Outcomes Measures for Sexual Minority Patients in an Opioid Treatment Program C. John-Hull, S. Kritz, M. Chu, C. Madray, G. Dominguez, C. Bowers, R. Sumpter, J. Mitchell, L.S. Brown Addiction Research and Treatment Corp, Brooklyn, NY Submitted as R-21 application in response to NIDA PA : Health Research with Diverse Populations

ABSTRACT Studies of sexual minorities have overwhelmingly been cross- sectional and descriptive. Some of the findings are: (1) increased risk for mental health and substance abuse problems; (2) different substances of abuse; (3) engagement in riskier sexual practices; and, (4) unique healthcare access issues as compared to heterosexuals. The Addiction Research and Treatment Corporation is the largest non-hospital based Opioid Treatment Program in New York State, serving more than 3,000 patients annually. We provide a wide range of healthcare and social services to patients throughout Brooklyn and Manhattan. On the basis of anonymous surveys, there is clearly an interest in having programs geared towards this population. In response to a NIDA R-01 Program Announcement (PA ), we propose to do a pre and post- intervention study that evaluates sexual minority patients participating in specialized groups in the following outcomes measures: (1) substance abuse; and, (2) quality of life. These particular outcomes were chosen because they will provide sufficient data for statistical analysis of significance, which is lacking in studies of this population.

ACKNOWLEDGEMENTS PATIENTS AND STAFF OF THE ADDICTION RESEARCH AND TREATMENT CORPORATION, A COMMUNITY- BASED SUBSTANCE ABUSE SERVICE AGENCY PATIENTS AND STAFF OF THE ADDICTION RESEARCH AND TREATMENT CORPORATION, A COMMUNITY- BASED SUBSTANCE ABUSE SERVICE AGENCY

ACKNOWLEDGEMENTS There are no financial interests or disclosures to report for any of the authors involved in this project There are no financial interests or disclosures to report for any of the authors involved in this project

BACKGROUND  Studies of sexual minority substance abusers have been largely cross-sectional and descriptive  Longitudinal studies have been virtually non-existent  ARTC provides substance abuse treatment to a predominantly (90%) racial/ethnic minority population that includes sexual minorities

STUDY DESIGN  Prospective, longitudinal study  Pre-post implementation evaluation  2-year timeline

STUDY POPULATION Sexual minorities, which can include…  Lesbians  Gays  Bisexuals  Transgender  Intersex ARTC’s patient population is 48% Hispanic and 42% African American

PRELIMINARY ACTIVITIES Needs assessment surveys of stakeholders: Needs assessment surveys of stakeholders:  Sexual minority patients  Treatment staff (medical, counseling, social service and case management staff) The surveys indicated clear interest by patients and staff in having programs for sexual minorities, and willingness by both to participate in a research project The surveys indicated clear interest by patients and staff in having programs for sexual minorities, and willingness by both to participate in a research project

HYPOTHESES Participation by sexual minorities in specialized groups will result in: Participation by sexual minorities in specialized groups will result in:  Decreased substance abuse  Improved Quality of Life

CURRICULUM Medical  Hormone therapy for transgender patients  Referral for cosmetic and sex reassignment surgery  LGBTI-specific healthcare services, including HIV-related services

CURRICULUM Clinical (Psychological): Clinical (Psychological):  Process of “coming out”  Behavior modification interventions to promote healthy lifestyle skills (i.e. HIV prevention and intervention to promote safer sex/harm reduction)

CURRICULUM Clinical (Psychological): Clinical (Psychological):  Definition of “self” as a sexual minority  Building self acceptance and self-esteem; dealing with societal discrimination and stigma; issues surrounding LGBTI Pride Week

CURRICULUM Substance Abuse:  Drugs of abuse by LGBTI patients  Relapse prevention; identifying triggers Legal:  Transgender legal rights issues (i.e. legal name change)  Parenting; legal issues concerning child custody and child abuse  Housing issues and homelessness

MEASURES Substance Abuse  Serial toxicology screens and Composite International Diagnostic Interview (CIDI) assessments Quality of Life  Serial World Health Organization Quality of Life (WHOQOL) – BREF assessments

DomainMeasure Data Source Substance Abuse Toxicology screens Patient chart Breathalyzer CIDI Patent interview Quality of Life WHOQOL-BREF Patient interview DOMAINS, MEASURES & DATA SOURCES

DATA ANALYSIS  Quantitative analysis of each study measure  Categorical variables: chi-square tests for statistical significance

CURRENT STATUS  Scientific Review Group (SRG) review: Not scored; SRG recommended inclusion of control group  ARTC analysis of SRG review: Logistics of control group deemed not appropriate; too few subjects in each arm  Next Steps: Submit to CSAT under Targeted Capacity Expansion grant program in early 2008