prostitutes and 24 clients of male prostitutes were interviewed face-to-face with the help of a semi-structured questionnaire. The respondents were living or working in different parts of The Netherlands. Alcohol and drug use was found to be relatively common among prostitutes. This was also so for the use of alcohol by clients, though to a lesser extent. Prostitutes' consumption varied widely according to the type of prostitution they were employed in. Those meeting their clients in clubs or bars reported the highest consumption of alcohol; hard drugs were used predominantly by street prostitutes. It appears that the main effects of alcohol and drug use are on how the individual experiences working as, or calling on, a prostitute, the social interaction between the two parties, and the sexual contact itself. The common assumption that drinking alcohol has negative effects on condom use was not borne out; though female prostitutes working under the influence of drugs were significantly more likely to report unsafe sex. The degree to which commercial partners were judged to be under the influence of alcohol or drugs was not found to bear upon the frequency of respondents' condom use. For those prostitutes who use hard drugs, this use plays an important role in their engaging in unsafe sexual activities. Prevention activities should focus especially on this group, and should take into account the role of such drug use.

ADDICTION AND RECOVER IN GAY AND LESBIAN PERSONS, ROBERT J. KUS, 1995 (ALSO PUBLISHED AS JOURNAL OF GAY AND LESBIAN SOCIAL SERVICES, 1995, VOL 2(1), JAMES J. KELLY & RAYMOND M. BERGER, EDITORS), INCLUDES:

ALCOHOLISM AND DRUG ABUSE IN GAY AND LESBIAN PERSONS: A REVIEW OF INCIDENCE STUDIES, ETHAN E. BICKELHAUPT, P5-14.

This review article examines the incidence of alcoholism, and insofar as possible, other forms of drug abuse, among gays and lesbians in the United States and one European society. The consensus is that about 25% of such persons suffer from definitive drug and alcohol abuse problems, while an additional percentage experience "suggestive or problematic" abuse patterns.

CHEMICAL DEPENDENCE AND HIV INFECTION, MELVIN I. POHL, P15-28.

In the United States, AIDS has affected gay men more than any social group. There are special relationships between drug dependence and HIV infections/AIDS. Any discussion of the special needs of chemically dependent gay and lesbian persons must include the special problems clinicians need to be aware of when caring for the HIV-positive patient. This article explores HIV disease including its causes, development, transmission, treatments, and effects.

HOMOPHOBIA: THE HEART OF THE DARKNESS, SHEPPARD B. KOMINARS, P29-39.

For gay men and lesbians, one of the greatest obstacles to long-term sobriety is internalized homophobia - the hatred of one's homosexuality. Unless the crucial stage of self-acceptance is reached in the coming-out process, the effect of internalized homophobia is to put the recovery process in jeopardy and leave the gay, lesbian, bi-sexual addict/alcoholic at constant risk. Internalized homphobia can be successfully treated, but a more fundamental approach needs to be implemented in order to eliminate societal homophobia that is at the heart of the issue. To begin to do this, we need to understand the underlying nature of homophobia and how it manifests itself in eveyday life. This article explores homophobia in America, how it impacts on the lives of everyone - gay, lesbian and straight - and how we can take action to eliminate it.

DYSFUNCTIONAL RELATIONSHIP PATTERNS: POSITIVE CHANGES FOR GAY AND LESBIAN PEOPLE, CHERYL HETHERINGTON, P41-55.

Just as people who grow up in dysfunctional families often have some special relationship problems, so too do chemically dependent people and their significant others. Gay and lesbian couples are no exception. This article discusses some of the issues of boundary confusion, perfectionism, intimacy, impression management, rescuing and others to show how these patterns contribute to chaos and pain in relationships. Suggestions are offered to help gay and lesbian clients deal with self-esteem, boundary problems, and anger so that they can lead more balanced lives that include positive relationships.

SPIRITUALITY AND THE GAY COMMUNITY, FATHER LEO BOOTH, P57-65.

