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1. Sexual behavior, or sexual activity, differs from sexual orientation and alone does not define someone as a lesbian, gay, bisexual, and transgender (LGBT) individual, and sexual identity is the personal and unique way that a person perceives his or her own sexual desires and sexual expressions.
A. True
B. False
2. Having a general understanding of heterosexism and homophobia is important for substance abuse treatment providers working with LGBT individuals. All of the following are accurate statements about heterosexism and homophobia EXCEPT:
A. Heterosexism resembles racism or sexism and denies, ignores, denigrates, or stigmatizes nonheterosexual forms of emotional and affectional expression, sexual behavior, or socially identified community
B. Homophobia is defined as the irrational fear of, aversion to, or discrimination against LGBT behavior or persons
C. Internalized homophobia describes the self-loathing or resistance to accepting an LGBT sexual orientation and is an important concept in understanding LGBT clients
D. Although most treatment programs ask about sexual orientation, many LGBT people are often afraid to speak openly about their sexual orientation or identity because of the bigotry they may face.
3. Although the size of the LGBT community is not known, a study that thoroughly analyzed the limited available data estimated that, in the United States:
A. 10 percent of men and 5 percent of women report same-gender sexual behavior since puberty
B. 7 percent of men and 6.5 percent of women report same-gender desire
C. 4 percent of men and 2 percent of women report a homosexual or bisexual identity
D. All of the above
4. The term "coming out" refers to the experiences of some, but not all, gay men and lesbians as they explore their sexual identity. Which of the following is NOT one of several stages that have been identified in this process?
A. Denial
B. Identity confusion
C. Tolerance
D. Pride
5. Substance abuse counselors need an understanding of the dynamics of LGBT interpersonal relationships including an awareness of the internal and external problems of same-sex couples and the diversity and variety of relationships in the LGBT community.
A. True
B. False
6. Lesbians resemble other women in that their patterns of substance use vary, but fewer lesbians than heterosexual women abstain from alcohol, even though rates of reported alcohol problems are higher for heterosexual women than for lesbians.
A. True
B. False
7. Substance abuse among some lesbians may be in part due to risk factors associated with trauma. One 1994 study reported that 15 percent of lesbians were sexually abused as children and 10 percent were abused as adults.
A. True
B. False
8. In spite of growing acceptance of gay people, social outlets for gay men still tend to be limited. Each of the following is an accurate statement about how these limitations can be a factor in treating gay males clients EXCEPT:
A. The number of gay coffee shops, bookstores, and activities that do not involve alcohol and drug use is increasing, but gay bars and parties that focus on alcohol and drug use are still very visible elements of gay social life
B. The percentage of HIV-infected people in the United States who are gay has steadily increased, and many gay men in treatment may be HIV positive, have AIDS, or have a sense of loss from losing friends
C. For some gay men, sex and intimacy may be disconnected and substance use allows them to act on suppressed or denied feelings but makes it harder to integrate intimacy and sex
D. Being effeminate is sometimes condemned in the gay community, and this characteristic adds to gay men’s shame, which may in turn lead to substance abuse
9. With transgender clients, hormone therapy is an often overlooked clinical issue. Hormone treatment is a standard medical practice for transsexuals, and clients may need assistance in maintaining regular, legally prescribed hormone therapy while in treatment for substance abuse.
A. True
B. False
10. LGBT youth use alcohol and drugs for many of the same reasons as their heterosexual peers, such as to experiment and assert their independence, to relieve tension, to increase feelings of self-esteem and adequacy, and to self-medicate for underlying depression or other mood disorders. However, LGBT youth may be more vulnerable as a result of the need to hide their sexual identity and the ensuing social isolation.
A. True
B. False
11. Little research has been done on the relationship between substance abuse and interpersonal violence in the LGBT community, but it is estimated that interpersonal violence occurs much more frequently in same-sex relationships than in heterosexual relationships.
