Working with LGBTTF clients with AOD issues

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Working with LGBTTF clients with AOD issues
ALAC Central Forum Tuesday 4th Nov 2008
Presented by Diana Rands CADS Gay Communities
Project Worker With help from many others!
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Who are we?

• LGBTTF is the generally accepted acronym in
  Aotearoa-New Zealand for
• Lesbian,
• Gay,
• Bisexual,
• Transgender,
• Takataapui
• Fa'afafine individuals

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This acronym incorporates terms that indicate
sexual orientation and gender identityIt is
very important not to confuse the two.
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Complexity of sexuality
SEXUAL ORIENTATION
SEXUAL IDENTITY

• SEXUAL BEHAVIOUR

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Sexual Orientation

• This refers to the nature of a persons basic
  sexual attraction to other people. Ones sexual
  orientation could be fixed or fluid.
• It is can be seen as being part of a continuum
  from
• Exclusively Heterosexual (EHet) to Exclusively
  Homosexual (Ehom)

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Sexual Identity

• This is the personal and unique way that a person
  perceives his or her own sexual desires and
  sexual expressions.
• Self-Identity How you see yourself in relation
  to romantic and social settings.
• Perceived Identity How people see you and/or how
  you perceive how other people see you in relation
  to romantic and social settings.
• Presented Identity How you present or announce
  your sexual identity in concrete social settings.
  (Troiden, 1989)

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Sexual Behaviour

• This is what the person does sexually. Our sexual
  behaviour does not always match our sexual
  orientation or our sexual identity.
• A person may engage in heterosexual behaviour but
  feel their sexual orientation is homosexual.
• Ones sexual behaviour could be heterosexual,
  homosexual, bisexual or asexual.

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Gender Identity

• SEX
• refers to the biological characteristics by
  which human beings are categorised as male,
  female or intersex.
• In society, sexual differences are given social
• and cultural meanings.
• GENDER
• refers to social and/or cultural identity which
  is conferred on the basis of assumed sex
  differences (masculine, feminine and
  androgynous).
• Social factors such as class, age, race and
  ethnicity also shape the specific meaning,
  expression and experience of gender, underlying
  the fact that gender cannot be equated in any
  simplistic way with sex.

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Transgender terms

• Transgender trans person
• Transsexual
• Cross-dresser
• Drag Queen Drag King
• Faafafine Samoan term, other Pacific Nations
  have other terms
• Intersex Hermaphrodite
• Whakawahine Whakatane
• See pages 12-13 of To Be Who I Am.

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Why is sexual orientation and gender identity
important in AOD treatment

• Studies indicate that when compared with the
  general population LGBTTF are more likely to
• Use alcohol and other drugs
• Have higher rates of substance use
• Are less likely to abstain from use
• Be more likely to continue heavy drinking into
  older adult life and
• Be over represented in incidence/morbidity, but
  under represented in access and engagement in AOD
  services

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• Video Launch
• A Question Of VisibilityHow to ask about
  sexual orientation in an alcohol and drug
  clinical setting.
• A joint project between Matua Raki and Auckland
  CADSVideo produced by Andrew Whiteside of Roll
  Tape Productions

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Why we made this video

• Prevalence of drug use for LGB
• Understanding of sexual orientation is essential
  in AOD assessments and treatment
• The difference between gay and straight
  assessments/treatment.
• What stops clinicians from asking?
• We need a how to video resource

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PrevalenceGAPSS 2006 Findings from the Gay
Auckland Periodic Sex Survey of men who have sex
with men 1228 men completed the survey.
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Comparison - GAPSS survey with SHORE general
population stats. Centre for Social and Health
Outcomes. Research and Evaluation
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Issues for LGB substance users

• Double stigmatized group that is often hidden and
  vulnerable, especially in relation to intravenous
  substance use and unsafe sexual practices
• Poor decision making skills associated with P
  use
• Nitrites and sexual activity linked to poor
  decision making regarding safer sexual practices
  (Ostrow 1993)

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Issues for LGB substance users contd.

• The coming out process
• Internalized homophobia
• Loss of family support
• Bullying/harassment/discrimination and other
  societal oppression
• Confidentiality
• Life stage issues (adolescence, marriage,
  bereavement et al)

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• Do we know what happens in AOD settings in
  Aotearoa?

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Differences in assessment and treatment
approaches for homosexual clients. Drug and
Alcohol Review (1994) 13, 57-62 MacEwan I.

