• No results found

Substance Abuse Treatment for Lesbian, Gay, Bisexual, Transgender Individuals

N/A
N/A
Protected

Academic year: 2021

Share "Substance Abuse Treatment for Lesbian, Gay, Bisexual, Transgender Individuals"

Copied!
8
0
0

Loading.... (view fulltext now)

Full text

(1)

Substance Abuse Treatment

for Lesbian, Gay, Bisexual,

Transgender Individuals

Substance Abuse Treatment

Substance Abuse Treatment

for Lesbian, Gay, Bisexual,

for Lesbian, Gay, Bisexual,

Transgender Individuals

Transgender Individuals

Jon E. Grant, JD, MD, MPH

University of Minnesota

School of Medicine

Medical Director, The Pride Institute

Jon E. Grant

Jon E. Grant, JD, MD, MPH

, JD, MD, MPH

University of Minnesota

University of Minnesota

School of Medicine

School of Medicine

Medical Director, The Pride Institute

Medical Director, The Pride Institute

Disclosure Information

Disclosure Information

‹

‹

I have the following financial relationships to

I have the following financial relationships to

disclose:

disclose:

•Grant/Research support from: Forest Grant/Research support from: Forest Pharmaceuticals, GlaxoSmithKline Pharmaceuticals, GlaxoSmithKline ‹

‹

I will discuss the following off

I will discuss the following off

-

-

label use and/or

label use and/or

investigational use in my presentation:

investigational use in my presentation:

•All medications used to treat non-All medications used to treat non-substance substance addictions are off

addictions are off--label and include label and include --SSRIs, lithium, SSRIs, lithium, antiepileptics

antiepileptics, , opioidopioidantagonists, stimulants, antagonists, stimulants, antipsychotics

antipsychotics, calcium channel blockers, muscle , calcium channel blockers, muscle relaxants,

relaxants, antiemeticsantiemetics

Substance and Non

Substance and Non

-

-

Substance

Substance

Addictions

Addictions

‹ ‹

Methamphetamine

Methamphetamine

‹ ‹

Cocaine

Cocaine

‹ ‹

Alcohol

Alcohol

‹ ‹

GHB, Ecstasy

GHB, Ecstasy

‹

‹

Compulsive sexual behavior

Compulsive sexual behavior

‹

‹

Pathological gambling

Pathological gambling

‹

‹

Compulsive Internet use

Compulsive Internet use

‹

‹

Compulsive spending

Compulsive spending

Gays, Lesbians, and Addiction

Gays, Lesbians, and Addiction

‹

‹

National Health and Social Life

National Health and Social Life

Survey (NHSLS) found that

Survey (NHSLS) found that

approximately 3% of men in a

approximately 3% of men in a

community sample identified as gay

community sample identified as gay

or bisexual

or bisexual

‹

‹

Gay and bisexual men appear to

Gay and bisexual men appear to

suffer from substance use disorders

suffer from substance use disorders

at two to three times the rate found

at two to three times the rate found

in the general population

in the general population

Epidemiology

Epidemiology

•Gay men more likely than heterosexual Gay men more likely than heterosexual men to use recreational drugs; 1/3 gay

men to use recreational drugs; 1/3 gay

men use drugs 1x/week; 2/3 used in

men use drugs 1x/week; 2/3 used in

past 6 months

past 6 months

•Lesbians at greatest riskLesbians at greatest risk •

•Substance abuse 1.47 times greater in Substance abuse 1.47 times greater in gay men compared to heterosexual men

gay men compared to heterosexual men

•Age at first alcohol or drug use younger Age at first alcohol or drug use younger in gays and lesbians

in gays and lesbians

Co

Co-

-Occurring Disorders

Occurring Disorders

‹

‹

Gay men twice as likely to have a

Gay men twice as likely to have a

mental disorder in their lives

mental disorder in their lives

‹

‹

More likely to have mood, anxiety or

More likely to have mood, anxiety or

substance use disorder

substance use disorder

‹

‹

Bisexual men more likely to have

Bisexual men more likely to have

psychiatric disorder compared to gay

psychiatric disorder compared to gay

men

men

‹

‹

Psychiatric disorders even greater in

Psychiatric disorders even greater in

African

(2)

Research and Data

Research and Data

In a recent (1999, 2000) San Francisco study by In a recent (1999, 2000) San Francisco study by Dr. Kristin Clements at the San Francisco Dr. Kristin Clements at the San Francisco Department of

Department of PublicHealthPublicHealthAIDS Office:AIDS Office:

‹

‹ HIV prevalenceHIV prevalenceamong MTF persons was among MTF persons was 35% 35% and 65%

and 65%among African-among African-American American MTFsMTFs..

