Drug Abuse

QUEER PRACTICES FOR HARM REDUCTION:
Inviting Lesbians, Gays, and Takatapui to be part of alcohol and drug harm reduction
Sharon Madgeskind & David Semp
Auckland Regional Alcohol & Drug Services, Aotearoa - New Zealand

Since the gay rights movement of the 1970's much has been written about the needs of lesbians and gays with regard to mental health services. However, with notable exceptions little has been written specifically about the drug and alcohol field. Even less has been written about agencies that have attempted to address the needs of lesbians and gays already highlighted by literature. This paper evaluates one agency in New Zealand that has attempted to address the needs of lesbians/gays/takatapui in regard to reduction of harm associated with alcohol and drugs. In relation to alcohol and drugs harm reduction is activities that attempt "to reduce the adverse consequences of drug use among persons who continue to use drugs" (Single, 1995, p.287). The harm reduction approach has been utilised to reduce the spread of HIV. As a concept then, harm reduction is not new to lesbian/gay/takatapui communities. By being proactive in the community, addressing relevant structural issues in the agency, and using a respectful motivational interviewing approach, Auckland Regional Alcohol and Drug Services (RADS) has invited lesbian/gay/takatapui to embrace harm reduction in relation to alcohol and drugs.

Why do lesbians/gays/takatapui (1) need to be invited into alcohol and drug harm reduction services?

Lesbians and gays have been variously reported to have a 30% prevalence rate for problems with drugs and alcohol (Ratner, 1993; MacEwan & Kinder, 1991; Paul, Stall, & Bloomfield, 1991; Diamond-Friedman, 1990), a rate which is much higher than the 10% for the general population studies (Paul ., 1991). A "stress-vulnerability" model of problems with alcohol and drugs (McKirnan & Peterson, 1989) suggests that culturally mediated factors as well as individual characteristics impact on the development of problems with alcohol and drugs.

There are many cultural factors that are likely to increase lesbian/gay/takatapui (Igt) vulnerability to problems with alcohol and drugs. For example, takatapui women confront issues of marginalisation around ethnicity, gender, and sexual orientation. Add the stigma attached to having a problem with alcohol and/or drugs and the vulnerability is increased. Furthermore, the oppression of Igt has resulted in the few safe meeting places available to these people becoming particularly important. As many of these venues are bars and clubs, these may further increase vulnerability to developing problems with alcohol and drugs (Paul et.al, 1991; McKirnan & Peterson, 1989). It must also be remembered that Igt also experience all the other stressors that have been attributed to the development of problems with alcohol and drugs in the general population. Given these numerous cultural vulnerability factors that Igt face, it is perhaps surprising that the prevalence rates for problems with alcohol and drugs in these communities are not even higher.

Furthermore, cultural vulnerability is not the only reason for invitation into alcohol and drug harm reduction programmes. First, research internationally (Bidwell, 1986; Hellman, Stanton, Lee, Tytun, Vachon., 1989; Israelstam, 1986; Zigrang, 1982) and in New Zealand (MacEwan, 1994), suggests that many alcohol and drug services are heterosexist. The research suggests that by not meeting the needs of Igt, such services both reduce the help seeking behaviour of Igt and limit the effectiveness of the help they offer when it is sought.

However, it must be acknowledged that some organisations have attempted to meet the needs of Igt regarding alcohol and drugs. These are the twelve-step organisations such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA). In North America and New Zealand there are AA and NA groups specifically for lesbians and gays. While this is of use to many who attend, the twelve-step model is unrealistic for many Igt. This is often due to the spirituality and/or abstinence components. Many Igt have had negative experiences with religious groups and because of the social importance already mentioned of bars and clubs, abstinence is often unrealistic for Igt. Accordingly, there is a gap for alcohol and drug harm reduction services for Igt.