A. True
B. False
12. In evaluating studies that examine substance use and abuse in the LGBT community, each of the following is an accurate statement EXCEPT:
A. The LGBT population is similar to the general population in that numerous factors predispose its members to substance abuse, but the additional stigma and tension of being a member of a marginalized community such as the LGBT community may increase the likelihood of substance use and abuse
B. The precise incidence and prevalence rates of substance use and abuse by LGBT individuals have been difficult to determine partly because studies rarely clearly define the difference between substance use and substance abuse
C. These studies generally state that gay men and lesbians have greater substance abuse problems than non-LGBT men and women
D. One study found that approximately 25 percent of all lesbians have an alcohol abuse problem, which is a far greater percentage than in the general population
13. Although LGBT persons use and abuse alcohol and all types of drugs, certain drugs seem to be more popular in the LGBT community than in the majority community. Which of the following is an accurate statement about drug use with LGBT persons?
A. One study of men who have sex with men (MSM) found that weekly use by this MSM sample was 4 times more likely for marijuana, cocaine, and stimulants and 22 times more likely for inhalant nitrites than the non MSM sample
B. Within the substance-abusing population in general, and the LGBT population in particular, injection drug users represent an often hidden and stigmatized group
C. Cocaine use appears to be integral to the sexual activities of a certain segment of gay men, especially in some urban communities
D. In comparing lesbians with heterosexual women, lesbians used alcohol three times as often in the past month and were six times more likely to use alcohol every day than heterosexual women.
14. The motivations for cross dressing vary, but most transvestites enjoy cross dressing and may experience sexual excitement from it, and most transvestites are homosexual.
A. True
B. False
15. Substance abuse treatment providers should remember that LGBT clients do not know the reaction they will receive when mentioning their sexual orientation. Public opinion measures indicate that homosexuality is not widely accepted, and in 1996, Gallup Poll data showed ____ percent of respondents reported that homosexuality was unacceptable and only ____ percent found homosexuality an acceptable lifestyle.
A. 50: 45
B. 45: 40
C. 40: 35
D. 35; 30
16. When treating LGBT clients, it is helpful for providers to understand the effect of heterosexism on their LGBT clients. Which of the following is an example of the negative effects of heterosexism?
A. Self-blame for the victimization one has suffered
B. A negative self-concept as a result of negative messages about homosexuality
C. Anger directed inward resulting in destructive patterns such as substance abuse
D. All of the above
17. One study of familial patterns of homosexuals found that gay men are much more likely to have gay or bisexual male siblings than heterosexual males, and are more likely to have lesbian sisters than are heterosexual males.
A. True
B. False
18. Bisexuality has existed throughout recorded history. Some people of color in the United States or people from different cultures may define themselves as bisexual, even if they focus exclusively on people of the same sex, probably as a way of coping with the stigma of homosexuality.
A. True
B. False
19. If a substance abuse treatment provider is concerned that a client is confused about his or her sexual orientation, some evaluation tools are available to help assess a client’s feelings. In 1987, Coleman developed a questionnaire that considers the combination of sexual behavior, feelings, self-identification, and:
A. Actions
B. Fantasies
C. Values
D. None of the above
20. To provide culturally competent treatment to LGBT clients, providers must possess attitudes that reflect openness to other cultures, values, and beliefs; a willingness to assess and change their own beliefs; and the ability to appreciate diversity. ____________________ is the term used to describe a set of academic and interpersonal skills that assists individuals in increasing their understanding and appreciation of cultural differences and similarities within, among, and between groups.
A. Cultural Sensitivity
B. Cultural Awareness
C. Cultural Competency
D. None of the above
21. When working with LGBT people from minority populations, providers must assess their level of acculturation and assimilation. Acculturation is adaptation to a new culture by taking on a new identity and abandoning the old cultural identity, and assimilation refers to accommodation to the rules and expectations of the majority culture without entirely giving up cultural identity.
A. True
B. False
22. There are four interpersonal skills represented by clients in treatment. Individuals who have rejected mainstream culture, and their emotional and spiritual needs are met exclusively in their ethnic community or in the gay community are considered:
A. Culturally immersed
B. Assimilated
C. Multicultural
D. Traditional
23. With all clients, counselors need to create an environment where clients can express themselves freely. According to the authors, understanding the message expressed through language is the essential task of treatment.