‹

‹ Injection drug use was 34%Injection drug use was 34%among MTF among MTF

transgender individuals and

transgender individuals and18%18%among FTM among FTM transgender individuals.

transgender individuals.

‹

‹ 55%55%of MTF individuals reported they had been of MTF individuals reported they had been

in alcohol or drug treatment sometime during in alcohol or drug treatment sometime during their lifetimes.

their lifetimes. Power Point Slide # 10-5, n40

Research

Research

A study from Hollywood, California, (

A study from Hollywood, California, (RebackRebackand and Lombardi1999) reported that the

Lombardi1999) reported that the drugs most drugs most commonly used by MTF transgender individuals commonly used by MTF transgender individuals were alcohol, cocaine/crack, and

were alcohol, cocaine/crack, and methamphetamine

methamphetamine

Other recent studies of transgender health risks Other recent studies of transgender health risks in urban areas around the country , including in urban areas around the country , including Boston, New York City, Washington D.C., Boston, New York City, Washington D.C., Chicago, Los Angeles and Houston, show Chicago, Los Angeles and Houston, show similar similar results with higher rates of substance abuse in results with higher rates of substance abuse in general and higher rates of substance abuse with general and higher rates of substance abuse with HIV prevalence, particularly among transgender HIV prevalence, particularly among transgender sex workers.

sex workers.

. .

Power Point Slide # 10-6, n41

HIV infection rates

HIV infection rates

have dropped

have dropped

among young gay

among young gay

white men and new

white men and new

infections are lower

infections are lower

among all gay men

among all gay men

than among their

than among their

heterosexual heterosexual counterparts counterparts FALSE FALSE ‹

‹ 7 % infection rates7 % infection rates among 3,000 15

among 3,000 15--to 22to 22-

-year

year--old old young gay menyoung gay men sampled in a rigorous new

sampled in a rigorous new

CDC study (

CDC study (VilleoyVilleoy2000). 2000).

‹

‹ Fully one half of all new Fully one half of all new

infections

infectionsoccur among occur among

people

people younger than 25. younger than 25.

‹

‹ Young gay white menYoung gay white men form the largest group in

form the largest group in

this age bracket,

this age bracket, followed followed

closely by young gay

closely by young gay

black men.

black men.

Power Point Slide # 11-2, n2

There is

There is

overwhelming

overwhelming

evidence that verbal

evidence that verbal

and physical and physical violence against violence against LGBT youth of all LGBT youth of all backgrounds can backgrounds can lead to high

lead to high--risk risk

behaviors that

behaviors that

increase their risk

increase their risk

for substance abuse

for substance abuse

and HIV/AIDS

and HIV/AIDS

TRUE

TRUE

Youth who were victims of

Youth who were victims of

bias related harassment

bias related harassment

and/or violence are:

and/or violence are:

‹

‹ Twice as likely to report Twice as likely to report

bingeing on alcohol bingeing on alcohol(5(5- -plus drinks at one time) at

plus drinks at one time) at

least once in the past

least once in the past

month

month

‹

‹ Twice as likely to report Twice as likely to report

using marijuana using marijuanain the in the

past month

past month

‹

‹ Three to ten times as likely Three to ten times as likely

to report having tried to report having tried cocaine

cocaine ‹

‹ Two to three times as Two to three times as

likely to report having ever likely to report having ever tried hallucinogens, tried hallucinogens, depressants or stimulants depressants or stimulants Report of the Anti

Report of the Anti--Violence Documentation Violence Documentation Project from the Safe Schools Coalition Project from the Safe Schools Coalition of Washington (1997).

of Washington (1997).

