Research reveals that individuals who identify as being part of the LGBTQ community represent a higher percentage of substance users as compared to those who do not identify. In fact, there are estimates to maintain that about 20 to 30 percent of the LGBTQ population is using substances as compared to about nine percent of the universal population (Hunt, J., March 9, 2012. American Progress, Why the Gay and Transgender Population Experiences Higher Rates of Substance Use). These percentages and statistics are also thought to be underreported due to factors such as fear of self-identification and lack of research (National Association of Lesbian and Gay Addiction Professionals, nalgap.org, July 2002). Despite these statistics, there are few facilities for LGBTQ substance users to engage in.
When considering substance use treatment services for the LGBTQ community it is imperative to understand the data that represents it at a much deeper level. In 2012, the Substance Abuse and Mental Health Services Administration (SAMHSA) stated in the Top Health Issues for LGBT Populations Information Resource Kit that those who identify as lesbians are 1.5 to 2 times more likely to smoke and that they are “significantly more likely to drink heavily than heterosexual women.” This publication also shed light on higher rates of suicide and major depression. In the same publication, it was noted that Gay Men “use substances, including alcohol and illicit drugs, at higher rates than the general population.” Bisexuals “exhibit significantly higher rates of binge drinking than their heterosexual counterparts” and transgender people are shown to have a higher rate of methamphetamine and injection drug use. It is also important to note that as a part of substance use treatment services for the LGBTQ community, the inclusion of mental health services is imperative. In a Hazelden Research Update, Klein, Audrey & Ross (2013) posit that 92% of the LGBTQ adult residential patient populations have a co-occurring disorder as compared to 78% of the heteronormative population.
With all of this quantitative information available it gives the impression that developing and implementing LGBTQ affirmative services into substance abuse treatment is warranted. To come to fruition, much planning is required. The initial stages of planning include the evaluation of resources. Resources to assess include those that are internal and external. Internally, consider the support that you have from management, administration and staff. Also contemplate the space that you have available as well as financial backing available for any training, staffing or LGBTQ inclusive materials. Externally, assess community resources, funding opportunities and existing services.
Training is a critical component when implementing LGBTQ substance abuse treatment services. In “A Provider’s Introduction to Substance Abuse Treatment for Lesbian, Gay, Bisexual and Transgender Individuals.” SAMHSA states that “understanding the appropriate terminology is essential to understanding LGBT clients.” These terms include, but are not limited to, sexual orientation, gender identity, coming out, homophobia and heterosexism. In addition to understanding terminology from a clinical perspective, administrative issues must also be addressed. Documentation and paperwork should be updated to reflect space for those who identify outside of the binary heteronormative population (Human Rights Campaign, Guidelines for Care of LGBT Patients, 2006). The Human Rights Campaign suggests providing several options for answering questions related to sexual or relationship partners, gender or sexual orientation, or, leaving the space blank for a participant to fill in themselves.
In regards to providing clinical services, it is recommended to incorporate differing therapeutic interventions and theories. Affirmative Therapy can be defined as “an approach to therapy that embraces a positive view of Lesbian, Gay, Bisexual, Transgender and Queer (LGBTQ) identities and relationships and addresses the negative influences that homophobia, transphobia, and heterosexism have on the lives of LGBTQ clients” (Rock, Carlson & McGeorge, 2010). Gay Affirmative Practice (GAP) models provide guidelines for behaviors and belief in social work practice with gay and lesbian individuals (Crisp, 2006). Utilization of either or both of these therapies is paramount when working closely with the LGBTQ population and community. Clinical services themselves may also merit alterations to be more inclusive. An example of a way to explore sexuality, gender and sexual relationship from an inclusive lens and perspective would be to use the “Genderbread Person” or The Sexualitree” from the website: www.itspronouncedmetrosexual.com.
Also of importance is the creation of a Safe Space. A safe space is both visual and sensed. Visually, a safe space will include literature, brochures and other materials that pertain to and are reflective of the LGBTQ community. It is also understood via clinical interactions and application of the aforementioned therapies. A Safe Space will also include gender-inclusive bathrooms. According to The Gay Alliance, a safe space is a “place where all people feel safe, welcome and included…aims to increase the awareness, knowledge, and skills for individuals and address the challenges that exist when one wants to advocate.”
A common discussion that exists is about the way in which these services are delivered. The question that is often posed is, “Do we facilitate these services separately from the general population or within already existing services?” This is a question that remains unanswered and exists with differing opinions. The ripple effect of this question is two-fold; if services are provided independently, the argument is that segregation is being perpetuated and if the services are provided within the general population one can question if there is there truly a safe space. Ultimately this dilemma leaves providers with a lot to think about.
Substance use treatment services are sparse for the LGBTQ community. In order to decrease the disparate percentages of substance users of the LGBTQ community compared to the general population, there is a need for additional services of quality and affirming interventions. It is evident that training is required and implementation of these services require much thought, planning and delicate execution.
If you have any questions or would like further information, please contact Jill Mastrandrea via email at jillmastrandrea@opiny.org or by phone at 718-383-7200 extension 6104.