A. True
B. False
24. There is a lively debate in the LGBT community over what constitutes gay culture, and gay culture is as diverse as all its members. Each of the following is an accurate statement about gay culture EXCEPT:
A. LGBT people’s behavior is still stigmatized, and because there is usually no way of identifying LGBT people apart from their own disclosure or identification with gay culture, gay culture is essentially hidden in the larger community
B. In contrast to how members of ethnic cultures are marginalized, LGBT individuals may receive disapproval and censure from those whom they most trust and rely on such as parents, relatives, religious leaders, teachers, and friends
C. Although homosexuality has existed throughout the ages and in many different cultures, gay culture as it is known today began to emerge in 1962, when the New York City police raided a popular gay bar, the Stonewall Inn
D. Because public acceptance is important, many LGBT persons want to advance the message that LGBT individuals are no different than non-LGBT persons
25. Although the number of LGBT individuals in American Indian and Alaska Native communities is not definitely known, American Indians and Alaska Natives in gay or lesbian relationships report a higher degree of bisexuality than do their Caucasian counterparts.
A. True
B. False
26. Which of the following is an accurate statement about how LGBT issues affect the African American community?
A. Homophobia in the African-American community is often less intense than in the dominant community
B. The sexual orientation of African-American lesbians and gay men is often known by the community and openly discussed
C. Most LGBT African Americans say that they usually feel welcome and comfortable in predominantly Caucasian LGBT settings
D. Identifying oneself as an LGBT individual publicly may put an African American at risk for losing his or her most important support system-the African American community
27. Cohesiveness among Asian/Pacific Islanders is an important value, and because of this, shame is a frequently used social constraint to control or deter expressions of homosexual behavior.
A. True
B. False
28. In the Hispanic community, homosexuality may be privately acknowledged, but it is usually not discussed openly and Hispanics may be more reluctant to self-identify as LGBT than members of the mainstream culture. In treating Hispanic clients, _________________ is the cornerstone.
A. Values of the client
B. Family
C. The support system
D. All of the above
29. LGBT individuals with substance abuse problems are doubly stigmatized in that as substance abusers, they are viewed by many as weak in character and moral fiber, and as lesbian, gay, bisexual, and transgender individuals, they are reviled by some as deviant and immoral.
A. True
B. False
30. It is very important to protect the confidentiality of LGBT individuals in substance abuse treatment programs. Confidentiality regulations permit disclosure without the client’s consent in several situations including all of the following EXCEPT:
A. Medical emergencies
B. For reporting child abuse
C. Upon request from law enforcement
D. Communications among program staff
31. Programs serving LGBT individuals may need to confer on an ongoing basis with other agencies, such as mental health or child welfare programs, and in general it is best to disclose only what is necessary, for only as long as is necessary, keeping in mind the purpose for disclosing the information.
A. True
B. False
32. In much of the United States, discrimination against individuals because of their sexual orientation is legal, and although some states have extended their laws to cover discrimination on the basis of sexual orientation, in most places LGBT individuals can be denied employment or fired, barred from housing, and excluded from health and social services.
A. True
B. False
33. There are a number of ways that programs can adjust their policies and procedures to protect LGBT clients, educate them, and help them deal with the discrimination they may face. Which of the following is NOT an accurate statement about this issue?
A. Programs should establish written policies that ensure that information about sexual orientation is confidential
B. Programs should encourage LGBT clients to disclose their sexual orientation to others since honesty is an integral part of recovery and since later discovery by others may hurt the progress that has been made
C. Programs should educate staff and clients about state and local laws and regulations regarding LGBT persons
D. Programs can help their clients review their employment, marital, and parental statuses and assess what steps they might take to protect themselves and their rights
34. The Federal Rehabilitation Act and Americans with Disabilities Act prohibit discrimination against individuals with "disabilities", a group defined as including individuals who are alcoholics or have a history of drug abuse, and many states also have laws protecting people with HIV/AIDS from discrimination.
A. True
B. False
35. In this chapter’s second case study, Denise is a 16 year old female in treatment as a result of alcohol poisoning and she is struggling with her attraction to and feelings about other girls, and she knows her parents would be horrified if they found out. After Denise has been in the program for a month, a staff member discovers her acting out sexually with another girl. What policy does this case present?
A. What policies should the program have in place to ensure that LGBT individuals are treated fairly?
B. Who is considered next of kin in this case?
C. What are program rules regarding client behavior?
D. All of the above
36. In treatment programs, it is important to ensure that LGBT staff and clients are safe by establishing personnel policies prohibiting harassment in the workplace, including harassment of LGBT staff by other staff and sexual harassment by persons of the same or a different gender.
