Abstract by author: To further understand HIV risk-behavior, this study examined the role played by the personality trait of sensation seeking explaining high risk sexual behavior. This analysis describes the HIV risk-related behavior of 168 self-identified gay and bisexual men from Pittsburgh. The mean age and education for the sample was 34.2 years (S.D. = 10.5) and 15.4 years (S.D. = 2.7) respectively. Eighteen percent were African American, modal annual income was in the $20,000 to $24,999 range, 95% were tested for HIV antibodies, and 15% were HIV seropositive. Risky Sex was a composite measure of the number of sexual partners reported, proportion of anonymous sexual partners, and proportional use of condoms during receptive anal intercourse. Alcohol use was defined as the product of quantity and frequency of drinking; and drug use was defined as use of marijuana only, or other use in the six months previous to the assessment. Substance use is represented by a series of dummy variables that were derived from the combination of the alcohol and drug use variables. Independent effects of high alcohol use with other drugs, and the disinhibition subscale and total score from Zuckerman's Sensation Seeking Scale Form V (1979b) were evaluated with hierarchical regression analyses. The results indicate that each predictor variable explained a small (2-5%), but statistically significant amount of the variance in the outcome measure of Risky Sex. The disinhibition subscale was found to independently explain as much of the variance as substance use. Social workers can play a critical role in AIDS-related research and practice because they have direct access to many of the most vulnerable populations affected by and infected with HIV, subpopulations that continue to be at risk. The expertise of direct practice social workers can be brought to bear on AIDS research through a variety of mechanisms including the development of collaborative projects, the strengthening of field practicum ties, and the use of focus groups. Social workers are in key positions to advocate for people with HIV/AIDS. Their knowledge of systems and familiarity with referral processes places social workers in a strong position to argue for necessary policy and service delivery changes.
Bellows JT (1995). Recovery house: residential facility for persons with mild mental retardation and substance dependence. PH.D. Thesis, The union Institute, DAI, Vol. 56-11A, p. 4553, 276 pages.
Abstract by author: This study assesses the current capabilities of drug abuse concepts to be applied appropriately to persons who are diagnosed with mild mental retardation. There are several outpatient or day treatment programs for persons with mental retardation, but there are no residential programs designed, or even, willing to treat this population. The need for such a program was established and led to the development of the documented model for treating persons with mild mental retardation who exhibit drug/alcohol substance dependence. It is the purpose of the Recovery House program to provide educational and therapeutic services to adults with mild mental retardation and drug/alcohol substance dependence. Here they can improve their self-esteem and learn how to live a drug free life. This is accomplished through a three phase, eighteen month, residential model. During the three phases, Self-Esteem, Work Skills and Transition, the program develops the self-esteem, social skills, independent living skills, and the work skills of the residents in order to facilitate the clients' return to the community and enhance their contribution to society without the use of drugs and/or alcohol. It is believed that by improving the self- esteem and the ability to live in the community, that the need to use drugs/alcohol will be decreased. The effects of self-esteem, anger management, depression and anxiety, communication and relationship, human sexuality, men's and women's issues, gay and lesbian issues, relaxation, parenting, physical exercise, health maintenance, drug and alcohol education are discussed as elements of the Recovery House Program. Program administration, case management, program evaluation, facility organization, house rules and client's rights, family inVolvement, resident's resources, staff qualifications and responsibilities, and staff training are considered and also discussed.
Berg SL (1989). AA, spiritual issues, and the treatment of lesbian and gay alcoholics. PH.D. Thesis, Michigan State University, DAI, Vol. 50-07A, p. 2121, 220 pages.
Abstract by author: Although Alcoholics Anonymous claims it is spiritual and not-religious, this distinction is blurred because it is a spiritual program based on religious tenets. Lesbians and gay men who have been the victims of church sanctioned hate and persecution are likely to reject the program because of its religious elements. This dissertation first points out the religious elements which are found in AA. It then reviews letters, essays, and articles which have appeared in the lesbian/gay press that demonstrate the four objections which many lesbians and gay men have against the Christian tradition: patriarchy, misuse of scripture, anti-pleasure/anti-love positions, and the conspiracy of silence. The dissertation then traces the American trends toward perfectionism and individualism from the eighteenth- century to the publication of Alcoholics Anonymous in 1939. It argues that because AA was able to incorporate individualism into what was essentially a perfectionist movement in the Christian tradition, the organization is able to work as a program of recovery for Christians and individuals from non-Christian religious traditions, as well as people from no formal tradition. Because it takes time for an individual to appreciate the fundamental truth behind AA's claim that it is spiritual and not religious, seven strategies are proposed which can be used to help lesbians and gay men to successfully integrate AA into their lives.
Buchanan DR (1992). AIDS prevention: an applied investigation of the health belief model and other psychosocial factors in the prediction of sexual risk taking among gay and bisexual males. PH.D. Thesis, The George Washington University, DAI, Vol. 53-01B, p. 607, 196 pages.
Abstract by author: This study explored the utility of the Health Belief Model (HBM) in predicting sexual risk taking in gay and bisexual males and identified the psychosocial factors that may predict sexual risk taking in gay and bisexual males in the Washington, D.C., metropolitan area. Study participants included 373 gay and bisexual males who Volunteered to complete a questionnaire and return it by mail. The major factors of the HBM (knowledge, cues to action, perceived vulnerability, perceived severity, and perceived benefits) and six perceived barriers (hedonism, impulse control, interpersonal, access, future projection, and technological barriers) were included. Nine additional psychosocial factors (alcohol and substance abuse, global self-efficacy, condom self-efficacy, self-esteem, partner norms, peer norms, internalized homophobia, loneliness, and isolation) associated with gay sexual risk taking were also included. These items were subsequently used as predictor measures in correlational and regression analyses. The frequency of unprotected anal intercourse was used as the measure of sexual risk taking for the major criterion variable. The hypothesis that the HBM would be a useful model for the prediction of sexual risk taking was not supported. The hypothesis that a global psychosocial model (including both HBM and psychosocial factors) would be a useful model for the prediction of sexual risk taking was supported. The results suggest that the major factors related to sexual risk taking among gay and bisexual males are education, race, perceived vulnerability, technological barriers (belief that condoms would break), future projection barriers (the ability to postpone gratification in lieu of long-term consequences), substance abuse, partner norms, and loneliness.
