This dissertation presents a model of treatment success of the nation's oldest and largest chemical dependency treatment provider for the lesbian, gay, bisexual, and transgender (LGBT) population. The Pride Institute provides LGBT culturally specific chemical dependency treatment in six facilities across America. A description is provided of the multifaceted problem of alcohol and other drug problems and sexual identity formation issues in this population.

Purpose: The main purpose of this study was to examine the interactive relationship between the predictor variables (degree of affiliation with Alcoholics Anonymous (AA), severity of chemical use, strength of higher power relationship, attitudes about sexual orientation) and the dependent variable, length of time clean and sober. A secondary aim was to test the stability of the model with different subsets of the sample. The predictor variables in the model were identified after a synthesis of the literature on alcoholism and related theories. Biophysical theory served as the underpinning for the level of AA affiliation and severity of chemical use variables. Existential theory served as the basis for the spirituality variable. Conflict theory provided the basis for the attitudes toward sexual orientation variable. The dependent variable was chosen based on previous research as a measure of treatment success.

Methods: A survey was developed which incorporated three reliable instruments from the literature. The cross sectional and contextual survey research design allowed for obtaining precise information from a hidden population. Aftercare and alumni clients representing all of the Pride Institute facilities comprised the nationwide purposive, convenience sample (n = 125).

Results: Multiple regression was used to test the model of treatment success. The model originally proposed for this study did not have strong predictive ability (14% of variance explained), however, a second model was found to have more predictive value (18% of variance explained) which incorporated length of time in treatment. An in depth examination of the sample using four subsets indicated stronger predictive ability with high risk groups of this population and specific intervention recommendations.

Implications for Social Work Practice: Specific implications for social work practice include continued holistic treatment specific for LGBT chemically dependent clients with emphasis on achieving sobriety using Twelve Step Facilitation (TSF) approaches along with strengths based approaches related to identity development. For clients who indicate another drug besides alcohol as their drug of choice, TSF approaches are vital to their treatment success. For clients who may be at risk to not follow up with aftercare support groups, TSF approaches are crucial to their ability to maintain sobriety. For clients who express great struggles in developing a relationship with a higher power, therapeutic intervention using twelve-step based approaches and extended length of time in treatment are recommended. This recommendation comes from the findings from the high risk group with higher power concepts other than Jesus Christ wherein time in treatment and affiliation with AA were the strongest predictors. Results provide powerful support for culturally competent treatment for this understudied, hidden, and disenfranchised population.