Recovery Housing and the LGBTQ Community

Objectives Gain knowledge about substance use and addiction health disparities experienced by the LGBTQ community. Learn best practices for serving the LGBTQ community with cultural humility. Develop strategies for implementation in their recovery environments for people who identify as LGBTQ. EquitasHealth.com

Check-In Question Why is creating welcoming and affirming recovery environments for LGBTQ people important?

Decoding the Gender Unicorn Sexual Orientation Homosexuality Heterosexuality Bisexuality Etc. Gender Identity Cisgender Transgender Fluidity Queer Questioning

What does substance abuse and addiction look like in the LGBTQ community?

Substance Use in the LGBTQ Community Overall rates of substance abuse are higher in the LGBTQ community than in the overall US population. According to the 2015 National Survey on Drug Use and Health, 39.1% of LGBTQ Americans use illicit drugs, compared to 17.1% of the rest of the US population. https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2015/NSDUH-FFR1-2015/NSDUH-FFR1-2015.pdf

More Data from 2015 NSDUH Substance use disorders were more prevalent among LGBT adults (15.1%) than for non-LGBT adults (7.8%) and was higher across age and gender groups. LGBT adults reported higher levels of alcohol use in the month before the survey than non-LGBT adults (63.6% versus 56.2%). LGBT women were more likely than non-LGBT women to be current alcohol users, binge drinkers, and heavy drinkers. https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2015/NSDUH-FFR1-2015/NSDUH-FFR1-2015.pdf

Additional Data LGBTQ smoking: 200% higher 25% abuse alcohol, compared to 5-10% of the general population. MSM: 3.5x more likely to use marijuana, 12.2x more likely use amphetamines, and 9.5x more likely to use heroin than non-MSM. Trans women are 6 times more likely than cis women to enter treatment for methamphetamine addiction, and are significantly more likely to use needles to inject drugs. Bisexuals are more likely to use marijuana and other illicit drugs. https://cdn.americanprogress.org/wp-content/uploads/issues/2012/03/pdf/lgbt_substance_abuse.pdf http://www.hazeldenbettyford.org/education/butler-center-for-research/research-updates/1601-lgbtq-substance-abuse-factors

Why do these disparities exist?

Social Norms Heteronormativity Cisnormativity Heterosexism Homophobia “Norms are the established standards of behavior maintained by a society.” –Richard Schafer Heteronormativity Cisnormativity Heterosexism Homophobia Transphobia

Minority Stress Minority stress describes chronically high levels of stress faced by members of stigmatized minority groups. It may be caused by a number of factors, including poor social support and low socioeconomic status, but the most well understood causes of minority stress are interpersonal prejudice and discrimination.

What Drives Substance Use/Abuse Disparities? Response to minority stress Prevalence of bars and clubs as traditional gathering places for LGBTQ people Marketing efforts that that target the LGBTQ community Lack of large-scale prevention efforts aimed at the LGBTQ community https://cdn.americanprogress.org/wp-content/uploads/issues/2012/03/pdf/lgbt_substance_abuse.pdf

LGBTQ People and Treatment In 2015, 15.3% of LGBTQ adults who needed substance use treatment received it at a specialty facility, compared to 10.6% of non-LGBTQ adults who needed treatment. Unfortunately, LGBTQ people who want to be in recovery all-too-often find that those environments are not welcoming or affirming. https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2015/NSDUH-FFR1-2015/NSDUH-FFR1-2015.pdf

Now that you know some basic facts about LGBTQ people and their needs, how can you create an environment that is affirming and inclusive?

Cultural Competency Builds knowledge, awareness, skills, and capacity to Identify, understand, and respect the unique beliefs, values, customs, languages, abilities and traditions of all people Provide effective programs and services. Enables effective work in cross-cultural situations. Includes mandates, laws, policies, rules, standards, practices, and attitudes. EquitasHealthinstitute.com

Moving from Cultural Competency to Cultural Humility Cultural competency assumes one can learn or know enough or reach a full understanding of a culture to which they do not belong Cultural humility incorporates a lifelong commitment to self-evaluation, self-critique, learning and reflection Also includes recognizing and addressing power dynamics in relationships. Involves working in partnerships Cultural humility is a process, not a goal. EquitasHealthinstitute.com

Cultural Humility Applied to the LGBTQ Community The problem of implicit bias What are some harmful heteronormative assumptions that might be made in a recovery context? What are some examples of homophobic attitudes that might get in the way of LGBTQ people staying in treatment?

