H1 Heading
Sub Text

Article Contents

H2 Heading

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Maecenas sodales metus sit amet ligula vulputate accumsan. Ut luctus ultricies lorem ut euismod. Quisque tempor, magna id pharetra tincidunt, tellus est sodales ex, sed lobortis quam libero id est. Donec tincidunt feugiat nibh, vel dignissim justo accumsan id. Class aptent taciti sociosqu ad litora torquent per conubia nostra, per inceptos himenaeos. In mattis elit quis nibh tempus, non mollis elit cursus. Ut aliquam volutpat porttitor. Ut rhoncus est sed feugiat faucibus. Nam in mauris ac mauris rutrum hendrerit at eu sapien. In tincidunt ipsum quis massa ornare sollicitudin. Sed non fringilla dolor. Suspendisse cursus at arcu et imperdiet.

H3 Heading

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Maecenas sodales metus sit amet ligula vulputate accumsan. Ut luctus ultricies lorem ut euismod. Quisque tempor, magna id pharetra tincidunt, tellus est sodales ex, sed lobortis quam libero id est. Donec tincidunt feugiat nibh, vel dignissim justo accumsan id. Class aptent taciti sociosqu ad litora torquent per conubia nostra, per inceptos himenaeos. In mattis elit quis nibh tempus, non mollis elit cursus. Ut aliquam volutpat porttitor. Ut rhoncus est sed feugiat faucibus. Nam in mauris ac mauris rutrum hendrerit at eu sapien. In tincidunt ipsum quis massa ornare sollicitudin. Sed non fringilla dolor. Suspendisse cursus at arcu et imperdiet.

