LGBTQ+ Affirming
Addiction Treatment

Is Your Center Equipped to Deliver patient-centered, culturally sensitive treatment services to the LGBTQ+ Community?

The Importance of Providing the LGBTQ+ Community with Affirming Care

This article shows why providing an LGBTQ-affirming treatment facility creates a more inclusive treatment environment and expands potential recruitment opportunities. Treatment programs that offer treatment to the LGBTQ+ community are vital to the growth of your treatment program.

The Importance of Reaching Out to the LGBTQ+ Community

It’s estimated that over 16 million Americans identify as LGBTQ+. Each generation of Americans sees a higher percentage of members identifying as LGBTQ+:1

Baby Boomers
Generation X
Generation Z

The significant increase from Generation X to Generation Z shows a trend that your treatment program needs to account for. Generation Z is approaching peak age for addiction issues, with its oldest members now in their mid-20s. In California, the numbers are more compelling. Approximately 28% of California’s LGBTQ+ population is Generation Z and 25% are Millenials.2

To remain competitive, your treatment program must create an inclusive environment for the LGBTQ+ community.

LGBTQ+ Members Experience Substance Use Disorders at a Higher Rate

Substance use disorder (SUD) can devastate lives if not treated, and LGBTQ+ people are 2.5 times more likely to develop SUD than non-LGBTQ+ members.3 However, healthcare and appropriate treatment for LGBTQ+ individuals are sparse. SUD treatment centers must bring more comprehensive LGBTQ+ affirming care to their models.

Without LGBTQ+ affirming care, treatment centers cannot properly aid a significant portion of patients.
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

How Do You Start Providing an LGBTQ-Affirming Treatment Facility?

Pair with a partner experienced in treating the LGBTQ+ community and who knows the ins and outs of providing an affirming treatment program. Partnering with experts allows you to provide urgent services quicker and with fewer missteps, thereby improving your reputation and profits.

The Bottom Line

Between 9% to 16% of your treatment demographic identifies as LGBTQ+ and experiences substance use disorders at a higher rate than the general population. Can you afford not to provide an LGBTQ-affirming treatment environment?

Defining LGBTQ+ and Substance Use Disorders

Let’s define the key terms that we discuss in this article. Namely, LGBTQ+ and substance use disorders.

What Does LGBTQ+ Mean?

The LGBTQ+ community is a minority group consisting of non-heterosexual and non-cisgender individuals. Cisgender means that one identifies with the gender assigned at birth. Because the LGBTQ+ community is diverse and complex, there are many definitions for each sexual and gender identity.

Gay is a term for those attracted to the same gender as themselves. Lesbians are women attracted to other women. Bisexuals are attracted to multiple genders. The Q in LGBTQ+ sometimes refers to questioning but more commonly means queer. Queer is a reclaimed umbrella term for members of the LGBTQ+ community.4 Other sexual identities embody the “+” in LGBTQ+. Asexual members do not experience sexual attractions. Pansexual individuals are attracted to someone regardless of gender. Some use bisexual and pansexual interchangeably, while others prefer one over the other. 4

The LGBTQ+ community also embodies varying gender identities. Transgender is a term for those whose gender does not align with the gender assigned to them at birth. 4 Being non-binary means something different for everyone. Non-binary individuals are those who experience gender outside of the male/female binary. Some nonbinary members use they/them pronouns over he or she.

These terms are constantly discussed, expanded upon, and debated amongst members of the community. Many members of the LGBTQ community will likely experience and define their identities differently than others. 5

Examples of Famous People in the LGBTQ+ Community

  • Lesbian – Ellen DeGeneres, Kate McKinnon
  • Gay Men – Pete Buttigieg, Neil Patrick Harris
  • Bisexual – Michelle Rodriguez, Drew Barrymore
  • Transgender – Laverne Cox, Caitlyn Jenner
  • Queer – Ezra Miller, Courtney Act
  • (+) Non-Binary – Elliot Page, Rose McGowan
  • (+) Gender Fluid – Ruby Rose, Miley Cyrus

Criteria for SUD

SUD harms one’s life and well-being. Substance use disorders can be mild, moderate, or severe. The symptoms fall into four overarching categories: impaired control, risky use, social impairment, and pharmacological criteria such as withdrawal and tolerance. 6 The DSM lists 11 different criteria for substance use disorder. Having 2-3 symptoms is a mild SUD, 4-5 symptoms signify a moderate SUD, and 6 or more indicates a severe SUD. Symptoms include:
  • The substance is taken for an extended period or in larger amounts than intended.
  • Unsuccessful efforts to cut back on the substance.
  • Excessive time dedicated to the substance, whether obtaining or using it.
  • Cravings for the substance.
  • Failure to meet major social and work obligations due to substance use.
  • Substance use occurs despite occupational problems related to it.
  • Quitting social, recreational, or occupational activities because of substance use.
  • Using the substance in dangerous situations.
  • Continued use of the substance despite the knowledge that it causes psychological or physical problems.
  • Tolerance of the substance increases.
  • Withdrawal symptoms when substance use stops.

For individuals with a substance use disorder, the misuse of drugs or alcohol is not voluntary. Brain imaging scans for those with SUD show physical changes in the areas responsible for behavior, decision-making, learning, memory, and judgment. In the LGBTQ+ community, substance use disorders consistently make life more difficult.6

