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Affirming one’s self-identity can be powerful and empowering. So, when an individual seeking help with their addiction is questioning their gender identification or sexual orientation, or if they are very clear about either one, they need to have a supportive encounter. The message given needs to be one of sensitivity, respect, and validation.
SOCIAL BEHAVIOR RESEARCH AND PRACTICE ISSN 2474-8927 Open Journal Nelson J. Tiburcio, PhD*; Kristin S. Kimmell, LCSW, LCAC; Scarlett L. Baker, AA The SASSI Institute, 201 Camelot Lane, Springville, IN 47462, USA *Corresponding author Nelson J. Tiburcio, PhD Chief Executive Officer, The SASSI Institute, 201 Camelot Lane, Springville, IN 47462, USA; T el. 800-726-0526; Fax: 800-546-7995; E-mail: research@sassi.com Article Information Received: April 6th, 2023; Revised: April 20th, 2023; Accepted: May 4th, 2023; Published: May 10th, 2023 Cite this article Tiburcio NJ, Kimmell KS, Baker SL. Are the LGBTQIA+ communities able to maintain their identity within twelve-step programs: A brief narrative. Soc Behav Res Pract Open J. 2023; 8(1): 15-17. doi: 10.17140/SBRPOJ-8-138 Are the LGBTQIA+ Communities able to Maintain their Identity within Twelve-Step Programs: A Brief Narrative A ffirming one’s self-identity can be powerful and empowering. So, when an individual seeking help with their addiction is questioning their gender identification or sexual orientation, or if they are very clear about either one, they need to have a supportive encounter. The message given needs to be one of sensitivity, re- spect, and validation. If you are unfamiliar with terminology and definitions as they pertain to the lesbian, gay, bisexual, transgen- der, queer, intersex, asexual or ally, and other identities (LGBT - QIA+) communities, you can find a comprehensive list online. 1 Note that definitions may vary with location, era, and culture. In March of 2023, during an interview with Yahoo Life, Shannon Minter, legal director of the National Center for Lesbi- an Rights and a transgender man, stated that “You can get into very complicated terminologies, but it’s about people. It’s mostly important to focus on humanity as opposed to terminology and to be patient and believe people when they say how they identify, and not use such discussions to make political points. Language is important, but what’s most important is just understand- ing and acceptance and inclusion and support”.2 During the last decade, we have seen a proliferation of substance use disorder (SUD) that has led to death and destruc - tion, such as never witnessed historically. Costs of SUD to the United States (U.S.) economy are profound, estimated at $193 bil- lion annually related to lost work productivity, healthcare, early mortality, and crime, from the abuse of illicit substances; when including alcohol-related costs these totals exceed $220 billion. 3 LGBTQIA+ individuals have higher rates of alcohol use than cis- gender people.4,5 Surveys among lesbian, gay and bisexual adults have found that sexual minorities have higher rates of substance misuse and SUDs than people who identify as heterosexual. Still in its nascency, it is not yet possible to establish long-term trends about substance use and SUD prevalence in LGBTQ popula - tions.6 Similarly, research is currently limited on rates of SUD treatment episodes among transgender populations, although ex- tant research shows that transgender individuals are more likely to seek SUD treatment than the non-transgender population. 5 Research on minorities has shown significant disparities in excess usage in lesbian, gay, bisexual (LGB) women and in greater mag- nitude for Black and Hispanic LGB women compared with White LGB women, which may reflect their unique experiences of dis- crimination at the intersection of multiple minority identities.7 In this commentary, discussion is on how LGBTQIA+ individuals are able to cope with and maintain their identities and yet avoid inherent and/or hidden stigmas associated with unfortunate add- ed barriers to their recovery and their involvement in twelve-step programs.
The first twelve-step program, Alcoholics Anonymous® (AA), was developed and founded in the 1930s by Bill Wilson and Bob Smith and aided its membership to overcome alcoholism. 8 Alcoholics Anonymous® was the first program of its kind and has been the blueprint for 12-step programs ever since. Over the last 85-years, demographic preferences related to the users’ drug of choice have led to the creation of specialized twelve-step groups with a focus on specific issues. Some of these include Cocaine Anonymous, Crystal Meth Anonymous, and Marijuana Anony- mous. Behavioral issues such as compulsions towards or addiction to gambling, food, sex, and other similar issues, led to the forma- tion of further specialized twelve-step groups addressing issues such as crime, gambling, dietary issues, sexual activities, etc. Poten- tial downsides of these types of programs are that they draw on outdated methods and theories originating in the 1930s and there is limited research into their effectiveness. They’ve ignored many scientific advancements in research of addiction and have been offering solutions which are not grounded in modern psychology. Recent scientific studies on addiction have led to the development of a number of medications for pharmacological interventions, along with other non-pharmacotherapies including behavioral, cognitive, and social interventions. 9 The spiritual component of these programs can be negative for some, thus dissuading indi- viduals who are in need of treatment from pursuing it. For many people, when they hear the phrase “spiritual awakening”, which is throughout AA literature and is in the Twelfth Step, it feels like a Commentary Copyright 2023 by Tiburcio NJ. This is an open-access article distributed under Creative Commons Attribution 4.0 International License (CC-BY 4.0)
Soc Behav Res Pract Open J. 2023; 8(1): 15-17. doi: 10.17140/SBRPOJ-8-138 Tiburcio NJ, et al requirement to have a religious awakening, which is often not an appealing idea to non-religious individuals and especially for those who may feel ostracized by religions that reject the LBGTQIA+ communities. For these reasons and more, non-twelve-step addic- tion treatment may be a good alternative for many recovering indi- viduals.
