Family Therapy for Substance Use among Sexual Minority Youth: A Review of Treatment Options

Abstract

Substance use disorders are nearly twice as common among sexual minority youth (SMY) as among their heterosexual peers. Most applied literature about this population suggests interventions on either the individual or community level, and the benefits of family therapy for this population are often overlooked. The present literature review (a) outlines clinical knowledge related to sexual minority youth and substance use (e.g., prevalence rates, contributing factors), (b) discusses the importance of clinical self-awareness around these topics, and (c) outlines clinical behaviors and interventions from literature that may be employed when working with substance-using SMY and their families.     

Association between adolescent rough-and-tumble play and conduct problems,substance use,and risk-taking behaviors: Findings from a school-based sample

Rough-and-tumble play (RTP), also known as play fighting, is a common form of play frequently reported and studied by researchers. However, one important limitation of past research in the area of RTP has been the neglect of the adolescence period. Consequently, little is known about the function of adolescent RTP as well as about clinical characteristics of youth who engage in this activity after childhood. In a school-based sample of 1,771 middle school students (ages 9–16 years), the current study sought to address this gap by examining, via bivariate and multivariate logistic regression analyses, the potential cross-sectional associations of adolescent RTP with (a) selected demographic variables, (b) conduct problem symptoms, (c) substance use, and (d) risk-taking behaviors, including adjustment for several demographic confounders. Results indicated that adolescents reporting higher rates of conduct problem symptoms were more likely to report a recent participation in RTP. In addition, substance use (experimentation and current consumption of tobacco, alcohol, and marijuana) and risk behaviors assessed all were strongly associated with an increased likelihood of reporting an engagement in RTP. This finding suggests that participation in this activity probably implicates particular phenotypic characteristics including the propensity to engage in health-damaging behaviors. But the most profound issue raised by this research concerns the strong relationship between RTP and great levels of conduct disorder symptoms, suggesting a possible significant change in the functional significance of RTP in the adolescence period.     

Childhood trauma and suicidal behavior in male cocaine dependent patients.

A consecutive series of 100 male cocaine dependent patients were interviewed about suicidal behavior and completed the 34-item Childhood Trauma Questionnaire (CTQ) to determine whether childhood trauma is associated with suicidal behavior in cocaine dependent men. Patients who had attempted suicide (n = 34) reported significantly higher scores for childhood emotional abuse, physical abuse, sexual abuse, and emotional and physical neglect than patients who had never attempted suicide (n = 66). In this study, various childhood traumas were found to be significantly associated withsuicidal behavior among adult male cocaine dependent patients.     

Self and identity in social anxiety disorder

Models of social anxiety (SA) place the self as an organizing and causal center involved in the maintenance of this condition. An integrative conceptual framework for the understanding of the self is used to review the literature on the self in SA. Two main distinctions are emphasized: the self-as-a-subject (I-self) versus self-as-an-object (Me-self), and the evolutionary-based distinction of social rank versus affiliation. We argue that (a) although much progress has been made in understanding the association between SA and Me-self, the association between SA and I-self remains largely unexplored (with the important exception of anxiety-related processes in social situations); and (b) experiences and representations of the self in SA center on social rank. We suggest that in SA, social rank themes constitute the linchpins of identity, defined as the content and structure of the Me-self. We speculate that processes related to low social rank contribute to the focus on representational (Me), rather than experiential (I), self-aspects. Finally, we delineate the ways in which such an understanding may direct and refine the construction of novel, individually tailored, therapeutic approaches.