Treatment Effectiveness

While the evidence on treatment outcomes for sexuality and gender diverse people in generalist programs suggested lower levels of abstinence, it is limited and dated. Specialised treatment programs for sexuality and gender diverse people seek to provide supportive and safe therapeutic environments to address the coming out process and how this contributes to substance use, and develop alternative ways to socialise without centering on alcohol. There is little evidence on the efficacy of these programs compared to treatment as usual; one US-study found specialised treatment “virtually eliminated any differences in current abstinence rates between heterosexual and gay/bisexual [male] participants” . The few specialised substance treatment services in Australia are provided by community-based organisations (e.g. ACON in NSW and Thorne Harbour Health in Victoria), and have not been evaluated.  

A growing evidence base on the efficacy of specific treatment modalities for sexuality and gender diverse people shows increased efficacy of motivational interviewing/goal choice in reducing alcohol use for men who have sex with men and for transgender women, and some evidence that individuals receiving behavioural couples’ therapy increased their days of drinking at a significantly slower rate than those receiving individual behavioural therapy. Concerns about the efficacy of mixed-group treatment due to potential homophobia or transphobia from other patients, or of family counselling where there is alienation due to sexuality or gender, have not been systematically explored.  

Despite concerns there is no research examining how sexuality or gender identity is addressed in relapse prevention, recovery, and aftercare. Sexuality and gender diverse people may anticipate and/or face challenges re-connecting with LGBT communities, seeking and maintaining social support, friendships and romantic partners in social, community and commercial spaces that are not organised around alcohol. They may also anticipate and/or experience stigma and discrimination in generalist recovery programs such as Alcoholics Anonymous, although there is little research on experiences or outcomes.