When assessing available social support for
LGBT patients, treatment providers should
recognize that LGBT individuals may
experience conflict with their family of origin,
especially around issues of sexual orientation or
gender identity, and it is important for treatment
providers to understand the interpersonal
relationships of their LGBT patients. In
addition, providers should be particularly careful
to protect the confidentiality of LGBT patients
because in many states LGBT individuals lack
legal protections against discrimination in
housing, the job market or social services.^109
Despite the need to tailor addiction treatment to
the needs of LGBT individuals, national data
show that only 6.2 percent of treatment facilities
offered any type of tailored treatment
specifically for LGBT patients in 2010.^110 A
2007 national study found that services provided
by 70.8 percent of LGBT-specialized programs
did not differ from services provided to patients
in other programs and only about seven percent
of facilities offered LGBT-specific services,
such as special groups for LGBT patients or
having counselors who were trained specifically
in LGBT issues.^111
Research evaluating the impact of treatment
specific to the needs of LGBT individuals is
lacking. Among a small sample of individuals
in addiction treatment, gay and bisexual men in
LGBT-specialized treatment reported better
outcomes, such as achieving abstinence and
completing treatment, than gay and bisexual
men in traditional treatment.^112
Veterans and Active Duty Military ..................................................................................
The U.S. Department of Veterans Affairs (VA)
and the Department of Defense have developed
practice guidelines for evidence-based addiction
treatment, and endorsed the U.S. Public Health
Services’ Clinical Practice Guidelines for
smoking cessation.^113 Among the recommended
practices for addressing risky use of addictive
substances and addiction in veterans and active
duty members of the military are the
following:^114
Active duty members involved in an
incident in which substance use is
suspected to be a contributing factor are
required to be referred to specialty
addiction care for evaluation. A treatment team shall convene with the
patient and command in order to review the
treatment plan and goals. Rehabilitation and referral services for the
patient require an individualized plan
designed to identify the continued support
of the patient with at least monthly
monitoring during the first year after
inpatient treatment. For patients who do not stabilize and refuse
to engage in any type of ongoing care with
any provider (e.g., medical, psychiatric or
addiction specialty), consider involving
supportive family members or significant
others if the patient agrees. This may
include a first line supervisor when
appropriate and the unit commander.Of particular importance in the veteran and
active duty military populations is the need to
attend to co-occurring mental health conditions,
particularly post-traumatic stress disorder
(PTSD), which are common in this
population.^115The VA has outlined certain treatment
guidelines for veterans and military personnel
with addiction and co-occurring PTSD, most of
which mirror the treatment approaches outlined
in Chapter V for the general population.
However, the VA notes that treatment for the
two conditions can be delivered simultaneously,
that the clinician should use first-stage treatment
approaches such as motivational interviewing to
initiate treatment and specifically states that
tobacco cessation services should be integrated
into the treatment protocol.^116 The most
commonly used treatment approach for veteran
patients with co-occurring addiction and PTSD
involves cognitive behavioral therapy (CBT).^117