Week 12

Question 1

Why is addiction among queer people different? (2)

Answer 1

There is a long and dark history of queer people and mental illness, diagnosis, etc.

Unique psychosocial factors that queer people face increase the risk of substance use (stigma, isolation, homophobia/transphobia, rejection)

Question 2

What is the Fruit Machine? (4)

Answer 2

Created by a researcher at Carleton University

The fruit machine measured and recorded the eyes of men as they were shown several photos of naked men to look for reactions that would indicate homosexuality

The government of Canada got the researcher to create this machine during the Cold War to determine if men were gay as they were seen as a threat to national security (the worry was that gay man working in the government would be vulnerable to blackmail and espionage by the Soviets, also seen as dangerous and deviant)

It never worked, mainly because they couldn’t get volunteers and it was on flawed assumptions

Question 3

How were queers classified in the DSM 1? (3)

Answer 3

Sexual deviation

Homosexuality was a mental health condition, specifically a sociopathic emotional disturbance

Listed with other paraphilia as it was illegal at the time

Reflective of how homosexuality was viewed at the time

Question 4

How were queers classified in the DSM-2? (3)

Answer 4

Sexual orientation disturbance

Changed it a little to include sexual orientation (not just the behavior of homosexuality itself, but also the attraction and desire)

It was no longer considered a mental disorder, but still considered a diagnostic category that could cause distress and disturbance

Question 5

How were queers classified in the DSM 3? (5)

Answer 5

Ego-dystonic homosexuality

Social movements for queer people resulted in the DSM changing how it conceptualized homosexuality

Created a new disorder for individuals whose values, wants and desires do not align with their sexual orientation and attraction

They do not want to be gay but they are, which creates distress, anxiety and depression

Not pathologizing homosexuality, but the distress experienced from it

Question 6

How were queers classified in the DSM 3-R? (3)

Answer 6

Dropped the disorder of homosexuality in this addition in all subsequent additions

Moved it to the category of sexual disorder not otherwise specified

Once again, pathologizing the distress about one’s sexual orientation

Question 7

How were queers classified in the DSM 4? (6)

Answer 7

Gender identity disorder

Strong and persistent cross-gender identification, where you feel one way or another

Disorder implies there is something wrong with them and pathologizes trans people and their experiences

Can create stigma, prejudice, and discrimination against trans people by calling them disordered

Trans people start believing these things and this internalization is a barrier to treatment for other things because they think there’s something wrong with them and they are not worth it

This leads to substances for coping

Question 8

How were queers classified in the DSM 5? (5)

Answer 8

Gender dysphoria

Not pathologizing the identity, but the distress they experience from it

Marked incongruence between one’s gender identity and assigned gender, and clinically significant distress or impairment resulting from it

Creates loneliness, isolation, bullying, discrimination, rejection, low self-esteem, depression, anxiety, difficulty forming meaningful relationships, etc. due to their gender identity, which impacts every aspect of their life

Less likely to seek treatment and healthcare due to fear of poor treatment and judgment, which could create or worsen health conditions

Question 9

What is the significance of queer people’s presence in the DSM? (2)

Answer 9

The content of the DSM is very much impacted by the cultural and social norms at the time

The DSM also impacts cultural and social norms as identifying people as disordered can create stigma, which an in turn can lead to substance use for coping

Question 10

What did early epidemiological research of SUDs in queer people find?

Answer 10

The estimated incident of substance use dependence was 30% among queer people compared to around 10% among the general population

Question 11

What is wrong with early epidemiological research on SUDS among queers? (6)

Answer 11

Inconsistent definitions of sexual orientation

Non-standardized measures of substance use

Lack of control/comparison groups

Small non-random homogenous samples (queer people often existed in secret and hid for mainstream society, making it hard to find participants and those they did find were usually from the same group/space of people)

Sampling bias

Exclusion of queer people who are not gay or lesbian

Question 12

What does more recent epidemiological research find? (6)

Answer 12

Addiction is much less prevalent, but there is an increased rate of drug and alcohol dependence among queer communities

A national survey in the US found 16.8% of gay men met AUD criteria compared to 6.1% of straight men

13.3% of lesbians met CUD criteria compared to 0.2% of straight women

Some studies show no difference, which really enforces how wrong the old studies were

The more rigorous the research, the lower the rate goes and the smaller the differences

Overall, non-heterosexual orientation is associated with a higher risk of substance and dependence

Question 13

What are the 4 psychosocial factors unique to queer individuals?