Power Point Slide # 11-3, n3

Dynamics of Multiple Addictions

Dynamics of Multiple Addictions

ƒ

ƒ

Switching: Replacing on addiction

Switching

: Replacing on addiction

with another

with another

ƒ

ƒ

Alternating: Cycling from one

Alternating

: Cycling from one

addiction to another in a

addiction to another in a

patterned, systematic way

patterned, systematic way

ƒ

ƒ

Masking: Using denial around one

Masking

: Using denial around one

addiction to cover up for another

addiction to cover up for another

ƒ

ƒ

Ritualizing: one addiction is part

Ritualizing

: one addiction is part

of the ritualizing for another

of the ritualizing for another

Dynamics of Multiple

Dynamics of Multiple

Addictions

Addictions

ƒ

ƒ

Intensifying

Intensifying: Using addictive

: Using addictive

patterns simultaneously to

patterns simultaneously to

intensify the overall experience

intensify the overall experience

ƒ

ƒ

Numbing

Numbing: using addiction to

: using addiction to

medicate shame and pain due to

medicate shame and pain due to

another addiction

another addiction

ƒ

ƒ

Disinhibiting

Disinhibiting: Using one addiction

: Using one addiction

to lower inhibitions for other

to lower inhibitions for other

addictive acting out

(3)

Methamphetamine

Methamphetamine

Methamphetamine

Methamphetamine

‹

‹Prevalence of people who have used Prevalence of people who have used

within the past 12 months is 0.6%

within the past 12 months is 0.6%

‹

‹Prevalence rates for methamphetamine Prevalence rates for methamphetamine

use in the previous 6 months among MSM

use in the previous 6 months among MSM

in San Francisco range between 11%

in San Francisco range between 11%–– 17%

17%

‹

‹Associated with high rates of HIVAssociated with high rates of HIV ‹

‹1313--25% experience psychosis; 11x the 25% experience psychosis; 11x the

population

population

‹

‹90% of gay men using 90% of gay men using methmethalso use also use

other drugs

other drugs

‹

‹In New York City, rates of syphilis In New York City, rates of syphilis

increased 400% in the past 5 years. Gay

increased 400% in the past 5 years. Gay

men account for virtually the entire rise.

men account for virtually the entire rise.

‹

‹Between 1998 and 2000, 15% of syphilis Between 1998 and 2000, 15% of syphilis

cases in Chicago were attributed to gay

cases in Chicago were attributed to gay

men. Since 2001, that number has grown

men. Since 2001, that number has grown

to 60%.

to 60%.

‹

‹25% of men who reported 25% of men who reported methmethuse in the use in the

previous month were H.I.V+. The drug

previous month were H.I.V+. The drug

appears to double the risk of infection

appears to double the risk of infection

‹

‹The number of men who say they use The number of men who say they use

condoms regularly is below 50%

condoms regularly is below 50%

‹

‹The number of new H.I.V. diagnoses The number of new H.I.V. diagnoses

among gay men increased every year

among gay men increased every year

between 2000 and 2003. between 2000 and 2003.

Compulsive Sexual

Compulsive Sexual

Behavior

Behavior

Compulsive Sexual Behavior

Compulsive Sexual Behavior

‹

‹

Sexual thoughts, urges and

Sexual thoughts, urges and

behaviors that are normative

behaviors that are normative

‹

‹

Engaged in with a frequency or

Engaged in with a frequency or

intensity that leads to distress or

intensity that leads to distress or

impairment

impairment

CSB Behaviors

CSB Behaviors

‹

‹

Compulsive masturbation

Compulsive masturbation

85%

85%

‹

‹

Phone sex dependence

Phone sex dependence

31%

31%

‹

‹

Pornography dependence

Pornography dependence

73%

73%

‹

‹

Ego

Ego

-

-

dystonic

dystonic

promiscuity

promiscuity

50%

50%

‹

‹

Sexual chat room dependence

Sexual chat room dependence

40%

(4)