00:00 so my name is Brian I'm an addiction 00:03 psychiatrist and I have the privilege of 00:05 supporting some of the most verbal 00:07 patients in LA County served by the Los 00:09 Angeles County Department of Mental 00:10 Health 00:11 I have no cuts of interested disclosed 00:14 and my pronouns are he/him and his so 00:19 I'm going to speak for about 40 minutes 00:21 take a few questions and then we have a 00:23 panel that's kind of my portion of the 00:26 morning and then there's a another 00:27 speaker this afternoon what I'm gonna 00:30 cover during our next 40 or so minutes 00:32 together I'm going to cover some 00:33 definitions and concepts I'm gonna talk 00:36 about substance use disorder treatment 00:38 also known as addiction treatment in 00:39 general I'm gonna talk about minority 00:42 stress and trauma a bit and then I'm 00:44 gonna talk about an approach to seeking 00:46 or to engaging LGBTQ individuals who are 00:49 seeking addiction services so that's 00:51 what I have planned for the next 40 00:52 minutes and I'm thrilled eager to join 00:54 me on the journey every person has these 00:59 four components to the human experience 01:02 we all have a biological sex we all have 01:07 a gender identity we all have a gender 01:09 expression and we all have such 01:11 orientation and this does not matter 01:13 whether you're a gay straight Syst trans 01:16 we all have this many people don't 01:19 necessarily need to think about it that 01:21 is their assigned sex at birth matches a 01:24 cisgender identity matches a 01:26 heterosexual identity and culturally 01:29 those things are normative and so you 01:31 don't necessarily think about that you 01:35 have a sex or sex orientation or gender 01:37 identity but these are all for 01:40 orthogonal related components what does 01:42 that mean that means that the sex you're 01:44 assigned at birth does not necessarily 01:46 dictate what your gender identity is 01:47 which does not dictate what your gender 01:49 expression is which doesn't have any 01:51 bearing necessarily on your sexual 01:52 orientation so with this framework I 01:55 want to talk about the gingerbread 01:56 person the gingerbread person has a 01:59 gender identity right somewhere between 02:01 you know man woman or genderqueer 02:03 potentially in the middle and a gender 02:05 expression between things that are 02:06 masculine potentially feminine or 02:08 somewhere in between 02:11 biological sex between sort of male and 02:13 female 02:13 and there's lots of terms that are 02:16 oftentimes used related to people who 02:19 don't identify as male or female 02:20 sometimes it's androgynous there have 02:22 been the term intersex has been proposed 02:25 the term that I use is difference of 02:27 sexes development just because you know 02:29 you can have sex development in some 02:31 ways it's atypical and sexual 02:33 orientation heterosexual gay or bisexual 02:37 okay so biological sex it can actually 02:40 be determined by a number of different 02:41 factors I could give an entire lecture 02:43 just on sex development but suffice to 02:45 say we have chromosomes that oftentimes 02:48 would not always match up with the way 02:50 external genitalia developed and the way 02:52 that sex is typically assigned at birth 02:53 is that the baby is born the 02:55 obstetrician looks at the genitals and 02:56 that's it that's the tip that's the 02:58 typical process and if the the 03:01 obstetrician looks at the generals and 03:02 can't tell or there's in some ways sex 03:06 developed is atypical it's usually 03:07 called a difference of sex development 03:09 so that's sex development now sexual 03:12 orientation refers to a sexual 03:14 attraction or arousal either to a 03:16 particular body type or identity and 03:18 actually we think of heterosexual 03:21 homosexuality bisexuality is sort of 03:23 common forms of sexual orientation 03:25 there's also some sexual orientations 03:28 that have been identified and are listed 03:29 in the DSM as pathologies or fetishism 03:32 Zoar paraphilias and these are distinct 03:35 from sexual orientation identity terms 03:38 so there are people that actually 03:39 identify as gay straight bisexual 03:42 lesbian and the terms like homosexual a 03:46 heterosexual generally are not identity 03:48 terms those are firm refers sexuality 03:50 but not necessarily are people identify 03:52 in the world so - this is the construct 03:56 that I use is the components of sexual 03:58 orientation include your sexual identity 04:00 that is how you label your sexual 04:02 orientation and could be gay straight 04:04 bisexual or other your sexual behavior 04:08 what you do sexually with other people 04:10 and then your sexual attraction and so 04:12 there are people for example that 04:14 identify their sexual identity is 04:16 straight and their sexual attraction 04:19 might be to people of different sexes 04:22 and their sexual behavior might be full 04:25 abstinence they may not have 04:26 on sexual relations with other people 04:29 right so those are people where you 04:31 don't always get perfect congruence 04:33 between how one identifies one's actual 04:36 attraction and then one's behavior so 04:38 there are for example straight men who 04:40 have sex with other men that don't 04:41 identify necessarily as gay or bisexual 04:44 that their behavior doesn't necessarily 04:46 match their identity but those are sort 04:49 of the components we think of sector 04:50 orientation so gender identity is 04:53 distinct from sexual orientation sexual 04:55 orientation is related to attraction 04:56 gender identity has to do with one's 04:59 internal sense of gender that's the 05:01 experience the experience of one's own 05:04 gender and it can correlate with the 05:06 assigned sex at birth it's generally 05:08 called cisgender people but it can 05:11 differ from it and that generally refers 05:13 to people who identify as transgender 05:15 and there are culturally established 05:17 gender categories that usually serve as 05:20 the basis for the formation of 05:22 somebody's identity so in the United 05:25 States and in most Western cultures we 05:27 have a binary between male and female 05:29 now that doesn't mean that those are the 05:31 only two options but culturally those 05:33 are the sort of the normative two 05:34 genders not every culture has followed 05:38 that right so I know in Native American 05:39 culture there's been sort of people 05:41 identify as two-spirit who it which is a 05:44 gender identity that's not a male or 05:45 female is sort of a distinct category 05:49 and I do want to talk a bit about gender 05:51 transition it's sort of it's early to 05:53 jump into this but I want to be clear 05:56 about what we mean when there are people 05:58 whose internal sense of gender does not 06:01 match the the gender that they were 06:05 assigned at birth or the sex that they 06:07 were assigned at birth there are people 06:09 who may choose to undergo what's called 06:11 gender transition gender transition 06:13 typically refers to the process where 06:15 somebody makes a change in their gender 06:17 expression or in actual their uses 06:22 medical procedures to adjust their 06:24 physiology or Anatomy in order to 06:27 comport their own bodies with their 06:29 internal sense of gender and I know that 06:32 this is small so I'm not gonna you know 06:34 torture you by reading all of it but I 06:36 do want to say for some people there's a 06:38 self-awareness or 06:40 self-realization that there's a 06:43 difference between the the gender they 06:45 were assigned at birth in their internal 06:46 sense of gender and oftentimes but not 06:49 always it can be helpful for somebody 06:52 who who's in you know who may identify 06:55 as transgender to get some support 06:58 around that now I'm a psychiatrist it's 07:00 sort of easy for me to say that oh you 07:01 should go get support but I will point 07:03 out that seeking assistance from a 07:05 mental health professional can be an 07:06 important part of transition it's not 07:09 mandatory right it's not that that being 07:10 transgender requires some special 07:12 treatment but I do think that it can be 07:15 helpful particularly if people want to 07:16 navigate like the medical treatment 07:19 world to be able to like coordinate 07:21 referrals and get and then some people 07:25 sort of stop there they realize that 07:28 their gender identity and that's and 07:32 they realize that but that's all that 07:33 they sort of choose to do about it 07:35 but over some timeframe there are people 07:37 that then choose to change their 07:39 appearance and their gender expression 07:40 to coincide with their internal sense of 07:43 gender and for some people that might 07:45 involve clothing changes that might 07:47 involve hair styling changes that might 07:48 involve makeup changes and for some 07:51 people that involves none of those 07:52 things but that there is some change in 07:54 their appearance and expression to 07:55 coincide with their internal sense and 07:59 often times you know is sort of 08:02 concurrent with this there's a 08:03 coming-out process 08:04 what do I mean by coming out coming out 08:06 so when somebody generally shares their 08:08 internal experience with the world it is 08:10 for most people a lifelong process I 08:12 think of coming out so I just full 08:17 disclosure identify as a he him in his I 08:20 am a cisgender gay man and I was gonna 08:24 be in Louisville this week so I needed 08:28 to buy flowers for my husband because 08:30 you know I wasn't gonna be there for 08:32 Valentine's Day 08:32 and so um and so I went to a flower shop 08:35 and I bought flowers and the flower shop 08:38 person said oh don't worry these are 08:40 gonna be so lovely for your wife I 08:41 thought ah this is a chance to come out 08:43 again right 08:47 and and and people who are identified as 08:52 lesbian gay bisexual or transgender 08:54 oftentimes are in the position of coming 08:56 out on a continual basis and it kind of 08:58 depends on a situation like there are 09:00 some people who don't necessarily by 09:03 virtue of the gender expression don't 09:05 necessarily need to come out but that is 09:07 so there are people who someone is just 09:09 make it clear by virtue of their gender 09:10 expression what their gender identity or 09:13 sexual orientation is but it really 09:15 depends and so point is is that for many 09:17 people there's a coming-out process that 09:19 coincides with a change process around 09:22 one's gender expression and for many 09:24 people that concludes their transition 09:26 now there are some people that then get 09:29 referrals from mental health for hormone 09:31 therapy on gender affirming hormone 09:33 therapy or gender affirming procedures 09:35 and there's a whole again we could 09:36 probably give a whole talk just about 09:38 gender transition but I put the slide up 09:40 as a way of illustrating that for people 09:43 with transgender gender identities 09:45 oftentimes there is a process associated 09:47 and the process involves an internal 09:51 process for some people an actual sort 09:54 of externalized change process and and 09:57 usually a coming-out process okay just 10:00 so that everyone knows there is a 10:02 guidebook to gender transition it's 10:05 called the world professional 10:07 association and transgender health 10:09 standards of care their latest standards 10:11 were published in 2011 this is the link 10:14 and the University of Louisville the 10:18 Division of Child and Adolescent 10:20 Psychiatry supports youth that are 10:24 exploring their gender identity and 10:26 transition in accordance with those 10:28 standards of care the experience related 10:33 to having a minority status can be quite 10:37 stressful and that's true sort of 10:41 regardless whether you're talking about 10:42 people of non majority religious 10:45 affiliation whether you're talking about 10:47 people with different abilities or 10:48 ableism you're talking about people at 10:50 different age groups but minority status 10:52 can be stressful and what we find is for 10:55 people with the transgender identity 10:57 that is the interpersonal trauma the 10:59 inner sort of discord between 11:01 somebody's experience of themselves and 11:04 between the gender role in which they 11:06 were assigned tends to be highest before 11:08 any transition process and improves 11:11 really throughout the transition process 11:13 but the the interpersonal so the 11:16 interest psychic process during 11:18 transition tends to get a lot better but 11:20 the interpersonal process the sort of 11:22 discrimination and frankly violence that 11:27 is sometimes enacted against transgender 11:28 people tends to peak in the middle of a 11:31 transition process when people are still 11:33 solidifying their presentation and their 11:35 ID and their externalized identities and 11:37 that we find that as people stabilize in 11:42 their lives as people sort of are you 11:44 know eventually sort of craft their 11:49 living according to sort of 11:51 authentically to their internal sense of 11:53 self that we find that the interpersonal 11:55 trauma eventually goes down but kind of 11:57 in the middle you get all kinds of stuff 11:59 for people this gender people there's 12:01 all these like bathroom bills that get 12:03 created I mean there's all these sort of 12:05 you know interpersonal traumas that that 12:08 that are created that oftentimes peak as 12:11 people in the middle of their transition 12:12 process point is is that gender 12:16 transition can be life-changing and 12:18 hugely affirming of mental health for 12:20 transgender people and that the trauma 12:23 sort of related to that improves in 12:25 interest psychically throughout order 12:27 personally ensure personally but 12:29 interpersonally out we do see sort of a 12:32 peak gender identity is not determined 12:34 by appearance or age or your observed 12:37 gender expression and I was taking an 12:39 English class in college and somebody 12:41 asked my professor well you know how 12:44 many transgender people you know if you 12:45 run into on campus being like there's 12:47 basically there's no transgender people 12:49 here and he says well how would I know 12:50 right I don't expect everybody that's 12:53 transgender oh so they're going to come 12:54 out right and the same way I don't 12:56 expect everyone that's LGBT to come out 12:57 unless the buying flowers okay that's a 13:00 joke 13:02 gender expression so I mentioned gender 13:05 identity that is internal sense of self 13:06 and I sort of alluded to gender 13:08 expression earlier but gender expression 13:10 really is whether or not do you conform 13:12 with societal norms 13:14 around the way that you're supposed to 13:16 dress and the way that you're supposed 13:18 to behave as somebody of a certain 13:20 gender so I I would say that I'm 13:24 comporting right now wearing a suit with 13:26 a lavalier and you know belt in these 13:28 shoes with stereotypical masculine sort 13:31 of gender expression hair looks the way 13:35 that I've shaved I mean this is the kind 13:37 of standard I would say relatively 13:39 normative male gender expression if I 13:42 was up here saying dragged 6-inch heels 13:44 big dress huge wig and lots of makeup 13:47 you would say this is somebody with who 13:51 might be gender non-conforming right I'm 13:53 still male I die I don't identify 13:55 something other than male but as one 13:58 example there are people in the drag 13:59 queen community who whose gender 14:01 identity is generally a still you know 14:05 cisgender male but whose gender 14:07 expression might be very different than 14:09 cultural norms around that and so it's a 14:12 way of illustrating this so you can have 14:15 a masculine gender identity that is you 14:18 can say that I'm a man and that a 14:21 masculine gender expression and then you 14:23 would say that person's gender 14:24 conforming but you can have a masculine 14:26 gender identity but have a feminine 14:28 gender expression and then be gender 14:31 non-conforming and then if you say well 14:33 I don't buy the gender binary at all 14:35 like that's not something I don't I 14:36 don't do you know I'm not sort of a 14:38 binary thinker then in my gender 14:41 expression you might be somebody that at 14:44 least in this schematic we label 14:45 androgynous somebody that doesn't 14:46 necessarily fit culturally norms around 14:48 gendered expression or behavior and then 14:51 sort of same thing with people who don't 14:54 identify necessarily with the masculine 14:56 or feminine gender identity who say I'm 14:58 non-binary I'm just a queer there's all 15:00 kinds of terms that are oftentimes used 15:02 for people that sort of reject 15:04 identities as either male or female and 15:06 so this is a screenshot of a music video 15:09 by a the lead singer of Rilo Kiley's who 15:14 she herself identifies as female but in 15:17 the course of the video has a whole 15:18 number of different gender expressions 15:20 that that range between what we think of 15:22 as culturally feminine and culturally 15:25 masculine gender 15:26 questions and is a way of sort of 15:28 illustrating the differences you see in 15:31 gender expression 15:32 so I want to actually I introduced the 15:34 gingerbread first at one point oh but 15:35 actually I think a better model is the 15:39 gingerbread person 2.0 which does not 15:41 posit that male and female nests are 15:43 binary or so in any ways opposite to 15:45 each other because they're not and so 15:47 you can actually have a gender identity 15:49 that has varying degrees of maleness or 15:51 womanís and there are people say I 15:53 actually am non-gendered and so this 15:56 doesn't then creates instead of there 15:58 being an access with two poles and 15:59 there's some way opposed you actually 16:01 have an axis where those things are 16:02 orthogonal II related and so same thing 16:04 with gender expression there are people 16:06 so I've seen I have friends actually who 16:10 have very masculine components of their 16:12 gender expression in terms of the way 16:15 that their bodies are there the the way 16:17 that their hair is but when they dress 16:18 in drag have very both masculine and 16:20 feminine components the way that they're 16:23 doing their gender expression at least 16:24 at that particular time as opposed to 16:26 people who were a gender right that they 16:27 don't identify or they're their gender 16:29 expression is relatively neutral and and 16:31 free of what we think of as 16:33 masculinizing or feminized in components 16:35 and so biological sex can include 16:38 varying degrees of maleness or 16:39 femaleness and attraction can go from 16:41 asexual to being attracted to men being 16:44 attracted to women being attracted to 16:45 women you know in around companionship 16:50 and men around sex activities I mean 16:52 there's all sorts of components of 16:53 sexual orientation that we could get 16:54 into but this I think is sort of a more 16:57 nuanced understanding than trying to say 16:58 that 16:59 so how male and female that are on 17:00 opposite ends of the poles and then just 17:02 other terms we should be aware of is 17:04 there's a term Ally that's oftentimes 17:06 used Ally refers to cisgender or 17:08 heterosexual people who support sexual 17:11 and gender diversity and then so the 17:14 term LGBT gets thrown around that refers 17:16 to lesbian gay bisexual and transgender 17:19 LGB or flexure orientation identity 17:21 terms transgender is a gender identity 17:23 term but that's a term that's often 17:25 times used I tried to find the longest 17:27 acronym that I could to sort of 17:32 illustrate that there's other that 17:33 there's other acronyms and so LGBT TI QQ 17:37 2 sa stands for lesbian gay bi 17:40 actual transgender transsexual intersex 17:43 queer questioning two-spirit and allies 17:45 right and and so it as you can I don't 17:49 know if it's I've made it obvious so far 17:50 but the terminology around these terms 17:53 can be quite messy and I've used the 17:56 term intersex here intersex is actually 17:58 not a universally established term so 18:03 what do I mean by that 18:04 well the intersex Society of North 18:06 America is a group devoted to addressing 18:08 a differences of sex development and 18:12 trying to support deferring any surgical 18:17 modification of a typical genitalia 18:19 unless there's sort of a medical 18:21 necessity around a managing malignancy 18:23 risk until somebody is old enough in 18:26 order to be able to choose such any such 18:28 procedures for themselves but intersex 18:31 is sometimes also used by people who say 18:33 I don't identify as a man or woman 18:35 identified somewhere in between and has 18:37 nothing to do with genitalia development 18:38 it has everything to do with just you 18:40 know somebody rejecting a gender binary 18:42 and so what I oftentimes do in cases 18:46 where somebody's using a term is I 18:47 provide sort of gently inquire so what 18:51 do you mean by that okay so you identify 18:52 like what is being so I put two spirited 18:57 up here I think I know what two spirited 18:58 means but if I'm talking to somebody 18:59 what do they think that it means sort of 19:01 just be open and and have a bit of 19:04 humility around terms that people use 19:06 all kinds of different ways okay so how 19:08 many LGBT people are there sort of 19:11 depends on how you count oftentimes 19:14 there there is a when I was in college 19:18 there was sort of like a culturally 19:21 assumed number of like one in ten but 19:24 actually it's probably less than that 19:26 somewhere between 2.2 percent and 5.6% 19:30 kind of depending on who's counting at 19:32 the time the last number that I looked 19:36 at up from a population-based survey was 19:38 somewhere around three and a half 19:38 percent but we do know that the term 19:43 sort of lesbian gay bisexual and 19:44 transgender are themselves culturally 19:46 defined and so they're for different 19:48 generations that people have different 19:50 cultural notions related to what those 19:52 terms mean 19:53 we know that 0.6 percent of adults the 19:55 United States are about 1.4 million 19:57 people identify as transgender and we 19:59 see that it's actually much higher in 20:01 younger generations than an older 20:04 generation so there's a generational 20:06 effect around people's identification 20:08 with being lesbian gay bisexual or 20:10 transgender 20:11 now Louisville actually ranks as the 20:13 11th among major US cities for hosting 20:17 LGBT populations so there it is you know 20:20 somewhere between Hartford and Virginia 20:23 Beach and actually if you sort of look 20:25 at the the percentage you know so if San 20:28 Francisco's to the top at 6.20 and you 20:31 know LA where I live is a 4.6 but Google 20:33 is like right there I mean you know 20:35 within I would say a percentage 20:36 certainly within a percentage point of 20:39 cities like Los Angeles select City 20:42 Denver Boston so I you know I think of 20:45 Louisville as having a really important 20:49 cultural impact in this part of the 20:51 country so I mentioned that being LGBT 20:54 can be stressful and so I want to sort 20:57 of put up and this is you know again we 20:59 could spend a whole 40 minutes just on 21:00 the minority stress model but there's 21:02 this idea that you have circumstances in 21:05 the environment that interact with 21:07 minority status or intersect with 21:09 minority status do create a minority 21:12 stress process that includes prejudice 21:14 events as well as expectations of 21:16 rejection consumed in and internalized 21:17 homophobia or transphobia and fertilised 21:20 isms the compound with general stressors 21:22 that can lead to mental health outcomes 21:26 that can be negative or positive and the 21:28 mediators of whether or not a stressful 21:30 event leads to a Mensa how come depends 21:34 on various characteristics of minority 21:36 identity and a number of resiliency 21:38 factors so that's a really complicated 21:39 way of saying this next slide which is 21:41 social support emotional openness 21:44 openness and hope and optimism can 21:47 create a lower reactivity to prejudice 21:49 and support psychological health and 21:51 people that have poor social supports 21:55 that are now particularly emotionally 21:57 open and who are not particularly 21:58 strongly future-oriented 22:00 people who have like an external locus 22:01 of control who do a lot of externalizing 22:03 I'm 22:04 often times have a higher reactivity to 22:06 prejudice and it can lead to poorer 22:08 psychological health does that kind of 22:10 make sense alright um so as a way of 22:13 sort of illustrating this we know among 22:15 people who identify as gender 22:17 non-conforming and I mentioned younger 22:19 generations have an increasing are 22:23 increasingly more likely to identify as 22:25 LGBT but overall in this California 22:30 population-based survey 17 percent of 22:32 the youth between the ages of 12 and 17 22:34 identified as gender non-conforming in 22:37 this particular sample and had a 22:39 significantly higher rate of severe 22:42 psychological distress compared to 22:43 people who are gender conforming um 22:45 there are other population-based survey 22:48 and I do want to sort of talk about 22:49 addiction services now we've gone 22:50 through identity firms and and and 22:52 endemic demographics and what we know 22:55 about sort of numbers to talk about what 22:58 do we know about substance use disorders 23:00 so the nice are the national 23:01 epidemiologic survey of alcohol and 23:03 related conditions long national survey 23:06 looking at a whole number of substance 23:07 use and mental health indicators found 23:09 that the odds of developing a substance 23:12 use disorder compared to people who were 23:15 straight for lesbian women was three 23:19 times as likely to have alcohol use 23:20 disorder thirteen eleven point three 23:23 precisely more likely to have cannabis 23:25 use disorder and fourteen percent more 23:28 likely to have or not 14 percent 23:31 fourteen times more likely to have 23:32 substance use disorder every bisexual 23:34 woman 23:35 you also see sort of elevated rates of 23:36 alcohol use disorder cannabis and other 23:38 substance use and then for for gay men 23:41 there's about three times for alcohol 23:43 use disorder 4.4 for cannabis use 23:45 disorder but you see sort of 23:47 dramatically increased risks related to 23:49 substance use which is