Cherry R (1996). The relationship between internalized homophobia and substance use in gay and bisexual men. PH.D. Thesis, California School of Professional Psychology, DAI, Vol. 58-05B, p. 2659, 97 pages.
Abstract by author: Data from a 1995-1996 survey of 84 gay and bisexual adult male residents of Seattle, Washington, were used to study the association between internalized homophobia and substance use in general as well as the use of substances while engaging in social and sexual relations with other gay/bisexual men. It was hypothesized that gay and bisexual men with high levels of internalized homophobia would report using more alcohol and drugs and experience more alcohol- and drug-related problems than would gay and bisexual men with low levels of internalized homophobia. It was also hypothesized that gay and bisexual men with high levels of internalized homophobia would use more alcohol and drugs in social/recreational activities and while engaging in sexual relationships with other gay/bisexual men. As predicted, there was a statistically significant association between high levels of internalized homophobia and (a) high quantity and frequency of alcohol use, (b) higher frequency of alcohol- and drug- related problems, and (c) higher frequency of drug use while engaging in sexual relations. No association was found between internalized homophobia and (a) frequency of drug use and (b) alcohol and drug use while engaging in social/recreational activities.
Coleman VE (1990). Violence in lesbian couples: a between groups comparison. PH.D. Thesis. California School of Professional Psychology, DAI, Vol. 51-11B, p. 5634, 213 pages.
Abstract by author: In contrast to the plethora of research available on domestic violence in heterosexual couples, violence in lesbian relationships has only recently begun to be addressed. This study examined the prevalence and severity of violence in 90 lesbian couples. Those couples in which abuse was evident were compared with those in which there was no evidence of on-going violence. The groups were compared on the following variables: (1) inter-partner reliability in reports of conflict tactics; (2) levels of cohesion and adaptability as measured by FACES III (Olson, et al., 1985); (3) status incompatibility; and (4) status inconsistency. The research used a cross-sectional non-experimental design. All 180 individuals (90 couples) filled out a 12 p. self-report questionnaire, which included a revised version of the Conflict Tactics Scale (CTS), (Straus, 1979), as a measure of violence. Several items were added to the CTS in order to assess a wider range of behaviors and make the scale more appropriate for lesbians. Following a factor analysis, participants were divided into two groups based on the level of violence in their relationships. There were 48 couples in the non- violent group and 42 couples in the violent group. The results of the factor analysis, as well as the method of classification, are presented and discussed. The study found that partners in the violent group were more disparate in their reports of conflict tactics, had lower levels of adaptability, and had a greater degree of status inconsistency than partners in the non-violent group. In addition, partners in the violent group reported significantly higher levels of drug and alcohol use. All of the couples evidenced very high levels of emotional closeness (cohesion). There were no significant differences between the groups in terms of self or others being physically or sexually abused in family of origin. The relationship between violence and several other variables of interest (such as current therapy, degree out as lesbian, length of current relationship, and cohabiting versus living separately) are presented and discussed. Finally, limitations of the current study, areas of future research, and clinical implications of the study are discussed.
Colton GM (1994). The relationship among affective style, substance use and HIV risk factors. ED.D Thesis, Rutgers The State university of New Jersey, New Brunswick, DAI, Vol. 55-02A, p. 243, 198 pages.
Abstract by author: The intent of this study was to investigate the HIV risk taking phenomenon that AIDS/HIV knowledgeable individuals engage in. The following factors were investigated: affective states (negative affectivity (NA) and arousal (AR)), substance use, intensity of sexual activity, AIDS knowledge, personal experience with HIV infection/AIDS, high risk sex behavior and injecting behavior. Data were collected using self report questionnaires. The Sixteen Personality Factor Test, John Hopkins Symptom Checklist, the Tridimensional Personality Questionnaire, and a stress measure were used to operationalize the affective constructs. One hundred and fourteen subjects recruited from the following groups participated in the project: methadone maintenance clients, therapeutic community residents, community college students, and AIDS activists (primarily gay men). Two significant HIV risk models were found in the data. AIDS knowledge was found to have no significant effects on high risk behaviors and increased levels of personal experience with HIV/AIDS is not associated with reductions in HIV risk behaviors. Injectors were found to be at greater risk for HIV infection due to their injecting behavior rather than their sexual behavior. Subjects with multiple sexual partners were found to score significantly higher in terms of AR, alcohol use intensity, sexual intensity and engage in high levels of sex risk behavior when compared to individuals with one sexual partner. Sexual intensity may play a major influencing role for subjects with multiple partners. Risk models indicate that NA and AR play significant roles in HIV risk behavior. NA and AR have direct and indirect effects on most outcome variables in the risk models. These outcome variables are: substance use intensity, alternate measures of substance use, intensity of sexual activity, injecting behavior, and sex risk behaviors. NA and AR were further found to be associated with HIV risk behaviors for all the subjects subgroups investigated. A hypothetical risk model based including regression and group differences is presented. Implications for intervention are discussed, as well as, limitations of the study, and directions for future study are presented.
Crosby GM (1993). Psychosocial variables distinguishing gay male substance abusers practicing risky and safer sex while under the influence of alcohol or drugs. PH.D. Thesis, The Wright Institute, DAI, Vol. 54-05B, p. 2745, 165 pages.