A. True
B. False
37. One of the resources available to LGBT individuals is a directory that contains tens of thousands of files about various topics of interest to LGBT individuals. The directory has one of the most extensive collections of materials devoted to LGBT legal issues on the Internet and it is called:
A. The Queer Resources Directory
B. It’s Time, America Directory
C. The ACLU Lesbian and Gay Rights Directory
D. The Legal Guide for Lesbians and Gays
38. Substance abuse treatment for most individuals focuses primarily on stopping the substance abuse that interferes with the well-being of the client. However, LGBT clients differ in that they need to address their feelings about their sexual orientation and gender identity before they can begin the recovery process.
A. True
B. False
39. According to the authors, substance abuse providers need to understand that a part of substance abuse recovery for many LGBT individuals is accepting themselves as gay, lesbian, bisexual, or transgender and finding a way to:
A. Be accepted by their family members
B. Feel comfortable in society
C. Deal with stigma and discrimination
D. None of the above
40. During the assessment of LGBT substance abusers, each of the following is an important factor EXCEPT:
A. The type of drug and the amount used by a client
B. The degree of need to be away from social and psychological stressors
C. The danger of a medically complicated withdrawal
D. Their level of comfort and stress about their sexual orientation
41. S ome LGBT individuals may express difficulty in participating in non-LGBT focused treatment, stating that heterosexuals may not understand LGBT issues and problems.This attitude may be a defense mechanism, or the person may have experienced problems with heterosexual treatment providers in the past, and the situation should be managed in a therapeutic manner.
A. True
B. False
42. A minimal level of LGBT-Sensitive Treatment and recognition that there are some LGBT clients usually occurs in:
A. LGBT-Naive Treatment
B. LGBT-Tolerant Treatment
C. LGBT-Sensitivity Treatment
D. LGBT-Affirming Treatment
43. Principles of care indicate that the care provided should be consistent with each client’s cultural needs and expectations and be:
A. Flexible and client centered
B. Firm and structured
C. Individualized and current
D. All of the above
44. Typical modalities for substance abuse treatment include individual, group, couples, and family counseling, but LGBT individuals can face other unique problems in these settings. Which of the following is NOT a true statement about issues that LGBT clients may face?
A. The group modality may be difficult for LGBT individuals if heterosexism/homophobia is demonstrated by staff and other group members
B. It is generally not a good idea to have additional or separate groups for LGBT clients because clients need acceptance and affirmation from non gay peers
C. LGBT clients are more likely to seek support for their partners if they view the program as LGBT sensitive
D. Providing one-to-one services may decrease the difficulty of mixing heterosexual and LGBT clients in treatment groups and decrease the likelihood that heterosexism/homophobia will become an issue
45. Twelve-step programs such as AA and NA recommend avoiding emotional stress and conflicts in the first 3 months of recovery, and LGBT clients should especially wait for that time period to elapse in order to allow for the increased confidence and clear head that sobriety brings.
A. True
B. False
46. Religion and spirituality may play a very important part in recovery from substance abuse for many LGBT people, and counselors will need to know the difference between religion and spirituality and help the LGBT client understand that difference, so that such a client may find spiritual comfort even if he or she cannot find religious comfort.
A. True
B. False
47. The coming out process for many gay and lesbian people is a way of transforming a negative self-identity into a positive identity. It is advisable to refer a client in the first or second stages to gay or lesbian Alcoholics Anonymous (AA) meetings or to suggest that the client discuss his or her sexual identity in group therapy in order to help facilitate the coming out process.
A. True
B. False
48. Stage models provide a useful description of the process by which some people come to call themselves gay or lesbian. Which of the following occurs during the identity confusion stage?
A. People may drink or use drugs to cope with their anxiety and shame or to socialize or be sexual with a person of the same gender
B. People begin entertaining the possibility that they may be gay or lesbian and anxiety can be considerable
C. Feelings about having a new identity can increase the sense of alienation and isolation
D. The person may try to partake in new experiences that help normalize a gay or lesbian identity and way of life
49. The length of time that gay individuals consider themselves gay or lesbian usually predicts whether they have worked through the process of claiming a positive gay or lesbian identity or of feeling good about themselves as gay men or lesbians.
