Despite consistently higher rates of depression, suicidality, binge drinking, and marijuana use among lesbian, gay, bisexual, and transgender (LGBT) individuals, a new SAMHSA report from the Substance Abuse and Mental Health Services Administration (SAMHSA) finds that few substance abuse treatment and behavioral health facilities offer programs tailored to LGBT consumers.
The SAMHSA report found that only six percent of addiction treatment facilities and seven percent of facilities treating both mental health and addiction offered such programs. Yet, according to a 2009 study by the Massachusetts Department of Public Health, The Health of LGBT Persons in Massachusetts, LGBT consumers face poorer health outcomes overall than their heterosexual counterparts due in part to ongoing stigma and lack of access to insurance and services. Of the facilities offering special programs for LGBT clients, private facilities were in the majority, with “for profit” facilities providing twice as many LGBT programs than government-run facilities (seven percent vs. 2.6 percent).
SAMHSA has been working since 2001 to remedy these shortcomings, partnering with the National Association of Lesbian, Gay, Bisexual and Transgender Addiction Professionals and Their Allies (NALGAP) to develop a free, introductory guide and training curriculum, facilitated by the ATTC Network, for staff providing LGBT programs. NALGAP is also working with SAMHSA to develop a standard for LGBT-specific programs.
“When you say you do culturally-specific programming, like a women’s program or serving ethnic minorities, there’s a standard that people follow,” says Joseph Amico, MDiv, CAS, LISAC, president of NALGAP and national marketing coordinator for Sante Center for Healing. “NALGAP has been really trying to work with SAMHSA and saying we need to do the same for LGBT folks as well.”
But whether a program standard exists or not, there are still several challenges that could prevent organizations from adopting a LGBT-specific program in the first place—especially community-based programs. For starters, Amico says, many organizations haven’t even recognized the need for these types of programs yet. “Every organization has LGBT clients whether they realize it or not,” he says. “But I don’t think folks have adopted it; administrators and boards haven’t embraced it and said this is an issue that needs to be addressed.”
Amico also cites the eight-year tenure of the Bush administration as a challenge for LGBT programs, as that administration did little to encourage the need for LGBT-specific services in behavioral health. “We had eight years of administration that pushed faith-based programs, and there are certain faith-based programs that are not going to treat LGBT issues in the warm, caring way we would advocate,” Amico, who is also an ordained Christian minister, says. “It was quite counter-productive.”
Once community-based programs have accepted that they do, in fact, need to develop programs tailored to LGBT consumers, funding the program is always a challenge. While Amico acknowledges that publicly-funded organizations are very limited in the services they can provide, he says that this challenge may actually work in favor of LGBT programs.
“If we can get the states to say to the publicly-funded organizations, ‘This LGBT program is now a standard of care, you need to do this,’ that will make a huge difference,” he says. “The organizations will then turn around to the state and say, ‘Fund the training for us.’ And that’s the only way it’s going to happen.”
Since the release of the SAMHSA’s LGBT treatment training curriculum in 2008, the ATTC Network has trained 170 individuals from around the U.S., who then provide training in their own organizations or geographic areas. The ATTC Network is currently working to educate enough trainers so they are available nationwide.
In the meantime, Amico says that it’s important for organizations lacking in LGBT-specific services to recognize that “we can’t be all things to all people.” He encourages community-based programs to refer LGBT consumers with needs beyond their scope of services to other programs with more expertise.
For those organizations looking to develop a LGBT service or training program, SAMHSA’s written companion to the LGBT-treatment curriculum, A Provider’s Introduction to Substance Abuse Treatment for Lesbian, Gay, Bisexual, and Transgender Individuals, is available for free.
Joseph Amico, MDiv, CAS, LISAC, president of NALGAP, will lead the workshop “What Everyone Needs to Know When Working With Sexual Minorities” at this year’s inaugural National Conference on Addiction Disorders (NCAD). In this presentation, he will cover the basics of meeting the needs of LGBT consumers, such as making your intake process and office more LGBT-friendly, understanding the politically correct terms for sexual minorities, and helping LGBT consumers heal from cultural victimization associated with sexual orientation. For more information on NCAD, visit www.ncad10.com.
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