Father Leo Booth examines the need to recognize the effects negative religious messages about homosexuality have on gay and lesbian clients. He describes the difference between religion and spirituality, and offers suggestions for guiding gay clients into self-acceptance, even in the face of a religious and social environment which does not always promote such acceptance.

SPECIAL INTEREST GROUPS IN ALCOHOLICS ANONYMOUS: A FOCUS ON GAY MEN'S GROUPS, ROBERT J. KUS, MARK A. LATCOVICH,
P67-82.

Millions of alcoholics around the world find their recovery in "working the program" of Alcoholics Anonymous (AA). Most AA members find belonging to AA groups and attending meetings to be very important parts of working the program. Many recovering alcoholics, however, find that "special interest groups" are highly desirable in their recovery. This is the case of many gay men who see gay groups as critical in their achieving and maintaining sobriety. In this article, we will explore the special interest groups in terms of their definitions, types, and history. We will then take one group, gay men, and see why they have formed special interest AA groups, the positives of such groups and the limitations of such groups. Clinical implications will then be provided.

THE NATIONAL ASSOCIATION OF LESBIAN AND GAY ALCOHOLISM PROFESSIONALS (NALGAP): A RETROSPECTIVE, DANA G. FINNEGAN, EMILY B. MCNALLY, P83-90.

In this article, the co-founders of the National Association of Lesbian and Gay Alcoholism Professionals - NALGAP - discuss the reason the association was originally formed, the influence it has had in the larger field of health care of gay and lesbian Americans, and some challenges of the organization for the future.

REFERRALS AND RESOURCES FOR CHEMICALLY DEPENDENT GAY AND LESBIAN CLIENTS, ROBERT J. KUS, GEORGE BYRON SMITH, P91-107.

Alcoholism and other forms of chemical dependence have the potential to cause havoc in all realms of life. Not surprisingly, then, recovering persons and their loved ones often need a myriad of resources. In addition to the resources which would likely be needed by any recovering persons, gay and lesbian persons often need resources specific to their needs as gays and lesbians. Many social workers and other helping professionals, however, do not know how to go about finding out what gay and lesbian resources are available to them, and therefore are unable to make needed referrals for such clients. The purpose of this article is to discuss some of the unique problems which gay and lesbian recovering persons and their loved ones may have which might necessitate referrals, how to decide whether one should treat or refer, some basic resources which may be available to helping professionals to meet these specific gay and/or lesbian needs, and how to go about finding out what is available in one's community.

SUICIDE AND SUICIDE ATTEMPTS IN THE LESBIAN AND GAY COMMUNITY, JULIE MILLARD,
AUSTRALIAN AND NEW ZEALAND JOURNAL OF MENTAL HEALTH NURSING, 1995, VOL 4, P181-189.

The most common suicide theories share a widely recognized set of social factors that contribute to suicide and suicide attempts. This paper discusses additional suicide risk factors that affect the gay and lesbian community such as: discrimination, gay adolescence, coming out, establishment of a gay identity, HIV/AIDS, intrapersonal stressors, drugs and alcohol, racial/ethnic factors and limited support structures. Poor awareness of these additional risks, both within mainstream society and within the gay and lesbian community, is also discussed. A review of the literature is conducted that examines the impact of these risk factors and the implications of these issues to mental health nursing.

A REVIEW OF THE LITERATURE EXAMINING THE RELATIONSHIP BETWEEN ALCOHOL USE AND HIV-RELATED SEXUAL RISK-TAKING IN YOUNG PEOPLE, CATHERINE DONOVAN, ROBERT MCEWAN, ADDICTION, 1995, VOL 90, P319-328.

Young people have been targeted as a potentially vulnerable population for the spread of HIV. The influence of alcohol on sexual behaviour is part of the popular knowledge. More recently, studies have attempted to illuminate the relationship between alcohol use and sexual risk-taking in relation to HIV transmission. In our review of the literature three important points are highlighted for researchers in this area. First, methodological problems make establishing any relationship extremely difficult. Secondly, the concept of sexual risk-taking has to be developed to include acknowledgement of the context in which sex takes place rather than defining risk only in terms of sexual acts. Finally, populations of gay men and men who have sex with men and lesbians are sufficiently different from heterosexuals, with regard to the influence of alcohol on sexual behaviour, to make generalizations about one population inappropriate for the other.

REMISSION OF SUBSTANCE USE DISORDERS: GAY MEN IN THE FIRST DECADE OF AIDS, ROBERT H. REMIEN, RAYMOND GOETZ, JUDITH G. RABKIN, JANET B.W. WILLIAMS, MITCHELL BRADBURY, ANKE A EHRHARDT, JACK M. GORMAN, JOURNAL OF STUDIES ON ALCOHOL, 1995, VOL 56(2), P226-232.

Objective: Participants in a 5-year prospective study of HIV-seropositive and seronegative gay men demonstrated a significant decline in the rate (from lifetime to current) of alcohol and other DSM-III-R psychoactive substance use disorders. The goal of the current study was to identify factors associated with the cessation of problematic substance use, to observe rates of relapse over 4 years, and to describe factors associated with relapse and no relapse.

Method: A volunteer community sample of self-identified gay men (N = 56) were administered a semi-structured interview and several self-report measures by trained mental health clinicians, twice annually over a 5-year period.

Results: Retrospective and prospective data revealed a significant decline in substance use and problems associated with use in the decade of the 1980s. This change occurred, for the most part, without formal treatment. Numberous motivating factors were associated with this change, which included a fear of AIDS, a change in attitudes in the gay community, changes in other risk-taking behaviors and concerns about self-image. A variety of informal methods were employed. Most notable was "avoiding situations associated with substance use."

Conclusions: Changes in substance abuse/dependence occurred in the context of health concerns, caring for oneself and "cleaning up one's act." Having a concern about "self-image," avoiding situations associated with drug use and not using "drug substitution" as a method of quitting were important factors for maintaining successful change.

ALCOHOL-RELATED RISK FACTORS ASSOCIATED WITH HIV INFECTION AMONG PATIENTS ENTERING ALCOHOLISM TREATMENT: IMPLICATIONS FOR PREVENTION, JOSEPH A. BOSCARINO, ANDREW L. AVINS, WILLIAM J. WOODS, CHRISTINA P. LINDAN, ESTHER S. HUDES, WAYNE CLARK, JOURNAL OF STUDIES ON ALCOHOL, 1995, VOL 56(6), P642-653.

Objective: Reports suggest that alcoholics may be at risk for HIV infection. In this article we examine several alcohol-related risk factors for HIV infection among patients entering alcoholism treatment in an AIDS epicenter. Our objective was to identify key factors for HIV prevention and screening among populations receiving treatment for alcohol abuse or alcohol dependence.

Method: Clients (N = 921) entering five alcoholism treatment centers in the San Francisco Bay area underwent an interview and blind serotesting for HIV antibodies (76% were male, 16% men who had sex with men, 50% black, 10% Latinos and 6.5% were HIV seropositive). Logistic regression was used to predict HIV serostatus from five possible alcohol-associated risk factors, controlling for demographics and traditional HIV risk factors. These were alcohol impairment, attitudes about socializing in bars, increased sexual risk expectancies when drinking, enhanced sexual expectancies when drinking and decreased nervousness when drinking. Male and female heterosexuals and men with a history of homosexuality were analyzed separately.

Results: Among male and female heterosexuals, HIV infection was positively associated with higher alcohol impairment (OR = 2.69,p = .031) and negatively associated with higher sexual risk expectancies when drinking (OR = 0.24,p = .075). Among men who had sex with men, HIV infection was positively associated with higher bar socializating orientations (OR = 10.06,p = .004). Infection was also negatively associated with higher alcohol impairment (OR = 0.26,p = 0.24) for these men.

