ADDICTION AND RECOVERY IN THE LGBTQI COMMUNITY

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1 The Foundations of Evidence-Based Care 2015 ADDICTION AND RECOVERY IN THE LGBTQI COMMUNITY By Rebecca Kuhn, M.D.

2 SOME DEFINITIONS Lesbian Gay Bisexual Transgender - A term referring to when one's gender and sex are not always or ever equivalent. Urban Dictionary Queer A term used to describe homosexuals, bisexuals, and transgendered people. In scholarly studies the word queer is also used to describe those who practice unconventional sex (e.g. bondage, etc.), therefore even heterosexuals can sometimes be defined as queer. Urban Dictionary Intersex - a general term used for a variety of conditions in which a person is born with a reproductive or sexual anatomy that doesn t seem to fit the typical definitions of female or male. Intersex Society of North America

3 SOME STATISTICS Not XX and not XY Klinefelter (XXY) Androgen insensitivity syndrome Partial androgen insensitivity syndrome one in 1,666 births one in 1,000 births one in 13,000 births one in 130,000 births Classical congenital adrenal hyperplasia Late onset adrenal hyperplasia Vaginal agenesis Ovotestes Idiopathic (no discernable medical cause) one in 13,000 births one in 66 individuals one in 6,000 births one in 83,000 births one in 110,000 births Iatrogenic (caused by medical treatment, for instance progestin administered to pregnant mother) no estimate 5 alpha reductase deficiency no estimate Mixed gonadal dysgenesis Complete gonadal dysgenesis Hypospadias (urethral opening in perineum or along penile shaft) no estimate one in 150,000 births one in 2,000 births Hypospadias (urethral opening between corona and tip of glans penis) one in 770 births Total number of people whose bodies differ from standard male or female one in 100 births Total number of people receiving surgery to normalize genital appearance one or two in 1,000 births

4 MORE STATISTICS It is estimated that between 20 percent to 30 percent of gay and transgender people abuse substances, compared to about 9 percent of the general population. Tobacco Gay and transgender people smoke tobacco up to 200 percent more than their heterosexual and nontransgender peers. Alcohol Twenty-five percent of gay and transgender people abuse alcohol, compared to 5 to 10 percent of the general population. Drugs Men who have sex with men are 3.5 times more likely to use marijuana than men who do not have sex with men. These men also are 12.2 times more likely to use amphetamines than men who do not have sex with men. They are also 9.5 times more likely to use heroin than men who do not have sex with men. Center for American Progress

5 LESBIANS AND ALCOHOL The tale of lesbian substance most often starts with selfloathing Curve Women who suffered childhood sexual abuse are more likely to have drinking problems NIAAA Women who have trouble with their closest relationships drink more than other women NIAAA Significant negative correlations were found for females between internalized homophobia and lifetime use of alcohol, marijuana, and cigarettes, as well as monthly use of marijuana. Journal of Gay&Lesbian Social Studies

6 LESBIANS AND ALCOHOL Rates of "heavy" alcohol use and alcohol-use-related problems among lesbians were much lower in this study than in early studies. However, lesbians were more likely than their heterosexual counterparts to be in recovery and to have been in treatment for alcohol-use-related problems. Further, high rates of childhood sexual abuse, depression, and suicidal ideation reported by lesbians suggest that at least some groups may be at heightened risk for "heavy" drinking and drinking-related problems Substance Use & Misuse 2003

7 GAY MEN AND METH Use of the illicit drug crystal methamphetamine is one of several factors that may be fueling increases in sexually transmitted diseases (STDs) among gay and bisexual men in the United States National STD Prevention Conference Viagra, Methamphetamine, Internet Use Linked to Increase in Number of Syphilis, HIV Cases Among MSM, Studies Say Kaiser Health News March 2004 It gets better: resolution of internalized homophobia over time and associations with positive health outcomes among MSM. AIDS and Behavior May 2013 Untreated or Undertreated ADHD Strattera as an alternative?

