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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