A. True
B. False
50. Counselors may be the first people to tell LGBT substance abusers that whoever they are is okay, that they do not have to declare themselves gay or straight or bisexual, and that an important part of recovery may be to spend time exploring who they are.
A. True
B. False
51. Family of origin refers to the birth or biological family or any family system instrumental or significant in a client’s early development, and taking a family history and reviewing the dynamics of the family of origin should be part of a thorough biopsychosocial assessment.
A. True
B. False
52. The LGBT experience is often different from the experience of other cultural minorities because LGBT individuals experience prejudice and, most frequently, a disconnection from other members of their minority group since most don’t grow up with other LGBT individuals.
A. True
B. False
53. Providing support for LGBT clients and those they are close to is a crucial element of substance abuse treatment. Each of the following is an accurate statement about working with LGBT clients and their loved ones EXCEPT:
A. The family of choice for the LGBT client includes it includes those who, by their support, nurturing, and understanding, have earned a significant place in the LGBT individual’s life
B. The life partners and significant others of their LGBT clients must be included in services similar to those offered to the spouses of heterosexual clients
C. Although substance abuse treatment counselors don’t need to understand the specific dynamics of LGBT interpersonal relationships, they should be aware that these clients face unique issues
D. Counselors need to be aware of their own biases when working with individuals who-as a result of their affections-find themselves outside the cultural norm of a heterosexual, monogamous, and legally sanctioned marriage
54. One of the most important things a counselor needs to bear in mind when working with lesbian clients is that there is no one lesbian client, and there is in fact tremendous diversity among lesbians. Which of the following is NOT an accurate statement about dealing with this population?
A. As women, lesbians share the diversity inherent in womanhood, and they also share the experience of dealing with sexism
B. While some lesbians are very comfortable with and public about their lesbian identity, others have great difficulty taking on a lesbian identity and may keep it secret and hidden
C. Many lesbians are not at all distinguishable from the general population of women
D. Studies indicate that lesbian substance abusers tend to exhibit similar patterns in their drinking and drug-taking behavior
55. Studies that have been conducted over the past fifty years indicate that there is a sexual cause for lesbianism, such as having had bad sexual relationships with men, or having been sexually abused by men, or not being sufficiently sexually attractive to men.
A. True
B. False
56. Although fewer lesbians than heterosexual women abstain from alcohol, drinking, heavy drinking, and problem drinking among lesbians show a greater decline with age than among heterosexual women.
A. True
B. False
57. In this chapter’s case example #1, the client is exhibiting anxiety about discussing her previous relationship and is very vague about her "friend" that she lived with for several years. The counselor is very gentle in pursuing this subject and uses ___________ which is crucial because it creates the safety essential to engendering the patient’s willingness to participate in the conversation as well as in further treatment and recovery.
A. Restraint
B. Empathy
C. Mirroring
D. Reflection
58. According to the authors, the psychological effects of heterosexism, antigay bias, and ___________________ may make gay men more prone to using alcohol and other substances, and that use, in turn, may lead to substance abuse or dependency.
A. Familial stress
B. Societal pressures
C. Internalized homophobia
D. All of the above
59. Since many gay men were brought up in a society that says they should not act on their sexual feelings, they may be very likely to internalize this homophobia so often their first homosexual sexual experience was while drinking or being drunk to overcome fear, denial, anxiety, or even revulsion about gay sex.
A. True
B. False
60. Cultural expectations about what it means to be male, regardless of one’s sexual orientation, add social and personal pressures. Which of the following is an accurate statement about male traits and experiences?
A. Certain men may be "effeminate"-that is having some traits that are in general culturally attributed to women, and effeminacy is strongly connected to sexual orientation
B. Most gay men grow up very similarly to their heterosexual peers, although myths and stereotypes may refute this
C. A good percentage of gay boys and men have traits and behaviors that are more commonly associated with girls or women
D. All of the above
61. Although gay men are probably no more sexually obsessed or active than males in general, there are important links between sexual activity and alcohol and drug use that add to the risk of gay men developing substance abuse problems and that pose challenges for recovery.
