1. Unifying science, education and service to transform lives Module 4: An Overview of Treatment Approaches, Modalities, and Issues of Accessibility in the Continuum of Care 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 Module 4 Treatment Approaches Understand special issues in working with LGBT clients Understand levels of care and modalities Know guidelines for insuring accessibility and LGBT– affirmative treatment PowerPoint Slide # 4-1 Learning Objectives

3. Unifying science, education and services to transform lives. A Provider’s Introduction to Substance Abuse for LGBT Individuals Module 4 Treatment Approaches Approaches, Levels and Continuum of Care, and Access to Treatment Treatment-readiness approaches –Sexual orientation and gender identity issues –Coming out –Social stigma and discrimination –Health concerns, such as HIV/AIDS –Homophobia and heterosexism Level of care –Residential vs outpatient –LGBT community based support services Continuum of care LGBT specific versus mainstream PowerPoint Slide # 4-2

4. Unifying science, education and services to transform lives. A Provider’s Introduction to Substance Abuse for LGBT Individuals Module 4 Treatment Approaches LGBT Client Do's and Don'ts Staff Sensitivity oKnowledge, skills, and attitudes Assessment Practices and Issues Facilities and Modalities oFor example, room assignments and shared bathrooms oIndividual, group, and family interventions Discharge and Aftercare PowerPoint Slide # 4-3

5. Unifying science, education and services to transform lives. A Provider’s Introduction to Substance Abuse for LGBT Individuals Module 4 Treatment Approaches Defining Care LGBT-tolerant Aware that LGBT people exist and use their services LGBT-sensitive Aware of, knowledgeable about, and accepting of LGBT people LGBT-affirmative Actively promote self-acceptance of an LGBT identity as a key part of recovery PowerPoint Slide # 4-4

6. Unifying science, education and services to transform lives. A Provider’s Introduction to Substance Abuse for LGBT Individuals Module 4 Treatment Approaches Special Assessment Questions Level of comfort being LGBT person ? Stage of coming out ? Family/support/social network ? Health factors ? Milieu of use ? Drug use and sexual identity or sexual behavior connections ? Partner/lover use ? Legal problems related to sexual behavior ? Gay bashing ? Same-gender domestic violence ? Out as LGBT in past treatment experiences ? Correlates of sober periods ? PowerPoint Slide # 4-5

7. Unifying science, education and services to transform lives. A Provider’s Introduction to Substance Abuse for LGBT Individuals Module 4 Treatment Approaches Modalities Group counseling Family counseling Individual counseling PowerPoint Slide # 4-6

8. Unifying science, education and services to transform lives. A Provider’s Introduction to Substance Abuse for LGBT Individuals Module 4 Treatment Approaches Research based Interventions PROP (Positive Reinforcement Opportunity Project –low-intensity contingency management intervention in both outpatient and community settings –Preliminary efficacy at reducing methamphetamine use (Shoptaw et al, 2006) Gay Specific CBT Groups (Shoptaw, 2005) –Significantly reduced depressive symptoms in sample of methamphetamine-dependant gay and bisexual men

9. Unifying science, education and services to transform lives. A Provider’s Introduction to Substance Abuse for LGBT Individuals Module 4 Treatment Approaches Case Example: RUTH (a) What key recovery issues is Ruth facing? (b) What issues is Ruth facing that are particular to her identity as a lesbian? What kind of interventions would you suggest if you were her counselor? (c) What kind of interventions would you suggest if you were her counselor? PowerPoint Slide # 4-7

10. Unifying science, education and services to transform lives. A Provider’s Introduction to Substance Abuse for LGBT Individuals Module 4 Treatment Approaches References and Further Resources SAMHSA's Substance Abuse Treatment Locator www.findtreatment.samhsa.govwww.findtreatment.samhsa.gov SAMHSA National Helpline (for locating drug and alcohol abuse treatment programs) –(800) 662-HELP (4357) (English and Espanol) –(900) 487-4889 (TDD) National Runaway Switchboard (Youth) –It’s anonymous, confidential and free. 1-800-RUNAWAY. AIDS Info 800-874-2572 9:00 a.m.-7:00 p.m. Spanish-speaking operators available. www.aidsinfo.nih.gov www.aidsinfo.nih.gov CDC National STD/AIDS Hotline 800-227-8922 English (STD) 800-342-2437 English (AIDS) 800-344-7432 (Spanish) 800-243-7889 (TDD) English: 24 hours/7 days a week; Spanish: 8 a.m.-2 a.m., 7 days a week (eastern time); TTY: 10:00 a.m.- 10:00 p.m., Monday-Friday (eastern time) www.ashastd.org/nah/index.html www.ashastd.org/nah/index.html Project Inform National HIV/AIDS Treatment Hotline 800-822-7422 9:00 a.m.-5:00 p.m., Monday-Friday (Pacific time) 10:00 a.m.-4:00 p.m., Saturday (Pacific time) Spanish-speaking operators available. www.projinf.org www.projinf.org Gay and Lesbian Medical Association http://glma.org/http://glma.org/ –"Resources for Patients" to access the LGBT-friendly physician database, list of important things to discuss with your health care provider, and information on hepatitis and depression.