not because being 23:52 LGB or tea is somehow intrinsically 23:55 associated with substance use but 23:57 because the minority stress experienced 24:00 by people who are LGBT in the context of 24:02 the world oftentimes creates an 24:04 opportunity through people to use 24:06 substances as a solution and for people 24:08 that use substances at least in my 24:10 experiences in addiction psychiatrist 24:11 who used substances as a solution to a 24:14 problem and that substance then becomes 24:16 its own problem 24:17 right so you have to then address the 24:19 problem that was the solution to the 24:21 problem to sort of begin with for 24:24 tobacco there's elevated prevalence of 24:25 smoking and LGBT populations or LGBT 24:28 populations this sample did not include 24:30 trans folks between 1.5 and 2.5 percent 24:34 and sorry I've mentioned now what we 24:37 know about lesbian women bisexual men 24:39 gay men and bisexual men I've talked a 24:41 little bit about LGBT folks but what 24:42 about trans people well now then the 24:45 SARC survey did not ask questions about 24:48 gender identity so we don't have any 24:50 information about gender identity from 24:51 that particular a PD illogic survey so 24:55 we have from trans people are generally 24:58 convenient samples and that are not 25:01 national they tend to be localized 25:02 convenient samples and as a result it 25:06 limits the generalizability so I'll 25:08 present what we do know about you know 25:10 substance use and transgender 25:11 populations but sort of take these with 25:13 a grain of salt because the gender 25:14 ability of this information may not 25:16 necessarily be fully generalizable here 25:18 to Louisville Kentucky so the New York 25:20 transgender project I looked at 25:22 self-reported prevalence of substance 25:24 use among the prior six months among 25:27 trans woman that found heavy alcohol use 25:29 hi marijuana use cocaine stimulant 25:32 opiate use biological assays of non 25:35 alcohol substances were approximately 25:38 ten percent or less 25:40 there was a 2014 study of individuals 25:42 entering addiction treatment and 25:43 publicly funded programs in San 25:46 Francisco we do know that among the 14 25:49 or so thousands admitted between 2007 25:52 and 2009 they did ask questions about 25:55 gender and sexual orientation and a 25:57 significant portion of the transgender 25:59 treatment seekers declined to answer 26:01 when they were worried about gender 26:02 parents enter woman what were the six 26:04 times as likely to be seeking treatment 26:05 for methamphetamine use but there were 26:07 no difference in the primary substance 26:08 or was transgender and cisgender people 26:10 stopped treatment so you can imagine if 26:12 you're asking a sample of people seeking 26:15 substance use virtually all of those 26:17 people are going to report substance use 26:19 so this is not a useful measure for 26:21 seeing what's the overall prevalence of 26:22 substance use but can give you some idea 26:24 of what do we know about the people that 26:26 are substance treatment seeking 26:29 and so we do know that oftentimes 26:31 transgender people declined to answer 26:33 questions about gender probably because 26:35 they are worried if it's safe to do so 26:37 and that we saw trans women more likely 26:41 to seek treatment for methamphetamine 26:42 use transgender individuals were more 26:44 likely the cisgender to ever have a 26:46 psychiatric diagnosis or even to be 26:48 prescribed a psychiatric medication a 26:50 meta-analysis looking at 18 studies on 26:53 substance use disorders on LGBT youth 26:56 there was a higher odds of substance use 26:58 in this population 26:59 it was almost twice of what we saw for 27:01 heterosexual youth over three times as 27:04 likely for bisexual youth and four times 27:06 higher for women who identifies the LGB 27:09 or T and that was corroborated by 27:11 similar trends and other sort of parts 27:12 of the world though so that's kind of 27:16 what we know which I would sort of have 27:18 to say is not much I actually think that 27:21 there's a whole like imperative for good 27:24 at the DV logic research around LGBT 27:26 populations particularly T populations 27:29 like transgender people that we just 27:31 don't have and there's again a whole 27:33 number of convenient samples looking at 27:35 people who are transgender so sort of 27:37 the self-report 27:38 but that is very different than what we 27:40 would be able to accomplish if we had 27:42 generated any questions embedded into 27:44 large national surveys where you could 27:45 actually get a good epidemiologic report 27:48 on what is the actual prevalence okay so 27:51 that's what we know so far there are 27:53 there was a survey looking at substance 27:55 use treatment programs in the United 27:57 States and 11.8% 27:59 that this was a survey of all treatment 28:01 programs sort of known to the substance 28:03 abuse mental health services 28:04 administration and 11.8% say we offer 28:08 LGBT specific services so the 28:10 investigators actually looked into what 28:13 are is the treatment that you offer if 28:15 you say you offer LGBT responsive 28:17 services or specific services what do 28:19 you offer and of that 11.8% seventy 28:22 point eight percent were no different 28:24 than what is offered in just general 28:28 population stuff so these treatment 28:29 programs um there is the perception of 28:31 significant barriers to accessing 28:33 treatments so I mentioned in the San 28:35 Francisco study treatment seekers 28:37 declined to answer questions about 28:39 gender my hypothesis because there were 28:41 safety issues around that 28:43 wonder if it's safe to do that and so 28:45 there's a perception that there is again 28:49 a significant barrier to accessing 28:51 treatment so we know that in programs 28:53 that do have bona fide LGBT services 28:56 LGBTQ clients are more likely to engage 28:58 in treatment that addresses issues of 29:00 gender and sexuality there's less 29:03 compliance as you can imagine to 29:06 treatment that are recommended by people 29:07 who are overtly homophobic or 29:09 transphobic and accessible treatment for 29:11 transgender people is particularly 29:14 lacking so what I imagine many people 29:18 room sort of know what I'm talking about 29:20 when I talk about addiction treatment 29:21 but let me just be clear when I'm 29:24 talking about addiction treatment I'm 29:25 talking about the treatment that is 29:27 focused on reducing or creating 29:30 abstinence of recovery from substance 29:32 use and recognizing that substance use 29:35 is oftentimes a tool that people use to 29:38 address some problems they're having and 29:39 then that tool then became itself a 29:41 problem you have to address the 29:43 substance use but I think good addiction 29:45 treatment then also needs to look at 29:46 what were the reasons that you were 29:47 using in the first place and how do you 29:48 address those so there's a variety of 29:51 psychotherapy s have been validated so 29:53 Samsa lists 12-step facilitation and 29:56 peer treatment 29:58 cognitive behavioral therapy 30:00 motivational enhancement therapy 30:01 community reinforcement contingency 30:03 management multi-systemic therapy and 30:05 multi-systemic Family Therapy all are 30:07 multidimensional family therapy is all 30:09 being well validated evidence-based 30:11 approaches there's also medications for 30:13 addiction treatment but not all 30:15 substances respond to medications so 30:18 alcohol opioid and tobacco use disorders 30:20 all have medications that can impact 30:23 substance use but there is no medication 30:25 that has been FDA approved or cannabis 30:27 use disorder and fetta mean use disorder 30:29 cocaine use disorder a loosening Junie's 30:31 disorder those are the the substance use 30:33 disorders for which there are medication 30:36 targets and so when I conceptualize 30:39 addiction treatment I think you need 30:42 therapy and psychotherapy or counseling 30:45 can be very helpful with skills right 30:48 how do you teach somebody how to 30:49 tolerate their lives in a world without 30:51 substance use those of you in the 30:53 treatment community will probably know 30:54 what I mean when I say live life on 30:56 life's terms right how do you live life 30:57 on life's terms I also think a component 31:00 of addiction treatment needs to be 31:02 support and support is different than 31:04 counseling counseling is about skills 31:06 support is about what is the milieu that 31:08 people places in things with whom you 31:10 interact on a daily basis now you need 31:12 skills in order to be able to navigate 31:13 those things the people places and 31:15 things that you navigate on a daily 31:16 basis but who do you have to call when 31:18 things aren't going well do you have a 31:19 sponsor do you have a group that you go 31:21 to and for some people their treatment 31:23 is support they go to meetings they 31:25 connect with other people maybe they 31:27 work some steps some steps and then may 31:29 teach somebody some skills but support 31:31 might be the mayor major ingredient for 31:32 some people and medications I think also 31:35 have a very important role to play in 31:37 supporting people with alcohol tobacco 31:40 and opioid use disorders potato peas the 31:44 sort of medications can be very strongly 31:45 effective so for for patients that I see 31:48 and you know endocrine psychiatrist so I 31:50 see patients um I want to make all three 31:53 of those a component of somebody's 31:54 treatment and I think if I don't offer 31:56 somebody the full range of options I'm 31:58 not doing my job so how does it's 32:00 relevant for LGBTQ folks well for LGBTQ 32:03 folks in particular I would say support 32:05 is paramount you want to be sure that 32:06 people have the support in order to lead 32:08 a healthful life you're giving somebody 32:10 skills that the skills the steps and the 32:13 therapies aren't necessarily different 32:15 for LGBTQ folks and they are for other 32:16 folks but the context is sort of set in 32:18 the setting in which those skills are 32:20 learned does need to be attuned to 32:22 people who - the people's real-life 32:25 context and then the medications do not 32:27 work differently for LGBTQ people than 32:29 other people we all have roughly 32:31 equivalent physiology okay so what do we 32:34 know about treatment in LGBT populations 32:36 interestingly studies have not found a 32:38 significant difference between LGBT 32:41 specific treatment and general treatment 32:43 for LGBT people so this guy Steve 32:45 shoptalk he's in Los Angeles has done a 32:47 lot of research on trying to show a 32:49 difference in LGBT specific treatment 32:53 from methamphetamine use disorder for 32:54 gay men he published in 2005 a study of 32:57 162 methamphetamine dependent or this 33:00 was in - you know this is before the DSM 33:02 was published so the dsm-5 was coupled 33:04 so it was cold nothing ketamine 33:05 dependence we would call it and fed him 33:06 useless order now looking at 33:09 cbt the entity management combined CBT 33:11 both considered a management and 33:13 culturally tailored a specific treatment 33:15 all groups got better but there was no 33:17 difference or improvement along the gate 33:19 specific treatment as compared with the 33:22 other treatment modalities and another 33:24 study also published by Steve shop Don 33:25 2008 compared gave specific treatment 33:28 and gaze specific social service therapy 33:32 and a community health clinic and both 33:34 groups showed significant reductions in 33:36 the grade and their rates of alcohol and 33:38 drug use at the end of the 16 week study 33:40 and there was durability when your 33:42 follow-up and then morganson compared mi 33:45 with CBT in a group of 188 men who have 33:48 sex with men without values disorder 33:49 again both therapy types led to 33:51 decreases in drinking so it tells me 33:53 that general treatment can be effective 33:55 for LGBT people and we haven't although 33:58 there's great anecdotal evidence that 34:00 LGBT people seek treatment in LGBT 34:03 specific programs more than in non LGBT 34:07 specific programs the actual treatment 34:09 itself once it's delivered can be 34:12 effective even if it's not necessarily 34:13 gay tailored or gay specific um so from 34:16 my perspective the outcomes of the 34:18 studies suggest that LGBTQ affirming 34:21 programs don't necessarily need to have 34:23 a lot of fancy LGBT specific stuff in 34:27 them as long as the clinicians involved 34:30 my view are reasonably free of 34:33 homophobia transphobia and heterosexism 34:34 that's really important like if you're 34:36 if you're running a program you don't 34:38 necessarily I mean there is a role for 34:41 LGBT specific programming and I'll sort 34:43 of get into that but the floor what I 34:45 would expect every program to be able to 34:47 do is have clinicians reasonably free 34:49 from the isms that drive people out of 34:52 treatment right be reasonably free of 34:54 again homophobia transphobia 34:56 heterosexism that leads to people who 34:59 are LGBT dropping and the treatment they 35:01 have generally positive regard for our 35:03 patients the welcome and promote 35:05 openness about sexual orientation and 35:07 gender identity in the therapeutic 35:08 setting and be familiar with many of the 35:10 issues commonly faced by LGBT people I 35:12 think we were to inculcate this list in 35:14 treatment in general it would make a 35:16 transformative impact on LGBT 35:18 communities being able to access LGBT 35:20 treatment 35:21 that's it LGBT programs I do think have 35:26 a role LGBT specific groups or LGBT 35:28 specific programs and their role in my 35:30 view is when people substance use is 35:33 tied to struggles with coming out um is 35:36 tied to difficulty talking about one's 35:38 personal life it's tied to inner 35:40 conflict around sexual orientation or 35:42 gender identity and it's a significant 35:44 factor affecting their substance use 35:46 people who have been traumatized and 35:49 their trauma is due to homophobic or 35:51 transphobic attacks and for people whom 35:53 druggin associated activities such as 35:55 compulsive sexual thought that Amin may 35:57 be difficult to discuss in a general 35:58 population setting in these settings I 36:01 think it makes sense for there to be 36:02 protected affinity space for LGBT people 36:06 to be able to address their substance 36:08 use um but if you are and I sort of I 36:11 mean no offense - but if you're like an 36:13 out lesbian woman that's been out 36:16 forever and you drink a lot of alcohol 36:18 and your alcohol use is not necessarily 36:20 related to like your specific sexuality 36:22 but is related to sort of general life 36:24 stressors in my view you don't 36:26 necessarily need to send that person to 36:28 a sort of segregated a specific group 36:30 just because she's lesbian right I think 36:33 it really depends on what is the drive 36:35 for the substance use is it specific to 36:38 somebody's LGBT identity and would it be 36:41 difficult to dress in the context of 36:43 general treatment so I support their 36:45 being LGBT specific programs but I do 36:47 not think that the only place that an 36:49 LGBTQ person can do well is an LGBT 36:51 specific program does that make sense 36:53 alright cool so I want to talk about a 36:56 case of a 32 year old patient named 36:59 George our client I'm a doctor when I 37:01 see a patient and I mean no [ __ ] I try 37:02 not to I'm not being paternalistic it's 37:04 the term that I learned but the 37:06 individual 32 year old individual walks 37:09 into a treatment program speaking 37:11 addiction treatment what sexual 37:15 orientation or gender related 37:16 information would be useful to know 37:18 about Jordan 37:20 what do you guys think what'd you say 37:28 pronouns yeah so it'd be useful to know 37:32 information about the their gender their 37:34 gender identity general gender 37:37 expression and in some cases it's useful 37:39 to know about sexual orientation and 37:40 sexual private sexual practices but at 37:44 the very least no pronouns I think that 37:45 that would be useful to know 37:47 so there's a whole push for pronouns now 37:50 that part when somebody walks into your 37:53 office one of the things that you ask is 37:55 what pronouns would you like me to use 37:57 so I started this presentation talking 38:00 about identifies he him in his and an 38:03 alternative would be she/her/hers 38:05 but there's a whole number of other 38:06 pronouns that actually people can 38:08 identify with so Webster's has changed 38:11 they them and theirs from being a plural 38:13 pronoun referring to groups of people to 38:14 actually being a singular pronoun for 38:16 people that don't identify as a he or 38:18 her so they them in theirs and then 38:22 there's all kinds of other variations 38:24 like am an air Vivi and B's z-zaman 38:28 there's I mean I could sort of go on but 38:30 there's a whole number of pronouns that 38:32 people might want to use it can be 38:33 challenging it's challenging for me when 38:36 somebody identifies as of them or I'll 38:39 just be real honest as is M of M or Z or 38:41 something other than he or her but if 38:43 somebody identifies that way and that's 38:45 the way they want to be referred to it 38:46 does not it's no skin off my back 38:49 from my perspective to dress people how 38:51 they want to be addressed right I don't 38:53 there are all sorts of cases where 38:56 health care providers take this stance 38:58 of I need to address you by your 39:01 biological sex why there's absolutely no 39:05 reason to address somebody anything 39:07 other than they want to be addressed it 39:09 would be like if somebody said hi my 39:11 name is Michael and I was like hey John 39:15 what why am i calling than Johnny just 39:17 like they've told me that name is 39:19 Michael okay so there's a New York Times 39:22 article on sort of who's they witnessing 39:25 a great explosion the way human beings 39:26 are allowed to express our gender 39:28 identities we've always been again 39:30 allowed but I think there's now a cult 39:32 relaxation over on what is sort of 39:36 culturally normative around expressing 39:39 gender so if Jordan looked like this 39:41 what pronoun would you use might be 39:45 tough it might be tough right you might 39:47 need to ask what if Jordan looked like 39:49 this or what if Jordan looked like this 39:53 right 39:55 report the point is it's important to 39:57 ask and then how would you collect 39:59 sexual orientation or gender identity or 40:02 for those of you that ride to this field 40:04 so G how would you collect a sexual 40:08 orientation or gender identity data 40:10 where would you put it 40:15 biopsychosocial yeah absolutely so 40:18 oftentimes it's collected on an intake 40:20 survey or during a bio psychosocial 40:22 assessment oftentimes asked during the 40:24 visit I I'll tell you what I do which is 40:28 I put pronouns as part of identifying 40:30 information I put it where I put next to 40:31 their name next to their date of birth 40:33 next addresses I sort of put the 40:35 pronouns is right there because it's 40:37 just a part of somebody's identity 40:38 they're such orientation I might go 40:41 under actually social history and then 40:44 if they have a difference of sex 40:45 development that kind of goes under 40:46 medical history so kind of it sort of 40:48 depends on what I'm collecting this or 40:50 where I put it and usually I record it 40:52 in the electronic health record 40:54 substance use records are protected 40:56 under both HIPAA the health information 40:59 of Portability Accountability Act and 41:01 under 42 CFR part 2 which provides extra 41:04 protection for the privacy of those 41:06 records 41:06 um here is a sample set of questions 41:10 that you can use in order to collect 41:11 information about sex orientation and 41:13 gender identity what sex were you 41:14 assigned at Birth male/female you can 41:16 include other most people aren't 41:18 assigned another but I guess you could 41:20 include it um what's your current gender 41:21 identity male/female trans male trans 41:24 man trans woman genderqueer gender 41:26 non-conforming or not I always recommend 41:28 including like an other field because 41:30 there as I mentioned the terminology 41:32 around this is not solidified and people 41:34 use all kinds of different terms on how 41:36 do you self identify as bisexual gay 41:38 lysed lesbian or heterosexual and I 41:41 mentioned pronouns if I was to include 41:44 pronouns I would include just a few 41:45 for people to write it in rather than 41:47 necessarily him or she right but you 41:50 know I would I would have a field where 41:51 people would be able to put in their 41:52 pronouns and then I always have this 41:54 field if not if one of the above does 41:56 not bet subscribe you please answer the 41:58 following um I don't ask about sexual 42:00 practices on a form I just think that's 42:02 weird but if it comes up but but and and 42:06 oftentimes I don't necessarily need to 42:07 ask about sexual practices unless 42:09 somebody brings it up in the context of 42:10 the sexual psychosocial interview point 42:12 is you can't necessarily make 42:13 assumptions about what sexual practices 42:15 somebody does based on the sexual 42:17 orientation and certainly not based on 42:18 their gender identity but there are 42:20 cases where it's important to ask 42:22 particularly gay men who come with 42:25 methamphetamine use disorder a lot of 42:27 times methamphetamine really is 42:28 important part of their sexual practices 42:29 and being able to address the sex and 42:31 love addiction component that oftentimes 42:33 co-occurs with amphetamine use disorder 42:35 is really important to know so it's not 42:37 that sexual practices aren't relevant 42:38 oftentimes they are but they're 42:40 oftentimes collected in the context of 42:42 somebody's substance use disorder 42:43 history not as part of like an identity 42:45 piece Health and Human Services has made 42:48 sexual orientation and generated any 42:50 part of meaningful use 42:51 so Jordan reported drinking and smoking 42:54 tobacco as a teenager describing this as 42:57 motivated by the desire to fill fit in 42:59 with peers as a teenager Jordan was 43:01 aware of same-sex attractions Jordan 43:04 report a contentious relationship with 43:05 their mother and moved out from their 43:07 mother's house as a teenager and people 43:09 in Jordan's shared house were 43:10 experimenting with drugs and drinking a 43:12 lot and Jordan started to use MDMA which 43:14 is ecstasy and cocaine and addiction to 43:16 alcohol and tobacco you could do a 43:19 sexual practices history to see to what 43:21 extent does the cocaine and ecstasy use 43:23 sort of impact some their sexual 43:26 behaviors and then what else would you 43:28 need to know well sexual practice 43:29 history you know do you have sex with 43:31 land women both anyone else who puts 43:33 what where do you use barriers or 43:35 contraceptives what is you've in your 43:37 history of STDs or STD treatment what 43:40 has been the history of all these things 43:42 over one's lifetime or over the past 43:44 twelve months but that is I think of is 43:45 like a fast and loose 43:47 back-of-the-envelope sexual practices 43:49 history you know this is sort of this 43:51 list of stuff you're in a decent place 43:53 and sort of knowing what about somebody 43:56 sort of sexual practices and oftentimes 43:59 you can link 43:59 people to STD treatment if they haven't 44:01 been treated so we know in the 44:04 population of LGBT patients that seek 44:07 substance use disorder treatment you can 44:09 you can have rates of STDs that it's 44:11 really important to address and I think 44:13 that HIV and hepatitis treatment should 44:15 be integrated and it's a substance use 44:16 disorder treatment so you know it 44:19 supports comprehensive medical and 44:21 psychosocial assessments in the context 44:23 of substance use disorder treatment and 44:25 I think if you collect information in 44:27 that way you lay it out hey how do you 44:29 identify you know you know it's part of 44:35 the intake we're open to whatever 44:37 identity or whatever gender identity or 44:40 sexual orientation identity or whatever 44:42 sexual practices information you're 44:44 willing to share um people will 44:46 ultimately share a lot more if they feel 44:47 like they're not judging and you're not 44:48 creating heteronormative versus 44:50 normative expectations um there's a 44:53 whole text book on international 44:57 perspectives on addiction treatment that 44:58 has an LGBTQ section Samsa has a 45:01 provider's introduction to substance 45:04 abuse treatment for LGBTQ individuals 45:05 that I would encourage everyone here to 45:07 check out and I helped with this guide 45:11 with the Association of American 45:12 colleges Association of American Medical 45:14 Colleges on implementing curricular 45:16 institutional climate changes to improve 45:18 care for individuals who are LGBTQ gen 45:20 and non conforming and/or born with a 45:24 difference of sex development because 45:25 again these are all orthogonal II 45:27 related and you might identify as LGBTQ 45:30 and or be gender conforming or 45:33 non-conforming and or have a difference 45:35 of sex development those are all again 45:36 orthogonal II related factors so at this 45:40 time I this is my email address if 45:42 there's questions that you want to ask 45:44 to me directly without benefit of the 45:47 full audience and I have time for one 45:49 question before we get to our panel so 45:50 what question 45:52 does anybody have yes 46:46 the comment was that in the experience 46:50 of this audience participant the ways of 46:55 asking questions that were positive here 46:56 are not uniformly done in treatment or 46:58 the even in primary care and without a 47:00 uniform way of actually assessing this 47:03 information we're left not knowing so 47:05 it's really important to ask the 47:07 questions in the context of delivering 47:09 health services so actually that's a 47:11 great segue and what I'd like to do now 47:13 is bring up our panel of a person with a 47:17 patient experience a counselor 47:19 experience and and a kind of the 47:20 organizational perspective so if I could 47:22 get Mandy Michael and Jennifer up to the 47:24 stage I'd appreciate it so while while 47:31 Mandy Michael and Jennifer coming up

