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.
Harmony Foundation Upgrades Mental Health Services
by Michael Rass
Harmony has provided addiction treatment at its Estes Park center in Colorado for half a century. In the beginning, Harmony was a place where alcoholic men could “dry out,” attend AA meetings, and then return home. Over the years, this first treatment approach was expanded to include group therapy sessions, the expertise of a physician, and a treatment protocol based on the Minnesota Model.
Beginning in 2008, Harmony expanded its detoxification facilities and revised its protocol to include Subutex detox methods for opioid addicts. More recently, Harmony added the HOPE Program which offers medication-assisted therapy using buprenorphine to clients with opioid use disorder.
Led by chief clinical officer Annie Peters, Harmony has now upgraded its dual diagnosis capabilities. Dr. Peters developed a roadmap for Harmony to become a dual-diagnosis capable facility serving clients with SUD and co-occurring mental health disorders. Dual diagnosis (also referred to as co-occurring disorders) is a term used for patients who experience a mental illness and a substance use disorder simultaneously. Harmony is now fully dual diagnosis capable.
This modern, evidence-based approach to addiction treatment acknowledges the important role mental health conditions play as drivers of substance use disorders. People may misuse drugs and alcohol because of mental health issues like trauma, depression, and anxiety. “If co-occurring conditions aren’t addressed, clients are more likely to relapse because they may be drawn to substance use to self-medicate those issues,” says Dr. Peters.
People with addiction may also have traumatic experiences as a result of their substance use. “When people are using substances, they may find themselves in dangerous, potentially traumatizing situations that cause further emotional pain, which then leads to more substance use,” says Peters. “This is a difficult cycle for people to pull themselves out of without help.”
Traumatic life experiences are extremely common among patients with substance use disorder. Many suffered adverse childhood experiences. “Studies of drug addicts repeatedly find extraordinarily high percentages of childhood trauma of various sorts, including physical, sexual, and emotional abuse,” writes Canadian physician Gabor Maté in his seminal addiction study In the Realm of Hungry Ghosts.
Because of this strong correlation, trauma-informed care is an important part of addiction treatment. All staff at Harmony have been trained in trauma-informed care. “When people come to treatment, they often have few coping skills to deal with traumatic memories and emotional pain,” says Peters. “Our primary goals are to help them feel safe in the world, manage emotions and situations without substances, and improve their self-esteem and quality of life.”
Trauma-informed dual-diagnosis care begins with a careful assessment. “Every client gets screened for mental health disorders,” says Harmony therapist Gretchen Leezer. “We identify the needs of the patient and establish which ones we can start working on immediately while they are at Harmony and what follow-up treatment they should get once they have been discharged.”
It’s important to address mental health issues as soon as possible, even if the main focus of treatment is the addiction. “When someone comes into addiction treatment with a long history of depression, anxiety, suicidal thoughts, or trauma, we want them to leave here with a roadmap for recovery from all of these difficulties,” says Peters.
Harmony mental health professional Uric Geer likens Harmony’s dual diagnosis approach to a Möbius strip which can be created by taking a paper strip, giving it a half-twist, and then joining the ends of the strip to form a loop. If one side reveals the SUD and the other the mental health disorder, then the twist makes both sides visible whereas a normal paper ring would keep the condition on the inside hidden from view. “If you only treat what’s visible on the outside—the substance use disorder—then an important part of the problem remains hidden and untreated,” says Geer.
The treatment team at Harmony works hard every day to address all relevant needs a client might have. “The culture at Harmony is simply amazing,” says Harmony psychologist Rob Leach. “The leadership has a great vision and the team as a whole is extremely dedicated. They put in great effort to meet clients where they are and develop individual treatment plans. There is great coordination of care. Really listening and meeting clients where they are, creates an atmosphere of trust and that’s crucial for their recovery.”
A Family Affair: Navigating Holiday Triggers by Khara Croswaite Brindle
It’s that time of year again, the time where people like to highlight the good, the cheer, and the happiness of the holiday season. But what if holidays bring on a sense of dread? What if you have to navigate the heavy drinking of your family members? Or be in the same room with a person who hurt you in the past? What if holidays create loneliness, risk of relapse, or critical self-reflection as the year comes to a close? For many people, these worries are just the beginning of what they may navigate from November to the New Year. So how can we each feel supported through the stressors of the season?
One important element of being successful in our functioning around family is boundaries. Boundaries can be defined as physical or emotional in the way they are implemented to allow feelings of safety. Here are some examples of boundaries to consider with family to support feelings of safety and security during the holiday season:
- Allowing someone’s refusal of a hug from a family member they barely know
- Supporting comfortable distance between individuals throughout holiday activity
- Encouraging space when close proximity is triggering such as a walk or errand
- Listening for verbal cues about safe and unsafe topics during meals
- Honoring a person’s decision to decline an activity due to risk of relapse
In other words, identifying ideas of how to support each family member’s needs can encourage enjoyment in all holiday festivities without judgement or conflict. This mindfulness of self and others can entice individuals to fully participate and engage in positive experiences as a family.
Mindfulness can support positive experience through coping with triggers in the holiday environment. Supporting each family member’s self-awareness of triggers can be a first step in determining adjustments to allow full participation in festivities. In the hope of healthy family connection, below are some examples of triggers that may arise:
- Interacting with a family member that was formerly abusive
- Talking of trauma topics that create conflict such as the time they had a drinking problem, eating disorder, or abusive partner
- Engaging in traditions that encourage relapse including spectator sports
- Recognizing people or places that are connected to trauma memories such as the holiday party where they experienced sexual assault
- Feeling peer pressure to engage in activities that feel unsafe including binge drinking
- Having the perception of criticism or judgement by their family, coworkers, or friends
- Remembering trauma anniversaries that overlap with the holidays including death and breakups
- Experiencing sights, smells, and other sensory information that connect to trauma such as cologne/perfume, alcohol, or ice and snow
With all of the potential triggers at play during the holidays, it becomes crucial that we feel a connection to one another in our efforts to contain the stress. Reaching out to trusted family and friends or seeking the help of a professional can support a person in navigating the holiday demands. Balancing out stress with positive connection can make a significant difference in our ability to participate in holiday traditions and create new, positive memories where trauma memories formerly dictated our experience. By connecting with people who can relate, we may also learn new skills of how to remain fully present in the holiday experience and find joy in the family and traditions we’ve come to value.
“Write it on your heart that every day is the best day in the year.”
Ralph Waldo Emerson
Khara Croswaite Brindle, MA, LPC, ACS, is a Licensed Professional Counselor in the Lowry Neighborhood of Denver, Colorado. She received her Masters Degree in Counseling Psychology from the University of Denver with a focus on community based mental health. Khara has experience working with at-risk youth and families, including collaboration with detention, probation, and the Department of Human Services. Khara enjoys working with young adults experiencing anxiety, depression, trauma, relational conflict, self-esteem challenges, and life transitions.