Characteristics

Characteristics

‹

‹

Begins in late adolescence

Begins in late adolescence

‹

‹

Peaks between ages 20 and 30

Peaks between ages 20 and 30

‹

‹

Ratio of males to females is 3:1

Ratio of males to females is 3:1

‹

‹

Minimum TSO of 7/week for at least

Minimum TSO of 7/week for at least

6 months

6 months

Health Concerns

Health Concerns

‹

‹ HIV and AIDSHIV and AIDS

‹ ‹ HepatitisHepatitis ‹ ‹ SyphilisSyphilis ‹ ‹ STDsSTDs ‹

‹ Self-Self-EsteemEsteem

‹

‹ Nicotine dependenceNicotine dependence

Body Image, Sex, and

Body Image, Sex, and

Crystal

Crystal Meth

Meth

Eating Disorders

Eating Disorders

‹

‹

Gay men 3x more likely than

Gay men 3x more likely than

heterosexual men to have an

heterosexual men to have an

eating disorder

eating disorder

‹

‹

Often takes the form of

Often takes the form of

compulsive exercise

compulsive exercise

‹

‹

Steroid abuse

Steroid abuse

Problem Gambling and

Problem Gambling and

Compulsive Sexual Behavior:

Compulsive Sexual Behavior:

Unrecognized Co

Unrecognized Co-

-Occurring

Occurring

Disorders

(5)

Gay Men, Sex, Gambling

Gay Men, Sex, Gambling

‹

‹

105 men with pathological gambling

105 men with pathological gambling

‹

‹

Twenty

Twenty

-

-

two (21.0%) subjects

two (21.0%) subjects

identified themselves as gay or

identified themselves as gay or

bisexual

bisexual

‹

‹

Gay/bisexual men were more likely

Gay/bisexual men were more likely

than heterosexual men to report a

than heterosexual men to report a

lifetime or current behavioral

lifetime or current behavioral

addiction

addiction

15 (68.2) 37 (44.6) 29 (34.9)

† 18 (81.8)†

Any MIDI diagnosis, n (%)

10 (12.0) 8 (9.6) 2 (2.4) 2 (2.4) 0 (0) 12 (14.5) 14 (16.9) 3 (3.6) 2 (2.4) 1 (1.2) 4 (18.2) 11 (50.0)‡ 0 (0) 0 (0) 0 (0) 5 (22.7) 13 (59.1)‡ 1 (4.5) 0 (0) 0 (0) Compulsive buying, n (%) Compulsive sexual behavior, n (%) Kleptomania, n (%) Trichotillomania, n (%) Pyromania, n (%) Current Lifetime Current Lifetime Heterosexual (n = 83) Gay/Bisexual (n = 22) MIDI Diagnosis

Addiction and Depression

Addiction and Depression

Self

Self-

-Harm and Suicide

Harm and Suicide

‹

‹

Gay men 7x more likely to have

Gay men 7x more likely to have

attempted suicide

attempted suicide

‹

‹

Gay youth comprise 30% of

Gay youth comprise 30% of

completed suicides annually

completed suicides annually

‹

‹

Gay and bisexual men have

Gay and bisexual men have

higher rates of deliberate self

higher rates of deliberate self

-

-harm

harm

Nicotine Dependence

Nicotine Dependence

(6)

Nicotine

Nicotine

‹

‹

20

20

-

-

24% of men and women smoke

24% of men and women smoke

‹

‹

Approximately 50% of adult gay men

Approximately 50% of adult gay men

and women smoke

and women smoke

‹

‹

Fewer gay men and women have

Fewer gay men and women have

made attempts to quit

made attempts to quit

‹

‹

Smoking associated with faster

Smoking associated with faster

progression to AIDS from HIV

progression to AIDS from HIV

‹

‹

Higher numbers of male partners

Higher numbers of male partners

correlate with higher rates of tobacco

correlate with higher rates of tobacco

use

use

Lung Cancer in PLWHA

Lung Cancer in PLWHA

‹

Elevated incidence of lung cancer

‹

As people with HIV live longer and

age, clinicians should be alert to the

possible diagnosis of lung cancer in

HIV-infected patients

‹

Need to develop effective

interventions to assist individuals in

their attempts to quit smoking

Women: Cigarette Smoking and

Women: Cigarette Smoking and

HIV Prognosis in the HAART Era

HIV Prognosis in the HAART Era

(

(

highly active antiretrovirals

highly active

antiretrovirals)

)

Feldman JG, Minkoff H et al. The association of cigarette smoking with HIV prognosis among women in the HAART era—A report from the Women’s Interagency HIV Study. Am J Public Health 2006;96(6):1-6