Abstract by author: An association between substance use and high risk sexual behavior has been empirically demonstrated in the literature (Stall, McKusick, Wiley, Coates, & Ostrow, 1986). However, the strength of this link is not clearly understood. The purpose of this study is to examine factors that contribute to unprotected sex among gay/bisexual male substance abusers. Four hundred and fifty-five gay/bisexual men entering substance abuse treatment at a gay-identified agency in San Francisco were recruited to complete surveys and interviewed using the Timeline Followback Method (TL) on sexual behavior, substance use, and related variables. The TL procedure uses a blank calendar form and a series of questions to cue recall of drinking, drug use, or anal intercourse on each of the 30 days prior to the last date of alcohol or drug use. Two patterns of substance use and concurrent sexual behavior are compared. Group 1 is composed of respondents who used alcohol and or drugs and always had protected anal intercourse (n = 43); Group 2 is composed of respondents who used alcohol and or drugs and always had unprotected anal intercourse (n = 88). The unprotected group was significantly more likely to not perceive that safer sex is the community norm (p < .001), not to have encouragement from friends to practice safer sex (p < .001), have less control of their impulses (p < .008), feel that sex without love is satisfying (p =.003), and perceive their risk of HIV infection (p < .001). These findings suggest that one of the goals for risk-reduction efforts may not simply be to avoid sex while under the influence of alcohol or drugs but to develop social support which encourages a safer sex lifestyle. Substance abuse treatment facilities can play a major in this through group and individual work. In addition, suggestions for the continuing use of the Timeline Followback Method are offered.
Debord KA (1995). The relevance of sexual orientation to substance abuse and psychological distress among college students. PH.D. Thesis, University of Missouri, Columbia, DAI, Vol. 57-09B, p. 5913, 106 pages.
Abstract by author: The current study was unique in its comparison of heterosexual and gay, lesbian, and bisexual (GLB) substance use patterns across the four years following college entry. Overall, GLB students were found to be more alcohol inVolved than heterosexual students. No differences in drug inVolvement, psychological distress, and suicidal ideation or attempts were found between GLBs and heterosexuals. Evidence suggested that year-two psychological distress differentially predicted year-two and year-three alcohol dependence for GLBs and heterosexuals, with stronger distress-dependence relations being evinced for GLBs. Finally, the process of self-identifying as GLB was not found to have developmental properties in the current study. The largest number of GLB participants self-identified as GLB in the last year of the study.
Durvasula RS (1997). The independent and interactive effects of HIV-1 and cocaine use on neuropsychological performance in African- American men. PH.D. Thesis, University of California, Los Angeles, DAI, Vol. 57-11B, p. 7222, 170 pages.
Abstract by author: The primary aims of this study were to examine the independent and interactive effects of HIV-1 serostatus and cocaine on neuropsychological (NP) performance and to test the brain reserve hypothesis in a sample of 237 gay and bisexual urban dwelling African American men. Consistent with current evidence, it was expected that: (1) symptomatic seropositives (SSPs) would evidence poorer NP performance than seronegatives (SNs) and asymptomatic seropositives (ASPs) especially in domains affected by HIV (i.e., memory, psychomotor speed and frontal systems) and tests that are sensitive to subtle slowing; (2) individuals with more current or recent cocaine use would perform more poorly than those with no current or past use; (3) serostatus and cocaine would interact to yield poorer NP performance; and (4) brain reserve theory would predict greater NP impairment in seropositives and cocaine users with low education. The study sample was relatively young, lower SES, moderately educated, but mostly unemployed/underemployed and most were light-moderate drug and alcohol users, with few injection drug users in this sample. Multivariate analyses controlling for age and alcohol revealed that SSPs evidenced significantly poorer performance than SNs on tests of psychomotor speed, especially Trails B. A significant serostatus effect was also observed on reaction time (CalCAP Sequential Reaction Time) and nonverbal memory tests (Picture Memory Interference Test, Books C & D), with SSPs evidencing poorer performance than ASPs. A significant effect of recent cocaine use was found for psychomotor speed, with current users performing worse on Digit Symbol than individuals without current or past history of cocaine use. No interaction of serostatus and cocaine was noted for any NP domain. The expected serostatus and cocaine differences on verbal memory and frontal systems were not obtained. However, lower alcohol consumption appeared to benefit ASPs' performance on tests of reaction time compared to SNs and SSPs. An interactive effect of education and serostatus was not obtained, but older age was associated with greater NP deficits. An attenuated range of education in this sample limited the sensitivity of the test of the reserve hypothesis.
Ghindia DJ (1994). The effects of differing stages of homosexual identity integration, diminished self-esteem and a substance abusive familial history on substance abuse among homosexual me. PH.D. Thesis, Case Western Reserve University, DAI, Vol. 55-09A, p. 2989, 208 pages.
Abstract by author: The purpose of this study was to investigate the effects of three psychosocial factors in the development of substance abuse among homosexual men, a group that appears to manifest appreciably higher rates and concomitantly greater associated problems than the general population. Adhering to the conviction that homosexuality is not intrinsically dysfunctional, two constructs were advanced as being negatively impacted by social stigmatization: the formation of an integrated homosexual identity and the development of self-esteem. Moreover, a significant familial history of substance abuse was explored as a third major predictor, given previous research which has firmly established it as a precursor of substance abuse among the general population. Data were obtained by Voluntary subject return of a self- report instrument that was distributed widely in the Northeastern Ohio (Cleveland) area, resulting in a moderately sized sample (N = 341). As with most urban samples of homosexual men, the group was overwhelmingly white and well educated. Operational measures of stages of homosexual identity formation, Case Stage Allocation Measure (CSAM); self-esteem, Index of Self-Esteem (ISE); a family history of substance abuse, Family History- Research Diagnostic Criteria (modified FH-RDC); substance use/abuse and related problems, Michigan Alcoholism Screening Test, Drug Abuse Screening Test (MAST/DAST); and a frequency of substance use measure (FM), for each of four drugs: alcohol, marijuana, cocaine and an other specified drug were utilized. Results indicated that diminished self-esteem and a significant family history of substance abuse were each found to have significant associations with both alcohol and drug abuse and were confirmed to be salient predictors, accounting for almost half the variance in alcohol abuse and over one-third the variance in drug abuse. Further, both variables had the ability to significantly discern between alcohol and drug use groups versus groups determined to be alcohol and drug abusive. Additional findings confirmed a strong positive association between the alcohol and drug abuse measures and significant positive relationships between alcohol use/abuse and frequency of alcohol consumption, as well as drug use/abuse and the frequencies of marijuana and cocaine use. As anticipated, alcohol was the preferred drug, surpassing marijuana, cocaine or any other designated drug. Moreover, as almost one half of the sample possessed diminished self-esteem and almost three- fourths had not reached full integration of their homosexual identities, notwithstanding age, study conclusions lent indirect support to the deleterious effects of societal stigmatization. No significant differences were found by age group in frequency of use of specific drugs with the exception of cocaine, which appeared to be cohort specific to the group, aged twenty-five through thirty-nine. This group also appeared to be the most profoundly effected by alcohol and drug abuse. Although, conjectural, an explanation given was that these men were most heavily invested in the ascribed homosexual lifestyle, which is inextricably to the homosexual bar, at least in the midwest, the geographic region from which the sample was drawn. Given these findings, salient practice and policy implications were outlined. Finally, recommendations for further research included longitudinal designs, attempts to obtain more representative samples, as well as investigation of these concepts with lesbians.
Hall JM (1992). Lesbians' experiences with alcohol problems: a critical ethnographic study of problematization, helpseeking and recovery patterns. PH.D. Thesis, University of California, San Francisco, DAI, Vol. 53-09B, p. 4590, 341 pages.
Abstract by author: There is evidence that lesbians have greater incidence of alcohol problems, and are collectively moving away from alcohol use. Discrimination based on gender, sexual orientation, class and race complicate recovery for lesbians with alcohol problems. This critical ethnographic study addresses how lesbians identify alcohol problems, seek help and describe health care interactions related to alcohol problems. It also provides descriptions of lesbians' images of recovery and their personal and collective experiences in twelve- step mutual help groups such as Alcoholics Anonymous. A racially and socioeconomically diverse group of 35 self-identified San Francisco area lesbians recovering from alcohol problems Volunteered for participation in indepth interviews. The interview data was examined through narrative analysis, matrix analysis and ethnographic coding. The findings indicate that problematization is ongoing, and includes identification of problems other than alcohol. A conceptual model of the problematization process is developed that emphasizes relationships among alcohol problem construction, interaction, action, validation and reconstruction. Accounts are differentiated on the basis of whether alcohol problems are perceived to be circumscribed or pervasive in the women's lives. Helpseeking and health care needs are identified, including safety and validation in health care and treatment contexts, and attention to multiple addictive problems, aftereffects of childhood trauma and adolescence as a critical transition for lesbians. Six dimensions of safety in health care interactions are described: client/provider conceptual compatibility, providers' preparedness to interact with lesbians, respect for boundaries, emotional climate, provider persuasiveness strategies and group dynamics. Images used by lesbian participants to describe their recovery experiences include, in order of their prominence, connecting, reclaiming self, empowerment, struggle with compulsivity, personal growth, vocational change, social transition, cycles/celebration, physical transition and conversion. Twelve-step mutual help groups are an important though controversial part of recovery for lesbians; three dialectical tensions are identified: assimilation/differentiation, authority/automony and false consciousness/politicization. Conclusions and implications for practice and research are guided by the concept of marginalization. Experiences of those living at the periphery of society not only differentiate them from those at the center, but from other marginalized persons, making standardized health care approaches to lesbians and others who are multiply stigmatized inappropriate.
Heffernan K (1997). Binge eating, substance use, and coping styles in a lesbian sample. PH.D. Thesis, Rutgers The State University of New Jersey, New Brunswick, DAI, Vol. 58-07B, p. 3924, 68 pages.
Abstract by author: The affect regulation model views binge eating as an attempt to manage negative emotions by eating. The precise nature of how food is used to regulate affect, and in response to which kinds of negative affects, remains unclear. A recent study of a lesbian sample found a high rate of binge eating related to the use of food for affect management. Thus, the present study addressed these questions in a lesbian sample, as a suitable population for further investigation of the mechanisms under consideration, and in order to replicate the earlier findings. It has been suggested that lesbians lack mainstream coping resources and are thus at risk for maladaptive coping efforts, which include disordered eating and substance abuse. However, data regarding stress, coping, and their relationships to disordered eating and substance use in this population are largely lacking. The present study investigated levels of stress, coping styles, rates of eating disturbances, problematic substance use, and the relationships among these variables. Specifically, it tested the hypothesis that stress would be more likely to be associated with binge eating, and with problematic substance use, in individuals with avoidant coping styles. The present study employed a self-report questionnaire to investigate these issues among a heterogeneous sample of 263 lesbians. The rate of bulimia nervosa was similar to that of heterosexual women, while the rate of binge eating was higher, replicating earlier findings. Almost half of the sample were at least moderately dissatisfied with their weight, almost one third engaged in dieting, and weight was positively associated with frequency of binge eating. While stress was moderately associated with binge eating, neither stress nor an avoidant coping style in general predicted binge eating. It was the specific use of food to manage emotions that predicted binge eating in this non-clinical sample. Emotions related to anger and frustration were most strongly associated with an increased urge to eat, particularly among individuals who reported binge eating. While participants who did not engage in binge eating reported using food significantly more for comfort than for distraction or anxiety reduction, those who reported binge eating used food equally for all three of these purposes. The level of perceived stress in this sample was not significantly higher than in the general female population. Participants also reported levels of social resources that were similar to their heterosexual counterparts. Neither high rates of heavy drinking nor drug use were found in this sample. Among those who did engage in excessive drinking, it was associated with an avoidant coping style. Overall, levels of stress, of social support, and coping style were not predictive of problematic substance use. The most significant predictor of alcohol use, and to a lesser extent, frequency of getting high, was reliance on bars as a primary social setting. Implications for conceptual models of binge eating, for psychotherapy, and for understanding the experiences of lesbians are discussed.