Without LGBTQ+ affirming care, treatment centers cannot properly aid a significant portion of patients.
  • list Item
  • list Item
  • list Item
0%
Baby Boomers
00:00 LAURA LEVIN: Hello, my name is Dr. Laura Levin 00:03 and I use the female pronouns she, her, and hers. 00:07 I'm a board certified pediatrician and addiction 00:09 specialist. 00:10 And I also have expertise in transgender medicine. 00:13 Today I want to talk about substance use and substance 00:17 use disorder in the LGBTQ population. 00:21 Let's start with some basic definitions. 00:23 LGBTQ stands for lesbian, females 00:26 who are attracted to other females, gay, 00:29 males who are attracted to other males, bisexual, males 00:33 or females who are attracted to both males 00:35 and females, transgender, individuals assigned 00:39 one gender at birth that does not match up 00:41 with their own sense of their own gender, 00:43 also known as their gender identity, 00:45 and queer or questioning, populations who are sexual 00:49 and or gender minorities that are not heterosexual 00:52 and or cisgender. 00:54 The opposite of transgender is cisgender, 00:57 where an individual's gender identity does match up 00:59 with their assigned sex. 01:01 And that probably makes up about 98% or 99% of the population. 01:06 People have come up with various ways 01:07 to define their experience of their own gender. 01:10 Importantly, gender identity and sexuality 01:13 are independent of one another. 01:15 Remember, it's never OK to casually inquire 01:18 about one's sexuality. 01:20 Although medical providers frequently 01:21 must do this to obtain the history, 01:25 gender expression is the gender one shows to society and gender 01:28 transition is the process of dressing, taking hormones, 01:32 or having surgery to arrive at the desired gender expression. 01:36 Some people choose to take no steps to express their gender 01:39 identity for various reasons. 01:42 It is usually best not to make any assumptions 01:45 about an individual's gender identity or sexuality. 01:49 And again, it's only OK to ask about surgeries 01:52 in the context of a medical history, 01:55 not out of one's curiosity. 01:58 What are the origins of discrimination? 02:00 Well, people are born into a society 02:02 where one's experience is based on average day 02:04 to day encounters. 02:06 Combine this with the tendency of the brain to generalize, 02:09 make assumptions about various people in situations, 02:13 and arrive at the concept of bias. 02:16 Conscious biases are also known as prejudice 02:19 if they are negative. 02:20 Unconscious or implicit biases are ingrained habits of thought 02:24 that lead to errors in how we perceive, 02:27 reason, remember, and make decisions. 02:30 Things that are common to implicit biases 02:33 are that they are ubiquitous, they 02:35 are distinct from conscious biases, 02:37 they frequently don't align with our declared beliefs, 02:40 they tend to favor the in group or the group we are part of, 02:43 and they are malleable. 02:46 So anyone that exists outside the norm 02:48 is subject to explicit and implicit biases. 02:52 This can lead to intentional and unintentional judgments related 02:55 to age, race, religion, gender, national origin, disability, 03:01 obesity, sexuality, and gender identity. 03:04 Multiple studies across various disciplines, 03:06 including health care, law enforcement, and advertising, 03:09 show that unconscious bias is one of the leading causes 03:12 of inequality in society. 03:14 In health care, this manifests as a lower likelihood 03:17 to recommend knee surgery to women, 03:19 increased rates of long term benzodiazepine prescriptions 03:22 to elderly despite geriatric society recommendations 03:25 to the contrary, decreased rates of aggressive treatment 03:29 of cancer in elderly, and lower rates of prescription pain 03:32 medication provided to people of color, just to name a few. 03:36 Ironically, these decreased rates 03:38 of opioid prescriptions to people of color 03:40 may have had a protective effect to that population 03:43 in the current opioid epidemic. 03:46 In LGBTQ patients, it may manifest as refusal of care. 03:50 1% of transgender patients report 03:53 having been assaulted in physicians offices, 03:56 according to Woods. 03:58 Now how does this apply to the LGBTQ population? 04:02 In 2011, an Institute of Health report 04:05 found a paucity of research related 04:07 to medical or mental health in the LGBT community, 04:10 including those related to substance use disorder. 04:13 And while there were lots of research biases in studies 04:16 up to that point, evidence has shown 04:19 that LGB youth start earlier and are more likely to use tobacco, 04:24 alcohol, and illicit substances compared to heterosexual youth. 04:28 This holds true in adult populations as well. 04:31 The National Center for Transgender Equality 04:33 found much higher rates of substance use 04:35 in transgender persons in comparison 04:37 to the general population. 