Last week as the Supreme Court debated the constitutionality of gay marriage, President Barack Obama tweeted his support for marriage equality with a picture and quote: “Same-sex couples should be able to get married.” Earlier this month former President Bill Clinton, Hillary Clinton, and an unlikely supporter—Senator Rob Portman, a Republican—said they support same-sex marriage, too.
This is something I never dreamed I’d see back when I worked for an organization that began the first LGBT outpatient addiction services in North Texas. In the 1990s, I helped launch a lesbian mentoring and education program, a hotline for LGBT teens, and HIV/CD prevention programs. Opinions have changed so rapidly, straight allies have stood up, support organizations have multiplied, and that’s a positive trend for our LGBT youth.
But even though our culture is more accepting than it used to be, we as treatment providers, parents, and community leaders need to recognize the unique challenges LGBT youth still face. There are still parents who will throw a gay child out of the home, and LGBT youth continue to have risk factors we can’t ignore, including higher rates of homelessness, substance abuse, depression and suicidal thoughts.
In a presentation I gave at the 2013 Adolescent Symposium of Texas Mental Health Association of Dallas, I talked with behavioral health care providers about these risks. LGBT youth are 40% to 70% more likely to smoke than heterosexuals, thanks to aggressive marketing by tobacco companies. Twenty-five percent of gay and transgender people abuse alcohol. They are many times more likely to have attempted suicide. Odds of substance abuse are twice as high for gay youth, over three times as high for bisexual youth, and four times higher for lesbians.
Substance abuse can lead to homelessness and also perpetuate it. Some researchers estimate that up to three in five homeless youth are LGBT. Many say that personal or family substance abuse led directly to their homelessness while others cite it as a key reason they’re still living on the streets.
Why the higher rates of substance abuse? Family conflict and discrimination in employment, housing, and health care are key reasons that are also barriers to getting help. Health providers can be hostile or just plain bewildered. One-third of medical schools did not provide training to work with LGBT patients during the years students work with patients and on average devoted only five hours of curriculum to medical questions specific to LGBT patients.
When I first provided substance abuse treatment for an LGBT population, I produced a video of LGBT folks talking about their experience in treatment. They spoke of the isolation they felt and their internal conflicts over coming out in treatment. Although so much has changed, that isolation can still be felt. Treatment providers need to integrate LGBT clients into the treatment community but also address specific issues such as discrimination and family conflict.
We can minimize isolation by creating a safe space and building trust, just as we do for other adolescent populations but especially for this population that often experiences higher rates of abuse and family conflict. Since kids have honed their ability to detect discomfort or judgment, outreach staff should show complete acceptance. Treatment centers should show—through LGBT symbols, equal signs, posters, books—that we’re open to all.
I believe education is key. As we increase acceptance and reduce discrimination, those high rates of substance abuse will diminish too—one very important step toward equality.
Program Director of Judge John C. Creuzot Judicial Treatment Center
Phoenix Houses of Texas
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