According to the Centers for Disease Control and Prevention, compared with the general population, gay and bisexual men, lesbian and transgender individuals have higher rates of substance abuse, are more likely to use alcohol and drugs and to continue heavy drinking into later life (http://www.cdc.gov/msmhealth/substance-abuse.htm). Many in the LGBTQ community have experienced violence, discrimination, harassment, and other issues that have impacted their physical and mental health, factors which may have steered them down the path of substance abuse.
The New York State Office of Alcoholism and Substance Abuse Services (NYS OASAS) recognizes that people in the LGBTQ community, especially younger individuals, with substance use disorder have specific needs during treatment and recovery and should even receive specialized prevention efforts. NYS OASAS, under the leadership of Commissioner Arlene González-Sánchez, assists all New Yorkers struggling with substance use disorder, regardless of sexual orientation, in getting the help and support they need so they can join the ranks of the millions of other Americans, living full, healthy lives in recovery.
The Lesbian, Gay, Bisexual & Transgender Community Center in New York City, an OASAS-certified and funded substance use disorder (SUD) treatment provider, has been a pioneer in treating and supporting LGBTQ community members with SUD. The Center’s programs and services provide more than 9,000 LGBT people annually with community-based services to foster healthy growth and development through the delivery of a range of supportive interventions, advocacy, outreach, education and capacity-building. The Center’s Chief Programs and Policy Officer, Carrie Davis, MSW, has decades of experience in developing guidelines, policies, regulations and best practices to better address the needs of LGBT individuals. Below are Ms. Davis’s responses to some key questions about the LGBT community and substance use disorder.
What substances are commonly misused in the LGBT youth community?
Davis: New York City does the annual Youth Risk Behavioral Survey, an annual survey where they engage with thousands of young people – including LGBT young people. 30 percent of gay young people are likely to use marijuana, only 14 percent of heterosexual youth are likely to use marijuana. 17 percent of gay young people are likely to use methamphetamines while only 1.9 percent of straight young people are likely to use methamphetamines. So, when you look at marijuana, it is almost twice as much, but when you look at something like methamphetamines we are looking at an almost eight times higher amount. And when we look at heroin use, 13 percent of gay young people are likely to use heroin and only 1.7 percent of heterosexual youth in the city’s survey are likely to use. The more we learn about LGBT youth, the more we learn that they are placed in extremely high risk for substance use.
What can we do to address substance misuse with youth?
Davis: When we talk about treating LGBT youth, we think about them as whole people. We think about them first as young people who are going through a very powerful, developmental stage, and we want to make sure we address their needs as young people—not just as people who are using substances. We want to help them become leaders in their own lives. We want them to envision what their future could be. We work with them to stay in school or get back into school. We work with them to get into college and to get good jobs. All these things are part of a modality of working with young people that is developmentally appropriate beyond just talking about substance use. A big part of our development is a strong connection to peers and role models.
In your years of experience, what have you found has worked best when working with the LGBT community?
Davis: Addressing LGBT substance use is most successful when using a holistic, asset-based model. Such a model combines aspects of evidence-driven best practices such as contingency management, trauma informed care, motivational interviewing and cognitive behavioral interventions. We also incorporate community-driven elements including LGBT cultural competency, peer role models and opportunities for peer leadership, LGBT community celebration and history, and a deep knowledge of LGBT identities. The Center perceives LGBT identities as normative and works with participants to develop a healthy and un-conflicted LGBT self-concept. Our approach also emphasizes positive LGBT role models and peer participation where participants adopt the behaviors of those who are similar, utilizing a harm reduction approach that emphasizes a “stages of change” methodology that the Center applies to abstinence recovery as well.
You offer psychiatric services on-site, which is unique. What types of services? Why is this important?
Davis: We offer psychiatric services on-site as part of our OASAS-licensed outpatient substance use treatment programs. Our psychiatrist is able to provide a complete psychiatric evaluation including diagnosis and ongoing medication management sessions to these clients, including Suboxone treatment for opiates. These services are important in the context of a substance use program for a number of reasons. First, because the psychiatric evaluation adds an additional layer of assessment to the treatment process from a psychiatrist/medical provider. Secondly, medications are often a useful tool in managing symptoms of Post-Acute Withdrawal Syndrome (PAWS) as clients cease using substances. Also, underlying mental health diagnoses can be assessed and treated. Those diagnoses may have contributed to the client’s use of substances in the first place. The ability to prescribe Suboxone on-site for opiate-addicted clients enables the program to retain these clients and further strengthen the likelihood that they will not return to opiate use. And lastly, like all of our services, having an LGBT competent psychiatric provider adds to the overall experience of our clients in the program.
How do you involve families in the process?
Davis: During the intake process we assess for supportive family members and/or attachment figures, such as supportive mentors, caseworkers or members of their chosen family. Given that LGBT youth are often faced with family rejection, we find that LGBT youth and young adults identify supportive figures within the LGBT community as part of their “chosen family.” We want to leverage these important people in the young person’s life to serve as a sustainable support to help the client maintain progress throughout treatment once it commences. This is facilitated through involving family member/attachment figures in some treatment sessions with the youth and giving them specific and concrete roles, such as helping with the implementation of contingency management, reinforcing progress and achieving clean drug screens (with incentives and positive feedback). They can also help to enforce consequences (for instance losing access to cell phone or certain privileges) when a youth has a positive drug screen or misses scheduled groups/appointments in treatment. We can also teach attachment figures how to provide and read drug screens to help monitor progress, even when the client is not coming to the treatment program.
NYS OASAS recently awarded you funding to start one of the first Youth Clubhouses in New York State, can you tell us about the program?
Davis: The Bridge-Q Youth Clubhouse program will be running within the next few weeks. It will be for LGBT young adults between ages 18 – 21 in need of recovery support services for substance use disorder as well as those at risk of SUD who are seeking a safe, drug-free environment. The goal is to create a Center member-led environment that utilizes the experiences of our clients and community to empower young LGBT adults both individually and as supports for each other.
In January 2016, Governor Andrew M. Cuomo announced more than $1.6 million in annual funding to create first-of-their-kind adolescent substance use disorder clubhouses in seven regions across New York State. For more on this community-based, innovative model visit www.oasas.ny.gov.
Carrie Davis, MSW, has worked collaboratively with New York City and New York State agencies and courts, as well as private enterprise to develop guidelines, policies, regulations and best practices to better address the needs of LGBT people. She is nationally recognized as an expert and advocate for the health and welfare needs of transgender people. The 2nd edition of Gary Mallon’s “Social Work Practice with Lesbian, Gay, Bisexual and Transgender People” included her chapter on “Social work practice with transgender and gender non-conforming people.”
Carrie currently serves on the HIV Health & Human Services Planning Council of New York, the New York City Police Department LGBT Advisory Committee and the New York City Department of Health and Mental Hygiene Advisory Board on Gender Marker Change. She joined the Hunter College School of Social Work in 2007 as an Adjunct Lecturer and served in this role through 2014. In 2015 Carrie was named a Woman of Distinction by the New York State Senate in recognition of her contributions to enrich the quality of life in her community.
The Center fosters a welcoming environment where everyone is celebrated for who they are. It offers the LGBT communities of NYC health and wellness programs; arts, entertainment and cultural events; recovery, wellness, parenthood and family support services. For more information about The Center, visit www.gaycenter.org.