04:41 The current best explanation for these increased rates 04:43 of substance use and substance use 04:45 disorder in LGBTQ population include the same risk factors 04:49 that are associated with the general population, 04:52 plus additional risk factors due to minority stress, 04:55 prevalence of use in the community, 04:57 and social isolation. 04:59 Risks for all populations include biological factors, 05:03 environmental factors, and factors 05:05 related to the substance itself, such as ease 05:07 of availability, route of administration, cost, 05:11 and effect on the brain. 05:14 Minority stress originates from the external stresses 05:17 of experienced bias or discrimination 05:19 in school, at work, by law enforcement, 05:23 in medical facilities, and in churches, and at home 05:26 or in housing. 05:28 Minority stress, if prolonged and severe, 05:30 leads to disruption in general psychological processes, 05:33 as well as to internal stigmatization. 05:36 These disruptions of general psychological processes 05:39 include harmful coping mechanisms, decreased 05:42 emotional regulation, or interpersonal function, 05:46 and worsening cognitive function. 05:48 It may be easy for you to see how any of these 05:51 might lead to substance use. 05:54 Other consequences of minority stress 05:56 are related to the internal stigma 05:58 related to the stressors. 06:00 Including the desire to conceal one's identity, 06:03 the expectation of rejection, and internalized homophobia 06:07 or transphobia, which is the false belief that lies, 06:10 myths, and stereotypes taught to everyone 06:13 in a heteronormative and cisnormative society are true. 06:17 And these lead to higher incidence 06:18 of anxiety and depression, emotional disorders, 06:21 and substance use disorder. 06:23 Not to mention, increased marginalized work, 06:25 such as sex work, drug trade, higher rates of sexually 06:29 transmitted infections, including HIV, 06:33 lower levels of self care, and higher rates of suicide. 06:36 In one study, as many as 41% of transgender people 06:40 have attempted suicide. 06:42 45% in transgender people of color. 06:45 When LGBTQ individuals seek care, which is often 06:49 delayed due to previous experiences of discrimination, 06:52 they experience barriers to treatment, 06:54 including limited availability of programs 06:56 able to address culturally specific LGBTQ issues, 07:00 social isolation and treatment, possibly leading to targeting 07:04 by staff and patients, heteronormative side 07:06 discussions which exclude LGB patients, 07:09 and lack of identification, leading to resistance 07:12 to treatment by the patient. 07:15 The goal in all our communities is 07:17 to encourage resiliency, which for the LGBTQ community 07:21 is tied to affirming medical and psychological services. 07:24 This leads to less psychological comorbidity, less dysphoria, 07:28 and improved quality of life. 07:31 We, as providers, can encourage resilience 07:33 through the provision of evidence based care services 07:36 and through culturally competent care to our LGBTQ community. 07:40 In the field of substance use disorder, 07:43 there is great evidence for cognitive behavioral therapy, 07:45 trauma informed therapy, motivational enhancement 07:48 techniques, and contingency management. 07:51 For the transgender community member 07:53 who wants to medically or surgically transition, 07:56 we can use this fact as a motivation enhancer 07:59 since many medical providers will not offer these services 08:03 to people unstable in their substance use disorder 08:06 as it reduces their ability to comply with the treatment. 08:12 We can improve LGBTQ specific culturally competent care 08:15 by creating safe and inclusive spaces through the use 08:19 of things like a rainbow flag sticker or safe space 08:22 sticker in a place a new patient can see upon presentation. 08:26 This can be subtle, but they will almost certainly notice 08:29 it, even if other patients don't. 08:32 Providers use of correct language, 08:33 like asking the pronouns the person uses, 08:36 or introducing yourself with the pronouns, 08:38 much like I did in my introduction. 08:42 Also ask about the patient's partner, instead of husband, 08:46 boyfriend, or wife, girlfriend. 08:48 Next, it's important to communicate inclusivity 08:51 through the use of forms that allow for variation in gender 08:54 identity and sexual identity. 08:56 It is important that we don't tolerate micro aggressions 08:59 by calling out infractions as soon as one is made aware 09:02 of them. 09:03 Remember, it's crucial that we maintain confidentiality. 09:07 As gay and transgender persons are 09:09 victims of violence at much higher rates 09:11 than the general population. 09:13 And an inclusive staff guest functions with an identified 09:17 advocate on staff. 09:19 Or better yet, an employee who is out in open, if possible. 09:23 And finally, a session or two about culturally competent 09:26 LGBTQ health care is a great start, 09:29 but more education may be required, especially if this 09:32 is not your area of expertise. 09:35 You can continue to educate yourself 09:37 through resources easily available online and listed 09:40 in the description of this video. 09:41 [MUSIC PLAYING] 09:45