Conclusions: Since these associations were independent of demographics and traditional HIV risk factors, our research suggests it may be important to also focus HIV screening and prevention on alcohol-related risk factors in AIDS epicenters. For heterosexual alcoholics, the focus should be on those with higher alcohol dependence. For male alcoholics who had sex with men, the focus should be on those who primarily socialize in bars. Further research is needed to determine why higher sexual risk perceptions when drinking were associated with lower rates of HIV infection for both groups, since this discovery may have important prevention implications. The negative association between infection and alcohol impairment among homosexual men also warrants further investigation.

CONDOM USE AMONG GAY/BISEXUAL MALE SUBSTANCE ABUSERS USING THE TIMELINE FOLLOW-BACK METHOD, G. MICHAEL CROSBY, RON D. STALL, JAY P. PAUL, DONALD C. BARRETT, LORRAINE T. MIDANIK, ADDICTIVE BEHAVIORS, 1996, VOL 21(2), P249-257.

Sexual risk for HIV transmission under the influence of alcohol and/or other drugs is not simply a cause-effect relationship; not everyone who drinks or uses other drugs has unprotected sex. The purpose of this study is to explore differences between substance using gay/bisexual men who use condoms during anal sex from those who do not. These differences are identified by comparing men whose anal sex while under the influence of alcohol and/or drugs is consistently protected to men whose anal sex while under the influence of alcohol/or drugs is consistently unprotected. Gay/bisexual men entering substance abuse treatment at a gay-identified agency in San Francisco were recruited to complete surveys and to be interviewed about sexual behavior, substance use, and related variables using an extended version of the Timeline Follow-back (TL). The TL procedure uses a blank calendar form and a series of questions to cue recall of drinking, drug use, and anal intercourse on each of the 30 days prior to the last date of alcohol and/or drug use. Men whose anal sex while under the influence of alcohol and/or drugs is consistently unprotected were significantly more likely to report having less than a college education (p = .04), more likely to have an income of less than $20,000 (p = .01), more likely to use amylnitrite (p = .01) and cocaine (p = 0.2) and more likely to report a higher frequency of anal sex (p = .007). In addition, they were less likely to approve of sex without love (p = .003), less likely to perceive that safer sex is the community norm (p = .001), and less likely to have encouragement from friends to practice safer sex (p = .001). However, HIV status did not differentiate between the two groups. These two groups provide clear and interesting contrasts in terms of behavior, thus comparisons of the factors influencing sexual safety in these subgroups may enhance our understanding of risk taking. A better understanding of possible mediating variables can be important both in guiding future research in this area and in formulating intervention strategies to target gay men who drink or use drugs in combination with sexual activity.

DRUG AND ALCOHOL USE AMONG LESBIAN AND GAY PEOPLE IN A SOUTHERN U.S. SAMPLE: EPIDEMIOLOGICAL, COMPARATIVE, AND METHODOLOGICAL FINDINGS FROM THE TRILOGY PROJECT, WILLIAM F. SKINNER, MELANIE D. OTIS, JOURNAL OF HOMOSEXUALITY, 1996, VOL 30(3), P59-92.

The Trilogy Project is a longitudinal study of lesbian and gay people living in and around two metropolitan areas in a southern state. The study was specifically designed to provide (1) epidemiological data on the lifetime, past year, and past month prevalence rates for the use of 6 illicit, 4 psychotherapeutic, and 2 licit drugs, and (2) comparative data to the National Household Survey on Drug Abuse (NHSDA). Self-report data were collected on 1067 respondents using multiple sampling strategies and a research design that yielded response rates averaging over 50%. Results indicated some age group differences in the prevalence of certain drugs by gay men compared to lesbians. When comparisons were made to the NHSDA, Trilogy Project respondents were found to have significantly higher prevalence rates for the past year use of marijuana, inhalants, and alcohol but not cocaine. While lesbian and gay people drink alcohol more frequently during the month than NHSDA respondents, few differences occurred between the two samples for heavy alcohol consumption. Research questions suggested by the data and theoretical directions for future research are discussed.

