| Treating
Addiction in Homosexuals
General Considerations
Addiction is like a fire; once started it
becomes self-sustaining, and the first order of business for the fire fighter is to put
out the blaze. Only later comes the search for the match. Similarly, treatment of the
addict in early recovery is largely behavioral and cognitive: daily attendance at AA
meetings provides (among other things) a support system and teaches the addict a number of
techniques to avoid drinking/using, break old habit patterns of action and thinking, and
reduce or manage the inevitable pain of withdrawal and recovery. Even psychodynamically
oriented therapists now agree that focusing on the underlying causes of active addiction
in an individual does not work to halt the addictive behavior (Colcher, 1982). Thus initially
the sexual orientation of an addict is largely irrelevant to his treatment (Colcher,
1982), except (1) as it may cause legitimate concerns as to the treatment he may receive
at the hands of a homophobic treatment staff, or may fuel his alcoholic denial that even
an unbiased staff could help him, and (2) that the homosexual because of his lifestyle may
be at special environmental risks to continued sobriety. In these cases, an addict should
be referred to a gay-sensitive rehabilitation program, or to one of the gay
special-interest groups of the 12-Step programs.
Treating Homosexuals
Internalized homophobia is common in gay
alcoholics, and often a source of considerable pain and dysfunction. In the author's
experience, addiction is most often initially driven by pain; thus it is important in
recovery to reduce pain and stress wherever possible in the recovering alcoholics life and
thus reduce the temptation for the alcoholic to self-medicate.
The alcoholic may be self-medicating
anxiety, anger and depression relating to the internalized homophobia. In addition, a
homosexual who has been taught by parents, church, school and society in general that
homosexual lovemaking is forbidden, sinful, bad, sick, disgusting, and perverted, may use
alcohol to medicate the anxiety which these negative thoughts provoke in him and thus
allow him to engage in sex at all. And to the alcoholic contemplating abstinence, the
prospect of not being able to have (or function in) sober sex can be a motivation to and
justification for not staying sober.
Gay special-interest 12-Step programs (and,
perhaps gay group therapy) can help the recovering alcoholic consciously work through
internalized homophobia, and understand and reject for himself the destructive myths about
homosexuality:
Most of these myths are counterproductive .
. . since they are based on assumptions that all gay males are identical, are fixated at
regressive levels, and can never achieve a "whole" and satisfactory life.
Examples of these myths are: gay males are hysterical and dramatic, especially in dealing
with conflict; gay male sex is compulsively driven sex; the treatment objective is a
dyadic, long-term relationship; gay males are basically narcissistic; gay sex is basically
masturbation; gay males are immature (fixated at pre-Oedipal stages, fixated at
adolescence, manifesting the Peter Pan syndrome); gay men are totally sexually liberated;
"something" will always be missing, in comparison with heterosexuality; gay
intimate relationships cannot last and cannot mature; gays are "sad young men";
casual sex is empty sex; gay men are psychotic; gay men cannot obtain relatedness; and so
on (Smith, 1982, p. 55).
In addition, strange though it might seem,
in the gay special-interest meetings of 12-Step programs, gay men and women can learn
(perhaps for the first time) to relate to other gay men and women in non-sexual ways, thus
building healthy relationships based on other common interests. This may be especially
important for older homosexuals, for whom the earlier, sexualized relationships may be
undesirable, unfulfilling, and unavailable.
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Treatment