H3 Style Section

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Maecenas sodales metus sit amet ligula vulputate accumsan. Ut luctus ultricies lorem ut euismod. Quisque tempor, magna id pharetra tincidunt, tellus est sodales ex, sed lobortis quam libero id est. Donec tincidunt feugiat nibh, vel dignissim justo accumsan id. Class aptent taciti sociosqu ad litora torquent per conubia nostra, per inceptos himenaeos. In mattis elit quis nibh tempus, non mollis elit cursus. Ut aliquam volutpat porttitor. Ut rhoncus est sed feugiat faucibus. Nam in mauris ac mauris rutrum hendrerit at eu sapien. In tincidunt ipsum quis massa ornare sollicitudin. Sed non fringilla dolor. Suspendisse cursus at arcu et imperdiet.

H3 Style Section

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Maecenas sodales metus sit amet ligula vulputate accumsan. Ut luctus ultricies lorem ut euismod. Quisque tempor, magna id pharetra tincidunt, tellus est sodales ex, sed lobortis quam libero id est. Donec tincidunt feugiat nibh, vel dignissim justo accumsan id. Class aptent taciti sociosqu ad litora torquent per conubia nostra, per inceptos himenaeos. In mattis elit quis nibh tempus, non mollis elit cursus. Ut aliquam volutpat porttitor. Ut rhoncus est sed feugiat faucibus. Nam in mauris ac mauris rutrum hendrerit at eu sapien. In tincidunt ipsum quis massa ornare sollicitudin. Sed non fringilla dolor. Suspendisse cursus at arcu et imperdiet.

H3 Style Section

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Maecenas sodales metus sit amet ligula vulputate accumsan. Ut luctus ultricies lorem ut euismod. Quisque tempor, magna id pharetra tincidunt, tellus est sodales ex, sed lobortis quam libero id est. Donec tincidunt feugiat nibh, vel dignissim justo accumsan id. Class aptent taciti sociosqu ad litora torquent per conubia nostra, per inceptos himenaeos. In mattis elit quis nibh tempus, non mollis elit cursus. Ut aliquam volutpat porttitor. Ut rhoncus est sed feugiat faucibus. Nam in mauris ac mauris rutrum hendrerit at eu sapien. In tincidunt ipsum quis massa ornare sollicitudin. Sed non fringilla dolor. Suspendisse cursus at arcu et imperdiet.

Resources

  1. link
  2. link
  3. link
Sub Heading Text

Article Contents

Article Contents

Opioid Challenges in the Hispanic Community

The Hispanic opioid crisis has unique concerns for prevention and recovery. Here’s what you should know about culturally competent care for the Hispanic community.

Rates of Substance Abuse in the Hispanic Community

With a growing population of over 60.6 million, the Hispanic community is the largest minority population in the United States. As the misuse of opioids continues to affect people of all backgrounds, the Hispanic opioid crisis has put many in the community at risk for misuse and addiction.1 

While the Hispanic opioid crisis puts those in the Hispanic community at increased risk for misuse, cultural issues also make getting help more challenging. Health care providers can sometimes fail to understand how Latino culture a critical part of care for Hispanic opioid disorders can be. Finding the right help with a recovery center and counselors that understand these obstacles and provide culturally competent care is crucial for recovery.      

Statistics on Addiction in Hispanic Communities 

Hispanic opioid disorders are on the rise, especially among the youth. While the older population is much less likely to use opioids, younger generations in the Latino community face growing opioid use above the average population. 

While Hispanic Americans have a lower lifetime rate of illicit drug use (37.7%) compared with White (54.5%) and Black (45.9%) communities, they have the same rate of drug use disorder as the total population.2 

However, research into the rates of opioid use among Hispanic youth found that they had the highest prevalence of both illicit drug use and prescription opioid misuse compared to the general high school population.3 

With the rise of Hispanic opioid disorders, it is critical to provide early intervention to keep these numbers from rising in the future.     

Drugs Commonly Abused in Latino Communities 

According to the CDC National Vital Statistics System, some of the most abused drugs among the Latino community include:4  

  • Heroin
  • Prescription opioids, such as Vicodin and OxyContin 
  • Synthetic opioids, such as fentanyl
  • Natural opioids, like morphine and codeine 

Opioids include drugs that doctors prescribe to help manage pain. However, if they are not carefully used as directed, misuse can lead to opioid use disorder, addiction, and even Hispanic opioid overdose deaths. Prescription use of opioids has led to an alarming rise in addiction to both prescriptions and illegal drugs. This factor is true within the Latino community with the increase of Hispanic opioid disorders. 

Rising Latino deaths 

Much like the rest of the population, Latinos are continuing to experience rising fatalities in the Hispanic opioid crisis. Hispanic opioid overdose deaths increased 170% from 2014 to 2017, with deaths from synthetic opioids rising a staggering 617%.4 

The concerning rise in Hispanic opioid overdose deaths points to the need to create care specifically targeted to the needs and challenges within the Latino community.    

The Opioid Crisis in the United Statesy

Signs and Symptoms of Opioid Addiction

Hispanic opioid crisis

One of the critical first steps in recovery is realizing and recognizing the signs of a use disorder. Identifying these symptoms in yourself and others makes it possible to get help as quickly as possible.

