Surely alert, competent, contemporarily up-to-date school counselors understand that they have the "daunting but imperative obligation to become social activists for gay, lesbian, and bisexual students" since these students are the most "stigmatized members of school environs," Stone continues. There is no doubt that certain legal and ethical issues come in the way of school counselors' being free to help LGBT adolescents with their difficult decisions.
It is a "complex landscape" for counselors indeed, and they need to use caution in discussing birth control, abortion, drug abuse and more with straight and gay / lesbian students; moreover, since parents have the ultimate authority when it comes to counseling their children on important matters (the U.S. Supreme Court has affirmed that fact in several cases), the counselor in some instances must become a partner with parents (Stone, 148).
Still, Stone understands the counselors' dilemma: "…It is hard to tackle an advocacy role in an area for which a school counselor has not received training" (148).
Solution-Focused Group Therapy (SFGT) for Substance Abusers
The Solution-Focused Group Therapy program appears to be an excellent alternative to long-term treatment, especially for clients in the adolescent age group, not known for a great deal of patience. A scholarly research article in the Journal of Marital and Family Therapy, while not specifically related to LGBT adolescents, highlights the usefulness of this therapy approach for substance abusers. Solution-focused brief therapy (SFGT) zeros in on creating solutions -- rather than solving problems -- for substance abusers (alcoholics and drug abusers), according to Sara Smock, et al. The list of authors' previous research on SFGT is lengthy, including empirical research by Metcalf (1998) that suggests "…using SFGT [which is actually SFBT in a group setting] can be uplifting, especially when working with individuals struggling with 'out-of-control behaviors' such as drug abuse" (Smock, 2008, p. 107).
The authors used a SFBT formula with 38 participants that had been referred to a university-based community marriage and family therapy clinic for substance abuse treatment. The group was led by two co-therapists (graduate students in the marriage and family graduate program) who rotated into the group for two weeks (the rotation model is standard procedure in SFBT treatment programs). The other members of the therapist team watched the group sessions from behind a "two-way mirror" to "aid the therapists in manual adherence" (Smock, 110).
The participants initially offered their own themes for the therapy on a questionnaire they completed, and the group leaders selected a common theme from the many answers presented. After the group was asked for its permission to address the theme a "future-oriented question" was asked, based on the theme. That theme was discussed, and the session continued around the idea of participants giving details in response to "scaling questions" designed to bring out details vis-a-vis the clients' own view of progress towards his goal. How will people in his life rate his progress -- and "what would cause them to rate him"? (Smock, 110). What role did the them play in their drive towards their own "Miracles"? At that point the clients assigned themselves homework; the sessions went about 1.5 hours and were video-recorded for supervision and model adherence evaluation.
Depression and substance abuse go hand in hand
There are of course follow-up questionnaires and interviews when the sessions near an end, and due to the fact that "depression and substance abuse tend to be Comorbid conditions," the mood of the clients is carefully measured before and after the substance abuse treatment. It is widely accepted in the literature that depression is associated with cocaine abuse and alcohol abuse -- as well as other
In this particular research, there was a "statistically significant difference" occurred in the treatment group, supporting the assertions that SFBT is an effective method of "decreasing depression for level 1 substance abusers" (Smock, 116). Moreover, the SFBT was found to be a "useful approach" and these results bode well for adolescents in the LGBT community both in their Comorbid issues and in treating their addictions.
The success that can be achieved in working with adolescent substance abusers with the SFBT (or SFGT) model will be based on "…the manner in which the [therapy] conversation is conducted, not in the ability to convey a venerated body of information," according to Elsie Jones-Smith. Solution-focused therapists are quite able to assist clients if they maintain "a neutral position" -- which is known as "the not knowing position" (Jones-Smith, 2001, p. 399). It seems especially imperative that a neutral position -- and not a judgmental attitude -- is used by the therapist leaders when working with adolescents, who may be intrinsically suspicious that adults are trying to manipulate them.
Motivational Therapy for adolescent substance abusers
Another model for use with adolescent substance abusers is motivational therapy; Dr. Lois Flaherty notes that while "motivational interviewing" (MI) was originally developed to treat alcohol use disorders, more recently it has been found to be successful in working with adolescents (Flaherty, 2007, p. 118). MI has been therapeutic for teens with addictions to heroin and other drugs including marijuana; and Flaherty asserts that MI is usually administered in "a single session," which would appear to fit seamlessly into the context of restless, impatient adolescents who wouldn't want to be stuck attending therapy sessions over several months. One of the guiding tenets of MI is "harm reduction": realizing modest goals at first rather than asking the client to "change the behavior completely" (Flaherty, 120).
Bloom's model, referenced by Flaherty in page 121, seems wholly appropriate for young participants. It is based on the Transtheoretical model of change (TMC) (changes in the right direction indicate progress) and does not embrace a pushy or "know-it-all" approach. Bloom's four features include: a) focus on one issue; b) therapist asks questions but doesn't lecture or "exhort"; c) "relevant information is imparted"; and d) the patient's current level of self-awareness is observed as part of the therapy. Basically this motivational approach allows for a single session but follow-up sessions are optional; usually a phone call to the client is made, to "ascertain what changes have occurred as a result of the session" (Flaherty, 121). For example, the client may tell the therapist that he is down to two beers a day instead of getting drunk every day. Adolescents that have become abusers are generally not in the "end-stage throes of addiction" anyway, so they are "ideal candidates for brief interventions" (Flaherty, 122).
Evidence-based approach to services for at-risk LGBT adolescents
If substance abuse can be nipped in the bud prior to an LGBT adolescent becoming hooked, that would appear to be valuable preventative medicine for the individuals and the community. Dr. Lori K. Holleran Steiker, Sociologist at the University of Texas, points to the "profound value" to be realized when therapists involve youth in "the cultural adaptation of evidence-based drug prevention curricula" (Steiker, 2008, p. 1). The author goes to significant lengths to show the importance of making treatment solutions relevant to distinct cultural groups, including LGBT individuals. Steiker defines "evidence-based" as generally relating to an "assessment of research findings from randomized controlled clinical trials" (3). In other words, a model that is based on empirical findings from treatments models is "evidence-based."
Previous research into LGBTQ substance prevention programs have often been reported to be "remedial" and even "offensive" to some of the participants, Steiker explains (2). In presenting the results from a number of existing interventions, the authors note that for specific subcultures like the LGBTQ group adapting highly relevant approaches to previously successful programs can "engage youth who are often opposed to prevention programs." The most relevant aspect of this particular evidence-based intervention for LGBTQ adolescents, according to Steiker, is through the introduction of "older adolescents… who have already used or even abused drugs as experts" into the intervention (5).
Clearly, using a "just say no" tactic is obsolete and annoying to modern youth. And "DARE" misses the mark for "the highest risk youth" and even "ostracizes them… making them less amenable to change" (Steiker, 7). Using "nationally marketed" drug interventions "may be problematic (if not unethical) due to the perception that they are effective with diverse youth across the board," Steiker continues. Those kinds of one-size-fits-all interventions -- based on Steiker's evidence-based research -- are "offensive" and "foreign" to LGBTQ youth (7).
Conclusion
The evidence gathered for and presented through this paper reports that fact that while substance abuse is a common problem for LGBT adolescents -- the literature reflects that fact many times in myriad contexts -- there are interventions that offer verifiable support for this subculture. This paper recommends: a) that all staff associated with intervention services be fully trained before working with LGBT clients; b) that therapists utilize creative interventions, in particular Solution-Focused Group Therapy and Motivational Therapy; c) that school counselors be trained in creative solutions at least to the extent that they know what kind of therapy works…
