Transgender Considerations in SUD TreatmentCAMERON DUVALL LMFT

8/22/2019

Agenda

Introductions

LGBTQ 101

Gender – What does it mean?

SUD Treatment Applications

resources

Introductions

Cameron Duvall, LMFT Worked with LGBTQ Population for past 10 years

Member of Marin County’s Cultural Competency Advisory Board 2015-2018

Member of Alameda County’s Pride Coalition 2018-present

Sitting Diversity Chairperson on San Francisco Gay Softball League (SFGSL)

Cammieduvall@gmail.com

(415) 968-9591

LGBTQ 101

LGBTQIA2-SP Lesbian

Gay

Bisexual

Transgender

Queer

Intersex

Asexual

2 Spirit

Pansexual

LGBTQ 101

Gender Identity Vs Sexual Orientation

Gender Identity Gender identity is the personal sense of one's own gender. Gender identity can

correlate with assigned sex at birth or can differ from it.

Sexual Orientation Sexual orientation is an enduring pattern of romantic or sexual attraction to

persons of the opposite sex or gender, the same sex or gender, or to both sexes or more than one gender.

LGBTQ 101

Gender Definitions

Gender Dysphoria

Previously known as Gender Identity Disorder (DSM-IV) “the condition of feeling one's emotional and psychological identity as male or female

to be opposite to one's biological sex.”

someone with the physical characteristics of a female would feel her true identity is male. Feeling that your body does not reflect your true gender can cause severe distress, anxiety, and depression. "Dysphoria" is a feeling of dissatisfaction, anxiety, and restlessness

Distress is Persistent & consistent

Previously known as Gender Identity Disorder (DSM-IV)

Informed Consent

Gender Definitions

Transgender (adj.) An individual who’s gender identity does not match gender assigned at birth

Trans – Latin for ‘Other’

Cisgender (adj.) An individual who’s gender identity does match gender assigned at birth

Cis – Latin for ‘Same”

Gender Definitions

Non-Binary A person who’s gender identity is not exclusively masculine or exclusively

feminine—identities that are outside the gender binary.

Gender Fluid A person who’s gender identity varies over time. They may at any time dentify

as male, female, neutrois, or any other non-binary identity, or some combination of identities.

May identify as multigender, non-binary, and/or transgender.

Gender Alignment

When treating Gender Dysphoria, we strive to bring aspects of self into alignment.

Biological Male . X. . . . . . . . Female

Psychological Male . . . . . . . .X . Female

Sociological Male . . . . X. . . . . Female

Gender Alignment

When treating Gender Dysphoria, we strive to bring aspects of self into alignment.

Biological Male . . . . . . . .X . Female

Psychological Male . . . . . . . .X . Female

Sociological Male . . . . . . . .X . Female

Alignment

There are as many ways to express a Transgender identity as there are Transgender individuals.

It is not as important for you to relate to their experiences as much as it is to respect their experiences.

Not everyone shares the same goals for alignment, so ‘be curious’ and ask what people want (individualized treatment)

Basic Do’s & Don’t

Deadnaming – using a person’s birth name after a different identity has been declared/chosen.

Pronouns – Use the pronoun that best matches the identity of the individual. If you are unsure, you may ask or simply use gender neutral pronouns. You may also replace the pronoun with the individual’s name in many cases. If you catch yourself making a mistake, simply correct yourself and move on.

Remember…being transgender is not all the client is. View clients as a whole person.

Factors Contributing to Substance Use

Stigma The American Journal of Public Health surveyed 1,093 male-to-female and

female-to-male transgender persons, 44.1 percent of whom reported clinical depression as a result of their stigma, and 33.2 percent who reported anxiety caused by their stigma. The researchers in the journal were confident that trans people “clearly fit the minority stress model.”

44.1 percent of whom reported clinical depression as a result of their stigma.

33.2 percent who reported anxiety caused by their stigma.

Factors Contributing to Substance Use

Devastating Levels of Discrimination This is directly associated with transgender people being at a greater risk for

participating in risky behavior, such as sex work and/or drug and/or alcohol abuse.. Transgender individuals are much more likely to get HIV/AIDS than the general population, which itself may be a source of mental health distress that exacerbates substance abuse compulsions.

Factors Contributing to Substance Use

Factors Contributing to Substance Use

Life in ‘Hard Mode’ Fear of violence Increased social Isolation Lack of family support/acceptance

The higher the levels of family rejection, the greater the likelihood of drug or alcohol abuse.

Minority Stress Minority stress is the theory that health disparities among minorities (whether ethnic, cultural, or, in this case,

sexual) are usually due to the stressors induced by a larger, more dominant culture, which may be at odds with the values of the minority. Immigrants, for example, are often subject to minority stress because their customs and languages tend to clash with the customs and language of their new home country; homesickness could be a symptom of minority stress.

For transgender people living in a majority heterosexual [and Cisgender] culture, minority stress takes the form of discrimination, victimization, harassment, and maltreatment.

Factors Contributing to Substance Use

Factors Contributing to Substance Use

Addiction and LGBT Bars and Clubs The Advocate writes of how LGBT culture “very heavily revolves around the bar

scene,” a place where transgender individuals can come together in safety and solidarity. This has made the alcohol and tobacco industries (as well as the illegal drug market) very interested in marketing their products to LGBT people, who are already at-risk for developing substance abuse and/or mental health issues as a result of the prejudice and social stress they experience at home and at work. Helping Clients find alternative social outlets may be indicated for a treatment plan

Factors Contributing to Substance Use

Stigma in Healthcare Even in addiction treatment, transgender people are either excluded entirely

from programs and services or grouped with sexual minority groups instead of being put into a dedicated category. Researchers writing in the journal of Substance Abuse Treatment, Prevention and Policy interviewed 34 transgendered individuals from 2012 to 2013 and found that those who were subject to stigma and transphobia in the form of social rejection and violence “left treatment prematurely after isolation and conflicts.” Treatment provider attitudes have been noted as one of the barriers to addiction treatment that transgender people face; the attitudes “are often rooted in stigma” toward transgender individuals for their apparent refusal to conform to society’s gender standards and expectations.

DMC-ODS Treatment/Program Recommendations – All LOC’s

Welcoming Signage

DMC-ODS Treatment/Program Recommendations – All LOC’s

Educate/Train/’Expose’ Staff

Affirming Documentation When working Intake/assessments, have gender affirming options on paperwork

Preferred pronouns in email signature line

Images/representation on advertising materials

Treatment planning should include endocrinologist visit (dimension 2) if client is on hormone treatment

Depending on stage of transition, gender specialist my be applicable for Dimension 3

DMC-ODS Treatment/Program Recommendations – All LOC’s

Employment and housing are often major hurdles for trans identified people

Family reunification (collateral) should be considered where appropriate Referral for Family therapy may be indicated

Explore with client where Social outlets may be altered/explored

DMC-ODS Treatment/Program Recommendations – Residential

Separate individuals based by Identified Gender Be prepared for Non-Binary needs

Hormone treatments may be included in meds client needs to be administered

Trans Males can become pregnant

Group programming should

Additional Resources

UCSF Trans 101 https://prevention.ucsf.edu/transhealth/education/trans101

National Transgender Health Summit https://prevention.ucsf.edu/transhealth/education/nths

Gender Spectrum.org https://www.genderspectrum.org/

Transgender Law Center https://transgenderlawcenter.org/

2015 Transgender Survey http://www.transequality.org/sites/default/files/docs/USTS-Executive-Summary-

FINAL.PDF