The CDC defines opioid addiction as a chronic disease. It affects both the brain and the body, so addiction is mental, physical, and behavioral signs.

Some of the common signs of opioid addiction include:
  • Inability to stop or limit opioid use even when wanting to
  • Needing more significant amounts of opioids to get high and developing a tolerance
  • Strong and uncontrollable cravings
  • Making mistakes at school or work because of opioids
  • Damaging relationships with loved ones because of opioid use
  • New financial difficulties
  • Decrease in libido
  • Legal issues
  • Mood issues, including depression, mood swings, and anxiety attacks
  • Poor decision making
  • Lack of hygiene
  • Changes in sleep habits
  • Stealing from loved ones or businesses to pay for addiction
  • Lack of motivation
  • Potential physical symptoms of opioid addiction include:
  • Loss or lack of coordination
  • Slurred speech
  • Oversleeping or drowsiness
  • Sweating
  • Nausea or vomiting
  • Shaking
  • Constipation
  • Weight loss
  • Frequent flu-like symptom

What Causes Substance Use Disorders?

Several behavioral, environmental, and genetic factors make substance abuse more likely. Some of the most significant risk factors for addiction include:
  • Regular tobacco use
  • Stressful home life
  • History of mental health disorders, including depression and anxiety
  • Family history of substance abuse or addiction
  • Risk-taking and thrill-seeking
  • Unemployment
  • Poverty
  • Previous drug use
However, anyone can become addicted to opioids, even without any of these risk factors. Even when a doctor prescribes an opioid and it is taken strictly as directed, the body can still become addicted to the substance. Prescribed opioids must be taken for the shortest amount of time possible to help lower the chance of developing an addiction.

The Impact of Opioid Abuse for the Hispanic Community

Recovery Obstacles for Spanish Language Patients

Hispanic opioid disorders should have a road to recovery that takes their culture into account. The Latino community faces different challenges that require understanding and help from professionals that understand Hispanic culture. Some of the most common obstacles that they may face when treating Hispanic opioid use include:   

Language Barrier 

One of Latinos’ most common issues when seeking help is finding providers that speak their language. The lack of Spanish-speaking professionals, as well as health-related materials in their language, can interfere with accessing treatment for a sensitive topic such as opioid addiction. 

Health care facilities that receive federal assistance are required by law to provide free interpreters for those who have limited English proficiency. However, this provision is not always the case, and, in many circumstances, Hispanic youth serve as interpreters. A lack of professional interpretation can make some individuals reluctant to talk about opioid misuse because of the stigma that it carries.  

Financial Issues

Financial issues make individuals more at risk for developing an opioid disorder and can provide a challenge to seeking treatment. In-patient facilities are often more expensive and keep patients from being able to work. Additionally, it limits their access to other more costly forms of treatment, such as medication-assisted treatment.  

Hispanics are more liable to economic insecurity. The lack of financial resources can make the prevention and treatment of Hispanic opioid use more difficult.   

Limited Access to Treatment 

Language barriers, financial challenges, and cultural issues leave Hispanics with less access to treatment options than White communities. Research shows that they are less likely to use medical-assisted treatments (or MAT), such as methadone or naltrexone. A study of over 28,000 people in treatment found that Hispanics rely more on detoxification only compared to white individuals.5 

Many Hispanics face a lack of access to providers who speak Spanish and are culturally competent to work with Hispanic populations. A one-size-fits-all approach to care is not appropriate to the needs of the Latino community, and facilities should treat Hispanic opioid use with culture in mind.  

Resistance to Trust Outsiders 

As a part of the tight-knit community, trauma resulting from immigration and fear of deportation, many in the Hispanic community distrust outsiders, especially those in authority. As a result, preventing and treating the Hispanic opioid crisis requires input and active involvement within the Hispanic community rather than leaning on  those outside of their culture.