Beyond SUD - The LGBTQ+ Community and Mental Health

Members of the LGBTQ+ community are more prone to mental health problems.

According to the APA, LGBTQ+ individuals are more than twice as likely to develop a mental disorder in their lifetime than straight and cisgender individuals. LGBTQ+ individuals also might experience higher levels of psychosis, bipolar disorder, and other mood disorders.

The rate of such disorders is because of the oppression and hardships LGBTQ+ members experience due to their sexual or gender identification. These difficulties lead to a higher risk of mental illnesses, and these mental illnesses can co-occur with substance use disorders. Both disorders must be considered during treatment. 7

Anxiety, Depression, and Suicidal Thoughts

LBGBTQ+ individuals are more likely to experience anxiety and depression than heterosexual and cisgender individuals. LGBTQ+ members are also more likely to experience severe depressive episodes, and suicidal thoughts are prevalent amongst members of this community.

While 2.2% of cisgender and heterosexual individuals have considered suicide, 4.4% of gay men and lesbians have considered suicide alongside 7.4 % of bisexual individuals. Approximately 30.8% of transgender individuals have also considered ending their own lives. When it comes to suicide attempts, lesbian, bisexual, and gay youth are over 4 times more likely to attempt suicide than cisgender, heterosexual youth. 8


LGBTQ+ individuals are at an increased risk for PTSD. This is likely because many members face an increased risk of violence and trauma due to their identification. When treating LGBTQ+ patients, it’s important to understand the potential likelihood of trauma. 9

Eating Disorders

People in the LGBTQ+ community are at a higher risk for eating disorders than their heterosexual and cisgender counterparts. Increased discrimination and the stress associated with being LGBTQ+ can lead to binge eating in lesbian and bisexual women. Furthermore, body dissatisfaction is common amongst gay men and can increase the risk of an eating disorder.10

The Minority Stress Model and Challenges for the LGBTQ+ Community

A significant factor behind LGBTQ+ mental illness statistics is the minority stress model. The minority stress model indicates that LGBTQ+ individuals face unique challenges that cause additional stress and mental health problems.10 To complicate matters, many LGBTQ+ people have reported stigma when trying to access health services, leading some individuals to forego healthcare and treatment completely.

LGBTQ+ individuals face homophobia and/or transphobia on an internal, social, and sociopolitical scale. They are more likely to be homeless and unemployed. Transgender people face higher rates of poverty than cisgender individuals, and this factor is worsened by a lack of legal and federal protection.

LGBTQ+ people are also more likely to face violence and harassment.

While all members of the LGBTQ community are at an increased risk for violence, transgender individuals are more likely to be victims of hate crimes and assaults.

LGBTQ+ people are also less likely to have social support in comparison to heterosexual individuals. This is particularly true for LGBTQ+ individuals who live in a region with a small LGBTQ+ population. Bisexual members might feel particularly isolated, facing discrimination from society as well as prejudice from within the community. All these factors and more contribute to the significant stress LGBTQ+ people face, which may lead to substance use. 11

How Common is Substance Use in the LGBTQ+ Community?

Like other mental illnesses, SUD is more common in the LGBTQ+ community than in straight and cisgender people. For instance, women who identify as lesbian/bisexual are more than twice as likely to engage in heavy alcohol use as heterosexual women.

Trans individuals are more likely to struggle with substance use due to the increased amount of violence and discrimination they face.

Trans people are also more likely to be assaulted and could develop a substance use disorder stemming from the assault. 12

Further studies must be done to determine the true extent of LGBTQ+ substance use and the contributing factors. It’s clear, however, that substance use disorders are more common in the LGBTQ community largely due to minority-related stress. Factors such as discriminatory government policies, violence, self-hate, social isolation, and family disapproval often contribute to the development of SUD. Transgender and gender-nonconforming individuals have unique stressors, as do LGBTQ+ people of color. Many studies have found that substance use in the LGBTQ+ community is due to stress-related coping.

Sociocultural differences and the targeting of LGBTQ+ people by tobacco and alcohol companies also exacerbate the problem. The LGBTQ+ community tends to have more permissive substance use norms. 13

What Substances are Most Abused or Misused in the LGBTQ+ Community?


Alcohol use is very prevalent within the LGBTQ+ community. Historically, LGBTQ+ people had to seek refuge from prejudice in standard bars, meaning gay bars became the norm for LGBTQ+ social settings. Many people within the community agree that the number of gay bars compared to non-alcohol-oriented settings is likely a contributing factor to alcohol abuse. While most LGBTQ+ people appreciate the historical significance of gay bars, many members have expressed social pressure to fit in and drink at them. 14 Alcohol misuse, especially in the form of heavy drinking, leads to a variety of dangers and problems. These problems include blackouts, suicide, and sexual assaults. For trans people, suicidal ideation became more common while drinking. 15


LGBTQ+ people are more likely to use stimulants than those not in the community. Stimulants include, but are not limited to, cocaine and methamphetamine. Stimulant use is typically higher for LGBTQ+ individuals than cis and straight individuals, though lesbians tend to use stimulants almost equally to their heterosexual counterparts. For gay and bisexual men, stimulant use is much higher than that of their heterosexual peers. Approximately 9.2% of gay men use stimulants in comparison to 3.2% of heterosexuals. 16


While there’s not much information available on transgender individuals for opioid use, studies show that lesbian, gay, and bisexual individuals are at a higher risk for opioid abuse. Bisexual women are particularly at risk. Many members of the LGBTQ+ community have reported more access to opioids than their heterosexual peers. 17

Addiction Treatment Options

Thankfully, there are various treatment options available for those with substance use disorders. LGBTQ+ people who struggle with substance use disorder can be put in detox therapy, inpatient treatment, outpatient treatment, or medication-assisted treatment. 18

Adding LGBTQ-Affirming Treatment to Your Facility

LGBTQ+ individuals need treatment centers that properly serve them. Create a welcoming environment in your treatment center by including LGBTQ+ media and pamphlets in the waiting room, enforcing non-discrimination policies, and acknowledging LGBTQ+ observances and holidays.

LGBTQ+ Staff

Including LGBTQ+ staff and providers can also make patients feel more comfortable. It is also important to provide ongoing training in culturally affirming treatment for the staff. Facilities should show LGBTQ+ affirmation as well. Gender-neutral restrooms, for instance, are essential for many in the LGBTQ+ community. Adopt LGBTQ+ friendly procedures and ensure all staff can carry out LGBTQ+ affirming interactions with patients.

Embracing Cultural Humility

During treatment, providers should embrace “cultural humility”. This is different from “cultural competency”. Cultural humility requires constant ongoing learning about the patient’s identities and experiences within them. Cultural humility recognizes that there will always be more to learn and that everyone within the culture is different.

Staying Up to Date

Stay up to date on current potential stressors for the LGBTQ+ community. Discriminatory laws and current events often play a vital role in an LGBTQ+ person’s mental health. It’s essential to stay up to date to understand the laws and potential discrimination LGBTQ+ patients will face. One’s language also matters. Avoid using outdated terms such as “homosexual” and remember that not all LGBTQ+ people have reclaimed the word “queer.” Avoid assumptions about a patients’ gender identity or sexuality. Ask a patient for their preferred pronoun and, if the wrong pronoun is used, apologize but don’t over-apologize. When it comes to training, there’s always more to learn. Sensitivity training programs for staff are a great place to start.

Trauma-Informed Care for LBGTQ+ Addiction treatment

Because LGBTQ+ people are marginalized and more likely to have PTSD, it is essential to recognize the impact of potential traumas on their substance abuse disorder recovery. A crucial part of trauma-informed care is creating an environment where the patient feels safe and secure. For LGBTQ+ people, that involves an affirming approach.

When you create a safe space for LGBTQ+ people, they’ll feel able to disclose and work through their traumas. Trauma may be the root of addiction and giving patients a safe space to work through it will make treatment more effective.19

Bostock and Title VII of the Civil Rights Act

Because LGBTQ+ people are marginalized and more likely to have PTSD, it is essential to recognize the impact of potential traumas on their substance abuse disorder recovery. A crucial part of trauma-informed care is creating an environment where the patient feels safe and secure. For LGBTQ+ people, that involves an affirming approach.

When you create a safe space for LGBTQ+ people, they’ll feel able to disclose and work through their traumas. Trauma may be the root of addiction and giving patients a safe space to work through it will make treatment more effective.19