Finally, another important reason for inviting Igt into alcohol and drug harm reduction programmes is to reduce risks associated with HIV. At least three scenarios link alcohol and drug use with HIV/AIDS. Firstly is the notion that alcohol and drug use can increase the practice of unsafe sex. Research suggests that while this link exists, it is not a simple causeand-effect relationship. Such factors as beliefs about safe sex (Crosby, Paul, Barrett, Midanik, & Stall, 1993; Rhodes & Stimson, 1994), and "identification with an active community" (Peterson & McKirnan, 1989) mediate the relationship between alcohol and drug use and unsafe sex. Secondly, there are health implications of alcohol and drug use for people already infected with HIV (Benton, 1994). Thirdly, there are the risks of transmission of HIV with injecting drug use. A review suggests that harm reduction interventions around this issue can reduce "risk behaviour and HIV infection among injecting drug users" (van Ameijden, Watters, van den Hoek, & Coutinho, 1995, p.S75). For all three of these scenarios linking alcohol and drugs with HIV/AIDS, it is imperative that alcohol and drug harm reduction programmes are able to adequately meet the needs of Igt.

Why should we study RADS regarding lesbian/gay/takatapui issues?

The first reason we chose to research RADS is that we work there. There are however many less subjective reasons for writing about RADS harm reduction work with Igt. There are visibly 'out' Igt staff at all levels within RADS. Lgt staff are encouraged to meet as a consultative peer group that has representation on the wider RADS consultative group. This group advises on such things as policy and practice. Part of the core training for all staff is a workshop on heterosexism and homophobia. There is a question on working with Igt colleagues as part of the staff selection interview. Part of RADS evaluations sent out to clients includes a question on how sensitive RADS was to clients' cultural needs around their sexual orientation. Lgt staff at RADS do harm reduction work within the Igt communities as part of their job descriptions. Thus while there is no written policy within RADS that advocates a Igt affirmative service, practice within the organisation suggests such a policy may be operating implicitly.

Recent New Zealand research suggested alcohol and drug services in New Zealand were heterosexist (MacEwan, 1994). An example of MacEwan's (1994) findings is that many lesbians and gay men were assumed to be heterosexual when their treatment plans were constructed. Lack of research contradicting this finding in New Zealand since then could well mean that RADS is unique in this country in attempting to invite Igt to be part of alcohol and drug harm reduction. A review of the relevant international literature on attempts by alcohol and drug agencies to be lesbian and gay affirmative found that with few exceptions (Driscoll, 1982; Zigrang, 1982) this issue is conspicuous by its absence. Accordingly, this exploratory evaluation of RADS affirmative work with Igt may be of international use. This research thus explores how as a mainstream alcohol and drug harm reduction agency RADS has worked affirmatively with Igt and what have been the outcomes so far in this endeavour.

How has it happened? Some relevant RADS and New Zealand history.

In order to gather information to answer this question we interviewed the RADS Quality Assurance manager who had previously held a managerial position at a RADS unit and who has been part of the organisation since its restructuring in 1992. As confirmed in the interview, there is no written policy guidelines for Igt issues. However, informal policy and individual agency culture regarding these issues have developed.

To explore the development of Igt policy and practice, the wider socio-political context is relevant. In 1986 in New Zealand the Homosexual Law Reform Act made Homosexuality between consenting adults aged 16 and above legal. Then the Human Rights Act 1993 made it illegal to discriminate on grounds of sexual orientation (among other things) in New Zealand. It is unlikely RADS Igt affirmative work would have been possible without these law changes.

According to our interviewee even with these law changes, there needed to be careful consideration of how to introduce measures to welcome Igt staff and clients without alienating her peers at management level. This meant prioritiising the battles and working toward the implementation of such measures at a pace that facilitated integration into the culture of the agency.

One such battle was the retention of the Gay Community Project position, a position currently held by a gay man working in the gay community and now widened to include clinical work with gay men. Another was to include Igt staff representatives on the organisation's consultative committee and the inclusion of regular regional meetings for Igt staff. Others were the inclusion of a workshop on homophobia and heterosexism as part of all staffs' core training and a question about working with Igt colleagues included at all staff selection interviews.

The interviewee's own lesbian orientation has played a crucial part in maintaining her focus on Igt issues. Whilst other Igt staff have assisted by keeping issues alive, they have provided her little personal support given her position in management and the isolation that can be created as a mediator between management and staff.

Overall, the interviewee thought that implementing Igt affirmative practices at ground level, and allowing time for people to become used to them and see the benefits of them, has beer important. Future plans are to include these practices in the organisation's clinical practice manual, clearly identified as "working with lesbian, gay, takatapui clients". This will also include a regionally standardised referral information form, a part of which will ask the client ii they have a preference to see a counsellor of a specific sexual orientation. The quality assurance manager also wished to see more designated positions for Igt staff created. Policy making regarding discrimination against Igt clients and staff will be included in a general policy statement including other marginalised groups.

