LGBT youth treatment program aims to serve growing need in NYC

A new substance abuse treatment program for LGBT (lesbian, gay, bisexual and transgender) adolescents and young adults has received a multi-year grant of $150,000 from The New York Community Trust (NYCT). The two-year pilot program called SAINT—Serving Adolescents in Need of Treatment—is being developed by New York City LGBT community center and cultural hub The Center. Having offered a youth LGBT program for 25 years and a state-licensed treatment program for LGBT adults for a decade, leadership at The Center says SAINT is a natural extension of these efforts.

“We’ve seen a lot of young people come to us really struggling with substance use over the last five to 10 years and started seeing the impact of that on their lives,” says Glennda Testone, executive director, The Center. “So we did a study over the last year to really dig in and see what’s going on for LGBT youth—what kind of substances they’re using and what kind of help they need.”

For example, LGBT youth in New York City are 10 times more likely to use methamphetamine than their heterosexual counterparts. LGBT youth in general are seven times more likely to use heroin, and six times more likely to use Ecstasy and cocaine. “We came out of that study believing that we had to create this program, and we have to deliver it in a way that’s evidence-based so that it can be potentially nationally replicable,” Testone says.

While there are existing LGBT organizations around the country that offer youth counseling and support services that address substance use, this program appears to be the only state-licensed treatment program specifically for LGBT youth, a population that’s 190% more likely to have substance abuse problems.

“Treatment is a very tricky thing,” Testone says. “There’s not a lot of really great research out there for specifically working with adolescents and methods that are effective, but if we work with the stressors in people’s lives, acknowledge their full identities and full selves, they’re more likely to do better and to feel better, and that’s our goal.”

Similar to The Center’s adult program, SAINT will be licensed by the New York State Office of Alcoholism and Substance Abuse Services (OASAS) and will provide treatment services to LGBT young people ages 13 to 27 in addition to addressing issues of poverty and homelessness, minority stress, and LGBT identity-related trauma.

“Gender identity and sexual orientation is a really important issue for a lot of people, and if that’s not discussed during treatment then it’s not a full, holistic intervention,” adds Rachel Pardoe, NYCT health program officer. “The SAINT program fuses The Center’s cultural competency and expertise in providing treatment, and it’s targeted to this underserved and particularly needy community.” 

Barriers to access
Specialized treatment for LGBT youth and LGBT adults alike isn't always readily available. A 2007 study found that of 854 agencies promoting themselves as having specialized programs for the LGBT population, 70.8% at point of contact acknowledged that no specialized programs existed and only 62 (7.3%) of the agencies actually had specialized LGBT programming. Of that latter number, almost half were in New York or California. LGBT homeless youth are even more at a disadvantage.

“LGBT youth are vastly underserved and we have an epidemic of homeless youth,” says Phil McCabe, president of NALGAP, The Association for Lesbian, Gay, Bisexual, Transgender Addiction Professionals and Their Allies. “Many that are on the streets are mislabeled runaways when the reality is they were disowned by their families.”

McCabe says more than a quarter of homeless LGBT youth are thrown out of their homes, and of the 1.6 million youths in the United States who are homeless, 40% are LGBT. “When you’re worried about clothes on your back, getting away from harm, your next meal, maintaining recovery is secondary for many young people,” he adds.

For youths not already on the streets, McCabe says treatment options can often be bleak, with some parents even forcing them into reparative therapy in an attempt to change sexual orientation or correct gender dysphoria rather than get them the substance use help they need. Experts say affirmative models, or programs that are LGBT-dedicated, have proven to be more effective than inclusive models, or non-specific programs with an integration of LGBT services.

Program design
Nicole Avallone, LCSW, interim deputy director of programs and policy, says The Center is currently working on fleshing out the details of what the SAINT program will entail but adds that organizers hope to have the program ready to accept clients this fall. She says SAINT will be a trauma-informed program because of the recognition that it can often be an underlying trigger for substance use among LGBT youth.

“The disproportionate rates of substance use and other mental health concerns affecting LGBT young people is not surprising when we look at the continued existence of homophobia and transphobia experienced in their homes, communities and schools,” Avallone says. “While things are certainly getting better, it’s still a reality that far too many young people are facing. We recognize and really take into account the experiences of trauma, and speaking to them in treatment and teaching them better coping skills will be an essential part of the program.”

Because LGBT young people tend to have higher rates of depression, anxiety and suicide, Testone says the integration of mental health services into the program will also be crucial. For example, Avallone says organizers have looked at Seeking Safety, an evidence-based counseling model, as well as other programs and workshops that can help address stress. 

Treatment that will be provided over a three-to-six month period is just one part of SAINT, says Avallone, adding that the program represents a much fuller spectrum that prioritizes early engagement and harm reduction approaches. She says there’s an outreach plan for engagement specialists who have peer experiences to go out into the community and meet LGBT youth where they live—whether they’re homeless, precariously housed or from unsupportive families—and facilitate potential enrollment. Through one-on-one connections, the goal will be to build trust, identify and solve non-clinical barriers, and explore with young people the possibility of treatment.  

For example, Avallone says, young LGBT individuals could say substance use isn’t a problem of theirs when in fact it’s preventing them from getting housing or a job. “For us it’s really about any positive change, and we want to put more options on the table,” she says. “We recognize that getting connected to treatment and achieving abstinence may be the best way, but if their goal is reducing their use so they can achieve certain goals, we will work with them on that.”

SAINT will also ensure that LGBT youth have access to non-clinical support that encourages sobriety, such as stable housing during and after treatment, Avallone says. For youths who successfully complete the program, there will be an incentive to become paid peer leaders.

 “Peers are a really important part of this model,” she says. “For young people to have not only support related to their substance use, but to have that within the context of a community of folks who may be able to relate more to their experience and provide a mentoring figure, is really key to positive clinical outcome.” 

Testone says her organization has been hearing for years that a program like this one will make a tremendous difference in the community.  “This is sort of one step in a larger cycle of really making sure LGBT people develop in a healthy way where they have the same opportunities and chances as their straight counterparts,” she says.