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LGBTQ+ Youth Substance Abuse
- 1. SUBSTANCE ABUSE BY LGBTQ+ YOUTH ALICIA HART SOCIAL WORK 662 UNIVERSITY OF LOUISVILLE
- 2. LGBTQ+ YOUTH AND SUBSTANCE ABUSE • Increased risks • Of engaging in negative health behaviors • Of developing substance use disorders
- 3. WHAT IS SUBSTANC E USE DISORDER ? 1. Hazardous use 2. Social/interpersonal problems related to use 3. Neglected major roles due to use 4. Withdrawal 5. Tolerance 6. Using of larger amounts or for longer periods of time 7. Repeated attempts to quit or control use 8. A lot of time spent using 9. Physical/Psychological problems caused by using 10.Previously enjoyed activities are given up 11.Craving
- 4. DEPENDENCY CONTINUED USE OF A SUBSTANCE DESPITE SOCIAL OR MEDICAL PROBLEMS OCCURRING DUE TO USAGE.
- 5. TOLERANCE THE NEED TO TAKE MORE OF A DRUG TO FEEL THE SAME EFFECTS.
- 6. CRAVING AN URGE TO ENGAGE IN SUBSTANCE USE
- 7. WITHDRAWAL DISCOMFORT DUE TO DISCONTINUED, DECREASED, OR INABILITY TO INCREASE THE USE OF SUBSTANCE
- 8. GENETIC LINKS TO ALCOHOL AND DRUG DEPENDENCY • Genetics • Specific genes • Chromosomal areas • Influences • Predisposition • Personality traits
- 9. SYMPTOMS OF ALCOHOLISM OR DRUG ABUSE Feeling like one must use the symptom regularly Cravings Tolerance Ensuring you maintain a supply of the substance Spending money on substance even if you cannot afford it Not meeting obligations (work or social) Continued use despite negative consequences Doing things while using drug that you would not usually do Spending a lot of time getting the substance, using the substance, or recovering from the substance Attempting to stop using but being unable to
- 11. STAGES OF TREATMENT Early Middle Late
- 12. FORMS OF TREATMEN T Detox/medically managed withdrawal Long-term residential treatment Short-term residential treatment Outpatient programs Individual drug counseling Group counseling
- 13. MYTHS AND UNHELPFUL STATEMENTS AROUND ADDICTION Individuals suffering with addiction come from a lower socioeconomic status MAT is not true recovery You can effectively stop addiction with church Only people with addiction get help and they do not deserve it You should not get involved with someone who has an addiction – they’re selfish, lie, and steal Everyone will continue to relapse – it is only a matter of time. They will never get better. Addiction is a choice Narcan is free but insulin cost a fortune People in active addiction want to remain in active addiction Drug addiction is a character flaw Relapse should not happen – recovery should occur after first round of treatment There is a one-size fits all approach to treatment
- 14. STAGES OF RECOVERY Awareness and early acknowledgement Consideration Exploring recovery Early recovery Active recovery and maintenance
- 15. SOURCES Ballantyne, J. C., & Stannard, C. (2013). New addiction criteria: diagnostic challenges persist in treating pain with opioids. Pain, 1, 1-7. Center for Substance Abuse Treatment. Substance Abuse Treatment: Group Therapy. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2005. (Treatment Improvement Protocol (TIP) Series, No. 41.) 5 Stages of Treatment. Available from: https://www.ncbi.nlm.nih.gov/books/NBK64208/ Cloninger, C. R. (1999). Genetics of substance abuse. Textbook of substance abuse treatment, 1999, 59-66. Csiernik, R. (2002). Counseling for the family: The neglected aspect of addiction treatment in Canada. Journal of Social Work Practice in the Addictions, 2(1), 79-92. Drug addiction (substance use disorder). (2017, October 26). Retrieved June 21, 2020, from https://www.mayoclinic.org/diseases-conditions/drug-addiction/symptoms-causes/syc-20365112 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (7th ed.). https://doi.org/10.1176/appi.books.9780890425596 Edidin, J. P., Ganim, Z., Hunter, S. J., & Karnik, N. S. (2012). The mental and physical health of homeless youth: A literature review. Child Psychiatry & Human Development, 43(3), 354-375 Heck, N., Flentje, A., & Cochran, B. (2011). Offsetting risks: High school gay-straight alliances and lesbian, gay, bisezual, and transgender (LGBT) youth. School Psychology Quarterly, 26(2). 