What harm reduction activities do RADS invite people into?

RADS provides a wide range of alcohol and drug services and while it does work with people who have the goal of abstinence, much of its work is underpinned by a harm reduction philosophy. By harm reduction, we mean activities that attempt "to reduce the adverse consequences of drug use among persons who continue to use drugs" (Single, 1995, p.287).

Within RADS various harm reduction activities, certain approaches are commonly used: motivational interviewing (Miller & Rollnick, 1991) is a style of therapy that is respectful of people's current use and works to support them in developing and maintaining motivation for change. Part of motivational interviewing is the Wheel of Change, which provides a visual model of the motivational stages of change. To add to the respectful approach and in order to avoid viewing people as the problem, RADS uses externalising language that locates problems within the relationship between alcohol and other drugs (Winslade & Smith, 1997).

Utilising these respectful approaches RADS undertakes a variety of harm reduction activities: training and education to a wide variety of community organisations and workers in how to do their own harm reduction work; a methadone programme to bring legality and stability to people's lives; a medical detoxification service augmented by a physiotherapist and a herbalist; home detoxification support; support groups for people who continue to use alcohol and/or drugs; counselling for people who use alcohol and/or drugs and/or their partners, friends, and families; and finally, a duty phone and walk-in service during office hours which provide among other things matching to appropriate services.

How was this research done? =

The starting point for this research was to find an appropriate model to work from. This model would need to be able to explore how a mainstream alcohol and drug service adapts to meet the needs of Igt. Fortunately, such a model was available in New Zealand. The New Zealand Alcohol Liquor Advisory Council (ALAC) responded to the requests of Igt health workers and hosted two conferences "to consider the needs of homosexual people and their alcohol use" (MacEwan & Kinder, 1991, p.3). One outcome of these conferences was a book "Making Visible - improving services for lesbians and gay men in alcohol and drug treatment and health promotion" (MacEwan & Kinder, 1991). This was co-produced by ALAC and the New Zealand Aids Foundation (NZAF). A model for understanding, working with, and preventing problems with alcohol and drugs in Igt communities was presented in 'Making Visible'.

There are three main elements to this model: One, the agent, which is the drugs themselves and their social context e.g. availability; two, the! host, which is Igt people; three, the environment, which includes socio-cultural influences that may mediate the development of problems with alcohol and drugs for Igt. This includes such things as oppression and peer pressure. In the model, the three elements are seen to interact to produce problems with alcohol and drugs. In this research the primary focus was on the third element - environment. This was because the environment, which RADS is part of, was seen as an element that could be influenced directly.

The next step was to identify the different ways that RADS may impact on the environment for Igt. The following were identified: Igt staff; staff who do not identify as Igt; community organisations and workers with whom RADS liaise; and structures and practices within RADS agencies. Accordingly, in consultation with staff and the RADS research committee, questionnaires were developed both for the three groups and to elicit structures and practices in RADS that might invite Igt to be part of RADS harm reduction work.

All staff questionnaires were confidential. All staff were given both the questionnaire for staff who did and did not identify as Igt. This was done in order not to make assumptions about how staff identified personally as opposed to publicly. The questionnaires for community organisations and workers were not confidential so they could be used to enable respondents to request more information about services for Igt from RADS (2).

While RADS is located in the environment factor of the model used for this research, it seemed imperative to seek feedback from the host factor - in other words, the Igt RADS has sought to invite !into harm reduction. Accordingly, in addition to organisations and workers who work in the wider community with Igt, a questionnaire was developed for Igt clients of RADS who had seen Igt counsellors. It was decided to only survey these clients and not Igt clients who had seen non Igt counsellors. There were two reasons for this. Firstly, getting non lgt staff to identify and survey Igt clients would have been logistically difficult. Secondly, Igt clients who had seen Igt counsellors may have been more likely to be in the unique position of having previously seen non Igt counsellors and thus be able to make a comparison.

What we found: The feedback from the questionnaires.

In the remaining sections of the paper we provide the results of our research. As the sample numbers were generally small, formal statistical analysis is not attempted. Alternatively, we have identified themes in the answers. Where appropriate we will indicate frequency of responses.

