Widening the Net: Engaging Sexual and Gender Minority Youth in Addiction Treatment

Sexual and gender minority (SGM) youth are at increased risk of substance use and misuse compared to their heterosexual and cisgender peers. This session will encourage participants to reflect upon the role of minority stress in driving SGM youth to use substances and the exacerbating effects of the COVID-19 pandemic due to the unique stressors that SGM youth face. The purpose of this session is to explore best practices for providing substance use care that is affirming and sensitive to the needs of SGM youth. We will draw upon our experiences working within a clinical care structure in which adolescent primary care, substance use clinic, and gender clinic are co-located and collaborative. We will discuss how to create a care environment that is affirming to SGM youth, emphasizing the importance of the physical space, the language we choose, the forms we distribute, and the staff training we provide. Knowing that SGM youth face higher rates of depression, suicide, childhood trauma, intimate partner violence, family rejection, and housing instability, we will discuss how to approach substance use treatment for SGM youth in a way that recognizes the many coexisting stressors these youth may face. Increasing our ability to identify and address the complex, interrelated needs of this vulnerable youth population is important to improve engagement in substance use care. We will underscore the value of engaging a multidisciplinary team by connecting youth with community supports as well as affirming behavioral health and primary care services, including providers who prescribe gender-affirming hormones when indicated. We will provide strategies to integrate substance use treatment with gender-affirming care for youth and address pharmacologic interactions between substance use treatments and gender-affirming hormones. Additionally, we will discuss the interrelation between substance use and high risk sexual behavior in youth. We will empower participants with harm reduction strategies for youth engaging in high risk sexual behavior, including STI screening, initiation and monitoring of PrEP, and office-based counseling to reduce harms associated with high risk sexual behavior. Participants will come away from this session with greater comfort engaging SGM youth in substance use treatment, integrating substance use treatment and gender-affirming care, implementing harm reduction strategies specific to the needs of SGM youth, and collaborating across disciplines to optimize care for this vulnerable population. We hope that our session will help reduce the inequities SGM youth face in accessing quality, evidence-based treatment for substance use disorders.