CO-FACTORS AFFECTING SUBSTANCE ABUSE AMONG HOMOSEXUAL MEN: AN INVESTIGATION WITHIN A MIDWESTERN GAY COMMUNITY, DENNIS J. GHINDIA, LENORE A. KOLA, DRUG AND ALCOHOL DEPENDENCE, 1996 VOL 41, P167-177.

In an effort to begin formation of an empirically based model of gay substance abuse, this study examined the effects of three psychosocial factors, homosexual identity formation, self-esteem and a familial history of substance abuse in the evolution of this phenomenon among homosexual men, a group that appears to manifest appreciably higher rates and concomitantly greater associated problems than the general population. Data were obtained by voluntary subject return of a self-report instrument that was distributed widely over a 6 month period in the metropolitan Cleveland area, resulting in a moderately sized sample. Although the sampling method limited the generalizibility of the results, diminished self-esteem and a familial history of substance abuse had significant associations with both alcohol and drug abuse and were confirmed to be salient predictors, together accounting for almost half of the variance in alcohol abuse and over one-third the variance in drug abuse. Moreover, both had the ability to significantly discern between alcohol and drug use groups versus groups found to be alcohol and drug abusive. Levels of a gay identity were not meaningfully associated with substance abuse. Finally, recommendations for further research are explicated.

LONGITUDINAL CHANGES IN ALCOHOL AND DRUG USE AMONG MEN SEEN AT A GAY-SPECIFIC SUBSTANCE ABUSE TREATMENT AGENCY, JAY P. PAUL, DONALD C. BARRETT, G. MICHAEL CROSBY, RON D. STALL, JOURNAL OF STUDIES ON ALCOHOL, 1996, VOL 57(5,) P475-485.

Objective: This study describes changes over a 12-month period in prevalence and frequency of alcohol and other drug use and correlates of change at 12 months in a sample of gay/bisexul men entering gay-identified outpatient substance abuse treatment.

Method: A sequential sample of gay/bisexual men (n = 455) were recruited for a study in which substance use, sexual risk and psychological factors were assessed every 3 months. Changes in substance use were evaluated in 321 men who used in the 90 days before entering treatment and who completed at least one follow-up interview, whether or not they continued in treatment.

Results: At baseline, 95% of the sample reported alcohol use in the prior 90 days; 64% marijuana/hashish use; 46%, amphetamine use; 33% inhalant nitrites use; and 31% cocaine use. Most men were polydrug users; 10% reported using only one drug (including alcohol); 39% used > 4 drugs. A marked reduction occurred in prevalence of use over time; declines on the order of 50% occurred in the first 90 days; prevalence then stablized in remaining assessments. Frequency of usage by those reporting use of any given class of drugs also declined. No consistent predictors of reduction or cessation of use across different drug categories were found at 1 year.

Conclusions: Substance use declined considerably in this sample. Given the scope of substance abuse problems among gay/bisexual men, and linkages to the HIV epidemic, considerable resources need to be focused on treatment and prevention for gay/bisexual men.

PERVASIVE EFFECTS OF CHILDHOOD SEXUAL ABUSE IN LESBIANS' RECOVERY FROM ALCOHOL PROBLEMS, JOANNE M. HALL, SUBSTANCE USE & MISUSE, 1996, VOL 31(2), P225-239.

