Working With Specific Populations: LGBTQ+

Sara Nelson, Loma Linda University, Mar 11, 2019

Rates of Drug Use

Trans

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• Most vulnerable population 
• Gender dysphoria and time spent as desired gender contributes to predicting substance use disorder

Gays/Bi Men

• More likely to develop problems with illicit drug use.

Lesbians/Bi Women

• More likely to develop alcohol and drug use related disorder.

SGM Teens

• 2x as likely to experiment with drugs and alcohol
• Attributed to higher instances of peer and family rejection

History

1933

Traditional safe spaces for SGM's may give insight as to why drug and alcohol use is so prevalent in this population 

Cafe Lafitte in Exile, New Orleans opens. Considered 1st gay bar still running today

1969

Marsha P. Johnson at Stonewall Inn initiates a movement against brutality in New York

1955

Daughters of Bilitis meets in San Francisco, as alternative to lesbian bars that were subject to raids and police harrassment

2016

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Predictors of Drug Use

Within each orientation, there are gender differences in types of substances used and differing subcultures around use.

Gender

Negative reactions to coming out may contribute to substance use, and is often correlated to recent drug use

Level of "Outness"

Correlated with higher drug use and polydrug use whether HIV status is known or unknown

HIV Status

Bisexuality and Transness appear to be an additional risk factor for problematic substance use.

Orientation

"Chronically high levels of stress faced by members of stigmatized minority groups. It may be caused by a number of factors, including poor social support and low socioeconomic status, but the most well-understood causes of minority stress are interpersonal prejudice and discrimination" (Gallego&Bockting, 2017)

Minority Stress

Refers to spaces SGM's often gathered (bars, clubs etc), and subcultures that can heavily feature drug use (gay men, gay fetish)

Affiliation With SGM Culture

Comorbidity

LGB more likely to suffer from mental distress and depression

Trans individuals more likely to experience depression, suicidality, self-harm and eating disorders

Higher rates of HIV from injectable drugs and unsafe sex

Sex addiction+Drug use

Treatment and Prevention Guidelines

“Substantial evidence from the cultural adaptation literature suggests that evidence-based treatments for distinct cultural groups (e.g., racial/ethnic minorities) yield better outcomes, including engagement, retention, and satisfaction in therapy, when they are adapted to address the distinct social-ecological contexts, presenting concerns, and symptom manifestations of those cultures compared with nonadapted versions of those treatments”

Pachankis (2018)

"

Prevention in Teens

• Setting expectations 
• Educating

Discuss

• Interest in teens activities
• Schools directly supporting SGM youth

Monitoring

• Family support
• Caring adults
• SGM Affirming school

Support

• Oppose 'zero-tolerance' policy
• Expand services to Homeless SGM youth
• Fund Prevention Research

Policy Changes

Cultural Competency

Treatment Guidelines

There need to be special considerations when treating SGM's

Being aware of SGM culture, history and issues as well as SGM affirming encourages retention

Trans Population

Due to vulnerability of this population inclusive safe treatment programs are a major priority

Differing Vulnerabilites

All orientations together have a high risk of substance use but certain orientation have additional risk factors that worsen symptoms

Inclusivity

There need to be more SGM targeted programs to send the message that these are also safe spaces

FOR LISTENING

Questions?

THANK

YOU!

References

Human Rights Campaign. (n.d.). Preventing Substance Abuse Among #LGBTQ Teens. Retrieved from https://www.hrc.org/resources/preventing-substance-abuse-among-lgbtq-teens

National Institute on Drug Abuse. (n.d.). Drug Use and Viral Infections (HIV, Hepatitis). Retrieved from https://www.drugabuse.gov/publications/drugfacts/drug-use-viral-infections-hiv-hepatitis

National Institute on Drug Abuse. (2017, September 05). Substance Use and SUDs in LGBT Populations. Retrieved from https://www.drugabuse.gov/related-topics/substance-use-suds-in-lgbt-populations

Green, K. E., & Feinstein, B. A. (2012). Substance use in lesbian, gay, and bisexual populations: An update on empirical research and implications for treatment. Psychology of Addictive Behaviors, 26(2), 265–278. https://doi.org/10.1037/a0025424

Gonzalez, C. A., Gallego, J. D., & Bockting, W. O. (2017). Demographic characteristics, components of sexuality and gender, and minority stress and their associations to excessive alcohol, cannabis, and illicit (noncannabis) drug use among a large sample of transgender people in the United States. The Journal of Primary Prevention, 38(4), 419–445. https://doi.org/10.1007/s10935-017-0469-4

Rosario, M., Schrimshaw, E. W., & Hunter, J. (2009). Disclosure of sexual orientation and subsequent substance use and abuse among lesbian, gay, and bisexual youths: Critical role of disclosure reactions. Psychology of Addictive Behaviors, 23(1), 175–184. https://doi.org/10.1037/a0014284

Pachankis, J. E. (2018). The scientific pursuit of sexual and gender minority mental health treatments: Toward evidence-based affirmative practice. American Psychologist, 73(9), 1207–1219. https://doi.org/10.1037/amp0000357

Gower, A. L., Rider, G. N., Brown, C., McMorris, B. J., Coleman, E., Taliaferro, L. A., & Eisenberg, M. E. (2018). Supporting transgender and gender diverse youth: Protection against emotional distress and substance use. American Journal of Preventive Medicine, 55(6), 787–794. https://doi.org/10.1016/j.amepre.2018.06.030

Nuttbrock, L. A. (2012). Culturally competent substance abuse treatment with transgender persons. Journal of Addictive Diseases, 31(3), 236–241. https://doi.org/10.1080/10550887.2012.694600

GLSEN. (2019). Bringing LGBTQ History to the Classroom. [online] Available at: https://www.glsen.org/article/lgbtq-history-1 [Accessed 11 Mar. 2019].

Sloane, C. (2019). [online] Naadac.org. Available at: https://www.naadac.org/assets/2416/craig_sloane_-_naadac_handouts.pdf [Accessed 11 Mar. 2019].

IMAGES

Dragons

https://www.redbubble.com/people/kaenith/works/14970564-pan-pride-dragon?p=poster

Cannabis

 http://thirdforcenews.org.uk/tfn-news/health-project-for-lgbt-people-launched

Marsha P Johnson

https://www.google.com/search?newwindow=1&biw=1440&bih=678&tbm=isch&sa=1&ei=3mGGXIq0MM2d-gSMvJbABQ&q=marsha+p+johnson&oq=mars&gs_l=img.1.0.0i67j0l5j0i67j0l2j0i67.26433.29885..31150...0.0..2.106.1317.17j1......2....1..gws-wiz-img.....0.dFqff-ea3f4#imgrc=EoFTCDQD-qSOLM:  

Gay bars

https://www.huffingtonpost.com/j-patrick-redmond/my-first-gay-bar_b_2920091.html   http://www.newnownext.com/oldest-gay-bars-in-america/10/2017/  

babadook 

https://mashable.com/2017/06/07/babadook-meme-lgbtq-pride/

Pulse photo 

https://www.google.com/search?q=pulse+nightclub&newwindow=1&source=lnms&tbm=isch&sa=X&ved=0ahUKEwi8-oye8frgAhWCCTQIHbVxCPgQ_AUIECgD&biw=1440&bih=678#imgrc=3Zkz_ozpZ4kEBM: