Rutgers Study Links Tobacco Use with Other Substance Use Among Sexual and Gender Minority Populations

Cigarette smoking is associated with frequent substance use and poor behavioral and physical health in sexual and gender minority populations, according to Rutgers researchers.

The study, published in the journal Annals of Behavioral Medicine, examined tobacco use by sexual minority men and transgender women to better understand the relationships between smoking tobacco, other substance use, and mental, psychosocial, and general health.

The Rutgers researchers surveyed 665 racially, ethnically and socio-economically diverse sexual minority men and transgender women, 70 percent of whom reported smoking cigarettes.

They found that smoking was associated with race/ethnicity, marijuana, and alcohol use, and mental health concerns of the participants. Current smokers were more likely to be white and reported more days of marijuana use in the past month. The study also found that current cigarette smoking was associated with more severe anxiety symptoms and more frequent alcohol use.

“Evidence also tells us that smoking is associated with worse mental health and increased substance use, but we don’t know how these conditions are related to each other, exacerbating and mutually reinforcing their effects,” said Perry Halkitis, dean of the Rutgers School of Public Health and the study’s senior author.

LGBTQ+ people are more likely to smoke than their cisgender and heterosexual peers to cope with an anti-LGBTQ+ society, inadequate health care access, and decades of targeted tobacco marketing. Those social stressors drive the health disparities they face, which are compounded by a lack of LGBTQ-affirming healthcare providers, research shows.

“Our findings underscore the importance of holistic approaches to tobacco treatment that account for psychosocial drivers of substance use and that address the complex relationships between mental health and use of substances like alcohol, tobacco, and marijuana,” said Caleb LoSchiavo, a doctoral student at the Rutgers School of Public Health and the study’s first author.

The study once again illustrates the strong correlation between severe stress—especially trauma—and substance use disorder (SUD). LGBTQ+ and transgender people continue to be exposed to strong social stigma—and even physical violence—simply because of their sexual choices or gender identities, leaving many of them severely traumatized.

As a webpage by the Centers for Disease Control and Prevention (CDC) about LGBTQ+ health warns that, “Stigma comes in many forms, such as discrimination, harassment, family disapproval, social rejection, and violence,” putting LGBTQ+ people at increased risk for particular negative health outcomes.

In many cases, smoking tobacco, and using other psychotropic drugs and alcohol are so strongly correlated because they are symptoms of the same kind of psychological stress. The more intense the stress, the greater the likelihood that a SUD will develop—and LGBTQ+ and transgender people generally experience higher levels of stress than their cisgender counterparts. They are simply trying to alleviate their stress with maladaptive coping skills.

Negative life experiences—especially in childhood—and persistent stress also increase the probability of developing mental health conditions such as anxiety, depression, posttraumatic stress disorder (PTSD), and panic disorders—all currently intensified by the COVID-19 pandemic and all in turn correlated with substance use disorder.

The Rutgers scientists correctly emphasized the “importance of holistic approaches to tobacco treatment that account for psychosocial drivers of substance use.” Evidence-based addiction and mental health therapy must address all underlying conditions to achieve a positive outcome.

Harmony has provided cutting-edge treatment at its Estes Park center in Colorado for half a century. Our modern, holistic approach to addiction treatment acknowledges the important role mental health conditions and psychosocial factors play as drivers of substance use disorders.

If co-occurring conditions are not comprehensively addressed, clients are more likely to relapse because they may continue to use psychoactive substances to self-medicate those issues. All staff at Harmony have been trained in trauma-informed care. Modern addiction treatment requires a holistic approach that addresses all mental health issues relevant to the SUD and provides a solid foundation for sustained recovery from addiction.

If you or a loved one is struggling with substance use disorder, or you have questions about our programs, call Harmony today at (888) 986-7848 to get the help needed as soon as possible.

September is National Recovery Month

Each year, Recovery Month celebrates the achievements of people in recovery from addiction. It’s an opportunity to promote new evidence-based treatment and recovery practices, the emergence of a strong and proud recovery community, and the dedication of service providers and community members across the nation who make recovery in all its forms possible.
Recovery Month is also an important reminder that the addiction crisis is far from over. Tens of thousands of people die from the disease of addiction each year. Drug overdose deaths increased again in 2019 in the United States, according to new preliminary data released by the Centers for Disease Control and Prevention in July. The CDC predicts that the final count for 2019 will be close to a record 72,000 overdose deaths, while 2020 is widely expected to exceed even that number because of the impact of the COVID-19 (coronavirus) pandemic.
The theme for this year’s Recovery Month is “Join the Voices for Recovery: Celebrating Connections.” Addiction is frequently driven by intense stress, trauma, extended periods of anxiety, prolonged grief, depression, and isolation.
Connections are crucial for a sustained recovery and COVID-19 has seriously disrupted traditional ways of connecting in recovery. With physical distancing measures and other restrictions in place across the US, meetings and counseling sessions for those who struggle with addiction had to be moved online in many cases. But that situation has also presented new opportunities.
“With the help of modern technology, we have the chance to be more connected than ever before,” says Michael Arnold is the director of alumni and recovery support services at Harmony Foundation. “The time COVID-19 is giving us at home is actually the greatest gift that our recovery can receive. If you are concerned about being isolated at home, pick up the phone, tablet, or use your computer to reach out to someone.”
Michael also found another engaging way to help people in recovery snap out of any dark moods they may be experiencing. In May, she started a podcast called “Monday State of Mind” to give the recovery community a positive start into the workweek. “I know the good that happens when I choose to be consciously aware of my state of mind,” she says. An alumna of Harmony herself, Michael continues to use the tools that were given to her while she was there as a patient.
The federal government’s Substance Abuse and Mental Health Services Administration (SAMHSA) is also utilizing the internet, offering a number of webinars during Recovery Month that cover medication-assisted treatment, employment support, communities supporting recovery, and the importance of integrating recovery support services.
Millions of lives in America have been transformed through recovery. Unfortunately, these successes in the battle against addiction frequently go unnoticed. Recovery Month gives everybody a chance to celebrate these accomplishments.
Harmony Foundation continues to serve clients during the COVID-19 outbreak and is taking new precautions to ensure staff and client safety. These include strict hand-washing protocols, heightened and ongoing disinfection of all areas at facilities, as well as updated admission assessments to consider previous travel, potential exposure, and health status. All new admissions will have additional medical screening upon campus arrival.