In narratives of 35 lesbians in alcohol recovery, 46% unexpectedly disclosed having survived childhood sexual abuse (CSA), linking it with addiction and recovery experiences. This subgroup described unbounded difficulties that pervaded their lives well into recovery. They reported mutiple addictions, self-harm, isolation, sexual problems, depression, self-loathing, physical illness, and inability to work more often than did other participants. Those not reporting CSA were more socially and occupationally stable, self-satisfied, and physically well in recovery; their alcohol problems seemed circumscribed and responsive to conventional intervention. Conclusions indicate that CSA history may foster health risks that complicate alcohol recovery, necessitating more comprehensive clinical attention.

USE OF ALCOHOL AMONG LESBIANS: RESEARCH AND CLINICAL IMPLICATIONS, TONDA L. HUGHES, SHARON C. WILSNACK, AMERICAN JOURNAL OF ORTHOPSYCHIATRY, 1997 VOL 67(1) P21-36.

A review of the literature on the prevalence of alcohol use and problems among lesbians reveals that the few studies yielding information on this population are beset by design and methodological problems. Those factors possibly associated with higher risk status of lesbians are identified, as are gaps in the literature, and implications for clinical practice and research are discussed.

LESBIAN USES OF AND SATISFACTION WITH MENTAL HEALTH SERVICES: RESULTS FROM BOSTON LESBIAN HEALTH PROJECT, LENA SORENSEN, SUSAN JO ROBERTS,
JOURNAL OF HOMOSEXUALITY, 1997, VOL 33(1) P35-49.

In response to the dearth of specific information about lesbians' health status and practices in the health literature, a national study utilizing a self-administered questionnaire was conducted in 1987 by four associates of the Fenway Community Health Center in Boston to access data in these areas. The questionnaire solicited information about demographics, health practices, stress in personal and work lives, mental and physical health problems, sexual practices, family history of health related problems, and genetic attributes hypothesized to be related to "gayness." Questionnaires from 1,633 lesbian women provided the database for the study.

This paper discusses the portion of the survey that dealt with mental health services and life experiences. Past studies that investigated mental health needs of lesbians focused on the quality of treatment by mental health providers, rates of suicide attempts, and alcoholism. This paper compares these past findings with the responses of the lesbians in this national, community-based study. Findings indicate that although a significant number of the lesbian women in this sample had been in therapy, they sought out therapy as a coping strategy to deal with similar issues as other women, i.e., depression and relationships. Suicide attempts decreased considerably after adolescence and "coming out." Rates of alcohol use and abuse, although difficult to compare with other studies, were higher than other women but similar to other studies investigating a community sample of lesbians. Even with a high family history of alcoholism, less than 5 percent reported having sought out therapy to deal with any issues of alcohol or drug use.

BOOKS

OUT FROM UNDER SOBER DYKES & OUR FRIENDS, ED. JEAN SWALLOW, SPINSTERS/AUNT LUTE, 1983.

GAY AND SOBER: DIRECTIONS FOR COUNSELLING AND THERAPY, T.O. ZIEBOLD & J.E. MONGEON, HARRINGTON PARK PRESS, 1985.

DUAL IDENTITIES: COUNSELING CHEMICALLY DEPENDENT GAY MEN AND LESBIANS, DANA G. FINNEGAN, EMILY M. MCNALLY, HAZELDEN, 1987.

NALGAP ANNOTATED BIBLIOGRAPHY: ALCOHOLISM, SUBSTANCE ABUSE AND LESBIANS-GAY MEN, STEVEN L. BERG, DANA FINNEGAN, EMILY MCNALLY, NATIONAL ASSOCIATION OF LESBIAN AND GAY ALCOHOLISM PROFESSIONALS, 1987.

MAKING VISIBLE, IMPROVING SERVICES FOR LESBIAN AND GAY MEN IN ALCOHOL AND DRUG TREATMENT AND HEALTH PROMOTION, IAN MacEWAN, PAUL KINDER, ALCOHOL LIQUOR ADVISORY COUNCIL, NEW ZEALAND, 1992. 27 PAGES.

LESBIANS AND GAY MEN: CHEMICAL DEPENDENCE TREATMENT ISSUES, DAVA L. WEINSTEIN, ED. HARRINGTON PARK PRESS, 1992.

