2022 California Council of Community Behavioral Health Agencies (CBHA) Conference

LGBTQ: A Community in Need of Effective Care

As the current heroin epidemic holds the nation in its grips, due in part to the over-prescription of opioid pain medications, there is another drug that continues to take its toll on the LGBTQ community: crystal methamphetamine. Crystal methamphetamine is not new to this community. According to Craig Sloane, LCSW, CASAC, in the late 1990’s and early 2000’s it became the most widely used drug among urban gay and bisexual men (The Perfect Storm: Gay Men, Crystal Meth and Sex, 2013). In 2004, the San Francisco Department of Health found 17-22% of gay men had used crystal methamphetamine within the last 12 months (SAMHSA, 2011). Data from the 2012 National Survey on Drug Use and Health (NSDUH) stated that over 12 million people (4.7 percent of the population) have tried methamphetamine at least once in their lives, while The Antidote, an LGBT support service, reported that its use amongst the LGBTQ community has quadrupled between 2011 and 2013. This research demonstrates a need for increased social awareness of this pervasive and prevalent issue and the need for urgency at LGBTQ-affirming substance abuse treatment centers.

The prevalence of crystal methamphetamine use and the severity of its consequences pose significant risks to LGBTQ individuals that must not be overlooked. Chronic use can cause heart problems, rapid weight loss, tooth decay, and can induce psychosis. Crystal meth users are more likely to engage in unsafe sex practices while under the influence; according to the National Institute on Drug Abuse (NIDA), crystal methamphetamine use raises the risk of contracting infectious diseases such as HIV and Hepatitis B and C through the unprotected sex that often accompanies it, as well as through intravenous use of the drug itself. NIDA also reported that use of crystal meth can worsen the effects of HIV/AIDS for those already living with the disease. The reality is that crystal methamphetamine addiction is a severe problem within the LGBTQ community that has grown worse in recent years and demands our attention toward the development of effective treatment options.

The crystal methamphetamine epidemic requires that treatment centers offer culturally competent and specialized care in order to cultivate a sense of community, hope, and recovery. Since its founding in 1984, Realization Center, an outpatient substance abuse treatment center in New York City, has been providing addiction treatment to individuals that identify along the LGBTQ spectrum. Within the LGBTQ program, there are more self-identified gay men with crystal methamphetamine dependence than self-identified lesbian women or those of transgender experience. Viewing this issue quantitatively, there are 105 clients within the LGBTQ program at Realization Center, 95 of whom are gay men; 79% of those gay men have entered treatment with crystal methamphetamine as their primary drug of choice. This translates to more than 70% of the population within the LGBTQ program dealing with crystal meth addiction and its consequences.

Developing specialized treatment and providing effective care for gay men addicted to crystal methamphetamine presents unique challenges, many of which are shared across the multitude of other addictions found within the queer community. The primary challenges include the lack of cultural competence regarding the both the shared experiences of and great diversity within the LGBTQ community. This can range from respecting someone’s preferred gender pronoun to being able to accept that the community has far exceeded society’s comfort with a binary perspective. Healthcare providers have sometimes found it difficult to adapt and respect the ongoing variety of self-identification, gender expression, or sexual orientation within the LGBTQ community. Furthermore, the vast majority of queer clients at Realization Center have self-reported experiences of prejudice, discrimination, and/or trauma. In order to provide effective care for LGBTQ-identified individuals, it is vital to create an environment that affirms their identity as well as validates the oppression and hurt they have experienced at the hands of society at large.

At Realization Center, addiction counseling for LGBTQ individuals aims to navigate treatment around such barriers, promoting an atmosphere of safety and support. Individuals are encouraged to identify their gender identity and sexual orientation with terminology that makes them comfortable. To begin LGBTQ counseling groups, clients introduce themselves with their preferred gender pronouns so they are not mislabeled. The combination of group and individual counseling helps clients develop a sense of identity and self-worth. They are advised to participate in 12-step meetings outside of treatment as a way to help them develop a sober support network and feel less isolated. For those who suffer from comorbid crystal meth and sexual addiction, Realization Center offers a gay men’s sexual health and recovery group aimed at breaking the association between sex and drugs. Additionally, clients who have reported a history of trauma and/or abuse are invited to enroll in a trauma and recovery group which follows the Seeking Safety curriculum. Finally, and perhaps most importantly, counseling staff members are encouraged to attend lectures, workshops, and seminars on LGBTQ issues to remain educated and competent to address topics particular to this community.

There needs to be a continued social dialogue regarding the substance abuse issue in the LGBTQ community in order to cultivate effective treatment and broad scale change. As important as it is to recognize and address the current heroin epidemic sweeping the country, it is just as important to remember the methamphetamine epidemic that preceded it and continues to affect millions of people worldwide, including a disproportionately high percentage within the LGBTQ community. Acknowledging the relationship between substance abuse in the gay community and the trauma and abuse its members have suffered as a result of their long-marginalized place in society is an important first step in creating a dialogue that can help these individuals begin to heal. Treatment options that focus on the affects that society has had on this community and begin to treat the specific cognitive needs that are contributing to their addictions must be created, utilized and discussed. It is with this dialogue, social awareness, and continued specialized treatments for those suffering with crystal methamphetamine addiction in the LGBT community that the stigma can disappear, and true recovery can begin.

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