Caring for the Queer or Transgender Person in Recovery by Luca Pax

The Center for American Progress reports that between 20-30% of transgender people struggle with addiction compared to an estimated 9% of the general population. This statistic is significant for those of us who are transgender, and for those of us who support transgender people in our lives. As family members and care providers, even if we have good intentions in caring for queer or transgender people in recovery, we may need to intentionally adjust our actions, in order to have a positive impact.

What can I do as a provider?

Ask, Affirm
When a transgender person shares an intimate part of their identity with you, honor and affirm their identity by using their correct name, pronouns, honorifics, and gendered or non-gendered terms when referring to them. If you ask someone their gender identity or pronouns, do so in a way that is not interrogative or invasive, but rooted in trust and relationship. Make it a normal practice to share your own gender pronouns, and to ask others’, so that transgender folks are not as singled out, or put into vulnerable situations.

Listen, Believe
If you are given the opportunity to learn more about the identities that your client holds, listen to their self-definition and believe what they share with you. Know that LGBTQIAP+ identities are valid and real, and that people who hold these identities deserve to be trusted in their self-knowledge. Remember that each individual is the expert on their own identity, and challenging or disrespecting a client about a marginalized identity contributes to their lack of safety.

Include, Support
As care providers, our first commitment is to do no harm. Keep this in mind for transgender clients when making room pairings and restroom designations in residential treatment. Consider using inclusive language in your policies and procedures, and in your new client paperwork. Making these changes may require us to deconstruct our own social conditioning about gender norms and stereotypes, in order to best respond to transgender clients’ assessment of their safety. We may also find ourselves in a position to educate, when confronted with discomfort that may arise for cisgender staff or clients.

What can I do as a friend or family member?

Your love and support matters! The 2012 Trans PULSE Project study shows that transgender people with a parent who is supportive of their identity experiences a decrease in attempted suicide rates from 57% to 4%. With a supportive parent, these subjects’ sense of self-esteem increases from 13% to 64%, and their overall life satisfaction increases from 33% to 72%.

Caring for our queer and trans family members in recovery means ensuring that our respect and love for them continues, unaffected by their transition or identities. We can lift some of their burden by explicitly supporting them in the choices they may make to transition or “come out” socially, legally, and/or medically.

As family and loved ones of transgender people in recovery, it is important for us to educate ourselves about what our loved one may be experiencing. It is equally important that we work to maintain clear and healthy boundaries, and that we prioritize our own self-care.

You may consider joining an Al-Anon or ACA group, and utilizing resources from organizations like PFLAG or Trans Youth Education & Support of Colorado (TYES). You may also consider picking up recommended reading like the WPATH Standards of Care, PFLAG’s Trans support publications, and publications by other addiction treatment providers.

For the transgender or queer person seeking recovery, I am here to reassure you that there is community who understands you. Whether you connect with other LGBTQIAP+ folks virtually, through social gatherings, or while receiving therapeutic care, recovering in relationship with others who love and support you is possible.

If you know the pain of isolation, you deserve to discover that freedom is available to you. Connection with people who have walked a similar path as you, and sharing honestly with others, can be your ticket to a life unbound by addiction, and rich in resources that affirm and sustain the health of your truest self.

There will be times when we, as queer or transgender people in recovery, feel very alone. Whether this is a result of an addiction, our environment, or the weight of simply being who we are in a world that often creates no space for us – know that there are people waiting to undertake this work and journey alongside you.

There are many tips online for how you can take small steps throughout your day to regulate and find relief (like 8 Mental Health Tips for Queer & Trans POC, and 5 Awesome, Immediate Self-Care Resources For When You Feel Like Actual Garbage).

You can also get connected to Queer Asterisk Therapeutic Services, a non-profit organization in Colorado run by queer and trans professional therapists and educators who provide queer-informed counseling services, community programming, and educational trainings to promote the inner wellness and social connectivity of queer and trans people. Follow us on Facebook, Instagram, and sign up for our monthly newsletter, to learn more!

Luca Pax (they/their/them), who is nonbinary transgender, holds a BA in Education and Peace Studies from Naropa University, and works as Director of Community Relations for Queer Asterisk Therapeutic Services.

Edited by RP Whitmore-Bard, Communications Specialist.

Queer Asterisk Therapeutic Services advocates for the importance of excellent individual and community-based mental health treatment for queer and trans folks. Our therapists and educators partner with healthcare providers to ensure that queer and trans clients receive the most inclusive, highest quality of care possible.
We have offices in Denver, Boulder, and Longmont, Colorado.

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