The Impact of Comprehensive Services in Substance Abuse Treatment for Sexual Minorities

Background and Purpose: Research dating back to the 1970s demonstrates that sexual minorities are at higher risk for developing substance abuse or dependence disorders than their heterosexual counterparts. Though often limited methodologically by lack of representative samples, more recent studies using population-based samples have generally confirmed this link. Far less research has been conducted on treatment utilization and post-treatment outcomes for this population, and it remains unknown whether or not existing comprehensive substance abuse treatment services are effective for sexual minorities. This study will begin to address this gap by comparing the impact of comprehensive services on treatment outcomes for sexual minorities and their non-minority counterparts.

Methods: Data from the National Treatment Improvement Evaluation Study (NTIES) was used for this analysis. NTIES is a prospective, cohort study of substance abuse clients and programs, comprised of 3,142 women and men from 78 publicly-funded substance abuse treatment facilities nationwide. The sexual minority sample was comprised of men who have sex with men (MSM) and women who have sex with women (WSW). T-tests were used to compare pre and post-treatment substance abuse rates among those who reported same-sex sexuality and those who did not. Generalized linear mixed modeling was used to determine whether same-sex sexuality moderates the impact of comprehensive services on post-treatment substance abuse. Missing values were specified for these comparisons.

Results: Despite similar levels of pre treatment substance abuse severity, sexual minorities were significantly more likely to benefit from the receipt of access services (including transportation and childcare) and substance abuse counseling services than those who did not report same-sex sexuality. Still, sexual minorities evidenced poorer post-treatment outcomes than their peers, as demonstrated by their significantly higher rates of substance abuse at the 12-month follow-up period.

Conclusions: This study suggests that the pathway to recovery from substance abuse may differ for those with sexual minority status. While those who reported same-sex sexuality did not differ in pre-treatment substance abuse rates when compared to non-minority peers, sexual minorities benefitted more from services that facilitate access to treatment and from substance abuse counseling. Nonetheless, any benefits conferred by access services and substance abuse counseling services did not offset the poorer post-treatment outcomes among sexual minority respondents. Poor treatment outcomes for sexual minorities suggest that comprehensive substance abuse treatment services may not be adequately addressing needs in this population and that specialized services may be warranted.

Funding: This research was supported by grant R01-DA-018741 from the National Institute of Drug Abuse.