00:00 and this is the follow-up page for this 00:02 program so every time we do this we have 00:05 a follow up page so that you'll be able 00:06 to view the video and this page will 00:08 also have a lot of other information 00:10 that we might discuss tonight anything 00:12 that comes up that any part presenters 00:14 mentioned as a resource I'll make sure 00:16 to add it to that page so that you'll 00:18 have the link you'll also find BIOS on 00:22 our presenters and their contact 00:23 information and so on just a reminder 00:27 that we also have a parent support group 00:29 that meets every Wednesday at 7 o'clock 00:31 there's where you can find out more 00:33 information about that group actually 00:35 Tessa will share links to both of those 00:38 that I just mentioned in your in the 00:41 chat box this one and this one Tessa if 00:44 you can grab those that would be great 00:45 and there are other meetings that take 00:49 place on different nights so if 00:50 Wednesday is not open to you then 00:52 definitely check out that page because 00:54 we have other ones listed on the tape 00:56 that are normally in other locations but 00:58 they're all online right now this 01:01 program is coming up next week we've 01:03 been holding this on the last Tuesday of 01:04 every month and I really love the 01:07 opportunity to talk about various 01:09 pathways and this time we're going to be 01:11 talking about supporting recovery so 01:13 we'll have some wonderful stories of how 01:16 people can stay connected different 01:18 kinds of support groups online pasta 01:21 probably and in most cases right now but 01:24 many other things that we're going to 01:25 talk about mindfulness and meditation 01:28 and somebody from Phoenix will be with 01:32 us which is a really great fitness 01:34 program for people in recovery my class 01:37 will be with us to talk about outpatient 01:38 programs so they've some really great 01:40 stuff lined up for next week as well and 01:43 also finally need to thank our very good 01:46 friends at Montgomery County Office of 01:48 drug and alcohol they are funding 01:50 tonight's program so thank you so much 01:51 to them we really really appreciate 01:53 their ongoing support so without further 01:57 ado I'm going to turn it over to Katie 01:59 really oh one more last thing sorry 02:02 there when you when the program finishes 02:04 when you stop watching this evening 02:06 you'll see a little prompt to take a 02:08 survey we really appreciate your 02:10 feedback even if you've provided us with 02:12 feedback before we 02:13 love to hear from you about each of our 02:15 programs so thanks so much 02:17 all right thanks Katie Thank You Kim 02:21 good evening everybody my name is Katie 02:23 girly I use she/her pronouns I am 02:26 thrilled to be here with this the 02:31 panelists tonight to discuss a really 02:34 really important topic that is near and 02:36 dear to my heart that is the LGBTQIA 02:39 community and the intersection of 02:42 substance use and how this community is 02:44 you know impacted due to facing certain 02:49 risk factors due to their who they are 02:52 I'm going to start off tonight's 02:56 discussion with a series visuals I'm a 03:00 visual learner 03:01 so I would like to just kind of I'm 03:04 going to share my screen I'm gonna go 03:05 through its kind of setting the tone and 03:07 the foundation for of knowledge for 03:09 tonight's discussion and then I will 03:11 hand it over to the rest of the 03:13 panelists feel free at any moment if you 03:16 have a question if you have you know 03:18 what would like clarification to enter 03:20 that question into the chat box you 03:23 won't be interrupting us and that way we 03:25 can answer your question as we continue 03:27 to go through our program tonight so let 03:35 me go alright so first off let me by say 03:44 say this it says lgbtqia+ something 03:50 about this population that as an ally 03:53 right and everyone that is watching this 03:56 program tonight you know you are 03:58 engaging in allied ship by learning how 04:01 to be a better support for those 04:03 individuals who identify as LGBTQ to ia+ 04:07 in the world right so this is a area in 04:12 which the language is constantly 04:15 evolving and changing and if you feel 04:18 like you can't keep up but you're trying 04:20 you're doing a good job so I learned 04:22 I've been doing this work with queer 04:25 individuals 04:26 I'm using queers an umbrella term for 04:27 about eight years now I just learned 04:29 about the two in the LGBTQIA this week 04:33 and so what that stands for is that 04:35 lesbian gay bisexual transgender queer 04:39 two-spirit intersex and asexual and so 04:44 when we're talking you know what we what 04:46 we discussed when you saw the the flyer 04:49 for tonight's program was you know why 04:51 is this population at higher risk and 04:55 and the answer isn't because they're 04:57 queer it's be live in a society where 05:02 homophobia and transphobia and queer 05:05 phobia exist right so being gay being 05:10 trans being bisexual is not within 05:13 itself a risk factor but living in those 05:15 societies where you're not supportive 05:17 and you are a victim of experiencing 05:20 minority stress is what leads to these 05:23 disparities in substance use I'm not 05:27 gonna read this slide verbatim it's 05:28 right there for you but I think that's 05:30 just really important to kind of just 05:31 start off with saying it's not being 05:33 queer it's living in a society that 05:35 might not support you and when it comes 05:38 to why individuals reached for alcohol 05:42 or other drugs there are several 05:45 different ways that this could look 05:46 especially depending on you know if you 05:48 belong to you know if you and if I as 05:51 gay but you're also a gay black man or 05:54 you're a trans black woman or you know I 05:58 get there's different intersections and 06:00 different experiences within different 06:02 marginalized populations that might 06:04 increase your risk level so we're just 06:07 gonna start off with that kind of 06:09 setting the tone when we look at 06:11 specific risk factors you know we live 06:16 in a society where for those who choose 06:19 to come out of the closet that is a 06:23 stressor and that is something depending 06:26 on where they are at in their lives and 06:29 and how they present themselves 06:31 interpersonally to their colleagues to 06:35 their peers to their family could vary 06:39 the fear of rejection you know not just 06:42 for young people which we know you know 06:46 when you're young the thing you want 06:48 most in the world one of the things you 06:50 want most in the world right is is just 06:52 to be accepted to be loved to fit in and 06:55 we know that a lot of young people will 06:57 make on healthy choices when it comes to 07:01 what it means for them or what they feel 07:03 or what they perceive it is for them to 07:06 help them fit in right so and the fear 07:10 of rejection in terms of friend groups 07:12 right it can be really traumatic but and 07:16 you know and being bullied in school and 07:20 physical and verbal harassment are real 07:25 but also you know often times we are 07:29 also leaving out the the violent act of 07:32 you know kicking somebody out of your 07:34 home you'll experience homelessness 07:36 queer individuals experience 07:38 homelessness and so that's also 07:41 something else to consider dealing with 07:45 the trauma of being abused for for who 07:48 you are verbally sexually physically you 07:52 know we know one of the causes for 07:55 substance use is trauma right so these 07:58 individuals who do who have had this 08:02 experience who have not been supported 08:04 in their lives by their peers family 08:06 colleagues whomever you know that puts 08:10 them at a higher risk for reaching for 08:12 alcohol of a drug use when we're looking 08:14 more specifically at the transgender and 08:17 non-binary non-conforming gender 08:21 expansive whatever you want to call it 08:24 right again this language is constantly 08:27 evolving for you know we're looking at 08:31 risk factors that can deck you know we 08:36 can nail down a little bit more which I 08:38 mean is like misgendering and and dead 08:40 naming which is constant invalidation of 08:43 that individuals identity bathroom 08:46 anxiety especially if you know and young 08:52 people and adults 08:53 as well but especially if you're in a 08:57 you know climate where you know there 09:00 are no gender-neutral bathrooms or 09:03 gender inclusive bathrooms or you know 09:07 there's a constant fear for a lot of 09:08 individuals of experiencing violence if 09:11 they were used the bathroom that doesn't 09:13 you know individuals perceive that is 09:17 not assigned to them and then body 09:20 dysmorphia and so when we look at body 09:23 dysmorphia in various individual and 09:27 individual there is a lot of I would say 09:31 a lot of people when they talk about 09:35 body dysmorphia in the trans community 09:38 some individuals say like body 09:40 dysmorphia is a requirement for 09:42 transition which is not always true or 09:45 body dysmorphia usually leads to 09:47 suicidal ideation which is which is 09:49 accurate but that's not everyone's 09:52 experience right there's a couple of 09:53 things about providing this appropriate 09:55 is a very individual experience personal 10:00 sorry my Siri was activated it is a very 10:03 very it's very dependent on the 10:06 individual and their relationship with 10:08 their body and how they present their 10:09 gender not always you know female to 10:12 male male it's a female you know there's 10:16 also those individuals that live that 10:18 might identify as gender expansive or 10:20 non-binary that live in between that 10:22 want different things for their body 10:23 something to note right when we're 10:25 looking at younger individuals pre 10:27 tweens and teens my work with them 10:33 you'll see a lot of more severe 10:40 increased anxiety and depression as they 10:43 start to enter the Tanner stages of 10:45 puberty as they start to experience the 10:49 dominant hormone that was you know that 10:53 is associated with their sex assigned at 10:54 birth and that can really start to 10:57 become a risk factor in terms of mood 10:59 and suicidal thoughts and so again this 11:03 various the individual to individual 11:04 but these are some just concrete 11:06 respecters that we can think of anxiety 11:09 and depression right mental health 11:11 obviously we know the link there between 11:13 how that puts an individual at a higher 11:15 risk to use substances if they don't 11:20 have the support that they need if they 11:22 don't have coping skills to manage that 11:24 anxiety and stress depression on their 11:28 their own all right so when we talk 11:34 about gender identity and sexuality I 11:38 know I said you know the LGBTQ 2ia right 11:42 it's it's kind of an umbrella term but 11:45 gender identity and sexuality are two 11:47 different things and I love this slide 11:48 it's you know this is a Venn diagram 11:49 right so and this takes a lot for people 11:54 to wrap their minds around at first you 11:55 know and when people are really starting 11:57 to you know want to want to be as 12:02 informed as they can and you learn that 12:04 someone can be in a male who decides to 12:07 transition into a female but still be 12:09 attracted to females and still be 12:10 romantically interested in females that 12:12 can you know that's a lot so when we 12:18 look at this gender is who you are who 12:23 you identify up here right as up here 12:25 gender expression is how you express 12:28 that right and that can be different for 12:30 everybody and then sexuality is is who 12:32 you're attracted to 12:34 and then sexual behavior right is who 12:37 you decide to engage in sexual behavior 12:39 with right so these are written like 12:41 very different things and again very 12:45 personal to each individual okay so you 12:52 know there are you know we do have to be 12:55 realistic about these risk factors and 13:00 these these individuals face and so when 13:03 it comes to suicide and this data is 13:06 from the Williams Institute right we let 13:08 me look at a temps right this isn't 13:10 suicidal ideation this isn't had 13:12 fleeting thoughts of suicide this is 13:14 actual attempts right I think this 13:17 picture is very powerful 13:18 because it you know when we look at the 13:20 T GNC trans gender nonconforming 13:22 population 41% of actually engaged in an 13:26 attempt when we look at lesbian gay and 13:28 bisexual it goes to 20% and then we 13:31 compare that to the overall population 13:34 it's a four point six percent right 13:38 again I'm not going to go too much into 13:40 this but I feel that you know it's it 13:45 speaks for itself when it as are really 13:49 specifically to substance use these are 13:55 some of the respect is why these 13:56 individuals are at high risk to consume 13:59 to binge drink like more likely to use 14:02 marijuana more all going to use 14:03 cigarettes IV drug use again these are 14:10 alarming numbers and I felt like this 14:14 visual itself didn't do it justice so I 14:18 have a visual that I put together that 14:20 is not the prettiest to look at I'm 14:22 gonna warn you all right now 14:24 but I think again it highlights those 14:25 disparities between LGB and non-lgbt qi 14:31 a individuals so this I warned you it 14:37 wasn't pretty to look at but in the the 14:39 pink and purple right are LGB students 14:42 and so this is data from the youth risk 14:45 behavior survey so this survey that's 14:47 done by the CDC and it's actually a 14:48 really great tool if you ever if you 14:50 ever go on their website you can 14:51 separate you know risky behavior in 14:54 terms of they add they they measure 14:56 every risk you could think of that 14:58 adolescence might be gauging in but 15:01 specifically looking at youth right and 15:05 I'm focusing on youth because I'm aware 15:07 from there with working with youth 15:08 specifically but one way we look at 15:10 youth right you know and when it comes 15:12 to substance use 15:13 we know individuals who start using 15:14 alcohol or their drugs you know before 15:18 the age of 18 or they're at higher risk 15:21 for going on to developing the substance 15:22 use disorders so this is why this youth 15:25 data matters so much 15:27 the pink and purple are LGB students 15:32 it breaks up in Jenin current and and 15:34 I've ever tried again I don't need to go 15:37 over every number but when you look at 15:38 the difference between non LGB students 15:40 it's it's jarring one thing that I think 15:45 we need to think about as a society and 15:47 as healthcare providers within this 15:49 field and is there's not too much data 15:53 on the trans and gender non-conforming 15:56 population why is that well many of 15:59 these surveys that they've existed for 16:01 years and years and years don't have 16:03 those options when individuals start 16:05 filling out surveys they're taking it 16:08 right like this the CDC youth risk 16:10 behavior survey is one of those surveys 16:11 another survey that monitors so since 16:14 you specifically is monitoring the 16:15 future right we they don't ask about 16:17 gender or sex assigned at birth and so 16:20 you know we we know that the trans 16:26 community those numbers are higher but 16:32 we don't have the data quite yet and 16:36 comparing it to non LGB individuals 16:40 right and so and one one thing to note 16:43 right this is aggregate data when it's 16:45 something lesbian gays and bisexuals 16:47 together and this looks different when 16:50 you look at lesbians specifically gay 16:53 men specifically or bisexuals 16:55 specifically and I'll talk a little bit 16:57 about that before I hand it over in a 16:59 moment again another graphic guy thought 17:02 which is really important to look at 17:04 right so we look at youth specifically 17:05 and again I'm focusing on youth here I 17:08 know we're talking about the whole 17:09 LGBTQIA population but many queer 17:16 individuals are working through the 17:20 traumatic experiences that they had when 17:22 they were come that lack of acceptance 17:25 that you know being again being abused 17:29 verbally or bullied or and and that 17:31 carries into their adulthood and once 17:34 they they've worked through that it has 17:37 impacted their relationships you know 17:39 take relationships their personal 17:41 relationships if and I'm not speaking 17:44 for everyone but it is a risk factor 17:46 there and so when we look at you know 17:48 the this these numbers specifically in 17:51 the dark blue is middle school and the 17:52 light blue is high school right 82% of 17:58 middle schoolers have heard homophobic 18:00 remarks or you know or 91% of both 18:03 middle schools and the high schoolers 18:04 have heard gay used in a negative way 18:07 and and over and over and over again and 18:09 what does that do you know at the age 18:12 when you're really starting to figure 18:14 out who you are right those those 18:16 messages again and again that who you 18:18 are is negative and not okay another 18:23 figure and I apologize for the quality 18:24 of the the graphic itself right but 18:28 again it's just looking at actual 18:32 harassment and it compares verbal and 18:35 physical harassment so again drawing 18:39 numbers certainly and then something 18:44 else that's that's really important that 18:46 I want to kind of touch on real quick 18:47 and that's availability of LGBTQ I and 18:53 resources visibility curriculum right do 18:58 they have the opportunity through the 19:00 community that they are and then they 19:02 you know the school that they attend to 19:05 see themselves in the curriculum and 19:08 we're you know we're seeing this start 19:10 change for many different reasons but 19:13 it's you know it's so important that 19:17 these young people have an idea you know 19:22 of that that that successful versions 19:26 queer is gay and queer and trans 19:30 individuals go on to live productive 19:34 healthy successful lives and how is that 19:38 represented in their curriculum in 19:40 school how much is it talked about I 19:42 know one thing that's you know with a 19:44 lot of my adolescents that I work with 19:46 when I talk about finding out like you 19:48 know how do they how did they begin to 19:53 explore the 19:53 our identity or what was that was that 19:56 experience like for them it is resources 19:59 that they went out and found on their 20:00 own through the internet right 20:04 they found queer and and community on 20:06 the Internet before they ever found it 20:08 in person and so how can you know as a 20:12 protective factor I listed a bunch of 20:14 risk factors earlier beginning my talk 20:16 right as a protective factor right 20:18 wanting to give these kids you know a 20:21 healthy development how can we make sure 20:24 that they're seen and and they see 20:26 examples of success and happiness and 20:28 joy within the queer community so this 20:30 is really important all right so I'm 20:36 about to kind of wrap it up real quick 20:38 but all I wanted to say is I mean we got 20:40 we got you know I'm excited to hear all 20:43 the panelists speak and based on all of 20:45 their their interaction and experience 20:47 we're working with this population my 20:49 population that I feel the most 20:50 comfortable working with is young queer 20:55 teenagers and adults and with the 20:57 specifically looking at trans 20:59 individuals and gender expansive 21:00 individuals but when we look at the 21:03 LGBTQ to ia umbrella right each 21:09 population under this umbrella care for 21:15 them looks different affirming care for 21:17 them looks different like I said earlier 21:19 the gay male experience is not the same 21:20 as a two-spirit indigenous person's 21:25 experience when it comes to fairness 21:27 it's just not there's different risk 21:28 factors there and so when it comes to 21:31 providing and affirming you know care or 21:36 supporting that individual it's really 21:37 understanding that they're the expert on 21:40 their experience and when we're seeking 21:42 you know if an individual is at risk or 21:44 an individual is seeking out treatment 21:47 we got a look at right like is you know 21:51 this organization or this you know rehab 21:54 just and yes we do everything or can 21:56 they say yes we have this history of 21:57 working with this population and this is 21:59 what that looks like right so we need to 22:03 honor diverse experiences under this 22:04 umbrella