GHOST PAINS, JANE SEVERANCE, SHEBA, 1992. (NOVEL)

THE NEXT STEP, LESBIANS IN LONG-TERM RECOVERY, OUT FROM UNDER, VOLUME 2, ED. JEAN SWALLOW, ALYSON PUBLICATIONS, 1994.

ADDICTION AND RECOVERY OF GAY AND LESBIAN PERSONS, ROBERT J. KUS, HAWORTH PRESS INC, 1994.

ARTICLES WITHIN BOOKS/CHAPTERS WITHIN BOOKS

ALCOHOLISM PROBLEMS IN WOMEN AND CHILDREN, M. GREENBLATT & M. SCHUCKIT (EDS), GRUNE & STRATTON, 1976, INCLUDES:

LESBIANISM AND ALCOHOLISM, JAMES L. HAWKINS, P137-153.

THE IMPACT OF SEX ROLES ON WOMEN'S ALCOHOL USE AND ABUSE
, SHARON C. WILSNACK, P37-63.

LESBIAN HEALTH MATTERS, MARY O'DONNELL, VAL LEOFFLER, KATER POLLOCK, ZIESEL SAUNDERS, A SANTA CRUZ WOMEN'S HEALTH COLLECTIVE PUBLICATION, 1978, INCLUDES:

CHAPTER ON ALCOHOLISM AND CO-ALCOHOLISM
, P73-85.

LESBIAN AND GAY ISSUES: RESOURCE MANUAL FOR SOCIAL WORKERS, HILDA HIDALGO, TRAVIS L. PETERSON, NATALIE JANE WOODMAN, EDS, NATIONAL ASSOCIATION OF SOCIAL WORKERS, 1985, INCLUDES:

SUBSTANCE ABUSE (OF BEING QUEER, MAGIC PILLS AND SOCIAL LUBRICANTS) E. SUE BLUME, P79-87.

LESBIAN PSYCHOLOGIES, EXPLORATIONS & CHALLENGES, ED BOSTON LESBIAN PSYCHOLOGIES COLLECTIVE, UNIVERSITY OF ILLINOIS PRESS, 1987, INCLUDES:

LESBIAN ALCOHOLISM: ETIOLOGY, TREATMENT, AND RECOVERY, LEE K. NICOLOFF AND ELOISE A. STIGLITZ, P283-293.

ALIVE & WELL, A LESBIAN HEALTH GUIDE, CUCA HEPBURN & BONNIE GUTERREZ, THE CROSSING PRESS, 1988, INCLUDES:

CHAPTER ON ALCOHOL, P192-197.

OCCASIONAL PAPERS/REPORTS

ASPECTS OF WORKING WITH LESBIAN AND GAY MALE CLIENTS IN ALCOHOL AGENCIES, MAEVE MALLEY, 1992, £2.53, ALCOHOL INTERVENTIONS TRAINING UNIT, RUTHERFORD EXTENSION, THE UNIVERSITY, CANTERBURY, KENT, CT2 7NX.

TREATMENT OF LESBIANS WITH ALCOHOL PROBLEMS IN ALCOHOL SERVICES IN NORTH WEST ENGLAND (1994), JAN BRIDGET, £6.50, 40 pages. L.I.S., P.O. BOX 8, TODMORDEN, LANCASHIRE, OL14 5TZ.

USEFUL ADDRESSES

Alcohol Concern, Waterbridge House, 32-36 Loman Street, London, SE1 0EE, 0171.928.7377.

Northern Ireland Council on Alcohol, 40 Elmswood Avenue, Belfast, BT9 6AZ. Tel 01232.664434.

Scottish Council on Alcohol, 2nd Floor, 166 Buchanan Street, Glasgow, G1 2NH. Tel 0141.333.9677.

©
Lesbian Information Service, April, 1998.