Social and Health Service Use and Treatment Outcomes for Sexual Minorities in a National Sample of Substance Abuse Treatment Programs

Abstract

This study examines substance use severity, levels of social and health service utilization, and the impact of service utilization on treatment outcomes for sexual minorities versus non-minorities. The sample included 3,094 clients from the National Treatment Improvement Evaluation Study (NTIES). Substance use severity among sexual minorities and non-sexual minorities was similar at treatment entry and at 12 months post-discharge. Differences in social and health service utilization were significant for substance abuse counseling and health services. Significant interactions between sexuality and access services and sexuality and mental health services were also found. Practice and research implications are discussed.

KEYWORDS:

• substance abuse treatment
• sexual minorities
• LGBT
• ancillary services
• treatment outcomes

Notes

1. A 2007 study by Cochran, Peavy, and Cauce found relatively more positive attitudes among treatment counselors, but this may have been a function of recruitment strategy, as all participants responded to advertisements that described the research as a study of LGBT issues in treatment.

2. Clients from correctional facilities were excluded because incarceration impacts clients’ need for social and health services in a systematic way. For example, incarcerated clients are very unlikely to need child care and transportation.

3. Many of the surveys from the 1990s that collected data on mental health among LGBT populations focused on adolescents and teenagers (Cochran, 2001).

4. Some service categories include services only applicable to those pregnant or parenting or only to those for whom English is a second language. Thus, control variables for pregnancy, presence of minor children in the home, and country of birth are included in the linear model.

5. The percent of people reporting same-gender sexual partners in the National Health and Social Life Survey (NHSLS) varied according to demographic factors, such as gender, race, geographic location, income, religion, and education. The NHSLS is the only national probability survey of adult sexual behavior conducted in the United States. The NHSLS data were collected in 1992 (Laumann et al., 2000).

6. Note that those who are less comfortable with same-gender sexual behavior may also be more likely to turn to alcohol and drugs to cope with stress. Thus we might expect to find differences in addiction severity between those with same-gender partners, depending upon whether or not they identify as LGBT. There are also well-documented differences between rates of substance use between those who identify as gay or lesbian versus bisexual or transgender (Marshal et al., 2008; Ziyadeh et al., 2007).