Helder LM (1992). The effects of a cognitive/behavioral stress management program on psychological distress and the immune system in HIV-1 seropositive and seronegative gay men. PH.D. Thesis, University of Miami, DAI, Vol. 53-05B, p. 2530, 164 pages.
Abstract by author: Psychological and immunologic effects of a ten week cognitive/behavioral stress management (CBSM) program were assessed for HIV-1 seropositive (HIV+) and seronegative (HIV-) gay men. Forty-nine gay men were randomly assigned to a CBSM group (N = 14 HIV-; N = 10 HIV+) or an assessment only control group (N = 16 HIV- ; N = 9 HIV+). Both groups learned of their HIV-1 serostatus during the 5th week of the protocol. The CBSM group met twice a week for ten weeks and the program consisted of cognitive restructuring techniques, assertiveness training, coping skills, and progressive muscle relaxation training. In addition to psychological (anxiety, depression) and immunologic (CD4#, CD56#, NKCC, PHA, PWM) measures, both groups were assessed on potential immunomodulatory confounds (i.e., alcohol abuse, sleep, physical activity, sexual behavior). An additional seven HIV+ subjects served in a second protocol and received the same CBSM program but entered the study already knowing their HIV serostatus. Differences in psychological distress measures between protocols were examined. Within protocol 1 HIV- controls showed a decrease in anxiety while HIV- CBSM subjects showed a marginal increase across the 10 week period. Similarly, HIV+ controls also significantly reduced anxiety while HIV+ CBSM subjects showed no changes across the 10 weeks. No changes were found in depression for any of the groups. HIV- CBSM subjects showed significant increases in CD4# while HIV- controls showed increases in lymphocyte responsivity to PHA across the 10 weeks. Relaxation frequency was associated with decreases in anxiety for HIV- men when post-notification effects were partialled out. No significant relationships were found between relaxation frequency and distress for HIV+ subjects. HIV+ subjects, however, showed positive associations between relaxation frequency and both PWM and NKCC values. Finally, no differences in psychological distress were found between protocol 1 and protocol 2, suggesting that participation in the program itself rather than HIV-1 status notification was responsible for changes in distress measures.
Jazwinski RM (1994). A study comparing lesbian, gay and heterosexual college students on drinking, problems related to drinking, and on the impact of several psychosocial variables on drinking behaviors. Ph.D. Thesis, New York university, DAI, Vol. 55-09A, p. 2989, 288 pages.
Abstract by author: This study compared, within gender, homosexual and heterosexual college students who reported drinking at least one alcoholic beverage during the academic year. The sample included 42 lesbians, 43 gay males, 184 heterosexual females and 224 heterosexual males. Using a 14 p. anonymous questionnaire, the subjects were compared on alcohol consumption, problems related to drinking, expectations of alcohol, self acceptance, locus of control, alienation, perception of bias, gender identity, and bar drinking. There were no findings of difference in alcohol use, number of problems due to drinking, expectations of alcohol, self acceptance, locus of control, preference for bars or five of the alienation measures. The differences found in perception of bias, one measure of alienation (cultural estrangement), and gender identity were unrelated to alcohol consumption. Besides the primary finding of no relationship between sexual orientation and alcohol use, the other independent variables explained only a small proportion of the variance in alcohol use.
Jolly DH (1993). An analysis of sexual practices among men attending gay bars in North Carolina. DR.P.H. Thesis, University of North Carolina at Chapel Hill, DAI, Vol. 54-08A, p. 2904, 354 pages.
Abstract by author: Risk reduction education remains the primary strategy for preventing AIDS and HIV disease. Effective health education efforts must be based on understanding the determinants of specific behaviors in the target population. While numerous studies have been conducted on HIV-related attitudes and behaviors among gay/bisexual men from large metropolitan areas in the U.S., much less is known about gay/bisexual men residing in more rural, low and moderate incidence areas. This study examined data on over 2,000 men from a survey conducted at gay bars in North Carolina in March 1990. In the descriptive portion of the study, an equal probability sampling method was used to describe the sexual risk-taking behaviors of men who attend gay bars in North Carolina. In the analytic portion of the study, a logistic regression model was applied to a conceptual framework based on Ajzen's theory of planned behavior in order to explore the relationship between the highest risk behavior (unprotected anal intercourse) and five psychosocial variables: perceived social norms, perceived behavioral control, attitudes, alcohol and drug use before or during sex, and personal acquaintance with persons who have AIDS or HIV. The descriptive study corroborated two major findings from other studies: gay/bisexual men have made substantial changes in sexual behavior in response to the AIDS epidemic and a substantial minority continue to engage in some high risk behaviors. Unsafe behaviors were associated with less education and residence in a rural county. In the logistic regression model the strongest predictors of unprotected anal intercourse (UAI) were personal acquaintance and alcohol/drug use. These findings run counter to the theory of planned behavior, which predicts that the effects of these variables should be mediated by the major determinants of behavioral intention: attitudes, subjective norms, and perceived control. Nevertheless, significant associations between UAI and certain measures of perceived control, attitudes, and social norms offer some support for Ajzen's theory. Significant interactions are analyzed to explain how certain demographic variables modify effects that several of these measures have on UAI. Implications of findings for theory, research, and practice are also discussed.
