I had the good fortune of meeting recently with Dr. James Barry, one of our illustrious, recent graduates from CalSouthern’s PsyD program.
In our warm and stimulating dialogue, Dr. Barry explored substance abuse in the LGBT community from multiple perspectives (not just psychology, but also sociology and biology). As one example: Dr. Barry described the interaction between two different targets of societal stigma: a) our addicted populations; and b) our LGBT population.
Dr. Barry went on to clarify how both LGBT and addicted individuals know what is to experience the “calling of the question.” That is, both groups must prepare in many social circumstances (dinners, parties) to be asked about their identities. For the one: “Are they going to ask me if I’m LGBT?” And for the other: “Are they going to ask me why I’m not drinking?”
Together, Dr. Barry and I reviewed studies about the highest stressors that most of us experience (leading to increased cortisol, or “allostatic load”). It turns out that threats to social acceptance, coupled with threats to self-esteem, represent for most of us that which we find most stressful in day-to-day life. Applied to substance abuse and addictive behaviors, the strongest trigger for relapse = stress (increased allostatic load) = societal/familial shame and personal shame (or what psychology calls “self-stigmatization”).
Dr. Barry hence emphasizes the need for interventions such as aiding clients in learning self-affirmation (where they learn to “normalize” their individual experiences as human beings), which may prove critical as a coping response effective in warding off their “barbecuing in their own adrenaline” (what one client called her sustained, hence untenable, elevated stress levels).
What Dr. Barry has discovered is that the foundation for addiction treatment must be in consistently affirming individual clients’ fundamental worth, just as they are, along with applauding, or “cheerleading,” their courage in seeking professional help.
One not uncommon fear of LGBT clients entering substance abuse treatment is: “Am I going to be safe, specifically in identifying as LGBT?” Dr. Barry responds: “Holistic recovery requires transparency, including one’s sexual orientation, for the sake of healing.” He cites the 12-step programs’ credo: “You’re only as sick as your secrets,” again stressing honesty and vulnerability as a prerequisite to effective treatment and sustained successful recovery.
Regarding the increased prevalence of substance abuse in the LGBT community, Dr. Barry discussed internalized homophobia, or toxic shame, as at the very root of much addictive behavior. We also reviewed the ACE (Adverse Childhood Experiences) studies, where significant childhood trauma was found to be a predictable precursor to subsequent addictive behaviors for most clients seeking substance abuse treatment. This is one reason why “just say no” rhetoric ends up not only being so often ineffective but actually can be quite counterproductive, owing to the shame and stigma it may unintentionally evoke – psychological factors which paralyze forward movement into needed healing.
There is now, at last, the opportunity, owing to studies like Dr. Barry’s, to explore more deeply all the above psychological, developmental, as well as cultural, contributions to addiction and repeated relapse to addictive behaviors, even by those clients sincerely committed to recovery.
In that spirit, one important resource will surely now be Dr. Barry’s doctoral project, which has been only recently revised into book form, and expects publication in December 2017:
Dr. James Barry’s Substance Abuse in the LGBT Community book
Dr. Barry’s groundbreaking book offers clinical and practical suggestions for a broad readership, both professional and lay. His central goal in writing this book? “That we all respectfully ask the right questions” when addressing substance abuse issues among the LGBT community. And Dr. Barry’s parting message of encouragement to LGBT individuals seeking recovery from addiction: “You need to be who you truly are for the sake of genuinely holistic healing and health.”