Sociocultural Factors Associated With Accessing Services

Beyond unique challenges, Hispanic culture also has other factors that need to be considered for opioid misuse prevention and treatment:   

Family 

In the Hispanic culture, familismo is a term that refers to the critical role that family plays in their everyday life. It stresses the importance of family social networks and distributing resources through these networks. It is a key concept to understand for preventing, treating, and enabling recovery for Hispanic opioid disorders. 

The involvement of family members and the inclusion of family in recovery is a critical approach throughout treatment, from engagement to continuing care. Hispanic opioid disorders are most successful when the concept of familismo is utilized throughout prevention, treatment, and recovery.  

Spirituality and Religion   

Religion is especially esteemed in Hispanic culture. Over 82% of those in the Hispanic community identify with a religion.6 Because religion plays such an essential part in Hispanic culture, it should be recognized and considered when creating effective engagement for the prevention, treatment, and recovery from opioid misuse.   

Immigration Issues 

The rise in instability in many Latin American countries has brought an increase in migration in the past few decades. Immigration and acculturation both impact mental health, and the trauma of these experiences increase the risk of addiction, especially when fleeing persecution. Fears of deportation can also cause mental health issues, as well as fear of seeking help. 

Immigration and acculturation must be considered and recognized as chronic stressors for many Hispanics. Although it can bring opportunity and is necessary for some, it can still increase the risk of mental health issues and addiction. It can also cause individuals to avoid seeking help if they worry they might be deported.  

Stigma    

One of the main barriers to the opioid crisis, in general, is the stigma that inhibits many from seeking help for themselves or their loved ones. While it is a treatable, chronic disease, many communities still view addiction as a moral failing. This stigma is especially problematic in the Hispanic community and causes many to avoid seeking treatment.  

It also puts others at risk for addiction because they do not understand how it can develop. It also prevents many from seeking help for mental health issues that can increase the risk of addiction. One study found that only 10% of Latinos with a mental health disorder even contacted healthcare professionals.7 

In addition, there is a lack of knowledge of and stigma about the treatments available, such as MAT. It is sometimes viewed in the Hispanic culture as a drug substitution instead of medication. As a result, many in the Hispanic community do not use MAT, which leads to lower success rates in recovery. Engaging and informing the Hispanic community about the nature of addiction and treatment options available is critical for preventing and treating the Hispanic opioid crisis. 

Families can also create an obstacle and can create stigma for Hispanic opioid disorders. If they have witnessed repeated relapse, family members may not believe that treatment and recovery are possible.  

Understanding the Hispanic Culture

How Can a Treatment Facility Be Culturally Competent?

To provide the best resources for those in the Hispanic/Latino community, professionals need to be culturally competent. A culturally competent facility should include:   

Hispanics are more liable to economic insecurity. The lack of financial resources can make the prevention and treatment of Hispanic opioid use more difficult.   

  • Staff Members educated in the Spanish language: Even for those who speak English fluently, Hispanic patients may feel more comfortable communicating in Spanish. In addition to bilingual staff members, providing resources in Spanish is critical for those who cannot read English. 
  • Staff sensitivity to the cultural nuances of the client’s culture: Culture affects a large part of who we are and how we react to our circumstances. Hispanic culture, like all cultures, is nuanced and should be respected. A culturally competent facility should have staff members that understand and are respectful of the Hispanic culture. 
  • Staff backgrounds representative of the client populationRepresentation is a critical component of inclusion. Hispanic professionals can most effectively help members of their community and have a more nuanced understanding of their culture. 
  • Treatment modalities that reflect the cultural values of the client’s culture. Treatments should reflect essential aspects of the Hispanic culture, such as the emphasis on family and reverence for religion.
  • Representation of the client population in decision-making and policy implementation. Many of us carry blind spots for cultures that are not our own. Hispanic leaders who have a voice in the decisions and policies that shape the facility are critical to ensuring there are no cultural blind spots.

The Hispanic community does not fit into a one-size-fits-all model of addiction care. Instead, facilities need to understand Latino culture’s unique aspects and nuances to ensure everyone has the support and resources they need for opioid prevention, treatment, and recovery. 

Resources

Article Contents