A. True
B. False
62. HIV/AIDS continues to be a major factor in gay male life. Each of the following is an accurate statement about this EXCEPT:
A. HIV/AIDS is not a "gay disease" since behaviors and not sexual orientation are the risk factors, but gay men are still at great risk
B. The percentage of HIV-infected people in the United States has steadily increased, particularly with gay men
C. Studies of gay men who have risky sex and know about precautions for safer sex report that they were much more likely to have risky sex after alcohol or drug use
D. Almost every gay man has lost friends or lovers to AIDS and knows someone who is HIV infected, so the grief and loss gay men feel and share is profound and has to be a consideration in working with any gay man
63. Clinicians working with self-identified bisexuals need to assess their clients’ issues and actions and realize that bisexual identity is most likely defined by sexual behavior.
A. True
B. False
64. For some bisexuals, their bisexual identity is continuous and fixed across their lifespan, and for others, sexual orientation may be more fluid and marked by changes from heterosexual to either lesbian or gay or vice versa.
A. True
B. False
65. Desire may be experienced by bisexuals as sexual attractions to same-sex or opposite sex partners at different times during their lives, and this is known as ____________ bisexuality.
A. Externalized
B. Sequential
C. Continuous
D. Development
66. Each of the following is important for counselors who are working with bisexual clients with substance abuse issues EXCEPT:
A. Counselors should develop their sensitivity to these social issues and to issues of gender, age, psychological development, socioeconomic status, and modes of sexual expression and desire
B. Counselors should help clients become more self-accepting
C. They should assist clients in healing from the shame caused by heterosexism and internalized biphobia
D. Counselors should refer bisexual clients to gay/lesbian 12-step fellowships as they will likely be more appropriate to meet their needs
67. In the psychiatric model of transsexuality, transsexuality is viewed as an overidentification with the same-sex parent or underidentification with the opposite-sex parent in infancy or early childhood.
A. True
B. False
68. Substance abuse treatment professionals should be aware of the definitions used in describing transgender clients. Which of the following is NOT accurate about terms used to describe transgender individuals?
A. Gender identity is the gender (male or female) with which one identifies which means that a person may be biologically male and have a female gender identity (male-to-female, or MTF) or be biologically female and have a male gender identity (female-to-male, or FTM)
B. Gender role refers to how individuals present their gender in the world and the gender one defines as one’s identity is a matter distinct from sexual orientation
C. Sexual orientation is described as the sex or gender one is attracted to
D. Bigendered individuals are born with ambiguous biological sex characteristics
69. The little research that has been done on the prevalence of substance abuse in the transgender community suggests significantly high substance abuse rates. One of the best available studies on substance abuse among transgender individuals showed a lifetime rate of intravenous drug use of _____ percent among MTF transgender individuals and _____ percent among FTM transgender individuals.
A. 34: 18
B. 32: 20
C. 30: 22
D. 28: 24
70. Like all potential clients, transgender substance abusers bring a variety of experiences with substances and readiness to change into the treatment setting, and it is vital that counselors avoid the common pitfall of focusing on gender issues as the assumed root cause of the addiction problem.
A. True
B. False
71. In a recent study among a multiethnic group of self-identified lesbian, gay, and bisexual youth, 83 percent of females and 79 percent of males reported using licit or illicit substances, with alcohol the most popular illicit drug and marijuana the most popular illicit drug.
A. True
B. False
72. LGBT youth have the same developmental tasks as their heterosexual peers, but they also face additional challenges in learning to manage a stigmatized identity. Which of the following is NOT an accurate statement about how stigma and sexual identity affect LGBT youth?
A. Studies have documented an increasing age of identity development and coming out among lesbian and gay youth, probably because of the negative stigma attached
B. The extra burden that the stigma brings puts LGBT youth at increased risk for substance abuse and unprotected sex and can intensify psychological distress and risk for suicide
C. Although people may be more aware that an adolescent may be gay, they are generally no more tolerant and may even be less accepting of homosexuality in adolescents
D. Adolescents may repress, deny, or attempt to change these feelings through a range of coping behaviors, including heterosexual activity, use of alcohol and drugs, dating the opposite sex, fathering a child or becoming pregnant, and immersing themselves in sports or school activities
73. T reating LGBT youth includes helping them with countless challenges involved with attempting to manage their stigmatized identity. The essential elements in prevention and treatment of substance abuse in LGBT youth are:
A. Assessing social environment and development of sexual identity
B. Evaluating the social network and level of support from the family
C. Recognizing the impact of gender, ethnic, and cultural identities
D. Proving safety and giving support
74. With few exceptions, appropriate models for treating LGBT substance abusing youth have not been designed, and those that exist have not been evaluated. Youth care providers and counselors caution that LGBT youth may be harmed by programs that lack appropriate content or experience.