Jones JM (1987). Sexual practices of alcoholic and nonalcoholic women in the '80s. PH.D. Thesis, Rutgers The State University of New Jersey, New Brunswick, DAI, Vol. 48-07A, p. 1887, 234 pages.
Abstract by author: Purpose. This research examines sexual functioning of alcoholic women in abstinence with sexual functioning of nonalcoholic women and it examines drinking practices in relation to sexual practices. Methodology. Participants are nonrandom samples of 104 noninstitutionalized alcoholic women and 120 nonrandom, nonalcoholic women ranging from 18 to 60 years of age. Subjects include self-identified heterosexual, bisexual and homosexual females. The study defines sexual dysfunction as inability to function sexually for the individuals' own needs. Data from the Zuckerman et al. (1976) sex questionnaire are analyzed to determine differences between groups regarding functioning and types of behavior. Data from the Marvin A. Block (1962) drinking practices questionnaire and a quantity-frequency-variability index (Corrigan, 1980) are analyzed to assess correlations between former drinking practices and current sexual behavior. There are four hypotheses and several subhypotheses. Major Findings. Alcoholic women in this study, in abstinence, are not more sexually dysfunctional than nonalcoholic women with the exception of being less sexually satisfied despite their being as sexually active and as orgasmic in six out of nine variables, as well as more orgasmic through masturbation, dreams and lesbian contacts. The source of differences between groups is the self-identified, heterosexual only, alcoholic women who reported more homosexual experiences than nonalcoholic females. The majority of study and comparison group women did not report homosexual behavior. No differences are reported between alcoholic and nonalcoholic women in the bisexual and lesbian groups. For both alcoholic and nonalcoholic subjects, the more hard liquor they had consumed and the more problematic drinkers they were, the more homosexual behaviors are reported. Frequency of alcohol use is not related to sexual practices.
Kleine-Kracht AE (1993). How hiv positive gay men perceive seropositivity and what significance they give this diagnosis as evidenced by sexual behavior changes and care needs. D.N.S. Thesis, Indiana University School of Nursing, DAI, Vol. 55-09B, p. 3817, 167 pages.
Abstract by author: The purpose of this study was to describe the relationships among HIV positive, symptom-free gay men's perceptions of being seropositive, their self-reported changes in sexual behavior, and their self-identified care needs. Ten HIV positive gay men served as participants in this study. They ranged in age from 25 to 41 years, with a mean age of 34 years. The subjects' initial diagnosis of HIV positivity occurred 6 months to 7 years prior to the first research interview. Data were collected during two audiotape-recorded, open-ended, subject-oriented, 1-hour interviews with each subject. Data were analyzed by identifying components of the seropositive experience to which the subjects referred and their associated meanings. The components were categorized and then analyzed in relation to the research questions. Each of the 10 subjects in this study reported that the knowledge of his HIV positivity evoked the following self-reported changes in his life: (1) The change in perception of self as a result of being seropositive inVolved confronting his homosexuality, his own finiteness, and his mortality. Dealing with his own mortality led a subject to review his lifestyle choices and relationships with partners, family, and friends. Lifestyle changes were reported by 9 of the 10 subjects. These men reported improving their diets, including exercise in their lifestyles, eliminating drug use, and greatly decreasing alcohol use. (2) All 10 of the subjects reported being very motivated to practice protected sex or celibacy. This self-reported behavior differed from the reported trend among gay men of returning to unsafe, unprotected sexual practices. (3) The subjects' self-identified care needs included the need to be emotionally supported and accepted. Their physical care needs mainly inVolved prescribed medications and intervention for mild periodic illnesses.
Kus RJ, Ed (1995). Addiction
and Recovery in Gay and Lesbian persons.
Press. Also published in the Journal of Gay and Lesbian Social Services,
2(1), 1995. Link
to BUBL abstracts for papers listed below.
Lluy MA (1993). Factors related to alcohol use and preventive health care practices in the lesbian community. PH.D. Thesis, University of South Carolina, DAI, Vol. 54-11B, p. 5947, 107 pages.
Abstract by author: Alcohol use within the gay and lesbian community has long been thought of as problematic, more so than heterosexual alcohol use. However, few studies to date have addressed the issue of alcohol use among homosexuals without employing biased samples, usually of bar-patrons. The current study is an effort to gain a less biased estimate of the percentage of lesbians who abuse alcohol and to clarify the relationship between gay bar attendance, degree of disclosure and alcohol use. Additionally, the study attempted to determine if different sources of subject recruitment lead to biased samples. Estimates of preventive health measures were also obtained. Results suggested that the lesbian women may indeed consume more alcohol and tobacco than heterosexual women, but not in the percentages suggested by previous research. Gay bar frequency was significantly related to, and predictive of, increased alcohol consumption. Degree of disclosure was not significantly related to any of the three measures of alcohol used in the study. Subjects recruited from gay bars, lesbian organizations and friendship networks, did not differ significantly on demographic, lifestyle variables, nor in terms of alcohol use. The finding suggests that the source of subject recruitment may not be as significant as previously thought. In this study, the three samples of lesbians were not found to be from different populations. Finally, the results suggest that lesbians, despite being at greater risk for breast cancer, are not practicing self-breast exams at the recommended frequencies. Nor are they obtaining the recommended annual gynecological exam. Limitations of the study are discussed and further research is recommended before conclusions can be drawn from any of the study's findings. However, this study clearly aids in the understanding of the complex and understudied dynamics of the lesbian community and is one of the few contemporary studies on alcohol use among lesbians.
McCuistion LE (1989). Alcohol and drug use among gay men. M.S.W. Thesis, The University of Texas at Arlington, MAI, Vol. 28-04, p. 531, 76 pages.