and we got a we got 22:07 be realistic you know the certain risk 22:10 to each of these individual populations 22:13 and also honor that you know again the 22:17 intersectionality is and how that shapes 22:19 identity real quickly I'm just gonna go 22:21 to two more slides and I'm gonna hand it 22:23 off how can we as you know I said you 22:28 know I wanted to thank everyone for 22:29 attending and being here and I said you 22:32 know my the the population that I'm most 22:38 familiar working with are the you know 22:39 trans and gender expansion 22:41 non-conforming young individuals and so 22:45 what are little things that we can do to 22:47 support them and you know be an ally and 22:53 that is again just you know 22:58 vulnerability is what I'm gonna say and 23:00 what I mean by that is where you're not 23:04 gonna do everything right all the time 23:05 and as young people or people in general 23:08 explore their identity you know things 23:14 are fluid things change and so one thing 23:16 that we know a respecter that identified 23:18 earlier in my in my presentation was 23:22 misgendering or dead naming ransom 23:24 misgendering is when you call an 23:25 individual who identifies as a certain 23:29 gender by a pronoun that they do not 23:30 identify with right and so what I always 23:33 say you know I start at the very 23:34 beginning about the presentation saying 23:35 hi my name is Katie going my pronouns 23:36 are she her it's okay to ask an 23:39 individual what their pronouns are and 23:41 if you mess up that's okay too but if 23:45 young people especially or anyone in the 23:47 queer community really sees that you're 23:48 trying and making an effort and you 23:49 correct yourself that is not that does 23:52 not go unseen and that relationship will 23:56 continue to be a good relationship right 23:58 so what does that look like 24:00 if you mission or someone and they 24:02 correct you thank them don't say I'm 24:05 sorry and why is that well you know if I 24:09 you know someone calls me heating right 24:11 and I say you know actually you see her 24:13 pronouns and they go oh I'm so sorry 24:15 Katie I didn't mean to you know my bad I 24:18 instinctively kind of get 24:21 I want to say to them oh it's okay don't 24:23 worry about it and then I'm consoling 24:25 them because they're uncomfortable if 24:27 you say if you thank them aren't they if 24:32 you know you misgendered them and you 24:34 thank them that's it they don't have to 24:37 feel like they have to make you 24:38 uncomfortable individuals who are trans 24:41 or gender expansive are you know their 24:45 whole lives until they finally are out 24:47 and and feel free to express themselves 24:50 and who they are are managing their 24:52 gender presentation to match other 24:54 people's expectations all the time so 24:57 saying that you know just as simple 25:00 thank you instead of I'm sorry they 25:01 don't manage your discomfort one more 25:03 time right correct yourself you use the 25:07 correct pronouns move on right I do a 25:12 lot of education with individuals in 25:15 schools and in creating a firming 25:17 environment within a school community 25:18 for this population and nothing is more 25:21 uncomfortable for a young person or an 25:23 individual when someone miss genders 25:25 them and they make a huge big blow up 25:27 deal about it right and they put that 25:29 kid on the spot or they put that person 25:31 on the spot and that person does not 25:33 want you know you know they just want 25:34 you to move on use the correct pronouns 25:37 they don't want to be you know in the 25:39 pot light any more than they already 25:41 were and then practice and that is 25:46 simply you know going like all right I'm 25:49 gonna see I'm gonna see Murphy later I'm 25:54 using Murphy as my sister I'm just using 25:56 that example Murphy used a them pronouns 25:59 and so Murphy when they go to the store 26:03 I want them to get me oatmeal right so 26:10 just kind of and until you see that 26:12 person so practice in your head before 26:13 you see that individual with their 26:16 correct pronouns and so that's just a 26:20 little thing that I can kind of you know 26:22 in terms of being supportive being 26:24 affirmed and you know the crazy thing 26:28 about this just this one thing when it 26:30 comes to dead naming or misgendering a 26:32 person right and 26:33 is using I guess I'd using calling 26:35 someone by their name assigned at Birth 26:38 rather than the name that they've chosen 26:40 doing this has been proven to reduce 26:43 suicidal ideation in this population by 26:46 65% right so it's these little things 26:50 that you know people that work with this 26:52 population are very aware of that are 26:55 considered affirming that is really 26:58 necessary for providing the best type of 27:00 care for this population experiencing 27:03 who need that support whether it's 27:05 substance use mental health art and so 27:07 on 27:07 so I'm gonna stop sharing my screen and 27:10 I would love to just continue passing it 27:12 on I believe to Tom is that correct that 27:15 is correct 27:17 all right thank you very much Katie and 27:22 my name is Tom McDermott and I'm the 27:24 regional resource director at Karen 27:26 treatment centers and before I getting 27:28 into that I was going to tell a little 27:30 bit about myself so and I learned a lot 27:34 I learned more today and I'm part of 27:37 this community and I'm learning every 27:38 day back in the day when when I came out 27:41 it was just you were part of the gay 27:43 community and it makes my heart warm to 27:45 see how much it has evolved because it's 27:48 more inclusive now including so many 27:50 members of this community which is so 27:52 important so you know a lot of those 27:56 things that you talked about in regards 27:58 to being bullied and teased and picked 27:59 on that that that was my story truly was 28:02 my story and you know I'm blessed to 28:04 come from a very loving and accepting 28:06 family both of my parents are still 28:08 alive I went and visited them this past 28:11 weekend they're both in their 80s and 28:12 you know they accepted me for who I was 28:14 at a very young age and I was that 28:16 little kid that wanted to play with 28:17 Barbie dolls and not play the trucks or 28:20 play basketball and you know at my house 28:23 it was fine but at school it was not and 28:27 I remember being called a [ __ ] and a 28:29 queer and pushed around on the 28:31 playground even before I knew with those 28:32 words men and you know I didn't 28:35 understand how much that impacted me 28:38 until much later in life so all through 28:41 elementary school and middle school was 28:44 probably the worst we were 28:46 forced to take Jim and Jim and this is 28:49 back in back in the early 80s you had to 28:53 take Jim and you had to play whatever 28:55 sports they were playing so it was 28:58 either flag football or basketball or 29:00 softball or anything with the ball and I 29:02 was awful at all of those things and you 29:05 know we would pick teams and I was that 29:06 kid that got picked last and so once 29:09 again not only you know you don't have 29:11 to call me a name but if I'm being 29:12 picked last and that's also telling me 29:14 too that I'm not good enough and you 29:16 know I remember being pushed around on 29:18 the basketball court because I just 29:19 couldn't grab a ball and even to this 29:21 day at age 52 I get a knot in my stomach 29:25 when I walk onto a basketball court and 29:27 you know and that's to solve from the 29:29 childhood trauma being bullied teased 29:31 and picked on and and so when I was a 29:35 teenager I kind of knew I was different 29:37 and so I you know I knew that I liked 29:40 boys however it was in the mid-1980s 29:43 when the AIDS epidemic was in full swing 29:45 and you know what you saw in the news 29:47 especially in the beginning that this 29:49 was a gay disease and this was God's Way 29:51 of punishing gay people and so so here I 29:54 am this this gay kid that's already been 29:56 teased and picked on and not accepted 29:58 and now the world is telling me that 30:00 this is gonna be your destiny so it was 30:02 a really terrifying time until I got 30:05 older and discovered alcohol and drugs 30:09 and gay bars and that's where I felt 30:13 that's where I fish aliy came out and it 30:15 was all about drinking dancing and 30:18 staying up as as you know as long as you 30:20 possibly could you know and having as 30:22 many partners as you could and you know 30:24 I was just at a point in my life where I 30:26 just didn't care enough about myself and 30:28 you know fast forward into the early 30:31 1990s I tested positive for HIV so you 30:35 know that was another like black eye on 30:38 my on my life that you know everything 30:41 that they said was going to happen has 30:42 now happened and in 1991 HIV was a death 30:46 sentence that didn't have the 30:47 medications that they had and so that 30:49 was the catalyst for my addiction to 30:52 really really take off and back in the 30:55 early 90s I used to do my partying in 30:58 Washington DC it was an 31:00 drug that had just hit the East Coast it 31:02 was huge in California but it hadn't hit 31:05 the East Coast yet and so I was the type 31:07 of addict that if you gave me something 31:09 I would try it I just didn't care and so 31:12 I did this drug and it was crystal meth 31:14 and I remember when I did crystal meth 31:17 the first time in the early 1990s I knew 31:20 that this is all a this is all I ever 31:22 wanted this is the feeling that I was 31:24 looking for it took me out of me and I I 31:27 felt I felt it I felt pretty I felt sexy 31:32 I felt like nobody could nobody could 31:35 say anything bad it just didn't bother 31:36 me enough and that really was the start 31:38 of the downward spiral fast-forward to 31:41 1995 where I was in a really bad car 31:44 accident due to crystal meth use 31:47 recovered from that and picked it up 31:49 again and started injecting it and 31:52 crashed and burned and ended up in rehab 31:55 and you know I remember and I didn't go 31:58 to rehab at Karen I actually went to 32:00 rehab in a little town in Winchester 32:03 Virginia and I remember when my mother 32:05 was driving me to rehab she said how do 32:07 you feel about treatment and you know 32:09 all of those years of stuffing those 32:11 feelings are being teased and bullied 32:13 and picked on had come right to the 32:16 surface and I'm like I'm absolutely 32:18 terrified then I'm gonna go into this 32:19 into this facility where it's gonna be a 32:22 bunch of straight people and they're 32:23 gonna call me a [ __ ] they're gonna 32:25 call me a queer and I'm gonna get the 32:26 [ __ ] like that I mean that's that's what 32:28 I thought was gonna happen and she said 32:30 you know what like your life's a 32:31 disaster and like this is the only 32:32 option we have so I hope that doesn't 32:34 happen and you know the experience was 32:37 okay I ended up coming out and for the 32:40 most part everyone was accepting but 32:42 there were some people that weren't and 32:43 you know they kind of you know kind of 32:46 shunned me to an extent but I you know 32:48 circled around people who who I felt 32:52 comfortable with so I was really blessed 32:54 to get a sponsor in treatment who was it 32:57 was openly gay he would come and give 32:59 lectures and so he and I became very 33:02 close and he really worked with me about 33:05 being an openly gay me an HIV positive 33:08 in early recovery and so I made a 33:12 commitment to him that I would do 33:13 whatever 33:14 you say for the first year of my 33:16 recovery so about two months into my 33:19 recovery and I was a disaster I mean I 33:21 was there two months off of crystal meth 33:23 I had no coping skills on how to 33:25 socialize with people and I didn't feel 33:27 comfortable in my own skin 33:28 I still didn't because I hadn't worked 33:31 on my stuff from all those years of 33:33 being bullied teased and picked on so 33:35 two months sober he said to me we're 33:37 gonna go to an HIV retreat in 33:39 Pennsylvania and I won't curse on here 33:41 but I told him to go F himself I'm not 33:42 going to I'm not going to an HIV retreat 33:45 because I'd never looked at that I mean 33:47 I said women like you know it's bad 33:49 enough I have to get sober and work on 33:51 myself I have never looked at my HIV and 33:53 I don't want to he said we're going so 33:55 we packed up his car and we went to on 34:00 Pennsylvania and it ended up being at 34:02 Karen Karen had HIV B treats which hard 34:06 to believe that they had started back in 34:08 the 80s so this crazy old priest Kim 34:11 knows fondly 34:12 I'm good ol father Bill who was 34:14 passionate about about the gay community 34:16 started these HIV retreats back in the 34:19 80s and so I got to be part of them and 34:21 they had them three or four times a year 34:23 and it basically was a safe place for 34:27 the LGBT to Q ia back then it was just 34:32 the gay community a safe place for these 34:35 people in recovery who were HIV positive 34:38 and who had AIDS to come to this place 34:41 and just spend a weekend together to 34:44 fellowship and just be there for support 34:46 and I remember going to that first 34:49 retreat where there were people who were 34:51 in the final stages of AIDS coming to 34:54 this place to be part of this weekend 34:57 and there was this one woman by the name 34:58 of Kathleen that they actually had to 35:00 carry her in and she said I'm sober and 35:03 I just have to come here just to just to 35:05 be around my people and you know that 35:07 was the first little glimmer of hope 35:08 this gay HIV positive crystal meth 35:11 addict had that maybe there is something 35:13 to this recovery so I started coming to 35:16 these retreats three or four times a 35:18 year and you know when things got really 35:20 bad I always knew that there was a 35:21 retreat right around the corner so so I 35:24 became really good friends with that 35:26 crazy Catholic priest he and I be 35:28 really good friends and between him and 35:31 my sponsor they convinced me that I 35:33 needed to really do work on myself so 35:34 working a 12-step program is great and 35:38 for me it only took me so far but I had 35:41 core issues that I had never looked at 35:44 or dealt with and that's when I rolled 35:46 up my sleeves and really started doing 35:47 the core work and as frightening and 35:50 it's terrifying and as painful as it was 35:53 I did it because I knew that if I was 35:55 gonna stay sober I was gonna have to do 35:57 that work and it was difficult work I 35:59 had to get in touch with that little kid 36:01 that got pushed around and bullied and 36:03 teased and picked on on the playground 36:05 get in touch with him and heal and do 36:08 the work around that and I believe 36:09 between the retreats that therapy that I 36:12 did as well as working the 12-step 36:15 program really allowed me the person to 36:17 be the person that I am today you know 36:19 so I started coming to these retreats 36:21 three four times a year and that crazy 36:23 Catholic priest convinced me to leave my 36:27 job of 17 years working for the airlines 36:30 in Washington DC to leave all of that to 36:33 come and work at Karen treatment centers 36:35 and you know he tried for many years and 36:37 I kept saying no thank you no thank you 36:39 no thank you and finally it just felt 36:41 right and so so I did I left everything 36:45 in Washington sold everything and took a 36:47 big pay cut to come and work here and 36:49 it's kind of interesting is I took an 36:51 entry-level position and the only 36:52 openings they had was to work with 36:54 adolescents and I didn't want to work 36:57 with adolescent because I was terrified 36:58 to be around a bunch of adolescent boys 37:01 because that you know the first thing I 37:03 walked in like all of those old feelings 37:04 were right there but you know the 37:07 adolescents today are definitely more 37:08 accepting than they were back in the 80s 37:10 but just like you know Katie said it's 37:12 still there it's absolutely still there 37:14 and so you know so I worked I work with 37:18 the adolescents for many years and one 37:20 of the gifts of coming to working Karen 37:22 was that crazy Catholic priest handed 37:25 those retreats to me so he said you're 37:27 gonna get to do these retreats now so we 37:30 still have them today three or four 37:31 times a year and about five or six years 37:33 ago I made the decision to change them 37:35 because you know it's great to have 37:37 these HIV retreats however people aren't 37:40 dying anymore there's medications 37:41 there and I wanted to broaden and open 37:44 it up to more people for the entire 37:46 LGBTQIA community so we have these 37:50 retreats three or four times a year at 37:53 Karen and we invite our patients that 37:56 are in treatment that identify as LGBTQ 37:59 ia or people from the outside and we 38:02 bring them together for a safe place to 38:04 be together to to do this work so also 38:08 about five years ago 38:10 Karen decided that we needed to do more 38:12 in regards to I'm just going to say gay 38:16 community in regard to speak into the 38:18 into the queer community we needed to do 38:19 more so I was invited along with four 38:22 other staff members to we were on a task 38:25 force to look at the treatment we did 38:27 and to put some put some changes in 38:30 place and we did a lot of Education and 38:31 you know just like Katie said we had to 38:33 work with our admissions department and 38:35 you know you don't know what you don't 38:37 know until you're trained and understand 38:39 it and so today they have a very very 38:43 good understanding especially with the 38:45 transgender and that's exactly what we 38:47 train them is that if you're not sure 38:49 just ask it's much better to ask you 38:52 know what pronouns do you prefer and if 38:54 you do make it do make a mistake just 38:55 like you said say thank you and move on 38:58 so you know so we've definitely evolved 39:01 and grown and today we have these 39:04 retreats three four times a year we 39:06 actually have a weekly pride group on 39:08 campus where we bring our LGBTQIA 39:11 clients together to have a pride group 39:13 we have a pride luncheon and we're 39:16 actually able to take transgender 39:17 patients I was actually honored to be 39:20 part of a team of people because you 39:23 know we had our first transgender 39:25 patient probably about eight or nine 39:27 years ago and it was a male-to-female 39:29 and admissions called me they're like 39:31 but we're not really quite sure what to 39:33 do with this patient and I said you you 39:36 ask how they identify and you put them 39:38 on the unit because we're gender 39:39 separate you put her on the female unit 39:43 oh okay and it actually it worked out 39:45 fine and we've even had transgender 39:47 adolescents come into treatment were 39:49 able to place them on the appropriate 39:51 unit and I can tell you it works every 39:53 time it works every time 39:55 so so again I'm really blessed today to 39:59 be part of this I'm passionate 40:01 especially for the crystal meth addicts 40:04 that come into treatment I spend a lot 40:06 of time with them and right now I 40:08 believe that it's really really hurting 40:11 the gay community especially with gay 40:14 men the Crystal Method it's at an 40:16 all-time high right now and it's really 40:17 devastating this community so it's great 40:20 to be here with all the panelists I like 40:22 to call this warriors because I believe 40:24 that where we're fearless warriors kind 40:26 of like working together to fight the 40:28 fight so that's my story and I'm 40:31 sticking to it thank you 40:37 and I'm not sure who's next Caroline do 40:41 you want to jump in or do you want to 40:42 turn it you know come in say four words 40:44 yeah sure um hi guys my name is dr. 40:48 Caroline Finkel and I go by she and her 40:52 pronouns I have been working with the 40:56 adolescent population for about 10 years 40:58 now and I've been running a partial 41:00 hospitalization program in Malvern 41:03 Pennsylvania for the past four years and 41:07 you know I would say that one of the 41:09 emerging trends that we consistently are 41:13 seeing every single day our clients that 41:15 are coming in and not really sure who 41:18 they are and how they want to identify 41:20 and feeling really confused and we are 41:26 frequently doing a lot of education with 41:28 parents around what it looks like to be 41:31 