Oral Health

Oral Health

‹

‹

HIV+ smokers are more likely to

HIV+ smokers are more likely to

develop

develop

•Oral candidiasisOral candidiasis

•PeriodontitisPeriodontitis

•Oral hairy leukoplakiaOral hairy leukoplakia

• •CancersCancers

Assessment and

Assessment and

Intervention

Intervention

‹

‹ Ask about interpersonal violence in privateAsk about interpersonal violence in private

‹

‹ Ensure confidentialityEnsure confidentiality

‹

‹ Ask questions in an affirming and culturally Ask questions in an affirming and culturally

sensitive manner sensitive manner ‹

‹ Empathize with clientEmpathize with client’’s feelingss feelings

‹

‹ Look for indicators of interpersonal violenceLook for indicators of interpersonal violence

‹

‹ Use thirdUse third--person examples to screen possible person examples to screen possible

batterers batterers

‹

‹ If a client is identified as either a victim or If a client is identified as either a victim or

batterer, refer him or her to an LGBT support batterer, refer him or her to an LGBT support group, to an LGBT affirmative batterers group, to an LGBT affirmative batterers’’ intervention program, and for ongoing intervention program, and for ongoing consultation with an LGBT domestic violence consultation with an LGBT domestic violence treatment expert

treatment expert

(7)

Treatment for Lesbian, Gay,

Treatment for Lesbian, Gay,

Bisexual, Transgender

Bisexual, Transgender

Individuals

Individuals

Curriculum for GLBT Substance

Curriculum for GLBT Substance

Abuse Treatment

Abuse Treatment

‹

‹

Prepared by

Prepared by

Prairielands

Prairielands

Addiction

Addiction

Technology Transfer Center (ATTC)

Technology Transfer Center (ATTC)

‹

‹

Anne Helene

Anne Helene

Skinstad

Skinstad

, PhD

, PhD

‹

‹

Jennifer

Jennifer

Kardos

Kardos

, MA

, MA

‹

‹

Candance

Candance

Peters, MA, CADC

Peters, MA, CADC

‹

‹

Barbara Warren

Barbara Warren

PsyD

PsyD

22 classroom hours

22 classroom hours

Overview

Overview

‹

‹

4 Modules: Overview, Cultural

4 Modules: Overview, Cultural

Issues, Legal Issues, and Treatment

Issues, Legal Issues, and Treatment

Approaches

Approaches

‹

‹

Clinician

Clinician

s Guide

s Guide

‹

‹

Administrative Guide

Administrative Guide

Neisen's

Neisen's

3

3-

-Phase Model

Phase Model

for Recovery From Shame

for Recovery From Shame –

Phase

Phase

I

I

Breaking the Silence

Breaking the Silenceparallels the process of parallels the process of coming out. It is important for LGBT individuals coming out. It is important for LGBT individuals to tell their stories and to address the pain of to tell their stories and to address the pain of being different in a heterosexist society being different in a heterosexist society..

Counselor Tasks:

Counselor Tasks:

1.

1. Facilitate client discussion of hiding LGBT Facilitate client discussion of hiding LGBT feelings from others

feelings from others

2.

2. Explore emotional costs of hiding/denying one's Explore emotional costs of hiding/denying one's sexuality

sexuality

3.

3. Discuss how the client has tried to fit in and at Discuss how the client has tried to fit in and at what cost

what cost

4.

4. Examine negative feelings of selfExamine negative feelings of self--blame, feeling blame, feeling bad or sick, and the effect of shaming messages bad or sick, and the effect of shaming messages on client

on client

5.

5. Foster client's ability to be out Foster client's ability to be out

Power Point Slide # 5-11

Phase Two: Establishing Phase Two: Establishing Perpetrator Responsibility Perpetrator Responsibility

Allows clients to understand their struggle in Allows clients to understand their struggle in the context of societal discrimination and the context of societal discrimination and prejudice.

prejudice.

Counselor Tasks

Counselor Tasks: :

1.

1. Facilitate focusing and, managing anger Facilitate focusing and, managing anger constructively, not destructively constructively, not destructively

2.

2. Help client understand and accept negative self-Help client understand and accept negative self -image as socio cultural, not personal

image as socio cultural, not personal

3.

