1. Unifying science, education and service to transform lives Module 11 Clinical Issues with Youth 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 CLINICAL ISSUES WITH YOUTH Learning Objectives Know risk factors for substance abuse and HIV/AIDS Know risk factors for substance abuse and HIV/AIDS Understand approaches to assessment and treatment Understand approaches to assessment and treatment Power Point Slide # 11-1, n1

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 HIV infection rates have dropped among young gay white men and new infections are lower among all gay men than among their heterosexual counterparts FALSE 7 % infection rates among 3,000 15- to 22- year-old young gay men sampled in a rigorous new CDC study (Villeoy 2000). Fully one half of all new infections occur among people younger than 25. Young gay white men form the largest group in this age bracket, followed closely by young gay black men. Power Point Slide # 11-2, n2

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 There is overwhelming evidence that verbal and physical violence against LGBT youth of all backgrounds can lead to high-risk behaviors that increase their risk for substance abuse and HIV/AIDS TRUE Youth who were victims of bias related harassment and/or violence are: Twice as likely to report bingeing on alcohol (5-plus drinks at one time) at least once in the past month Twice as likely to report using marijuana in the past month Three to ten times as likely to report having tried cocaine Two to three times as likely to report having ever tried hallucinogens, depressants or stimulants Report of the Anti-Violence Documentation Project from the Safe Schools Coalition of Washington (1997). Power Point Slide # 11-3, n3

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 Reports of higher rates of suicidal behaviors and suicide among LGBT youth have not been supported in the research on adolescent suicide. FALSE The Youth Risk Behaviors Survey in the States of Vermont and Massachusetts (2000) found that LGBT youth are Twice as likely to report having seriously considered suicide in the past year. Twice as likely to say they made a suicide plan in the past year. Three to four times as likely to report having attempted suicide in the past year. More than four times as likely to say they made a serious enough suicide attempt in the past year to have been treated by a health care professional. Power Point Slide # 11-4, n4

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 LGBT adolescents are twice as likely as straight students to feel unsafe or afraid at school, some, most, or all of the time. TRUE 97% 97% of students in public high schools report regularly hearing homophobic remarks from their peers. two to four times more likely LGBT youth are two to four times more likely than their heterosexual peers to have been threatened or injured with a weapon at school. 34% 34% of lesbian, gay, and bisexual students surveyed had been the target of verbal assaults at school or en route to or from classes. Power Point Slide # 11-5, n5

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 School officials and guidance counselors are more aware today of the need to protect LGBT youth from antigay harassment School officials and guidance counselors are more aware today of the need to protect LGBT youth from antigay harassment. FALSE one in six thought there were no lesbian, gay, bisexual or transgender youth in their schools. Of 289 high school counselors surveyed in the Seattle Safe Schools Survey, one in six thought there were no lesbian, gay, bisexual or transgender youth in their schools. 20% 20% believed they were not competent at counseling LGBT students Power Point Slide # 11-6, 6

8. 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 Risk and Protective Factors for LGBTQ Youth (CSAP 1993) ; Power Point Slide #11-7, n7 Risk Factors Higher school dropout rates related to discrimination Protective Factors Social support and prosocial bonding with peers Inadequate social services that are not culturally relevant Increases in knowledge through peer education Violence and fear of disclosure among peers in the community Situational self-efficacy; teaching youth coping skills for dealing with school victimization Pro-use norms in the adult LGBT communities; lack of adult LGBT role models Community support- positive LGBT adult role models Family support

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 SEXUAL IDENTITY: AGE OF ONSET Average Age (Years) Event Occurs Behavior/ Earlier Studies* More Recent Identity Studies** Males Females First awareness13 14–16 9 10 of same-sex attraction First same- 15 20 13–14 14–15 sex experience First self- 19–21 21–23 14–16 15–16 identified as lesbian or gay *Studies of adults who remembered their experiences as children and adolescents **Studies of adolescents who described their experiences as they were happening or right after they happened Power Point Slide #11-8, n8

10. Unifying science, education and services to transform lives. A Provider’s Introduction to Substance Abuse for LGBT Individuals Clinicians Guide, Part 2 of 2 Special Issues for LGBT Youth LGBT Youth of Color: Integrating their sexual, racial, and ethnic identities Interacting with three separate communities- ethno-cultural, LGBT, and mainstream Managing more than one stigmatized identity. All LGBT Youth: Higher risk for depression and suicide Homelessness is a particular concern for LGBT youth with reports from various studies showing ranges from 20 percent to 40 percent Homeless youth are at high risk for exploitation; e.g. survival sex (exchanging sex for food, drugs, or shelter) LGBT homeless and runaway youth have many health and social problems. Power Point Slide #11-9, n9

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 LGBT Adolescent Assessment and Treatment Checklist Alcohol, tobacco, and other drug use The adolescents’ social environment Sexual identity development and stage of coming out Level of disclosure about sexuality Gender identity Family and social support network Impact of multiple identities, gender/ethnic/cultural/sexual orientation Knowledge and use of safer sex practices Power Point Slide # 11-10, n10