1. Unifying science, education and service to transform lives Module 12 Related Health Issues A Provider’s Introduction to Substance Abuse for Lesbian, Gay, Bisexual, and Transgender Individuals First Edition

2. Unifying science, education and services to transform lives. A Provider’s Introduction to Substance Abuse for LGBT Individuals Clinicians Guide, Part 2 of 2 Related Health Issues Learning Objectives Understand health issues for LGBT persons Be able to list barriers to adequate health care Be able to recognize and assess mental health issues Understand the effect of interpersonal violence in the LGBT community Power Point Slide # 12-1, n21

3. Unifying science, education and services to transform lives. A Provider’s Introduction to Substance Abuse for LGBT Individuals Clinicians Guide, Part 2 of 2 LGBT people are the victims of the most violent hate crimes in America. TRUE Hate crimes based on sexual orientation are probably among the most underreported crimes. Hate crimes against sexual minorities are generally more violent than other hate crimes. Power Point Slide # 12-2, n22 True Or False

4. Unifying science, education and services to transform lives. A Provider’s Introduction to Substance Abuse for LGBT Individuals Clinicians Guide, Part 2 of 2 Lesbians are at lower risk for breast and cervical cancer than heterosexual women. FALSE Lesbians may be at increased risk for HPV infection and, hence, cervical cancer, depending on their sexual practices. Lesbians typically see healthcare providers less frequently than do heterosexual women, and, thus, may not undergo sufficient screening. Power Point Slide # 12-3, n23 True Or False

5. Unifying science, education and services to transform lives. A Provider’s Introduction to Substance Abuse for LGBT Individuals Clinicians Guide, Part 2 of 2 Gay men are at higher risk for hepatitis A and B, and, in some cases, hepatitis C. TRUE Hepatitis A and B can be transmitted through sexual contact. Hepatitis B and C can be transmitted through sexual contact and/or sharing needles. Power Point Slide # 12-4, n24 True Or False

6. Unifying science, education and services to transform lives. A Provider’s Introduction to Substance Abuse for LGBT Individuals Clinicians Guide, Part 2 of 2 There is a relatively low prevalence of HIV infection among male-to-female transgender persons. FALSE In recent San Francisco study HIV prevalence among MTF persons was 35% and 65% among African-American MTFs. Other recent studies of transgender health risks in urban areas around the country show similar results. Power Point Slide # 12-5, n25 True Or False

7. Unifying science, education and services to transform lives. A Provider’s Introduction to Substance Abuse for LGBT Individuals Clinicians Guide, Part 2 of 2 Gay men tend to smoke less than heterosexual men. FALSE Recent and representative studies among gay men have indicated strikingly higher rates of smoking among gay men than in the general male population. Power Point Slide # 12-6, n26 True Or False

8. Unifying science, education and services to transform lives. A Provider’s Introduction to Substance Abuse for LGBT Individuals Clinicians Guide, Part 2 of 2 Gay and bisexual men are at higher risk for HIV but lower risk for gonorrhea and chlamydia. FALSE Even when men who have sex with men refrain from unprotected anal sex, they may engage in other activities such as unprotected oral sex that increases risk for both gonorrhea and chlamydia. Power Point Slide # 12-7, n27 True Or False

9. Unifying science, education and services to transform lives. A Provider’s Introduction to Substance Abuse for LGBT Individuals Clinicians Guide, Part 2 of 2 Barriers to Adequate Health Care Many gays and lesbians do not disclose their sexual orientation to their healthcare providers. Many LGBT persons are reluctant to use mainstream healthcare services. Gay and Lesbian Medical Association Survey (1994) results indicate substandard care for LGBT patients. Power Point Slide # 12-8, n28

10. Unifying science, education and services to transform lives. A Provider’s Introduction to Substance Abuse for LGBT Individuals Clinician’s Guide: Part 2 of 2 Mental Health Issues a higher rate of bipolar and depressive disorders in gay men Recent research on mental health issues for LGBT persons indicates that there is a higher rate of bipolar and depressive disorders in gay men than among heterosexual men. higher rates of lifetime depression in homosexual males Atkinson et al. found higher rates of lifetime depression in homosexual males compared with heterosexual men. depressive disorders in lesbian women Gilman et al. found significantly higher prevalence rates of depressive disorders in lesbian women compared with heterosexual females. barriers to mental health service utilization Distinct barriers to mental health service utilization have been described for sexual minorities that include  A tendency to pathologize LGBT identity  Lack of LGBT-sensitive care  Discrimination and marginalization of LGBT clients  Unwillingness to address LGBT-related issues in treatment  Unwillingness to work with partners and lovers of LGBT clients. Power Point Slide # 12-9, n29

11. Unifying science, education and services to transform lives. A Provider’s Introduction to Substance Abuse for LGBT Individuals Clinicians Guide, Part 2 of 2 Research on Interpersonal Violence in the LGBT Community Overall the same rate in same-sex relationships as in heterosexual relationships. 8% rate of partner violence in a diverse, nonclinical sample of nearly 2,000 lesbians. 17% of gay men reported having been in a physically violent relationship (Gay and Lesbian Community Action Council 1987). 40% of 228 gay male perpetrators abused drugs (Farley 1996). 25-33% of same sex couples report some sort of abuse (Page, 2000). Power Point Slide # 12-10, n30

12. Unifying science, education and services to transform lives. A Provider’s Introduction to Substance Abuse for LGBT Individuals Clinicians Guide, Part 2 of 2 Assessment and Intervention Ask about interpersonal violence in private Ensure confidentiality Ask questions in an affirming and culturally sensitive manner Empathize with client’s feelings Look for indicators of interpersonal violence Use third-person examples to screen possible batterers If a client is identified as either a victim or batterer, refer him or her to an LGBT support group, to an LGBT affirmative batterers’ intervention program, and for ongoing consultation with an LGBT domestic violence treatment expert Power Point Slide # 12-11, n31

13. Unifying science, education and services to transform lives. A Provider’s Introduction to Substance Abuse for LGBT Individuals Clinicians Guide, Part 2 of 2 CASE EXAMPLES How would you proceed with the assessment? What questions would you ask and how would you ask them ? Ron Ron DeeDee Power Point Slide # 12-12, n32