What did lesbian/gay/takatapui clients tell us?

Of the questionnaires sent out to 35 Igt clients, 16 were returned completed. This is a response rate of 46%. Of those who responded, 69% did not know Igt counsellors were available before they made contact with RADS. Some were told by health workers in the wider community that RADS had Igt counsellors, some found out through Igt community organisations and media. Of those who did not know of the availability of Igt counsellors before coming to RADS, some asked if this service was available, some were offered this by RADS counsellors.

Many advantages of seeing Igt counsellors were reported. Lgt clients without exception experienced their Igt counsellor as understanding Igt issues and that this resulted in reduced barriers to addressing alcohol and drug issues. Clients cited specific ways this assisted them in their alcohol and drug goals: quicker rapport, felt more relaxed, fostered hope, having a role model and less fear of being judged. Similarly, for the Igt clients having previously seen a heterosexual counsellor (over half of the respondents), they reported benefits of seeing a Igt rather than a heterosexual counsellor. These benefits included greater rapport, feeling safer, and feeling counselling was more effective as the counsellor was more able to be seen as credible. One client did however point out that in their experience there was not much difference between seeing a heterosexual or a Igt counsellor.

While most Igt clients identified no disadvantages of seeing an Igt counsellor, the few who did stated the issue of knowing the counsellor from elsewhere in the Igt communities as a disadvantage. One client mentioned becoming attracted to her counsellor as a disadvantage. Clients differed in their views on the impact of these issues on their alcohol and drug goals. For example, one thought it had no impact and one thought it had more of an impact on the counsellor than on themselves.

Lgt clients identified the following as welcoming them into the agency: Igt newspapers, pamphlets and posters in the waiting room, having Igt acknowledged in groups, and having non judgmental administration officers. No clients reported anything in the agencies that was less welcoming to them as Igt. Suggestions for improvements included: a sign advertising Igt counsellors; more of the same; more Igt counsellors; a warmer greeting at reception, that counsellors be less concerned about dual roles in Igl' communities, and increasing awareness of alcohol and drug issues in Igt communities.

What did lesbian/gay/takatapui staff tell us?

Questionnaires were given to all nine of the Igt staff at RADS who had their names on the membership list for the RADS Igt consultative group. Eight replied. When asked how supported they felt in sexual orientation matching for clinical work, the responses of six ranged from being supported to 'some extent', to being supported 'well'. Two felt poorly supported in this area. However, most felt 'well' to 'fully' supported as a Igt staff member by their colleagues.

In answer to the question "what specifically supports you in your sexual orientation in RADS?" the most common responses were other Igt staff, the lgt regional meeting, and the existence of the Gay Community Project position. Other supports mentioned more than once included Igt supervision, RADS management, and Igt questions asked of all staff in recruitment interviews. When asked what else could support, Igt staff in RADS, a wide range of suggestions were made: non-Igt staff being aware of and challenging homophobia; training for Igt staff; a lesbian project worker; more Igt staff; acknowledgement of and provision of appropriate resources for Igt project work; Igt supervision; offering Igt staff for all referrals; and Igt being included explicitly in RADS brochures.

There were some common themes in Igt staffs views on the rewards of working with Igt clients: working with clients of your own culture was the most commonly reported. This was followed by the notion of serving lgt communities. Other rewards mentioned were having one's own sexual orientation acknowledged, networking with Igt staff and communities, and connecting Igt clients with Igt communities. Lgt staff were also asked of the challenges of working within the marginalised group(s) to which they belonged. The two most common responses were lack of recognition of issues for Igt by non Igt staff and the way social life and counselling is affected by working as a counsellor in small communities. Other challenges reported were challenges of having a high profile in the Igt communities, transference issues, and insufficient resources for Igt staff.

To summarise, there were a wide range and variety in the responses of the Igt staff. Clearly, there were good and less good things for Igt working for RADS. However, none of the Igt staff suggested any major changes to what was in place. The main theme of the responses given seemed to be a continuation and further development of what is already happening.

What did staff who do not identify as lesbian/gay/takatapui tell us?