Abstract by author: A high incidence of alcohol and drug use has been noted in the gay population, yet few definitive answers have been given as to factors contributing to the problem. This study was designed to investigate the effects of participation in a gay organization on levels of alcohol consumption and illicit drug use among the gay community. Survey questionnaires were completed by 58 gay men in the Dallas area. Results indicate that 90% of the sample have tried some form of psychoactive drug in their lifetime. Participants in a gay organization do have lower levels of alcohol consumption than non-participants. However, both participants and non-participants are equally likely to use psychoactive drugs. Furthermore, illicit drug use is negatively correlated to self-acceptance. Clinicians dealing with gay clients should be alert to the possibility of high levels of alcohol consumption and illicit drug use.
Neisen JH (1992). Family history, high risk behaviors and human- immunodeficiency virus (HIV) infection status in adult gay men with chemical dependency problems. PH.D. Thesis, University of Minnesota, DAI, Vol. 53-07A, p. 2560, 162 pages.
Abstract by author: As the AIDS (Acquired Immune Deficiency Syndrome) epidemic has moved into its second decade there are still few studies that have identified the role of familial antecedents in the development and progression of AIDS. This study examined familial antecedents of high risk sexual and intravenous (IV) drug using behaviors associated with HIV infection. Whereas most previous AIDS epidemiological studies focused on either sexual behavioral risk factors or IV drug using risk factors, this study examined both in a population of 100 gay men in one alcohol and drug treatment program. Data from this study indicates: (1) family variables are predictors of both sexual and IV drug using risk behaviors known to transmit HIV and (2) high risk sexual behaviors and IV drug use are predictors of HIV seropositivity. A series of multiple logistic regression analyses were used to identify predictors for (1) IV drug use, (2) high risk sexual behaviors and (3) HIV status. Parental psychoactive substance abuse increased the odds of IV drug use by 13% and high risk sexual behaviors by 12%. Parental divorce or separation increased the odds of engaging in IV drug use by 27% and high risk sexual behaviors by 73%. Subjects from families with a history of both parental psychoactive substance abuse and parental divorce or separation increased the odds of a history of IV drug use by 44% and high risk sexual behaviors by 95%. Concomitantly, IV drug use increased the odds of self-reporting HIV seropositive by 35%. High risk sexual behaviors increased the odds of self-reporting HIV seropositive by 92%. Lastly, exposure to HIV by both IV drug use and high risk sexual behaviors increased the odds of self- reporting HIV seropositive by 160% indicating that exposure via more than one mode of transmission greatly increases the likelihood of HIV seropositivity. These results indicate the need to target high risk families and youth to prevent IV drug use, high risk sexual behaviors and ultimately HIV infection.
Parks CA (1997). Passing phases: a study of motivating and constraining factors to lesbian alcohol use. PH.D. Thesis, Bryn Mawr College, The Grad School of Social Work and Social Research, DAI, Vol. 58-05A, p. 1921, 336 pages.
Abstract by author: Lesbians reportedly use alcohol more frequently and in greater quantities than heterosexuals, a practice that places them at greater risk for alcohol related problems. Though past explanatory theories have focused on psychosocial variables such as stress or the centrality of the gay bar to socialization, researchers have not examined lesbian drinking within the historical, social, and cultural contexts in which it occurs. This paper presents the findings of a qualitative, phenomenological interview study of thirty-one, Caucasian, non-urban, self-identified lesbian social drinkers (ages 23-79) conducted by the author between September 1995 and October 1996. Interviews focused on sexual identity development and alcohol use over the life course. Analysis focused on the meanings and interpretations assigned to alcohol and the motives and constraints to drinking that respondents identified in their lives. Findings reveal the importance of generational, social, and cultural contexts in understanding lesbian alcohol use. The author proposes a developmental model that reflects a correspondence between identity development and alcohol use. Both processes unfold within the contexts of bicultural competency acquisition and the changing social conditions of different historic eras. The normalized presence of alcohol in lesbian contexts, and norms related to its use, present distinctive dilemmas for alcohol problem identification within this population. Within limits imposed by the qualitative methodology employed, these findings and the proposed model have several implications for practice with lesbian clients. Risks for alcohol problems vary as lesbians progress from identity awareness to acceptance, suggesting different strategies and foci for intervention over time. Practitioners may act as mediators to facilitate bicultural socialization and acquisition of competencies for effective functioning in lesbian and heterosexual domains, thus reducing risks for problem drinking. Identification with a lesbian community and alcohol use norms operative in lesbian contexts may provide additional resources to support alterations in individual alcohol use patterns.
San-Giovanni D (1989). The association of drug use history with neuropsychological status in gay men with AIDS. PH.D. Thesis, California School of Professional Psychology, DAI, Vol. 50-08B, p. 3713, 134 pages.
Abstract by author: The association of a history of drug use for the six months and seven years preceding hospitalization with neuropsychological (NP) status in Gay men with AIDS was investigated. The subjects were 46 gay men hospitalized for their first episodes of Pneumocystis carinii pneumonia (PCP). Subjects with secondary diseases other than HIV infection that might lead to NP impairment were excluded. The subjects were interviewed for demographic information, had a battery of NP tests administered, and completed the Beck Depression Inventory (BDI) and drug use questionnaires. The NP measures analyzed were the Wechsler Memory Scale - Russell Version, Trail Making Test parts A and B, Shipley Hartford Institute of Living Scale, and Finger Tapping Test. Impairment on one NP measure was found for 78% of the sample and impairment on three or more measures for 67% of the sample, irrespective of degree of drug use. Drug use, predominantly alcohol and marihuana, was found in 93% of the sample. The sample was not selected for drug use and the use was primarily mild to moderate. There was a significant decrease from the seven year to the six month levels of use. Drug use was not found to be significantly correlated with NP performance. This was true for use over the six months and seven years preceding hospitalization, and for use of CNS stimulants, CNS depressants, and for poly-drug use. Controlling for the length of time that AIDS-related symptoms were experienced and for scores from the BDI did not enhance the results. Post-hoc analysis did reveal a small association between a verbal NP cluster and alcohol, sedative and stimulant drugs. The main hypothesis of an association between drug use history and a decrease in NP performance was not supported in this sample representing mild to moderate drug use. The hypothesis that AIDS alone leads to significant NP impairment was supported. The need for early assessment of NP functioning in patients with AIDS displaying signs of impaired functioning is strongly recommended.