affirming and what it also looks like to 41:33 in a very gentle and kind way talk about 41:37 their fears and their concerns about 41:40 their child's identity choices how 41:44 they're looking et cetera so I think 41:48 that you know when I was kind of 41:50 prepping for this I was spending a lot 41:53 of time thinking about the broader 41:55 issues that bring us to this which are 41:59 really impacted by the system which is 42:01 what Katie spoke about about this idea 42:05 and really what tom was talking about in 42:07 his own personal experience about this 42:08 idea of you know feeling different and 42:12 feeling like you are a round peg that's 42:15 being shoved into a square hole and what 42:19 that must feel like on the playground 42:21 and what that must be like as you're 42:22 sitting in classes and what that must be 42:24 like when you are invited over to a 42:26 all-girls sleepover party but you don't 42:28 really know if you're a girl those are 42:30 things that are really tough clients 42:34 have come to me and talked about this 42:35 idea of you know being in gym class and 42:37 people saying like boys on this side and 42:39 girls on this side you know and this 42:41 idea that like well I kind of like feel 42:43 like I'm both and I don't really know 42:45 what to do about that like which side do 42:47 I go on 42:49 and it's challenging I think as a as a 42:53 white straight male to white straight 42:56 male white straight female that was like 42:59 it's some kind of a Freudian slip right 43:01 at some point straight female to really 43:04 just try my best to understand and and 43:09 know that I've I've never been through 43:11 something like that and I don't know 43:12 what that feels like but I absolutely 43:14 have had feelings of being different I 43:16 have a learning disability that I dealt 43:19 with my entire life and I know what it's 43:21 like to feel inadequate and I know what 43:23 it's like to feel different and I know 43:24 what it's like to really struggle a 43:26 thing that's something that other people 43:28 seem to just get and I think that's 43:31 oftentimes what the teens that were 43:33 treating feel I mean I think that on a 43:37 panel like this my big message to the 43:40 participants who are here is this idea 43:42 that you know and I'm talking 43:44 specifically about teenagers but that 43:46 teenagers need the space to explore 43:48 different identities and that there are 43:52 identities that they there are certain 43:55 identified entities that they actively 43:57 hide right and there are certain 44:00 identities that they actively try and 44:03 put in front and there are certain 44:05 identities that they didn't even know 44:09 that existed 44:10 until they meet somebody else that has 44:12 that identity and they think wow I can 44:15 really relate to that and it's really 44:18 important to take those three different 44:21 ways that kids might come to that 44:23 identity and like respect it right I 44:25 have so many parents that come to me 44:27 that are like so my kid came to that of 44:29 her families and she went by sheet her 44:31 and now she's been center for families 44:33 with all of your kids that go by they 44:35 like you know like gender-bender kids 44:39 I'm like now she wants me to call her 44:41 and they you know and like I'm like well 44:43 it's not like about the other kids like 44:45 necessarily it's that they're talking 44:47 about something that she they identify 44:50 with you know and just trying to help 44:52 parents understand that and just trying 44:55 to provide more education but I think 44:57 that it's really important as clinicians 45:01 to validate pair 45:03 fears and concerns and have sessions 45:05 with them by themselves and be like this 45:07 must be really weird to have your kid 45:08 walk down the stairs and wear something 45:10 completely different like what is that 45:11 like for you and really like dig into 45:14 that uncomfortability I think that 45:17 oftentimes we when it comes to these 45:20 types of situations we tend to live in a 45:22 society of shame so what happens is is 45:25 that when a you know a straight big 45:28 macho dad who like loves the Eagles and 45:30 like has a kid that's like you know we 45:33 used to be a football player and now 45:34 he's wearing a dress like you know and 45:36 it's like so in us to be like you're 45:38 wrong and he should be able to 45:40 experience these things and like you 45:42 know you're just being incredibly 45:44 invalidating and you're just part of the 45:46 patriarchy awful society it's like no 45:48 like that's really weird for him like 45:50 this is out of his comfort zone and like 45:52 can we just sit with him and like let 45:55 him take out the uncomfortability on the 45:58 clinician or on the family therapist 46:00 without the kid present right to protect 46:02 them but really allow him to have that 46:06 space to like be angry about this and be 46:09 upset and and feel grief and loss that 46:12 you had this son that's now a girl and 46:14 what is that like and those are the 46:17 things that I think are really important 46:18 when it comes specifically they're 46:20 treating this population which is you 46:22 know giving them the space and again 46:26 this goes for both of them right giving 46:27 the teens the space to explore 46:29 identities that they've hidden 46:31 identities that are emerging or 46:33 identities that they they very much feel 46:36 about and giving the parents the space 46:41 to feel angry to feel grief and loss and 46:45 the education for the parents to be able 46:49 to teach them the ways in which to best 46:53 support their teenager right because 46:54 when they are supporting them and 46:56 affirming them we know that the suicides 46:58 go down right and the truth is is that 47:00 I've never sat with a parent before 47:03 where I have you know and I've had a lot 47:05 of parents that I've been pretty adamant 47:07 ly against the gender-bender 47:10 non-conforming type of thing and just 47:12 choose and all these things but I've 47:13 never sat with a parent and looked at 47:15 them and said I just want you to 47:16 know that your approach to this is going 47:18 to lead to more mental health issues and 47:20 more suicide up you know suicide 47:22 attempts and more issues so you either 47:24 change your approach to like save your 47:26 child's life and like stop with all of 47:30 this and just be affirming and be kind 47:32 and you can get angry and you like give 47:34 that all to me I'm fine with that 47:35 um or like you know you can be that way 47:39 and we can lower that risk right and 47:41 take give them some protective factors 47:43 around that and I never sat with a 47:45 parent that's like yeah I'd rather that 47:48 like my can be more you know more 47:50 mentally ill you know like parents are 47:53 very much when put into that scent that 47:55 state of like okay I really need to look 47:59 at you know look at the education look 48:01 at the statistics and change my approach 48:03 to this and I've always found that 48:05 that's just you know a really helpful 48:07 way but also allowing them them that 48:09 space to experience feeling sad you know 48:13 I'm feeling grief so that is my little 48:17 spiel 48:18 for tonight so I actually I'm really 48:28 glad that I'm on this panel my story's a 48:30 little bit different I came out 5 years 48:34 ago but I've known that I was gay for my 48:38 whole life but I'm still going through 48:41 the process right of like fully 48:43 accepting Who I am like I'm confident in 48:49 saying you know I'm a lesbian I'm in 48:52 recovery however when I step outside of 48:56 either my friend circle my server 49:00 supports my family who I've been blessed 49:03 with that have been extremely accepting 49:05 I'm immediately filled with fear and 49:08 that goes all the way back to my 49:11 childhood my entire childhood and my 49:16 early adolescent years going up until I 49:18 finally seeked help firm my addiction 49:21 was so much filled with like 49:25 internalized homophobia I I never 49:30 felt like I could actually be myself 49:34 because I was so fearful of the reaction 49:38 from the outside world aside from using 49:43 to cope with that I engaged in really 49:48 risky behaviors because I was trying to 49:50 do anything I could to not fully look 49:55 into the fact that I'm sexually 49:57 attracted to women I'm romantically 49:59 attracted to women I want to be with a 50:02 woman I pressed all of that down and 50:05 replaced those feelings with drugs and 50:08 alcohol 50:09 because drugs and alcohol can completely 50:13 get rid of any of those impure thoughts 50:16 that I felt like I had throughout my 50:21 entire even recovery process after I 50:26 went to rehab I went to detox and rehab 50:28 partial hospitalization treatment 50:31 intensive outpatient treatment halfway 50:33 houses I still was scared the first 50:39 person I came out to was actually my 50:41 counselor but I didn't come out to her 50:44 as a lesbian I came out to her as 50:46 bisexual because I was still scared of 50:48 saying that I'm a lesbian because honest 50:50 on when it comes to being bisexual in my 50:54 head I thought okay well I'm gonna say 50:57 I'm bisexual because people will semi 50:59 sort of accept me still because there's 51:01 a chance that I could be with a man 51:02 right because a man and woman is the 51:05 only thing that is acceptable 51:09 obviously I've changed my thought 51:12 patterns throughout discovering who I 51:15 really am but there was something 51:19 interesting that I heard that I've been 51:22 hearing and I've heard from my whole 51:24 life and I'm gonna bring this point out 51:26 because it's June so its Gay Pride Month 51:30 I've heard on multiple occasions people 51:33 say if there's a Gay Pride Month why is 51:35 there not a straight Pride Month and I 51:38 think this is really important to bring 51:40 up because I think 51:43 especially for clinicians that are 51:45 treating people that are an addiction 51:47 you know main point that we dry comb is 51:49 developing sober supports you know 51:52 finding places where you can feel safe 51:54 and supportive and have people that can 51:56 relate to you right well as a lesbian in 51:59 the LGBT - I - Qi a plus community you 52:06 know I need to find my supports - and be 52:11 marginalized population in general can 52:14 feel completely uncomfortable and unsafe 52:19 and I've spent my five years in recovery 52:25 finally being able to accept myself and 52:30 have pride in myself so Gay Pride Month 52:34 it's for all of the individuals that 52:38 have felt so unaccepted fearful not good 52:43 enough you know potentially suicidal 52:47 being you know kicked out of their 52:49 houses not feeling like they have 52:52 anybody that's on their side to feel 52:54 like they finally have somewhere to feel 52:55 safe Oh kind of related back to to my 52:59 using you know throughout I started 53:01 using when I was 15 I started drinking 53:04 and smoking weed and that continuously 53:08 progressed to alcohol marijuana benzos 53:13 and heroin and I I was also an addict 53:18 that would just do anything that was put 53:20 in front of me to try to get rid of 53:23 feeling like who I really was like cuz 53:27 who I really was was wrong I every time 53:35 that I was using I was pushing the real 53:40 me down further and further and further 53:42 and I finally went into recovery and I 53:47 met a counselor that I fully trusted and 53:51 felt safe with I find 53:55 we felt like okay I'm in a place where I 53:58 can be myself and I really value that 54:02 relationship that I had built with my 54:04 counselor because now I'm finishing up 54:08 my master's in mental health counseling 54:09 so I'm doing my internship and ethos 54:11 with Mike Blanche and Patrick Dowling 54:14 and I'm recognizing that like I want to 54:18 be that safe space for people right like 54:21 but I also find it extremely important 54:24 for me to continuously educate myself 54:25 because I don't know everything like I 54:28 identify as a lesbian however I don't 54:30 speak for the entire community 54:32 and I have to continuously be aware of 54:35 that because sometimes in like a 54:37 countertransference way I want to sit 54:39 with a client and be like oh you're a 54:41 part of the LGBT community oh I 54:44 completely understand what you're going 54:46 through I empathize with you let me just 54:48 tell you everything that I've been 54:50 through right but like you can't do that 54:53 because it's not about me it's about the 54:55 client I'm the one thing though that I 55:00 think I still think about is the fact 55:03 that like when I'm out walking around 55:06 with my girlfriend I'm still looking 55:09 around like everywhere I am to make sure 55:12 that it's safe for me to hold my 55:14 girlfriend's hand or like put my arm 55:17 around her that feeling that I've come 55:23 so far but then I pushed back every time 55:26 that I go into a place that might be 55:28 unsafe is so unsettling and it's a 55:32 really difficult thing to accept that 55:34 there's continuous education that 55:37 continuously has to happen however some 55:39 people might not understand them might 55:41 not accept it and I have to accept that 55:44 too I'm not going to be able to convince 55:46 everybody that they have to support my 55:51 lifestyle or the LGBT community however 55:54 I can educate and hope that maybe 55:58 something excuse me something that I'm 55:59 saying is getting through I think a big 56:03 part of the reason why 56:07 addiction is so much more prevalent in 56:10 the community it's because you're using 56:15 with this intense fear of not feeling 56:24 worth it and you have all of these 56:29 thoughts that societally were wrong yeah 56:34 you know if you look in society and you 56:35 look at ads right like it's starting to 56:37 become more acceptable it's starting to 56:39 be seen more but that doesn't mean that 56:45 I'm still not full of fear and I still 56:50 like that fear wasn't valid when I was 56:53 using I was using to stop thinking I 56:57 didn't I didn't want to have the 57:00 feelings that I did and I would act out 57:04 and get into relationships with men that 57:07 were extremely toxic because the way 57:09 that they treated me is how I felt like 57:11 I deserved to be treated anyways I'm 57:16 [Music] 57:19 continuously learning and I feel like I 57:22 learned so much tonight but I also think 57:29 that you know when I look at the 57:33 counseling world and the LGBT community 57:38 itself with addiction coming in as 57:41 clients I think that there's a lot more 57:45 that still needs to be done you know I'm 57:48 recognizing I'm doing my internship that 57:53 it's I've noticed with clients that I've 57:56 seen it's not something that a lot of 57:58 people really want to talk about fully 58:02 and educating ourselves and learning 58:07 about you know the difference between 58:10 gender and sexuality learning about how 58:13 to properly ask about pronouns like 58:15 these are the things that we can take 58:16 with us to impart to other clinics 58:20 so that every client that comes in no 58:23 matter what their what how they identify 58:25 or what their sexuality is can feel like 58:27 they're in a safe space you're already 58:30 coming in vulnerable if you're an early 58:32 recovery you're already coming in not 58:34 knowing what your identity is or how to 58:37 really live without the use of drugs and 58:40 alcohol so adding the sexuality gender 58:46 identity component on top of that is 58:48 just bringing that person further and 58:50 further and deeper and deeper into this 58:52 intense fear that they're never going to 58:54 be accepted so that was my story / my 59:01 experience / - what I've been learning 59:03 in my internship but yeah am I am i 59:08 removing you Kim 59:09 or am I going back okay that's awesome 59:13 well I don't know how to thank all of 59:15 you I really don't I I mean I to what 59:18 your your point just now live you know 59:20 like I think they're so we have such a 59:23 long long way to go but it's so 59:25 comforting to know that all of you are 59:27 working in this field Olivia you're your 59:30 future clients or I'm happy for them 59:34 already but I I really want to thank all 59:38 of you for your honesty and your 59:40 insights and all of that so thank you a 59:42 couple of questions that came in ahead 59:44 of time then a couple that have come up 59:46 since you started let's start with well 59:50 somebody just asked for some 59:51 clarification and maybe Katie I'll turn 59:53 this back to you the difference between 59:54 gay and queer if you want to there's if 59:57 you can maybe help with some of the 59:58 distinction around that absolutely so 60:02 you know queer was a pejorative up until 60:06 the past couple years that has been 60:08 reclaimed by the community and and and 60:11 you know gay when we're looking at gay 60:14 if we wanted to look at that identity 60:19 specifically gay men right and then 60:21 lesbian women who are attracted to the 60:24 same sex right but queer is the idea 60:26 that you you know that's the Venn 60:29 diagram 60:30 talking about with the sexuality and 60:33 gender identity right queer is the idea 60:36 that we kind of break all of these 60:37 barriers or you know and that you can 60:41 identify you can be you know someone who 60:43 has assigned female at birth 60:45 that is non-binary you know and presents 60:49 masculine right but also is still 60:52 attracted to men and that's queer right 60:54 it but and women it's just the it's the 61:00 the breaking of the binary it's the you 61:04 know the fluidy among identities under 61:06 that umbrella it's the idea that we're 61:10 always evolving and learning and it's 61:14 you know it's also about a movement 61:16 right when we look at you know this 61:19 month being Pride Month you know this is 61:23 a Pride Month that it's unlike anything 61:25 I've experienced it's not you know 61:27 Chipotle floats and Bank of America you 61:31 know you know and cowboys you know 61:34 wearing only you know you know thongs 61:37 right it's it's people in the streets 61:40 you know protesting for the they're 61:45 there black and brown brothers and 61:46 sisters and the identity of queer is you 61:50 know we're a family and we're going to 61:52 fight for all of us across this umbrella 61:57 so you know my understanding is it's 61:59 it's breaking that binary it's it's 62:02 about being a family and fighting for 62:05 those in this LGBTQ to is you hear me 62:10 slow because I'm getting used to saying 62:12 it you know and making sure that we all 62:17 have equal rights so it's it's an 62:20 identity it's a movement it's it's a lot 62:24 you know I think I think back to what's 62:29 the difference right queer theory right 62:31 and what queer theory is about it's 62:33 about breaking all those binaries and 62:35 and and you know questioning everything 62:38 and and flipping things around and not 62:42 conforming so 62:44 that would be my answer and please 62:45 anyone else feel free to kind of share 62:47 with everyone what how you view it 62:50 but that's my interpretation thanks 62:57 Katie I think that's helpful here's 62:59 another question that came in and pretty 63:01 recently at registration are there any 63:03 special thoughts for high school 63:05 GSA's which are gay straight alliance I 63:07 believe to help prevent substance of 63:10 years and I don't know I know some 63:14 schools I know the school district where 63:16 my kids went hyper Horsham they had a 63:18 Gay Straight Alliance and I but I don't 63:20 know that they have got into any 63:22 substance use talks I would think just 63:24 SAP program Student Assistance Programs 63:26 probably have some kind of one or the 63:28 other or hopefully a combination of both 63:31 but you guys have any thoughts about gay 63:34 straight alliances and schools Caroline 63:36 do you know much about this yeah I mean 63:44 I think that you know the the idea 63:48 around the Gay Straight Alliance is is 63:52 enough in and of itself a protective 63:55 factor against substance use right so 63:57 the idea is is that I'm young I just 64:02 came out and instead of sitting in my 64:05 room thinking about how anxious I am 64:08 about the things that kids have said to 64:10 me or what my parents are gonna say or 64:12 the fact that I feel like I'm never 64:14 gonna have a traditional wedding or a 64:16 traditional family I am instead going to 64:20 this club and watching movies about you 64:25 know Harvey Milk and watching you know 64:27 cool