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LGBT Populations - Recovery from Addiction and Mental Health Problems

1. The goal of the Substance Abuse and Mental Health Service Administration (SAMHSA) is a high-quality, self-directed, satisfying life integrated in a community for all Americans that includes:

A. Overcoming or managing one’s disease or symptoms, and, for everyone in recovery, making informed, healthy choices that support physical and emotional wellbeing

B. A stable and safe place to live that supports recovery as well as meaningful daily activities, such as a job, school, volunteerism, family caretaking, or creative endeavors, and the independence, income, and resources to participate in society

C. Relationships and social networks that provide support, friendship, love, and hope

D. All of the above


2. Although lesbian, gay, bisexual, and transgender (LGBT) adults in the United States typically are well adjusted and mentally healthy, the Institute of Medicine (IOM) reports that LGBT populations are at substantially greater risk for substance use and mental health problems.

A. True

B. False

3. Research indicates that bisexual men and women report consistently elevated levels of depression, anxiety, and other mood disorders, and regularly demonstrate higher rates of difficulties in these areas than lesbians and gay men.

A. True

B. False

4. According to the authors, LGBT individuals remain subject to the traumas of negative stereotyping, rejection, ____________, and discrimination, all of which impede help-seeking behaviors.

A. Intolerance

B. Exclusion

C. Marginalization

D. Disapproval

Recovery: Note on Language

5. Which of the following are NOT included in SAMSHA’s 10 guiding principles of recovery?  

A. Recovery emerges from hope and occurs via many pathways

B. Recovery is relationship-driven, as well as family based and influenced

C. Recovery is holistic and based on respect

D. Recovery is supported by addressing trauma, and involves individual and community strengths/responsibilities

Dialogue Themes and Findings: In Their Own Words

6. In some cases, short-hand “LGBT” terminology neglects the breadth of sexual orientation and gender identity among members of these communities, and may not recognize, for example, that many bisexuals are in heterosexual relationships, and many people of transgender experience identify as heterosexual.

A. True

B. False

Family Rejection and Family Acceptance

7. LGBT individuals frequently experience __________________ due to lack of acceptance and support from their families of origin, which may create emotional distress, especially for young people who may lack other sources of support.

A. Confusion and indignity

B. Alienation and isolation

C. Indifference and neglect

D. Humiliation and detachment

8. Some LGBT individuals make a conscious choice to separate from their family of origin as a positive step to enhance self-determination, personal identity, and self-esteem, and may create their own families of choice that offer strength and personal affirmation.

A. True

B. False

Coming Out

9. While in the past, the sexual orientation of LGB individuals was thought by many to be deviant or pathological, the DSM-5 focuses on a more clinical picture by using the term gender dejection to refer to “the distress that may accompany the incongruence between one’s experienced or expressed gender and one’s assigned gender.”

A. True

B. False

10. Some health professionals and organizations discourage and may even prefer not to treat LGBT persons, which creates reluctance to seek healthcare and often results in late diagnosis and suboptimal treatment outcomes for LGBT individuals.

A. True

B. False

LGBT-Related Stress

11. According to the minority stress model, a constellation of stressors affect LGBT individuals, including identity stress related to concealment and/or disclosure of a stigmatized identity and negative internalized identity, expectations of rejection and discrimination, and:

A. The experience of violence and threat of violence

B. An inability to integrate ethnic identity, sexual orientation and spirituality

C. Lack of support and affirmation

D. Poor physical and emotional health

Intersection of LGBT with Other Identities

12. Several studies show that LGBT individuals in rural communities often feel more comfortable coming out or being open with their sexuality than those in large cities, probably because they are in a smaller and more secure environment with people they know well.

A. True

B. False


13. Hate crimes based on sexual orientation bias have more serious and long-lasting psychological effects than other crimes because of the link to core aspects of the victim’s identity and community.

A. True

B. False


14. LGB youth are significantly more likely to report having attempted suicide than their non-LGB peers, which is attributed to them having more risk factors, more severe risk factors, and fewer protective factors than heterosexual youth.