When the AA twelve-step program was initially formed, it was assumed that alcohol addiction was a moral defect that could be cured alone with willpower. As outlined in the AA book “Twelve Steps and twelve traditions”, it was positioned that meetings led by others in recovery would provide moral support and accountability, thus encouraging abstinence, and participants are to place faith in a higher power and accept that they are powerless.10 We now know much more about the science of addiction and have a greater understanding of biopsychology and the way addiction fundamentally alters the structure of a person’s brain. Based upon this knowledge, non-twelve-step programs can pro - vide science-based treatments such as cognitive behavioral therapy and provide customized treatment plans built around an individ- ual’s needs rather than a one-size-fits-all approach. Options may include individual and group counseling sessions, pharmacologi- cal therapies, motivational interviewing, and psychodynamic (sup - portive–expressive) therapies.11 Many programs incorporate some form of group meeting which provides a safe space for discussion and moral support, but these meetings will make up just one part of holistic and integrative therapy.
Belief in a higher power can provide comfort and assur- ance for some people throughout the difficult recovery process. A lot of science-based programs still encourage individuals to em- brace spirituality. But by removing it as a requirement for recovery, these programs can reach people who would otherwise reject the teachings of a faith-based plan.
One individual, King, a male-to-female transgender, spoke to us (March 2023) about what she considered a turnoff to twelve-step treatment, that is the “powerlessness” that twelve- step treatment invoked. She and her partner felt they needed to be empowered, rather than made to feel helpless. By empowering themselves and others they could better meet the challenges of active addiction.
However, many recovering alcoholic members of the LG- BTQIA+ community reported feeling quite comfortable in twelve- step groups and found, for identification purposes, additional sup- port at “special interest” Alcoholics Anonymous ® groups for the LQBTQIA+ community.12 Michael Radkowsky, PsyD, a licensed psychologist who specializes in LGBTQIA+ individual therapy and couples counseling in Washington, DC, wrote in a column for the Washington Blade, America’s LGBTQ News Source, that the best way to learn if twelve-step programs are a good fit for an indi- vidual, is to actually attend several twelve-step meetings, including LGBTQIA+ meetings.13 LGBTQIA+ individuals who have shared their positive experiences can be found in the Alcoholics Anony- mous® publication “LGBTQ Alcoholics in AA”.14
Ultimately, each individual’s experience with twelve-step groups and recovery is as unique as they are, and more research and discussion need to be done. Prior studies have demonstrated that transgender people with substance use disorders are the least studied of all, and the least catered to in treatment.15 More than ten years ago, Grant et al 16 stated that “Rates of human immunodefi- ciency virus (HIV) infection, attempted suicide, drug and alcohol abuse, and smoking among transgender and gender non-conforming people were just some of the identifiers to the overwhelming need for…transgender-sensitive recov - ery programs”. These issues have compounded with the addition of even deadlier substances and greater availability, further exacerbat- ing already precariously deadly rates.10 A study on how non-binary people who use drugs are an underserved group at high risk of harm, concluded that clinicians should be trained in trans-affirm- ative language and practice, that development and implementation of specialist substance use disorder interventions for trans and/or non-binary people are needed, and a greater effort to include trans people in sexualized drug use research is needed as well. 17 Find- ings from an additional study illustrated the need for gender-based, anti-stigma policies and programs to be established within exist - ing addiction treatment programs, and as recommended by the participants in the study, it is vital to establish transgender and/ or LGBTQIA+ specific treatment programs. 15 Examining these phenomena will hopefully provide a more profound understanding of the issues these individuals encounter. The hope is to further discussions about what has been witnessed, document various ex- periences, and what others throughout the world may contribute towards this dialogue for future commentaries.
CONFLICTS OF INTEREST The authors declare that they have no conflicts of interest.