8 THE TRANSGENDER COMMUNITY AND SUBSTANCE USE Like all potential clients, transgender substance abusers bring a variety of experiences with substances and readiness to change into the treatment setting. Many transgender people have had one or more negative experiences with institutions, including those that provide health care. They may be unusually distrustful of professionals and treatment recommendations. It is vital to remember that these clients, like all clients, need to be met with sensitivity and respect. Clients should be allowed to self-identify and cannot be judged on the basis of their self-identification. SAMHSA 2001

9 HEROIN BACK ON THE SCENE There are two key reasons for heroin s resurgence: A larger, cheaper supply stemming from an increase in heroin importation by Latin American cartels, and a bigger market for opiates, driven by prescription painkillers. Time Feb 2014

10 PRESCRIPTION MEDICATIONS Prescriptions more than doubled in 20 years from 76 million to 207 million, according to the suit. In 2007, Americans consumed 51.6 tons of the generic form of Oxycontin, oxycodone, or 82 percent of the world s supply. Opioids generated $8 billion in revenue in Philly.com May 2014 A recent article in a Toledo newspaper asserted that the prevalence of heroin in the LGBTQ community is a result of its easy accessibility Now, I know many heterosexuals, too, who have chosen to self-medicate with prescription pills or illegal substances. Turning to drugs to numb pain isn't solely a homosexual behavior. But the ridicule, rejection, and even disownment that gays and lesbians frequently endure just makes us that much more likely to fall down the rabbit hole. My ex certainly experienced a lifetime of fear and emotional trauma, as she struggled with coming out of the closet in her twenties. Huffington Post May 2014

11 MEDICAL MARIJUANA Proponents of medical marijuana argue that it can be a safe and effective treatment for the symptoms of cancer, AIDS, multiple sclerosis, pain, glaucoma, epilepsy, and other conditions. They cite dozens of peer-reviewed studies, prominent medical organizations, major government reports, and the use of marijuana as medicine throughout world history. Opponents of medical marijuana argue that it is too dangerous to use, lacks FDA-approval, and that various legal drugs make marijuana use unnecessary. They say marijuana is addictive, leads to harder drug use, interferes with fertility, impairs driving ability, and injures the lungs, immune system, and brain. They say that medical marijuana is a front for drug legalization and recreational use.

12 HARM REDUCTION Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. Harm Reduction is also a movement for social justice built on a belief in, and respect for, the rights of people who use drugs. Harm Reduction Coalition Pros: Harm reduction approaches are practical, feasible, effective, safe and cost-effective. Harm reduction has a commitment to basing policy and practice on the strongest evidence available. Most harm reduction approaches are inexpensive, easy to implement and have a high impact on individual and community health. Cons: Needle exchange demonstrates a practical aspect of harm reduction leading to personal irresponsibility. With a program like harm reduction, there is never light at the end of the tunnel. program communicates apathy in an area where integrity is essential.

13 ADDRESSING THE RELIGIOUS ISSUES Soul Force Gay Christian Network Nehirim Affirmation Muslims for Progressive Values

14 INTERNALIZED HOMOPHOBIA RESOLUTION It Gets Better: Resolution of Internalized Homophobia over Time and Associations with Positive Health Outcomes among MSM Understanding resiliencies and incorporating them into interventions may help to promote health and well-being among gay and bisexual men. AIDS and Behavior 2013

15 IDENTIFY AND EVALUATE Identify The tweak, the sniff and the nod Relationships and valuables begin to disappear Inconsistencies and Lies Evaluate Urine tox screen? Blood tox screen? CPK for meth?

16 EFFECTIVE DIALOGUE 1. Do you have sex with men, women, or both? 2. Does your substance use compromise who you say you are? 3. Are you willing to address the people, places, and things that compromise what you say you want? 4. Are you willing to fire your judge and jail keeper? 5. Are you willing to have a vision that carries you through the pain of transformation?

17 2015 Warmly wishes to thank Rebecca Kuhn, MD for being with us today.