Listening as a Key Part of Cultural Humility Established procedures allow us to complete work more quickly and efficiently – But what if those procedures are biased? Creating a welcoming and inclusive environment requires active listening. Think about how you ask questions, and be mindful of giving respondents the chance to elaborate. What would be an example this applied to serving the LGBTQ community?

Respecting Authenticity Someone’s sexual orientation is a core part of their personhood – It is not just who we love, it’s also a big part of who we are. Affirming this for an LGBTQ person is a key part of building trust – Trust that is essential to help keep someone in treatment. What are some ways that one can indicate that they respect another person’s sexual orientation?

Pronouns and Gender-Inclusive Language Getting it right on pronouns and gender-inclusive language takes a little bit of adjusting and a lot of practice, but it pays great dividends in terms of building trust between organizations and the traditionally underserved LGBTQ population. Failing to properly address these issues erodes trust and makes it less likely that LGBTQ patients will stay engaged in care, be honest with providers, and keep up to date on preventative care.

Why is important to get names and pronouns right? The person you are interacting with may have been misgendered/deadnamed earlier that day, maybe more than once. For most trans people, being misgendered/deadnamed is invalidating and somewhere between aggravating and traumatic. Experiencing these things in a treatment setting often confirms trans folks’ worst fears about recovery experiences. In a practical sense, not being mindful of names and pronouns can lead to trans & non-binary people falling out of treatment programs.

Best Practices for Pronoun Usage Introduce yourself as “Hello, my name is _______, and my pronouns are _________.” This will cue the person you are talking to that it is OK to reciprocate. Using pronoun stickers and buttons signals to TGNB people that you have considered pronouns. Consider making it policy that staff will state their pronouns when introducing themselves at meetings and public events.

Best Practices For Pronoun Usage IF you get someone’s pronouns wrong, apologize sincerely and quickly and then move on from it. Don’t dwell. Don’t keep apologizing, and don’t try to explain why or make it about yourself. Practice getting other people’s pronouns right even when they are not around, and correct other people when they get absent people’s pronouns wrong. If you don’t know what a person’s pronouns are, default to using their name or the singular they (they/them/theirs).

Strategies for Implementation

The Need for LGBTQ Inclusive Treatment/Training of Staff Research shows that treatment which addresses the unique issues faced by LGBTQ patients is more effective than a “one-size-fits-all” approach. LGBTQ patients report that their main dissatisfaction with programs stem from feeling a lack of acceptance. Thus, training staff on LGBTQ cultural humility is an essential part of creating a more inclusive and welcoming environment. Consider forming a Diversity and Inclusion/Cultural Humility Committee in your workplace. http://www.hazeldenbettyford.org/education/butler-center-for-research/research-updates/1601-lgbtq-substance-abuse-factors

Achieving Structurally Competency Be mindful of structural competency: What language is used on signage and brochures in your physical space? Is it gender-inclusive? Are there pictures of LGBTQ folks on any materials? Are there indications of inclusivity, such as rainbow stickers/flags, etc? Make forms and printed materials inclusive – Do your current forms make heteronormative and/or cisnormative assumptions? Place your nondiscrimination policy (inclusive of sexual orientation and gender identity) on display.

Housing and Restrooms People should be housed in accordance with their gender identity, not their sex assigned at birth. People who identify as non-binary should be able to choose the housing arrangements they feel most comfortable with if mixed-gender or gender-neutral options are not available. Make single-occupancy restrooms gender neutral, and allow people to use gendered bathrooms in accordance with their gender identity.

Create Programs Specifically Aimed at LGBTQ People Programs should include a focus on building self-esteem and self-acceptance. Programs should be led by personnel who have training and experience serving LGBTQ populations. Family counseling for family members, including spouses and partners, should be available. Groups and meetings that are tailored towards LGBTQ addicts and their unique needs. Dual diagnosis treatment for LGBTQ people also dealing with mental illness. Triggers for LGBTQ addicts can be unique, and family support may not be available. https://beginningstreatment.com/lgbt-drug-addiction/ https://www.recovery.org/topics/find-the-best-gay-lesbian-bisexual-transgender-lgbt-addiction-recovery-centers/

Follow best practices for pronouns and gender inclusive language. Points of Emphasis for Providing an Inclusive and Welcoming Environment Take the minority stress experienced by LGBTQ people into account when you interact with members of that community. Follow best practices for pronouns and gender inclusive language. Avoid heteronormative and cisnormative questions and assumptions.

Impact of Providing Culturally Humble Services Closing substance use and addiction disparities Improving treatment outcomes Increasing “community trust” of providers and institutions Creating safe spaces Decrease in ability of stigma to function as a barrier to treatment

Questions? Ramona Peel, MA Phone: 614-643-6847 Email: ramonapeel@equitashealth.com