Of the 55 questionnaires given to staff who were not on the list of Igt staff, 25 were completed (45%). The first question non Igt staff were asked was in what ways were they aware that RADS was an Igt affirmative organisation for staff and clients. The most common responses were presence of visible Igt staff, training on Igt issues, being asked a question about working with Igt colleagues in their selection interview, knowing of the Igt staff consultative group, practices of client matching for sexual orientation, the existence of the gay community project position, and agency culture. A few staff also mentioned they had seen Igt posters/resources at RADS and were aware of the practice of offering counsellor sexual orientation matching at point of contact.

Secondly, non Igt staff were asked of the impact on them of RADS being an Igt affirmative organisation for staff and clients. The most common responses were enjoying the diversity this brought to RADS, enjoying being able to offer clients choice, being able to consult with Igt staff, and helping maintain awareness of Igt issues. Other responses included it being a challenge, supporting them in their own beliefs, and increasing their sense of safety at work. A few non Igt staff reported there was no impact for them by RADS being an Igt affirmative organisation for staff and clients.

Finally, non Igt staff were invited to make any other comments on the issues raised in this research. While the range of responses to this question was broad the two most common responses were that providing Igt appropriate services was important and that RADS was doing well in this. The range of other comments included those such as the need for more Igt staff, where bisexuals fit in this study, and questioning the value of this research. However, while there was diversity in the responses of non Igt staff, the overall response appeared supportive of RADS affirmative practices regarding Igt staff and clients.

What did the wider community have to say?

Thirty-six community agencies were sent questionnaires, of these 25 were returned (69%). Each agency was contacted to make them aware of the questionnaire before it was sent. The organisations ranged from mental health agencies to Igt agencies, GP practices and other health agencies. It also included private counselling agencies, support accommodation and residential treatment programmes.

Of the 25 replies all reported having had previous contact with RADS. The main contacts were referral of clients from and to RADS and for consultation. Some had received staff training from RADS and one contact had been to arrange accommodation.

Out of the 25 replies 22 knew that Igt counsellors were available. Thirteen knew from RADS staff, six through community liaison, one through media and one by sifting in on a joint assessment between RADS and a mental health service. Five knew of the Gay Community Project through RADS staff. Of those 13 that knew about Igt counsellors, eight had referred clients and six had done so because of RADS practice of offering matching of Igt clients to Igt counsellors.

Those that had not referred Igt clients, did not, mainly due to lack of recent alcohol and drug presentations. However, three did not because they do not ask about sexual orientation and three other agencies were unaware of RADS Igt service. Seventy-five percent of the agencies that referred Igt clients reported that it was easier for Igt clients to contact RADS knowing that Igt counsellors are available.

Feedback from clients to the agencies was positive in the main. Of the three less favourable reports, one was feedback from a client who was coerced into an alcohol and drug assessment by another agency and one from a client who preferred abstinence for all. Two agencies had received mixed feedback from clients.

Of those who knew of the Gay Community Project all thought the project was worthwhile, one had also found the model of harm reduction useful and another had received useful training from RADS. Without exception all agencies replied that now they knew about Igt services at RADS they would be more likely to refer Igt clients and 92% were interested in knowing more about Igt harm reduction services that RADS could offer.

Other comments were five requesting specific information and resources, eight to affirm the Igt service as worthwhile, one stated that their agency 'would now give Igt information to clients, one was to request more takatapui staff and more consultation with takatapui, and two comments raised questions about bisexual and transgender clients.

Conclusions, suggestions, and questions.

This paper discusses the history, challenges, and achievements in regard to RADS harm reduction work with the lesbian/gay/takatapui communities. The main finding of this research was a positive stance towards RADS inviting Igt into alcohol and drug harm reduction. Lgt clients and staff, non Igt staff, and community organisations all reported benefits of RADS' invitations to Igt. RADS' consumer survey asking about the sensitivity of RADS' services to sexual orientation also supports this conclusion (3). The fact that no Igt staff questionnaires were received from RADS staff other than those on the Igit list (4), may also suggest that RADS is a safe enough environment that Igt staff are able to be, open about their sexual orientation. Alternatively, it may mean that some are resolutely closeted. Furthermore, it appears that the most important part of RADS' Igt harm reduction activities is RADS' visible Igt staff. While the benefits of sexual orientation matching are largely not addressed in the literature, the benefits of this form of matching were reported by all groups surveyed in this research. Additionally, without specific training in this themselves, Igt staff were reported to be able to support non-Igt staff regarding Igt issues. Lgt staff also report a variety of ways in which RADS supports them in their work. For example, the Igt consultative group was mentioned by many Igt staff. Accordingly, this paper suggests that mainstream alcohol and drug services can engage Igt in harm reduction. However, to do this effectively, visible Igt staff are essential and they need to be supported as Igt by the organisation.