stuff and and getting to know the 64:30 culture that I'm gonna be a part of as I 64:32 get older um you know a lot of these 64:36 clubs like in general tend to be 64:39 protective factors for mental health 64:41 issues or for substance use because the 64:43 idea is is it's creating connection 64:45 between teenagers and peers in a in a 64:49 healthy way right instead of connecting 64:51 over like smoking a few bowls or going 64:55 to a kegger like there 64:57 acting in a safe way and I know that 65:01 I've experienced with the teens that we 65:04 treat that they're seeking out that 65:06 connection that they could get from a 65:08 GSA crew but they find it on Grindr and 65:10 end up meeting up with somebody that's 65:12 older than them like on a dating app 65:14 right and and so if we were able to sort 65:17 of drive them more towards these groups 65:20 like GSA we could potentially protect 65:24 them from some from substance use or 65:26 unhealthy behaviors and decisions I know 65:30 that when I was in high school they had 65:33 what did they have that it's like 65:35 mainline you guys know what I'm talking 65:39 about it's in Wayne there were dances 65:42 the mainline youth alliance right my 65:46 right yeah totally and we would all go 65:52 to like dance and you know I mean again 65:56 like I didn't identify as being you know 65:59 identified as an ally and but I loved it 66:02 because everybody was super cool and 66:04 they all dress super cool and we had a 66:06 lot of fun and nobody judged each other 66:07 and I never felt like I felt like I was 66:09 in a safe space instead of going like a 66:11 stupid DJ hauer dance you know with like 66:13 with like Devon prep boys no offense to 66:17 the Devon prep boys but you go what I'm 66:19 saying it's like you know just seemed a 66:21 lot safer so I definitely think that you 66:25 know as far as special thoughts go the 66:27 idea would be just to encourage any kid 66:30 that's questioning to check out these 66:31 types of groups 66:35 great thanks Caroline Tom do you want to 66:39 address that question that came in about 66:42 the opportunities for gay men to connect 66:45 and meet one another they mentioned that 66:47 it had always been in the bar scene but 66:50 as you said earlier not really the way 66:54 things are going these days and Caroline 66:56 mentioned apps that you want to talk a 66:57 little bit about that yeah so I mean 67:00 when I came out there was we didn't even 67:02 I'm gonna really send old you know we 67:04 didn't even have cell phones they were 67:05 like bricks that you had to carry around 67:07 in the bag so they weren't really too 67:09 functional so you went to the you went 67:11 to gay bars and you went to two gay 67:13 clubs that's kind of how you socialized 67:15 and you know today a lot of the gay bars 67:18 and especially the gay clubs are 67:19 shutting down because people just aren't 67:21 you know going to them anymore and a big 67:23 part of it is because of the apps and in 67:25 some ways you know dating apps are great 67:28 however unfortunately a lot of the the 67:31 gay apps are really used for for sex and 67:35 drugs that's the bottom line 67:36 especially Grindr I mean I could I live 67:40 in Berks County Pennsylvania and I could 67:42 I could download Grindr on my phone 67:44 right now and have somebody with crystal 67:46 meth within 10-15 minutes that's how 67:48 easy and quick it is there's code words 67:50 that identify I like to party and I like 67:53 to party with drugs so it's actually 67:54 kind of sad that that's how it's evolved 67:57 into today and that's what a lot and 68:00 there's probably about 10 different apps 68:03 similar to Grindr that are that are out 68:06 there and they're again they're 68:07 predominantly you know used for hookups 68:11 I actually am lucky there's actually in 68:16 LGBTQ campground in Lehighton which is 68:19 about an hour and 15 minutes from where 68:21 I live so that's actually a fun 68:23 opportunity to go and be around other 68:25 queer people and it's very inclusive and 68:27 very diverse there's a lot of various 68:31 groups within the community that go 68:33 there so it's a lot of fun however 68:34 there's a lot of drinking you know 68:37 there's drug use not so much but there's 68:39 a lot of drinking and it again you know 68:41 that kind of goes hand-in-hand 68:42 unfortunately with the with the with the 68:45 LGBTQ community so 68:51 thanks Tom anybody else have anything 68:53 okay okay I had something yeah I think 68:55 when I think about you know I was 68:58 talking about queer being a movement 69:00 right I you know a lot of young people 69:05 that that I work with you know young 69:08 people especially now right James II 69:11 their moral compass points so north 69:14 right they want to get involved they 69:15 wanna they wanna they want to March they 69:17 want to they want to talk about climate 69:19 change right I think and queerness 69:22 inherently is act like is you know part 69:26 of that identity is being an activist 69:27 right so I encourage a lot of my young 69:29 people that I'm working with to sign up 69:32 for you know community organizing or you 69:38 know activist meetups and I mean it is 69:41 diverse it's not all queer individuals 69:44 LGBTQIA individuals but right with the 69:48 history of you know being gay in the 69:51 United States being queer in the United 69:53 States and the community's commitment to 69:55 activism that is a safe environment it's 69:59 something it's it's something that 70:01 individuals are passionate about outside 70:03 of of their gender identity or sexual 70:05 orientation and it's a great place to 70:07 meet people and get involved and do some 70:08 good so that's always something that I 70:11 say you like what are you passionate 70:12 about in terms of activism and that 70:15 everyone has that fire in them and feels 70:18 that a lot of young people I work with 70:20 do and so kind of making them you know 70:22 pushing them towards that and and a lot 70:25 of times they do find queer community 70:27 within that you know especially 70:30 depending on where that actors and falls 70:33 along the political spectrum right but 70:36 that's I've had a lot of success with 70:39 that and I think that's just worth kind 70:43 of noting 70:48 nice thanks I think that's a good segue 70:51 into this question while acceptance may 70:54 be where we need to head what is the 70:56 real ultimate destination is it greater 70:59 than acceptance and if yes then what and 71:03 where and there's an interesting 71:04 response to this too but I want to ask 71:07 you guys to share your thoughts first is 71:10 there something beyond acceptance that 71:12 you think is the ultimate goal so my 71:17 head right away 71:20 kind of like internalized that so I was 71:22 thinking is there something greater than 71:24 acceptance well yes for everybody to 71:27 feel safe right like if I'm looking if 71:31 I'm looking on the outside and I'm like 71:33 thinking to myself okay I want everybody 71:35 to accept my lifestyle and Who I am to 71:39 be completely honest with you I have no 71:41 I have no say in changing every single 71:44 person's mind you know I would really 71:49 like just like and this is like me as a 71:52 member of the LGBT community but also 71:54 just for just in general in the world 71:57 right I would like to I think beyond 72:00 acceptance is just allowing others to 72:03 live their life and feel safe and not 72:06 scared for their life right I think 72:10 that's really difficult and I think 72:12 that's really challenging but like as 72:13 was just talked about with like activism 72:15 and everything you know getting involved 72:19 with doing something or standing up for 72:21 something that you believe in is pushing 72:27 pushing that acceptance in an acceptable 72:30 way right like you're not telling 72:32 anybody 72:33 you're not looking somebody in the eye 72:34 and saying you have to believe what I 72:36 believe you're standing up for what you 72:38 believe in to stop to potentially impact 72:41 others that might not have the same 72:43 mentality as you do that was my team 72:49 like that that's great and so it kind of 72:53 an along the same lines this is a friend 72:55 to many of us who's one of our attendees 72:57 tonight following up on the previous 73:00 moment that mattered for him and his 73:02 daughter is when shared with her how 73:05 happy he was that she is clear because 73:08 the person she is now is so amazing and 73:10 what she was always meant to be 73:13 she said that she felt celebrated is 73:15 that the ultimate goal not only 73:17 acceptance and support but celebration I 73:21 would you know that thank you for 73:24 sharing that Kim because that's where my 73:26 my head went is celebration right safety 73:28 of course yeah apps yeah safety and 73:30 celebration right I'm thinking you know 73:33 one of the most rewarding things as a 73:35 clinician is to move the needle with the 73:37 parents from tolerating questioning to 73:41 accepting to celebration right because 73:43 you know I'm an individual who's queer 73:46 and who's sober right and I remember and 73:48 here's the only thing I can compare it 73:49 to right for because we're talking about 73:51 substance use because we're talking 73:52 about the LGBTQIA population right I 73:55 remember individuals when I went into 73:57 12-step saying I'm a grateful recovering 73:58 alcoholic and right and so many people 74:00 are like what does that mean that's so 74:02 annoying right I have said to parents 74:04 right you know that have said I you my 74:07 kid is trans I said congratulations 74:10 right you have your kid feel safe enough 74:15 to share with you who they are right and 74:19 how brave they are to to go against the 74:24 gender binary which is so embedded to 74:28 every single thing that we do you know 74:31 you have raised an individual who is 74:33 brave enough to to live in their truth 74:35 and they feel safe enough with you you 74:39 know maybe that preparer is probably 74:41 thinking us anything 74:41 I was thinking when I went into twelve 74:43 steps at first like grateful recovery 74:45 but when you move the needle on that 74:46 individual from tolerance to acceptance 74:48 to celebration and they're celebrating 74:51 their their queer child their gay child 74:53 their lesbian child their trans shot 74:55 whatever that's incredibly powerful and 75:00 I think the ultimate goal yeah I love it 75:06 great question about LGBT 12-step 75:10 meetings 75:12 are they out there probably not in 75:15 abundance I'm guessing or are they hard 75:17 to find are they easy to find 75:18 I can I can speak to that because I got 75:20 sober going to LGBTQ meetings there's a 75:23 there's a the William wage Center in 75:27 Philadelphia is pretty phenomenal I 75:29 actually don't know if the meeting still 75:31 exists but niteowl was 11a at 11:00 p.m. 75:34 to 12 a.m. and I used to go there every 75:38 night because I I couldn't sleep in 75:41 early sobriety so I went there every 75:44 night and it was great and you know the 75:48 art in there is awesome there just have 75:50 like this split like that you know every 75:52 week was different 75:53 sometimes it was penises that were up 75:55 all different types other times it was 75:57 just people that are naked it was great 75:59 I thought there was the coolest but it's 76:02 just it is it's a really really good 76:04 meeting there are when you go to you 76:07 know AAA and look at meetings they will 76:11 specify if they are gay gay or LGBTQ to 76:15 ia meeting so they are they are 76:20 relatively easier to find I found and 76:23 they tend to be pretty awesome 76:29 even here in Berks County we have an 76:32 LGBTQIA 76:33 meeting every Sunday night and we 76:35 actually take the clients of Karen to it 76:38 not right now in the midst of the 76:39 pandemic nobody leaves the campus but 76:42 normally they do and it's really great 76:44 because it's a it's a there's a lot of 76:46 great recovery and it's a very accepting 76:48 group and you know if people kind of 76:51 break the rules of a 12-step meeting 76:53 they don't get shunned as some that 76:56 happens in meetings sometimes so you 76:58 crosstalk or you ask questions 77:00 everybody's really open it's great it's 77:02 really it's great for people in early 77:05 recovery to experience a safe place so 77:08 they are everywhere 77:11 yeah and yeah what Billy's got a 77:15 trans-pacific transgender expensive 77:17 specific a a na meeting and I love it 77:23 because they use all gender inclusive 77:25 language when they read the big book 77:27 twelve steps right so now it's yeah and 77:31 they it's it's such a safe place and 77:35 such a great community I'd be super 77:41 grateful to all of you if you could send 77:43 me any links that you can to some of the 77:45 things you just mentioned did not get 77:47 them on that resource page or follow-up 77:49 page so thanks for that and we also have 77:54 the question about resources for parents 77:58 mmm and of course there's there's PFLAG 78:02 but it's not necessarily for substance 78:04 use and i know when i started reaching 78:06 out to try to answer this question and 78:09 it actually came from somebody who I 78:10 thought would have the answer to this 78:11 question but I was hoping to find some 78:14 groups where there is that convergence 78:17 of su G and and the LGBTQ program 78:20 population but I'm not necessarily 78:22 finding them and he got you guys have 78:26 any ideas about resources for family 78:28 members 78:36 all right I guess we have to work on 78:38 that and I have a question for you guys 78:42 too 78:45 somebody had asked about you know the 78:48 access to treatment for they for the 78:50 transgender population but I'm just 78:53 wondering in general what your 78:54 experience has been whether it's 78:56 personal or through clients patients 78:58 you've worked with about the barriers to 79:00 accessing treatment for for substance 79:03 use disorder if you're from the LGBTQ 79:05 q2i a + community 79:18 I think a lot of people are especially 79:22 queer individuals you know for reasons 79:25 like you know Tom mentioned when he was 79:28 discussing going into treatment and that 79:30 fear of oh man is this gonna be like the 79:32 basketball court is is gonna be like you 79:34 know all you know am I gonna experience 79:36 this all over again being surrounded by 79:38 not my people I think a lot of 79:43 individuals are so you know what oh and 79:48 I won't speak for all individuals but I 79:49 think what what treatment centers need 79:52 to do more specifically is outline not 79:55 just make broad statements that yes we 79:58 provide affirming care to this 79:59 population outline what that affirming 80:02 care looks like because not everyone has 80:05 access to like the Pride Institute in 80:07 Minnesota you know which treats 80:10 specifically this population but they 80:13 you know really take the time and maybe 80:15 even have you know and I know this is a 80:17 position that that like you know these 80:20 you know treatment centers are starting 80:23 to fund and bring on is you know someone 80:27 who is focuses on LGBTQIA affair right 80:29 and who can really speak to these 80:31 families and really speak to the 80:32 patients that are coming into care and 80:33 say like this is what you're capable of 80:35 like this is what we can provide to you 80:37 as a game in what we can provide to you 80:39 as it trans individual and this is what 80:41 that looks like rather than you know 80:44 intake over the phone you know checking 80:48 insurance and saying yeah yeah yeah we 80:50 okay you're approved for the in-person 80:52 intake and we'll talk about that when 80:54 that gets here right so like you know so 80:57 making that crystal clear ahead of time 80:59 is something I think as you know 81:03 systemic Lee needs to needs to change 81:05 and I think there are places that do 81:06 excellent jobs and a lot of places that 81:08 just say yeah of course we we providing 81:10 firming care for that population so I 81:13 mean that's my experience you know I 81:16 don't work for a big treatment center 81:18 but I've referred a lot of individuals 81:20 to them if anyone else has something to 81:23 share that me yeah I appreciate that 81:26 Katie you're you're right I mean you 81:28 know I can only speak for what I know in 81:29 that and that's 81:30 I work closely with the admission staff 81:32 now and they do a really great job but 81:34 there are times when the potential 81:38 clients are still fearful and so just 81:40 last week I got a call from admissions 81:42 asking if I would call this gentleman 81:45 from Washington DC that was ready to 81:47 come into treatment but he was he was 81:48 fearful he had a lot of questions and so 81:51 you know I've worked with a lot of gay 81:54 men coming into treatment so I was able 81:55 to call him and answer his questions and 81:57 you know you can you can't make 81:59 guarantees like I can't guarantee that 82:01 it that every other clients are going to 82:03 be you know affirming and caring but 82:05 what I can tell you is there's a zero 82:06 tolerance for any type of you know any 82:10 type of whether it's racial sexual 82:12 orientation zero tolerance and people 82:14 will be discharged immediately if they 82:15 are you know if they're inappropriate so 82:18 and I'm actually going to probably meet 82:20 with him at some point in the next week 82:22 or so and he did make it in so you know 82:25 so if if our staff are unsure they'll 82:27 bring in an expert and not saying I'm 82:29 the expert but they might even bring in 82:31 a psychologist or somebody from the 82:33 clinical staff to come to speak to that 82:35 to speak to the patient you know it's 82:37 it's interesting that as I was speaking 82:40 to him you know in the year 2020 I'm 82:43 like that was me in 1995 it's still 82:47 there it's still there so 82:52 still got a lot of work to do definitely 82:56 well I think this was a really good 82:57 start and hopefully people will share 82:59 this once it's recorded and available so 83:02 just a little feedback from some 83:04 attendees I'm so appreciative for 83:06 everyone's candor and insights I learned 83:08 so much and can utilize what I've 83:09 learned this evening to my at risk team 83:11 clients I appreciate all of your time so 83:16 any less thoughts from anybody I really 83:26 really appreciate all of your time and 83:28 the thought you put into this and you 83:30 know again your transparency and trying 83:33 to move that needle a little further in 83:35 the right direction right thank you guys 83:37 so very much I really appreciate it and 83:40 to our attendees please do take our 83:42 survey and this video will be on that 83:45 follow-up page by morning and we're 83:48 going to try to get as much additional 83:50 information on the follow-up page as 83:52 possible thank you all so much a really 83:57 wonderful evening take their care a 83:59 night

Bostock and Title VII of the Civil Rights Act

In 2020, the Supreme Court ruled that gender identity and sexual orientation were protected from discrimination by the Civil Rights Act of 1964.

On January 20, 2021, President Biden signed an Executive Order applying these protections to all federal laws, regulations, and agencies. Because of the Supreme Court decision and the Executive Order, anyone doing business with the federal government is prohibited from discriminating based on gender identity or sexual orientation.

President Biden ordered all federal agencies to consult with the Attorney General as soon as possible to review all existing orders, regulations, guidance documents, policies, programs, or other agency actions.20 Meaningful change is arising quicker than expected.

Can your treatment facility avoid actions that might be construed as discriminatory to the LGBTQ+ community? You need to consider your interactions with patients and staff. The last thing a treatment facility can afford is an LGBTQ+ discrimination lawsuit that drives away potential patients.

Recapping Why Reaching the LGBTQ+ Community is Vital

Including LGBTQ+ affirming programs will prompt more members of the LGBTQ+ community to your treatment center.

The LGBTQ+ community is an often misunderstood minority group that needs better healthcare and services. Incorporating LGBTQ+ affirmation into your treatment center could do a world of good for your patients and your business. When it comes to LGBTQ+ patients, an affirming program can make all the difference.



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