• A study by our own Ian MacEwan
• 50 self-reporting heterosexual and
• 50 self-reporting homosexual clients
• From a range of treatment providers

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Question

• Would the practitioner completing the admission
  and history-taking have been clear about your
  sexual orientation?

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Results
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Question
By the time you completed your treatment at the
agency, would your practitioner/s have been clear
about your sexual orientation?
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Results
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Question

• Was your sexual orientation included in your
  treatment plan?

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Results
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Question

• Did the agency use your sexual orientation as a
  causal factor in your dependence upon substances?
• i.e. pathologising homosexuality rather
  than homophobic world

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Results
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• Response to use of group-based treatment

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Results
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Question

• Was your partner or significant other invited to
  be involved in your treatment?

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Results
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Question

• What about friends or members of your community?

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Results
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Question

• Was your sexual orientation taken into account
  when planning for after-care, relapse prevention
  and management?

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Results
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• Change in alcohol or drug
• problem at three months after
• completion of treatment

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Results
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Barriers to clinicians asking about sexual
orientation

• Feeling uncomfortable
• Too much information gathering
• Not wanting to offend heterosexual clients
• Just doesnt come up
• Dont know how

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Show A Question Of VisibilityHow to ask about
sexual orientation in an alcohol and drug
clinical setting.A joint project between Matua
Raki and Auckland CADSVideo produced by Andrew
Whiteside of Roll Tape Productions
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Questions for small groups

• What did you think of the video?
• Is it useful? Why?
• How could it be utilized within your service?
• What would be the most efficient and effective
  way to distribute it?

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Clinical guide lines

• First identify where your client is at in their
  coming out process or journey of self discovery
• Identity Confusion
• Guidelines For Assisting
• Reassure them they are ok
• Basic value-free information
• Reflectively listen to their feelings
• Be sensitive about using labels (gay, bi,
  transvestite etc) with them

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Identity Comparison where do I belong?

• Guidelines for assisting
• Reassure you wont reject them
• Support them to learn more about themselves in
  their own time
• Point out they are not alone
• Counter myths and stereotypes with factual
  information
• Clear support for them. No matter what their
  orientation
• Check out safety (safe sex, cruising,
  suicidality, AOD use)

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Identity Tolerance

• Guidelines for assisting
• Support their wish to explore their developing
  identity
• Gay community contacts available
• Safe places to go to and safe people to talk to
• Safety/risk issues
• Acknowledge it will take time to build networks

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Identity Acceptance

• Guidelines for assisting
• Respect their right and need to be part of LGBTTF
  community
• Support their exploration for new
  friends/partner(s)
• Explore the inter-personal skills they need to go
  into new space and meet new people
• Help support the client if they want to come out
  to friends/family
• Work out a plan of who is safe to come out to and
  who isnt

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Identity Pride

• Guidelines for assisting
• Continue to be supportive
• Work through any feelings the client has about
  resentment towards homophobia, discrimination or
  other people being in the closet
• Work through how they feel about other young
  people experimenting with their same sex
  attraction but not being as identified or sure of
  their sexuality as your client is of theirs
• Safety around being under age in bars/clubs,
  safety at events, mixing with older people on the
  scene etc
• Trans people need specific ongoing support. This
  could be around gender reassignment, employment,
  reconnecting with their families etc see To Be
  Who I Am.

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Identity Synthesis

• Guidelines for assisting
• Coming out is a life-long journey - the client
  may experience homophobia on lots of levels,
  support around this may be needed
• Affirm to client that is has been a long journey
  to get to this stage and a lot of courage and
  strength has been needed

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A framework for support summary

• Confidentiality
• Rapport and trust building
• Continually assess risk during the treatment
  process
• Dont assume a client is/is not LGBTTF just
  because of how they act or look
• Sexual orientation should always be part of the
  assessment process dont assume

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Summary contd

• Avoid closed ended questions so client has space
  to talk about their sexuality
• Make sure the client has cues that they are in a
  Queer friendly environment
• (rainbow flags, posters etc)
• Be aware of the organisations who work with queer
  youth and have rainbow recognition (queer
  friendly organisations)

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Creating A Safe Place Rainbow Recognition
Areas to consider Physical Surroundings Recruitm
ent Staff Leadership Assessment Counselling
Protocol Training
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Discussion

• Brainstorm a process to institute Rainbow
  Recognition into AOD services
• Barriers?
• Solutions?

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Lesbian Gay Bi-sexual
Transgender Takataapui
Faafafine People are WELCOME HERE!