These conclusions can be related to the three component model (agent, host, and environment) of alcohol and drug harm reduction for Igt (MacEwan & Kinder, 1991). This research agrees with the model's claim that due to the specific needs of Igt it is necessary to consider environmental factors in inviting Igt into harm reduction. By making the alcohol and drug harm reduction environment more appropriate for Igt they are more likely to enter it.

In addition to supporting the need for and feasibility of inviting Igt into alcohol and drug harm reduction, this research suggests some ways in which RADS could improve its effectiveness in this area. One area for improvement became apparent early on in the research. For RADS to act on its commitment to The Treaty of Waitangi and takatapui as tangata whenua of New Zealand, RADS needs to consistently consult with takatapui in regard to Igt services. Other areas for improvement came from the questionnaires. Feedback from Igt staff about the need for non Igt staff to be more aware of homophobia could suggest a need for more training around Igt issues for non Igt staff. Other feedback from Igt staff raised the issue of lack of resources to support Igt staff in their roles. Two examples of insufficient resources are the lack of a lesbian project worker and the uneven distribution of Igt staff throughout RADS agencies. Some agencies have Igt staff, and some do not. The takatapui community organisation surveyed highlighted that there is only one takatapui staff member in RADS. The fact that most Igt clients did not know about availability of Igt counsellors before contacting RADS could suggest that more needs to be done to promote the visibility of RADS Igt staff. One way for this to happen would be to offer all new clients Igt counsellors at the point of first contact with RADS. Following this, RADS is currently updating its initial contact forms to support staff in offering this. With regard to the wider community, there seems to be a need to train some organisations/workers in finding ways to inform their clients of RADS Igt service. To do this, they need to be comfortable about raising this issue with clients. This training is part of the role of the Gay Community Project worker. Thus, it appears that prior to this research RADS has already been responding to feedback about its harm reduction work with Igt.

However, while this research provides support for RADS actions in inviting Igt into harm reduction, and acknowledges that RADS is continuing to improve this aspect of its services, there are issues arising from the research that remain unaddressed. Research respondents raised questions as to where transgender and bisexual clients fit into RADS harm reduction activities. To help understand these issues and others that this paper may raise it would be useful if more organisations would tell their stories about attempts to invite Igt into harm reduction. There is a wealth of literature arguing that Igt need such invitations. This research suggests that RADS as a mainstream alcohol and drug agency has had some success ininviting Igt into harm reduction. We encourage more organisations to consider how they have invited Igt into alcohol and drug harm reduction and if they have not, to try to.

 

Reference List

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Bidwell, Roberta. (1986). Lesbian alcoholics. Social Work, 31 (3), 238.

Crosby, G; Paul, J; Barrett, D; Midanik, L; & Stall, R. (1993). Gay male substance abusers who only have safer sex. International Conference on AIDS. 9 (2), (Berlin) June 611, 696 (Abstract No. PO-C12-2873).

Diamond-Friedman, Cassandra. (1990). A multivariant model of alcoholism specific to gaylesbian populations. Alcoholism treatment Quarterly, 7 (2), 111-117.

Driscoll, Rosanne. (1982). A gay-identified alcohol treatment program: A follow-up study. Special Issue: Alcoholism and homosexuality. Journal of Homosexuality, 7 (4), 71-80.

Hellman, Ronald; Stanton, Michael; Lee, Jacalyn; Tytun, Alex; Vachon, Ron. (1989). Treatment of homosexual alcoholics in government funded agencies: Provider training and attitudes. Hospital and Community Psychiatry, 40 (11), 1163-1168.

Israelstam, Stephen. (1986). Alcohol and drug problems of gay males and lesbians: Therapy, counselling and prevention issues. Journal of Drug Issues, 16 (3), 443-461.