161-174. Howell, A. N., Leyro, T. M., Hogan, J., Buckner, J. D., & Zvolensky, M. J. (2010). Anxiety sensitivity, distress tolerance, and discomfort intolerance in relation to coping and conformity motives for alcohol use and alcohol use problems among young adult drinkers. Addictive behaviors, 35(12), 1144-1147 Jordan, K. (2000). Substance abuse among gay, lesbian, bisexual, transgender, and questioning adolescents. School Psychology Review, 26(2). 201-206. Mersy, D. (2003). Recognition of alcohol and substance abuse. American Family Physician, 62(7). 1529-1532 McCabe, S. E., Hughes, T. L., Bostwick, W. B., West, B. T., & Boyd, C. J. (2009). Sexual orientation, substance use behaviors and substance dependence in the United States. Addiction, 104(8), 1333-1345 NIDA. 2020, June 3. Types of Treatment Programs. Retrieved from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third- edition/drug-addiction-treatment-in-united-states/types-treatment-programs on 2020, June 21 Sussman, S., & Sussman, A. N. (2011). Considering the definition of addiction. The 5 Stages of Addiction Recovery. (n.d.). Retrieved June 21, 2020, from https://www.crchealth.com/find-a- treatment-center/washington-treatment-information/5-stages-addiction-recovery/ West, R., & Gossop, M. (1994). Overview: a comparison of withdrawal symptoms from different drug classes. Addiction, 89(11), 1483-1489. Witkiewitz, K., & Bowen, S. (2010). Depression, craving, and substance use following a randomized trial of mindfulness-based relapse prevention. Journal of consulting and clinical psychology, 78(3), 362 Wright, T. E., & Smith, N. (2013). Bullying of LGBT youth and school climate for LGBT educators. GEMS (Gender, Education, Music, and Society), The On-Line Journal of GRIME (Gender Research in Music Education), 6(1).
Editor's Notes
- LGBTQ+ - Lesbian, Gay, Bisexual, Transgender, Queer/Questioning Health behaviors include suicide and substance use Why do LGBTQ+ youth have increased rates of addiction and substance use? In School bullying: LGBTQ+ youth experience bullying 2-3x more often. 51% of LGBTQ+ youth report being verbally harassed at school compared to 21% of heterosexual youth. Homelessness: Youth homelessness affects neurocognitive development and academics, mental and physical health. Substance use and psychiatric disorder rates are high within the homeless youth population. LGBTQ+ youth are exceptionally vulnerable to becoming homeless as a youth, as 20-40% of youth that are homeless, identify as part of the LGBTQ+ population Marginalization and stigmatization: Heterosexual youth are more likely to report their top two school concerns as classes/exams/grades and college/career. LGBTQ+ youth are more likely to report their top two school concerns as non-accepting families and school bullying. Depression, Isolation, and chronic stress ****When considering Maslows’ hierarchy of needs, heterosexual students are focused on achievement and confidence while LGBTQ+ students are still working to have their basic needs met (safety).
- Depending on how many of the criteria are met, the diagnosis can be mild (2-3 criterion are met) moderate (4-5 criterion are met) severe (6+ criterion are met). Individuals can change in severity over time by reductions or increases in substance used, which can be self-reported, clinically observed, or reported by someone the client knows. Specifiers and descriptive features for this diagnosis include in early remission, in sustained remission, on maintenance therapy, and in controlled environment I plan to go over the diagnostic features of SUD and breakdown each piece to explain to client. I will also work with the client to see if they’re able to identify pieces that they feel fit specifically to them. I may do this looking specifically at the DSM criteria or using a self-administered survey.
