Abstract
Sandra C. Anderson, Substance use disorders in lesbian, gay, bisexual, and transgender clients: Assessment and treatment. New York: Columbia University Press, 2009, 264 pp., $32.50 (pbk), ISBN 9780231142755, $84.50 (hbk), ISBN 9780231142748.
A dearth of literature exists concentrating on substance use disorders in lesbian, gay, bisexual, and transgender (LGBT) clients. Anderson attempts to fill this void. This book appears to follow three broad categories. The first, comprising the initial three chapters, provides an introduction, important definitions, prevalence and etiological data, and a discussion of heterosexism. The second category, the practice section, consists of the majority of chapters. Topics range from Anderson’s assessment format to practice with various subgroups and issues related to specific drugs, age groups, and diversity. She also provides discussion on intervention models and a case study. These chapters provide a broad base of information regarding issues relevant to assisting LGBT clients with substance use disorders. The third, last section focuses on legal and political issues related to practice. It addresses ongoing legal, ethical, policy, and legislative challenges facing practitioners who assist LGBT clients. Anderson concludes by reflecting on the future of the field.
This book has remarkable strengths. Anderson provides an extensive literature review on LGBT clients and the problems they experience with substance use disorders. The discussion on heterosexism is exceptionally noteworthy. Practitioners serving LGBT clients would do well to familiarize themselves with this salient material. It is markedly candid in describing the effects of stigma on LGBT clients and practitioners alike and how to address heterosexism in the practice setting.
Anderson provides two extensive assessment formats for LGBT clients with substance use disorders. The Assessment seeks details on lifestyle variables such as impact of societal heterosexism, gay meeting places, coming out and identity formation, internalized homo/bi/trans/phobia, partner violence, sexual compulsivity, and HIV-infection status besides the ‘normal’ information sought. The Initial Health Assessment for the HIV-Infected Substance Abuse Treatment Client also seeks detailed information needed to serve LGBT clients, while providing them with a sense of safety in discussing extremely sensitive material. These are valuable ‘tools’ for any practitioner’s toolbox.
Next, Anderson presents Harm Reduction and advocates for its use in everyday practice serving LGBT clients with substance use disorders. While ‘catching on’ in the USA, it is often ridiculed by traditional substance use disorder professionals. As an advocate of Harm Reduction, this was refreshing and encouraging to read.
Finally, Anderson intersperses short case examples throughout the book exemplifying the point of a particular section, helping readers to better understand each point. The Case Study chapter provides an exemplar of her practice in action. The step-by-step process provides a road map for any practitioner serving those with substance use disorders. Especially remarkable is the use of both Harm Reduction strategies and encouragement of self-help groups other than Twelve Step meetings. Recovery is not a ‘one size fits all’ approach and Twelve Step meetings are not the only source of healthy social support.
Notably, this book has a few shortcomings. While providing an extensive review of the literature, at times, the references ramble. This makes it difficult to follow what points are being made and may cause some readers to miss important details due to tedium or confusion.
Second, chapters on practice with specific populations provide only short descriptions of assessment and treatment. It would have been instructive to expand both sections to better inform readers what to seek out and how to handle specific situations. Further, while Anderson broaches issues of spirituality and God, it is too brief. It could be argued an entire chapter may be devoted to this. Practice experience with LGBT clients with substance use disorders has found this a core issue and discussion on how to engage clients, help them feel safe to disclose their fears and feelings, and possible roads to resolution would have strengthened this book. Also, discussion on clients exposed to conversion therapy (sexual reorientation therapy) and what strategies to use to help clients work through their issues linked with this experience would have been meaningful.
Finally, in the section on stages of change, it would have been instructive to describe the processes of change and the role they play in determining specific interventions. Being integral in identifying interventions applicable to a client’s stage of change, they suggest whether experiential or behavioural approaches are appropriate. The rationale for this is that practitioners knowing this may avoid setting clients up for failure by not suggesting behavioural interventions clients are not prepared to engage in.
In the main, Anderson’s book is very useful for practitioners serving LGBT clients with substance use disorders. It provides readers with significant information on LGBT clients and excellent practical strategies to help clients attain and maintain a healthier lifestyle.