A. True
B. False
75. LGBT clients should, as with any client, be screened for other health problems before beginning treatment. Each of the following is an accurate statement about health issues that may affect gay and bisexual men EXCEPT:
A. Substance-abusing gay and bisexual men may have a greater risk for STD’s and HIV/AIDS infection than non-substance-abusing gay and bisexual men if their substance abuse disinhibits safe sex practices
B. Gay and bisexual men may be exposed to STDs at multiple sites, such as the pharynx and rectum, and may be at risk for anal trauma or the human papilloma virus
C. Even though cancer and heart disease are not the most significant causes of death and morbidity for gay men as they are for heterosexual men, they still may present serious health risks and should be evaluated
D. Gay men are at higher risk for hepatitis A and hepatitis B through sexual contact, and hepatitis C also may be spread by sexual contact, although transmission via infected needles is probably a far more significant route
76. Some experts speculate that lesbians may have an increased risk for specific health problems, such as cancers of the breast, colon, and ovaries, endometriosis, and other health issues related to factors such as a higher fat intake, alcohol abuse, not bearing children, and inconsistent medical care.
A. True
B. False
77. Past sexual abuse and trauma may well lead to other mental illnesses, such as PTSD, and complicate treatment for substance abuse. For example, an outcome study of lesbians and gay men who had completed inpatient substance abuse treatment found that 32 percent had been sexually abused and abstinence was much more likely among those who had not experienced abuse.
A. True
B. False
78. The seriousness of interpersonal violence has finally been acknowledged by the LGBT community over the past decade. Which of the following is an accurate statement about working with LGBT clients who are experiencing violence in their relationships?
A. It is important that the clinician ask difficult questions about abuse immediately in order to let the client know how serious the issue is
B. Clients should be allowed to be interviewed about interpersonal violence in the presence of another individual who is not the batterer if this increases the comfort level
C. Establishing rapport and trust is critical in accurately gathering sensitive information and care is needed in selecting words and phrases that reflect sensitivity to LGBT issues is imperative
D. None of the above
79. In working with LGBT clients, counselors need to understand that nearly all clients who have been or are being discriminated against may respond to others’ power by being overly passive and accepting of others.
A. True
B. False
80. In 1993, Neisen discussed steps that could be useful in helping clients heal from homophobia and heterosexism. These include:
A. Allowing clients to break the silence by telling their stories and addressing the pain of being different in a heterosexist society
B. Helping clients establish perpetrator responsibility in order to understand their struggle in the context of discrimination and prejudice
C. Encouraging them to reclaim personal power so that they may improve their self-confidence and self-concept
D. All of the above
81. Counselors who wish to be sensitive to the needs and feelings of their LGBT clients and improve their own treatment and counseling skills should create safety for LGBT clients, get to know the population, and create an atmosphere that is supportive without labeling the clients or pressuring them to come out.
A. True
B. False
82. Most incarcerated LGBT clients report that they find it easy to bond with other LGBT offenders and are more comfortable with clear expression of sexual orientation or gender identity while incarcerated than when they are back in their community.
A. True
B. False
83. A program committed to serving LGBT clients should first demonstrate its commitment in written administrative policies and procedures.
A. True
B. False
84. Advertising and public relations policies and procedures are often overlooked in the promotional activities of mainstream substance abuse treatment organizations. Which of the following is included as one of the important advertising procedures?
A. Ensure that promotional materials include information about LGBT-specific services, if appropriate
B. Use language that specifically identifies LGBT individuals as people the program is attempting to reach
C. Advertise programs and events in LGBT periodicals as well as in the mainstream press and those publications that are geared to particular cultural communities
D. Include images in promotional materials that depict those identifiable as LGBT individuals
85. Aftercare is critical for any client being discharged from a substance abuse treatment program. Although it is not necessary to identify an openly gay staff member as a contact person for LGBT clients, it is important that someone who is sensitive to LGBT issues be available.