- DSM 4 – Loss of control or inability to abstain from substance use despite occurrence of problems due to use. Dependence is separate from abuse. Abuse is maladaptive substance use without tolerance, withdrawal, or compulsive usage. Complications dependency can cause getting a communicable disease (ex. HIV), other health problems (short-term/long-term), accidents, suicide, family problems, work issues, problems at school, legal issues, financial problems. Being LGBTQ+ increases the risk of developing substance dependency. Examples: Lesbian and bisexual women have greater odds of alcohol use and dependency. It is noted that sexual identity is potentially more important when looking at correlations with substance use and dependency than sexual behavior. Women who reported being heterosexual but reported having sexual partners that were women did not significantly differ from heterosexuals in their substance use and dependency scores. I plan to help the client understand substance dependency by exploring what issues the client has experienced due to using the substance, and exploring what happens when the client does not use the substance.
- Tolerance is a consequence of continued drug use – If an individual is unable to increase their substance dose (due to tolerance), the individual may begin experiencing withdrawal. Therefore, tolerance can also promote continued use, and an increased use, of a substance. And individual can experience psychological and pharmacological tolerance Tolerance and dependence are significant drivers of continued drug use. First included in DSM 3 together along with social and cultural factors. Factors related to continued substance use, and therefore gained tolerance of substance use, are anxiety sensitivity, distress tolerance, and discomfort intolerance. However, other research indicated that substance use (specifically when looking at alcohol use) is more significantly related to distress tolerance. I plan to help the client understand tolerance by exploring how much of the substance the client first used and helping them to compare it to the amount they currently use. I will attempt to making a chart with the client if they’re able to remember a rough idea of moments they noticed that they were craving more of the substance than they previously had.
- Cravings are a “hallmark” feature of addiction as they overcome all other thoughts. Having a craving is subjective and can be toward the act of using the drug, or the “high” itself. There is also a relationship between depressive symptoms and cravings, as well as a strong relationship between depressive symptoms and substance use disorder relapse. Experiencing cravings can strongly predict the potential for relapse. I plan to help the client understand cravings by first looking at other things they may have craved in the past – a food item, affection from a partner, etc. I will talk about what the client enjoys most about the substance (obtainment of substance, preparation for use, use, or high), and then help the client to link this to repeated thoughts around the substance, and the clients craving for that.
- Addiction is sustained through positive and negative reinforcers. In early stages of drug use, positive reinforcers are the primary drivers of addiction. Later in drug use, negative reinforcers such as withdrawal become a driver of continued drug use. Individuals will experience withdrawal when unable to use a substance after prolonged use, or when unable to increase their dose as their tolerance raises. Withdrawal symptoms include physiological and psychological symptoms that can be dependent on what substance the individual is experiencing withdrawal from. Common symptoms include mood changes, sleep changes, sweating, tremors, seizures, flu-like symptoms, irritability, etc. I plan to help the client write down what happens when they are unable to use the substance, and how that feels (psychologically and physically).
- There are some mapped specific genes and chromosomal areas that influence an individual’s predisposition to substance abuse and dependency. As well, genetically speaking there have been identified chromosomal areas and specific genes that influence personality traits that can make someone more susceptible to substance abuse and tolerance. Hereditability: Marijuana – 33% Stimulants – 44% Sedatives: 38% Opiates – 43% Phencyclidine/Psychedelics – 25% Any drug – 34% Substance abuse is associated with antisocial personality traits. Severe substance abuse is associated with impulsive personality disorders (self-directedness and cooperativeness) I plan to use the pictures above to help explain the genetic and biological links to alcohol and drug dependency. I will work with the client to write around the reward system image what that feels like to them, examples of it, and etc. For the second image, I will work with the client to write down on the image what trains or characteristics they feel are genetic under each initial category – and offer examples of them myself.