Saulnier CF (1994). Alcohol problems and marginalization: social group work with lesbians and black women. PH.D. Thesis, University of California, Berkeley, DAI, Vol. 56-05A, p. 1988, 348 pages.
Abstract by author: Women may be more prone than men to the negative effects of heavy drinking yet problem drinking among women has not been given sufficient attention. Marginalized women's needs are often overlooked. This study provided two intervention groups for women with histories of alcohol problems, one for lesbians, another for African- American women. The goals were: (1) to create alternative interventions; (2) to expand the range of alcohol services for women; and (3) to provide a simultaneous focus on individual and social problems. This study used a multiple methods approach: (1) case studies of the intervention groups; (2) pre-test/post- test structured questionnaires; and (3) exploratory interviews. The structured instruments were: (a) quantity frequency measures of drug and alcohol consumption (Midanik & Clark, 1993); (b) political activist behavior scales (Robinson, Rusk and Head, 1968): (c) Attitudes Toward Women Scale (Spence & Helmreich, 1978). The majority of the data was managed qualitatively using HyperCard.Quantitative data was managed using MTSTAT. Twenty six women participated. The mean age of the black women was 38. For the lesbian group it was 34. Most participants were college educated. Lesbians scored higher on the Attitudes Toward Women scale, (p < .05) and were more likely to have been politically active (t = 2.504, df = 23, p < .05). The lesbian group. With each participant setting her own goals relative to alcohol use, consumption decreased significantly (t = 2.074, df = 7, p < .1). Frequency of drunkenness also decreased. The women used the group to reduce isolation and define appropriate uses for alcohol in their lives. They formed a peer-facilitated support group when the study ended. The black women's group. Members had stopped drinking prior to participation. Generally, the issues they addressed were not alcohol-specific but they reported valuing the opportunity to meet as a group of abstinent black women. Discussions often pertained to problems arising from the dichotomization of self and society. Results suggest that policy makers need: (1) a general approach that focuses on eliminating structural impediments to women; (2) to redesign the treatment delivery system for women to include recognition of the limitations in the notion of alcoholism as a disease.
Tao G (1995). Modifying high-risk sexual behaviors among gay and bisexual adolescents: evaluation of an intervention program. Ph.D. Thesis, University Of Minnesota, DAI Vol. 56:08B, p. 4273, 202 pages.
This study tries to identify historical trends and predictors of high-risk behaviors in gay and bisexual youth, using Social Learning Theory as a conceptual framework, and to evaluate the Youth and AIDS Project, using cost benefit/effectiveness analysis. Five-hundred and one male volunteers, 13-21 years of age, self-identified as gay/bisexual or having sex with men, were recruited into the initial interview in Minnesota during June 1, 1989-May 31, 1994. Three-hundred and seventy-six of them participated in the 3-month follow-up interview. The written instruments used in the interviews include measures of sexual behaviors, motivation, self-efficacy, knowledge about HIV/AIDS transmission, and psychosocial and demographical information. Loglinear regression in trends study, covariance structure models in HIV risk reduction study, and a model of HIV transmission in the evaluation of the Youth and AIDS Project are mainly used in this study. The findings indicate that with the increase of social supports, participants have an increase in their AIDS knowledge, but that good AIDS knowledge does not guarantee that participants change their high-risk sexual behaviors. High-risk sexual behaviors are correlated with participants' motivation, drug and alcohol use, parental relationship, AIDS knowledge, suicide attempts, and peer support. HIV risk reduction is predicted by past sexual experience, drug and alcohol use, and parental relationship. The intervention program could limit HIV prevalence to under 8% at year 2000 if all risky gay and bisexual adolescents were recruited to program participation and educated to modify their sexual behaviors. Without the intervention, HIV prevalence is predicted to be approximately 22% at year 2000. The cost-benefit ratio of the intervention program is approximately 1:18.7. The federal government should increase expenditures for AIDS prevention programs such as the Youth and AIDS Projects since the return to society from investment in these programs clearly exceeds their costs. Effective HIV prevention should be carried out at group or individual levels for gay and bisexual adolescents. Targeting of programmatic efforts at those who practice high-risk sex, those who have been involved in drug and alcohol use, or those whose parents have divorced would yield the greatest benefits.
Turner DC (1994). For the sake of male pleasure: gay identity, HIV, grief and risky sex. PH.D. Thesis, University of California, Los Angeles, DAI, Vol. 55-12A, p. 3900, 244 pages.
Abstract by author: This project uses an ethnographic and life history approach in providing a descriptive study of gay Identity development and the impact of HIV and AIDS on the mental, social, and physical wellbeing of HIV negative gay men who reside in West Hollywood, California. Theories and models of gay identity acquisition, notions of a cohesive self, and gay culture are discussed and modified based upon the data collected. The impact of HIV/AIDS on study participants includes styles of coping with the deaths of friends and lovers as well as sexual behaviors which put individuals at risk for HIV infection. Most gay men report occasional behaviors that put them at risk for HIV infection and are labeled as "relapsers" in the literature. In this study, comparisons of safer and unsafe sexual encounters suggest that unsafe events may occur because of the perceived extraordinary sexual abilities and physical attributes of sexual partners, heavy foreplay, and/or the use of alcohol and drugs. Moreover, all of these reasons have an impact on the brain which may impair the individual's ability to calculate risk. In light of these results, health education theories and psychological constructs such as self-esteem are discussed and suggestions for health interventions are given.
Publication No. 9513841
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