3. Counteract client's experience of heterosexism Counteract client's experience of heterosexism and homophobia by role

and homophobia by role--modeling and by modeling and by providing a treatment environment that is providing a treatment environment that is empowering for LGBT persons, not empowering for LGBT persons, not stigmatizing.

stigmatizing. Power Point Slide # 5-12

Phase Three:

Phase Three:

Reclaiming Personal Power

Reclaiming Personal Power

Involves improving self

Involves improving self--concept, selfconcept, self--esteem, esteem, and self

and self--confidenceconfidence

Counselor Tasks

Counselor Tasks::

1.

1. Facilitate client's self-Facilitate client's self-concept and selfconcept and self--efficacyefficacy

2.

2. Identify and change negative messages to Identify and change negative messages to affirmations

affirmations

3.

3. Recognize and release residual shame Recognize and release residual shame

4.

4. Develop a positive affirming spiritualityDevelop a positive affirming spirituality

5.

5. Integrate public and private identitiesIntegrate public and private identities

6.

6. Build a support network, connect to communityBuild a support network, connect to community

(8)

Special Issues for Lesbians

Special Issues for Lesbians

1.

1.

Multiple stigmas and stressors

Multiple stigmas and stressors

related to sexism, lesbian

related to sexism, lesbian

identity, and substance use

identity, and substance use

2.

2.

Relationships as a major

Relationships as a major

treatment focus for all lesbians

treatment focus for all lesbians

3.

3.

Relapse

Relapse

to protect themselves

to protect themselves

from painful feelings

from painful feelings

surrounding their sexuality

surrounding their sexuality

Power Point Slide # 7-8, n21

Special Issues for Gay Men

Special Issues for Gay Men

1.

1.

Linking of substance abuse and

Linking of substance abuse and

sexual expression

sexual expression

2.

2.

Internalized homophobia

Internalized homophobia

3.

3.

The role of sexual abuse and

The role of sexual abuse and

violence

violence

4.

4.

Limited social outlets

Limited social outlets

Power Point Slide # 8-6, n27

Clinical Issues and

Clinical Issues and

Implications for Treatment

Implications for Treatment

1.

1. Issues about Issues about

appearance, appearance, "passing" and "passing" and body image body image 2.

2. History of hiding History of hiding

or suppressing

or suppressing

gender identity

gender identity 3.

3. Lack of family and Lack of family and

social support

social support 4.

4. Isolation and lack Isolation and lack

of connection to of connection to positive, proactive positive, proactive transgender transgender community community resources resources 5.

5. Hormone therapy Hormone therapy

and use or

and use or

injection history

injection history 6.

6. Stigma and Stigma and

discrimination discrimination 7. 7. Employment Employment problems problems 8. 8. Relationship/child Relationship/child custody issues custody issues

Power Point Slide # 10-7, n42

Summary

Summary

Conclusions

Conclusions

‹

‹

Addictions appear to be common in the

Addictions appear to be common in the

GLBT

GLBT commuity

commuity

‹

‹

Frequently co

Frequently co-

-occur with other disorders and

occur with other disorders and

health issues

health issues

‹

‹

Treatment interventions should to target

Treatment interventions should to target

issues within the community and

issues within the community and

comorbidities

References

Related documents

To isolate “pure” sustainability experts, we used students that chose the elective on corporate environmental management while at the same time having less than 8 prior courses

anterior median supraocular; frontal narrow, much longer than wide; frontoparietals small, widely separated by frontal; interparietal much smaller than parietals

A hypothesized extraterrestrial impact in North America at ∼ 12,900 calendar years BP (12.9 ka) has been proposed as the cause of Younger Dryas climate changes, terminal

Through the cooperation between the Basaisa Community Development Association (Basaisa-IRTECTAP), the Agricultural Research Center (ARC) and the Technology Transfer Component of

Temporary lodging - Camp LeJeune's temporary lodging faclllty, Lejeune Inn, Is located rour miles from the main gate on Holcomb Boulevard, Consisting of 90 rooms, Lejeune

Journal reviewer 2007 – 2013 Peer reviewed journals: Computer Graphics Forum, IEEE Transactions on Visualization and Computer Graphics, Information Visualization Journal,

Here we apply a similar approach to analyse bargaining between EMEA service providers and regional health care purchasing agencies responsible for contracting these services in

Based on professional learning, scientific research and solid academic basis, students can promote knowledge application and skills transformation through