MacEwan, Ian. & Kinder, Paul. (1991). Making Visible: improving services for lesbians and gay men in alcohol and drug treatment and health promotion. Wellington: Alcohol Liquor Advisory Council.

MacEwan, Ian. (1994). Differences in assessment and treatment approaches for homosexual clients. Drug and Alcohol Review, 13 (1), 57.62.

McKirnan, David; & Peterson, Peggy. (1989). Psychosocial and cultural factors in alcohol and drug abuse: An analysis of a homosexual community. Addictive Behaviours, 14, 555-563.

Miller, William., & Rollnick, Stephen. (1991). Motivational Interviewing: Preparing people to change addictive behaviour. New York: The Guilford Press.

Paul, Jay; Stall, Ron; & Bloomfield, Kim. (1991). Gay and alcoholic: epidemiological issues. Alcohol Health and Research World, 15 (20,151-160.

Peterson, P; & McKirnan, D. (1989). Gay identification influences the effects of alcohol use on AIDS risk behaviour. International Conference on AIDS, 5, (Montreal) June 4-9, 717 (Abstract No. M.D.P.39).

Ratner, Ellen. (1993). Treatment issues for chemically dependent lesbians and gay men. In L. Faderman, & L. Gross (Eds.), Psychological perspectives on lesbian and gay male experiences (567-578). New York: Columbia University Press.

Rhodes, Tim; & Stimson, Gerry. (1994). What is the relationship between drug taking and sexual risk? Social relations and social research. Sociology of Health and Illness. 16 (2), 209-228.

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van Ameijden, Eric; Watters, John; van den Hoek, J, Anneke; & Coutinho, Roel. (1995). Interventions among injecting drug users: do they work? AIDS, 9 (suppl A):S75-S84.

Winslade, John., & Smith, Lorraine. (1997) Countering Alcoholic Narratives. In G. Monk, J. Winslade, K. Crocket, D. Epston (Eds.), Narrative Therapy in Practice: The Archeology of Hope. San Francisco: Jossey-Bass Publishers.

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Acknowledgements

Waitemata Health, RADS, Carol Wilson, Paula (Parsonage, Mary Ann Gulliver, Cathie Menzies; Te Waka Awhina Takatapui; lesbian/gay/takatapui clients; lesbian/gay/takatapui staff; community organisations and workers who participated; RADS staff who completed questionnaires; Grant Paton-Simpson, Karen Jennings, Vanessa Houghton, Colleagues, ALAC, Barbara, Todd, Ernie, Heather, Jin, Phayth, Sarah, and Tamati.

If you wish to have further details please contact:
Sharon Madgeskind or David Semp
CADS Central
9 George Street
Mount Eden
Auckland
New Zealand
Tel: New Zealand (9) 623 2323 
Fax: New Zealand (9) 623 3393

1 Takatapui is a Maori word that is inclusive of Maori lesbians, gay men, and transgender people. RADS is an organisation that respects its obligations under the Treaty of Waitangi to operate in equal partnership with Maori as tangata whenua (people of the land) of New Zealand (Aotearoa). Accordingly, the needs of takatapui cannot simply be assumed to be the same as for non- Maori lesbians and gays in New Zealand. (The Treaty of Waitangi is a document that guaranteed that Maori rights and values would be protected and equity and anuality maintained

2 An unfortunate mistake occurred when we sent out these questionnaires that highlighted the need for consistent consultation with takatapui. In the questionnaires, every time reference was made to clients, it included takatapui. However, reference to staff was only made for lesbian and gay staff. This meant that takatapui staff were not acknowledged. This mistake was most likely a product of the researchers 'blind spot' on takatapui issues as pakeha (people of European descent who live in New Zealand), and also to insufficient consultation. We again thank 'Te Waka Awhina Takatapui for bringing this to our attention.

3 Separate from this research RADS sends out client feedback surveys to all clients who have consented to receive them. This is done three months after their treatment is completed. A question in the RADS client feedback survey asks "How would you rate the following aspects of RADS services'? Sensitivity to your sexual orientation (e.g. heterosexual or gay, lesbian, bisexual, or transgender). Of 336 respondents in 1995, 97% answered acceptable or better than acceptable.

4 While the questionnaires were confidential, Igt staff talked amongst each other about filling in their questionnaires. This meant that the researchers knew which Igt staff had completed questionnaires.