Answer 13

Stigma and phobia

Coming out

Youth and coming out

Social settings as triggers for substance use

Question 14

How does stigma and phobia based on sexual orientation and gender identity impact SUD? (5)

Answer 14

The most common problems that queer people face mainly stems from homophobia, hetero-sexism, and transphobia

This makes their sexual orientation and/or gender identity of source of pain, trauma, and danger

This can create internalization of self hatred, creating anxiety, helplessness, and depression, which are ideological causal factors for using substances as a means of coping

Studies sampling the general population have found that victimization, violence, trauma, and ostracism have all been associated with increased rates of substance use

There is also a lack of legal policies to protect queer people from discrimination, which leaves queer people feeling even more helpless

Question 15

How does coming out impact SUD? (4)

Answer 15

Coming out may help with overcoming the negative mental health consequences of discrimination and victimization

Social identification with other queer people can be a protective/resiliency factor (creates a sense of belonging and community)

Queer people who have not come out experience more psychological distress

Added concern of finding community when you consider intersectionality (being queer and Muslim could create difficulty in finding a community where you belong)

Question 16

How do queer youth and coming out impact SUD? (3)

Answer 16

Adolescence is a developmental stage that is associated with experimentation and substance use

In addition to the usual difficulties of adolescence, queer youth have the additional challenge of trying to understand their sexual orientation and gender identities, and dealing with stigma from largely hetero-sexist peers (balance the risk of coming out and facing stigma)

Queer teens often feel helpless and alone, making them more likely to turn to substances to cope with these emotions (and this early use makes them more like to develops SUDs)

Question 17

How does family rejection and homelessness impact SUD? (6)

Answer 17

Family acceptance is extremely important to the psychological well-being of adolescence

Coming out can threaten this family acceptance as parents can reject their children due to their beliefs and biases

Queer youth who are rejected by their families are more likely to experience distress, depression, attempt suicide, use illegal substances, etc., than queer youth who were not rejected

Family acceptance is a protective factor, family rejection is a risk factor

Homelessness is a tragic consequence for many queer youth who are rejected

Homeless youth who are sexual and ethnic minorities are at increased risk of resorting to the sex trade for survival, and drugs are often used to enhance one’s psychological state to do sex work and cope with the stresses of resorting to sex work

Question 18

How are social settings triggers for substance use? (4)

Answer 18

Bars have become the focus of social life for many queer people as sites for organizing and activism, as well as the symbol of the communities right to exist and experience a sense of belonging with their community

Alcohol and drinking is a big part of gay bars as drinking is associated with positive feelings of group membership

For many people, alcohol is present during their first social experiences in the queer community, and for some it becomes an integral part of these experiences in the future

Circuit parties are a popular venues with some gay men that exposes them to extremely high levels of drug use (club drugs are a cultural norm and part of them celebrating/establishing their identity)

Question 19

What are LGBT-Specific Treatment Centers? (2) Where was the first?

Answer 19

Treatment centers that affirms their identity and gives them a sense of community and belonging by placing them with other clients and clinicians with similar experiences who understand their struggles

Facilitate a better relationship between treatment providers and their clients which makes treatment better and more likely to work

The first queer specific addiction treatment center was the pride institute in Minnesota

Question 20

Do queer treatment centers work? (2)

Answer 20

One study shows that gay specific treatment saw no difference between abstinence rates of methamphetamine use but did make clients less likely to partake in risky sexual behavior

Helpful for people who are struggling with queer specific issues (coming out, identity crisis, victims of discrimination) that contributes to their substance use problems