2. Director of LGBTQ-Integrative Program M.A., Certified Sexuality Counselor, Certified Alcohol and Drug Counselor, and Licensed Professional Counselor Certified by the American Association of Sexuality Educators, Counselors and Therapists (AASECT) Adjunct at Hazelden Graduate School of Addiction Studies My role is 50% clinical and 50% outreach

4. LGBTQ Language Research Findings on LGBTQ Overview of LGBTQ-Integrative Treatment Model Preliminary Outcomes LGBTQ Services Outside of HSB

8. Health and Human Services uses LGBT as the agreed upon acronym in the United States. They don’t use GLBT, GBLT, LBGT, GLBTQ, LGBTQ, etc. LGBT stands for Lesbian, Gay, Bisexual, and Transgender.

9. Q represents the “continuums” Questioning clients represent a significant portion of those engaging in our program

10. How many people identify as LGBT? 3.4 percent of the U.S. adult population - more than 8 million people. (2012 Gallup report)

11. How many struggle with substance abuse? As much as 20-30 percent of the LGBTQ community may struggle with substance use disorders (Substance Abuse and Mental Health Services Administration) - Compared with 10 percent of the population as a whole.

12. Data that informs our program

13. Hazelden’s Butler Center for Research study Statistical analysis of two samples of patients in adult residential treatment at Hazelden. Findings published in Research Update Article published in the current edition of Journal of Gay & Lesbian Social Services

14. Mean or average: LGBTQnon-LGBTQp = Number of detoxifications 1.540.65.002 Number of inpatient CD episodes 2.081.32.015 LGBTQ Research Findings

16. 92% of LGBTQ clients have a co-occurring disorder Nearly twice as likely to report physical and emotional abuse Three times as likely to have a history of sexual abuse (48%) More likely to have polysubstance diagnoses LGBTQ Research Findings

17. Percent of patients with LGBTQnon-LGBTQp = Axis I disorder 9278.003 Depressive disorder 7050.001 Anxiety disorder 6850.003 Emotional abuse 7344.000 Physical abuse 5128.001 Sexual abuse 4815.001 Major Issues

18. Introducing the new model

19. Integrative – intending to unify separate things

20. Model suggests that LGBTQ and non-LGBTQ shared treatment experience is a critical asset… –If affirming policy and sexual health education are understood by staff and visible in the milieu

21. Hazelden’s Springbrook campus has been offering specialized services for LGBTQ-identifying clients for three years. LGBTQ Program Director role began in 2014 Formal program launch last month Program Background

22. Treatment Modalities

25. HSB’s LGBTQ-Integrative Treatment Bridging LGBT-Sensitive and LGBT-Affirming models, offering unmatched sensitivity for those early in the stages of “coming out” and in identity and relational conflict. Program equitably accommodates heterosexual and LGBTQ clients. LGBTQ groups with focus on dynamics of an integrated treatment environment. Sexual Health Education for entire community LGBTQ staff visible throughout multidisciplinary team. “Gay-affirmative straight clinicians.” Homophobia and heterosexism directly addressed through process work in community and ongoing policy change. Trauma and co-occurring disorders addressed as primary recovery concerns. Certified sexuality professional(s). Emphasis on Sexual Health Model over Sex Addiction Model. Treatment components reinforce the commonality all addicts share. Treatment components are client specific.

26. LGBTQ-specific groups Interventions across the multidisciplinary team Sexuality counseling Variety of curriculum Program Structure

27. Affirming policy backed by senior leadership Sexual health as a milieu intervention Strong regional LGBTQ bridging Specialized referral network Program Structure

28. Proven to reduce relapse and increase program completion Creates common ground, shared language Gets beyond “LGBTQ” to universal sex/drug linked relapse risks Connects recovery principles to LGBTQ / non-LGBTQ Gets information to closeted/questioning clients Weekly Sexual Health in Recovery Group

29. Sexual health bridges the gap between sensitive and affirming models LGBTQ or Sexual Health?

30. Ongoing research of LGBTQ population and development of evidence based practices Leading the system in implementation of sexual health curriculum Addressing higher incidence of trauma through integration with our trauma program Regular all-staff training in both LGBTQ and sexual health in recovery

31. LGBTQ-friendly policy, emphasizing non- discriminatory treatment of transgender clients Family and spiritual care staff with strong LGBTQ competency Certified Sexuality Counselor on staff Integration with LGBTQ community, from Twelve- Step meeting engagement to volunteer and sober community opportunities

32. Measuring program impact

33. Average Days in Treatment

34. More likely to Engage in Extended Care

35. Suggests Higher Abstinence Rates at 6/12 months

36. Living A Double Life Attempted Murder Drinking Ipecac, Receiving Electroshock “Trauma Re-enactment/Avoidance” “Sex Addiction” Case Examples

37. Extending our reach to LGBTQ patients

38. Throughout our system we emphasize the need for individualized treatment for all of our clients. In this way, the LGBTQ population receives treatment addressing their needs at all of our facilities.

39. Beaverton—LGBTQ outpatient services rolling out presently Center City—continues to develop its strong LGBTQ support for clients Betty Ford Center—currently developing LGBTQ- Integrative programming St Paul, Chicago, Plymouth, Naples, Chelsea and our other sites-continue to explore how to best meet LGBTQ clients needs

40. Access to Research Update on LGBTQ Links to podcast and video about LGBTQ program Overview of services across system Client/family/referent oriented Future training, including online offerings

41. A Provider's Introduction to Substance Abuse Treatment for Lesbian, Gay, Bisexual, and Transgender Individuals (2001, SAMHSA/CSAT) BKD392: www.health.org/govpubs/BKD392/index.pdf Cass, V.C., 1979. Homosexual identity formation: A theoretical model. Journal of Homosexuality 4(3):219-235 Coleman, E., 1987. Assessment of sexual orientation. Journal of Homosexuality 14:1-2 Coleman, E., 1981/1982. Developmental stages of the coming out process. Journal of Homosexuality 7(2/3):31-43 Kort, J. (2008). Gay affirmative therapy for the straight clinician: The essential guide. New York, NY: W. W. Norton & Company, Inc Ratner, E.F., T. Kosten, A. McLellan, April 1991. Treatment outcome of PRDI Institute patients: First wave-Patients admitted from September 1988 through February 1989. In: A.T. McLellan, (ed.) Outcome Report. Eden Prairie, MN: PRIDE Institute

42. Buster Ross LGBTQ Program Director 503-554-4316 blross@hazelden.org