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Abstract
Gay men and lesbians reportedly use and abuse alcohol and substances at rates higher than the general population. This higher rate has been questioned, but, whether gay men and lesbians have more use and abuse or not, unique clinical considerations are involved in addiction treatment for gay men and lesbians. The psychodynamic factors that contribute to the creation and powerful influence of internalized homophobia for gay men and lesbians can explain the predisposition to substance use and abuse. Parents may not be able to acknowledge or reward the differences that may be apparent in the pre-homosexual child. The child will learn to hide or dissociate from those differences. In addition, the psychology of difference, that is, learning how to live with and accept things about one's self that are different from the majority, will contribute to further denial and dissociation from true feelings and needs. Substance use allows the expression of suppressed and repressed desires and needs and facilitates denial and dissociation. Gay men and lesbians may find the comfort in using drugs and alcohol leads to increased use, abuse, and possible dependency. Treatment of gay men and lesbians with substance use disorders will need to address the internalized homophobia as part of the recovery process. Traditional psychotherapy will not be helpful while the individual is actively drinking or drugging but supportive therapy can be quite helpful until the individual is in recovery. Psychotherapy then can be used to help accept and integrate a gay or lesbian identity and help support relapse prevention.