A. True

B. False

Invisibility of LGBT Individuals and Groups

15. Some families view LGBT behavior as rebellion against their ____________ and against the family itself, rather than as a part of an individual’s identity, and as a result they withdraw their love and support.

A. Spiritual beliefs

B. Traditional values

C. Cultural ideals

D. Sense of honor

16 Person-Level Factors That Promote Recovery

16. Although study participants acknowledged the ability to develop and integrate their authentic identity and experiences, engagement in creative activities, and achievement of self-validation as critical in successful recovery, they did not believe that the coming out process played a particularly critical role in their wellness and overall health.

A. True

B. False

Person-Level Factors that Impede Recovery

17. Overarching themes that were presented when discussing person-level factors that impede recovery include each of the following EXCEPT:  

A. A history of trauma

B. Negative stereotypes and discrimination

C. A history of systematic prejudice that denies appropriate access to needed services

D. Poverty and the lack of safe and stable housing

18. Healthcare providers have a critical obligation and opportunity to enhance recovery by hiring LGBT-identified staff persons to whom perceived LGBT clients can be referred, and who will be able to train other staff members to become more culturally competent.

A. True

B. False

System-Level Factors That Promote Recovery

19. System-level factors that participants assert promote recovery relate principally to culturally competent, trauma-informed, integrated services provided by well-trained professionals and peers, as well as public awareness and:

A. Needs-based practices

B. Research that confirms the effectiveness of subordinate practices

C. LGBT settings that motivate engagement in mental health and addiction treatment

D. Social inclusion

Recommendations for Action

20. Training and technical assistance recommendations to advance recovery opportunities for LGBT people include convening an expert panel to develop strengths-based educational curricula for healthcare providers and designing and offering professional training on LGBT-related issues.

A. True

B. False

Trauma and Justice Issues

21. To promote evidence-based practices for trauma recovery in LGBT populations, experts recommend using and expanding on current research on LGBT-related/minority stress and intersectional disparities in LGBT populations.

A. True

B. False

Public Awarewness

22. Which of the following is NOT one of the recommendations to enhance public awareness regarding LBGT advocacy?

A. Engage social and mainstream media to portray positive images of LGBT people, without focusing on LGBT people in recovery, as this will likely enhance negative stereotypes

B. Replicate the LGBT recovery dialogue in communities nationwide to promote increased understanding, respect, and social inclusion

C. Advocate for legal sanctions against discrimination on the basis of sexual identity and gender identification and promote support of marriage equality

D. Create and disseminate brochures to HIV clinics, primary health clinics, gay community centers, and other settings that help LGBT people access help for mental health and substance use disorders

Milestones in the LGBT Mental Health Consumer Movement

23. In 1992 significant milestones for the LGBT community included the founding of The Zappalorti Society, the first LGBT peer-run mental health support group in New York, and the inclusion of LGBT workshops and caucuses held for the first time out of the closet at the The Alternatives Conference in Philadelphia.

A. True

B. False


24. The term unspecific gender refers to those who possess biological characteristics of both sexes or sexual anatomy that is indeterminable.

A. True

B. False

Appendix C. LGBTQ Inclusive Action Steps in SAMHSA’s Strategic Initiatives

25. Action steps to assist LGBT populations that are incorporated in Strategic Initiative 1: Prevention of Substance Abuse and Mental Illness include:

A. Develop a dissemination, training, and technical assistance strategy to promote trauma-focused interventions for those who are struggling with substance abuse and mental illness

B. Develop a behavioral health guide for racial and ethnic minorities and the LGBTQ population about the challenges and strategies for coping with marginalization

C. Hold regular meetings with groups representing a broad and diverse range of behavioral health stakeholders, including people in recovery and racial and ethnic minorities

D. Support best practice guidelines for health and behavioral health providers to prevent and reduce LGBTQ problems associated with rejection, such as homelessness, behavioral health disorders, risky sexual behavior, and suicide

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