- Things people do while using that they may not usually do – stealing, partaking in risky behaviors (driving under influence) Attempting to stop but being unable to due to withdrawal (psychological or physiological) How can you notice substance abuse in another individual? Issues occurring at work or school Physical health issues such as weight changes, motivation and energy changes, red eyes Neglected appearance Behavioral changes – changes in relationships, not wanting family/friends in their room, Money issues I will help the client understand what symptoms they are experiencing through a self-administered survey and discussion. I will help the client understand how each symptom sustains the substance use and how it negatively affects the clients life.
- Effects of substance use on the family include functioning and development of children, economic hardship, potential for violence, increased risk of the children using substances. The experience for the entire family is one of the many reasons why family therapy can be beneficial when someone is in active addiction or working through treatment. I would work with the client to write out every family member currently close to the family or previously close to the family. Then I would help the client to identify how their substance abuse has affected that member already or could potentially affect that member. I would also want to do this exercise to see how adult family members enable the client to use substances, and if the client had a parent that used substances, I would want to help the client understand how their parent’s use affected them.
- Stages: Early stage of treatment – Emotional fragility, ambivalence towards treatment – Focuses on immediate concerns (abstinence, relapse prevention, managing cravings), hope, group cohesion, universality Middle stage of treatment – aka action stage. Work to recognize that substance use is causing a lot of their problems and preventing them from getting what they want in life. Focus on managing loss, finding healthy coping skills, understanding and managing emotions Late stages of treatment – Identifying the treatment gains and risks – Focus on living, resolving guilt, reducing shame, introspection and relational view of self. I will walk the client through every stage of treatment, as well as offer brochures (SAMSHA has a variety).
- Detox and medically managed detox (the process by which the body clears itself of the substance) helps manage physiological risks. This does not address psychological, social, or behavioral issues associated with the substance abuse. Long-term residential treatment – 24/7 inpatient care for 6-12 months Short-term residential treatment – 24/7 inpatient care for 3-6 weeks, followed by outpatient care and participation in self help groups like AA Outpatient programs – Intensive day treatment and group counseling Individual drug counseling – Encourages 12 step participation as well I will discuss different forms of treatment and assess the client to see which treatment would be the best option, as well as which option the client is most comfortable with. I will work to resolve all concerns and questions around treatment options.
- I asked 8 people what myths they had heard about substance abuse, and the above is what was reported. Individuals suffering from addiction come from a lower socioeconomic status – This is rooted in the idea that addiction only affects the poor, weak minded and lazy. When in reality, it affects people of all socioeconomic status and people coming from every walk of life. Relapse should not happen – Relapse is a common occurrence with recovery There is a one-size fits all approach to treatment – There are different treatment options as different people needs different forms of treatment. Narcan is free and insulin costs a fortune – Narcan is a life saving drug that is used in emergency situations, insulin, while important, is used regularly. My goal will be to understand the myths that clients have internalized around substance use disorders, and how this impacts them, their use, and attitude toward recovery.
- Awareness and early acknowledgement – Growing awareness that there is a problem – goal is to go from denial to willingness to make a change Consideration – Shifting from awareness to action – the individual starting to look beyond themselves at who is affected by their illness Exploring recovery – The recovery stage – Education, what sober living means, potential for addiction treatment programs Early recovery – Great vulnerability – Developing new coping skills, rebuilding broken relationships Active recovery and maintenance – Continuing to work hard on remaining sober, living a life they may not have imagined they could, mind, body and spirit transformation A therapist once explained recovery to me as “the illness will always be there, but it will not feel like it’s on top of you or nipping at your heel”. I plan to use this analogy when explaining recovery to client