A. True
B. False
86. Walden House, Inc., is a large, nonprofit organization providing substance abuse rehabilitation services in San Francisco and the greater California community. Each of the following is an accurate statement about Walden House Inc. EXCEPT:
A. The agency now provides services to more than 3,500 individuals each year in its residential and outpatient programs. Approximately 30 percent of the clients in Walden House’s main city-funded programs fall into the categories of lesbian, gay, bisexual, and transgender
B. Recognition of LGBT lifestyles, values, and families is part and parcel of the fabric of the Walden House work and treatment community
C. Staff members who are LGBT are frequently open about their sexual orientation, and the agency ratio of LGBT staff to LGBT clients is two to one
D. There is no tolerance within the Walden House community for discrimination, including homophobia, transphobia, racism, sexism, or any other discriminatory practice
87. A holistic approach to treatment is most likely to enable LGBT individuals to effect real change in their lives, so a (an) ________________ approach is suggested to improve the present situation, wherein treatment professionals and society have incomplete information that often leads to a misunderstanding of LGBT issues and even a denial that LGBT individuals have special needs.
A. Integrated
B. Multifaceted
C. Supportive
D. Comprehensive
88. Lacking specific and often essential information about the special problems of LGBT clients, professionals may attribute treatment failures to the clientele rather than to the insufficient training and education about LGBT issues that resulted in inappropriate treatment by the providers.
A. True
B. False
89. Managed care organizations, consumers, and quality improvement measures demand that health care be evidence based, so therefore, any training or educational program needs to be based on current research findings.
A. True
B. False
90. In assessing quality improvement with respect to organizations that serve LGBT clients, many factors need to be considered. Ensuring that LGBT clients’ cultural, psychosocial, spiritual, and personal values are respected falls under the category of:
A. Education of patients and families
B. Patients rights and organizational ethics
C. Assessment of patients
D. Care of patients and continuum of care
91. The ability to elicit baseline demographic data about their LGBT client population is an important measure of competency for LGBT care providers, although confidentiality should always be respected.
A. True
B. False
92. In order to monitor progress with respect to quality improvement goals for LGBT clients, which of the following is NOT one of the means that the authors recommend?
A. Client feedback
B. Staff feedback
C. Exit interviews
D. Patient satisfaction interviews
93. In evaluating treatment outcomes for LGBT clients, it is generally not appropriate to compare outcomes with the agency’s general client population due to the relatively low number of LGBT clients and differences in case complexity.
A. True
B. False
94. The LGBT community is well schooled in working together and forming alliances. These alliances serve several important functions including bringing people together socially, providing a culture and ideology, accepting same-gender orientations, and:
A. Validating lifestyles
B. Emphasizing independence
C. Increasing cooperation with non LGBT individuals and communities
D. None of the above
95. LGBT individuals, especially LGBT persons of color, tend to remain hidden, neither accessing the health care system nor communicating honestly with health care providers, especially since the specific needs of LGBT individuals are not well understood by managed care organizations (MCO’s).
A. True
B. False
96. Another difficulty that LGBT clients face is that they are often identified as "high-cost-of-care" populations and available data seem to support this notion.
A. True
B. False
97. The American Psychiatric Association (APA) has, since 1974, affirmed that certain sexual orientations are not mental illnesses and the practice guidelines APA issued in 1995 prohibited specific discrimination against gay and lesbian clients. Additionally, the APA officially opposes portrayals of LGBT persons as mentally ill because of their sexual orientation and supports the dissemination of accurate information about sexual orientation and mental health.
A. True
B. False
98. LGBT populations abuse substances at rates that are the same as or higher than the rates in the general population, but more information is needed in this area. It is recommended that substance abuse among lesbians, bisexual women, and transgender individuals should be further studied and substance abuse among them distinguished from substance abuse among gay and bisexual men.
A. True
B. False
99. Counselors and treatment providers need to have a better understanding of the interplay between sexual orientation and the sociocultural context in relation to substance use, abuse, and treatment.
A. True
B. False
100. In order to work more effectively with LGBT communities, training should be provided to staff members in cultural diversity and sexual orientation sensitivity to promote better understanding of LGBT populations.
A. True
B. False
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