NASW Social Work Talks - EP82: How Social Workers Can Help People Who Are LGBTQIA+ Overcome Addiction

Episode Date: March 16, 2022

Guests Kyle Temple and Rio Bauce talk about how social workers can help people who are LGBTQIA+ overcome addiction to substances. Kyle Temple, LCSW, is Senior Director, Stonewall Project at San Francisco AIDS Foundation.   Rio Bauce is on track to graduate in May 2022 with a master's in social work from California State University - East Bay. Read the show notes to learn more and get related resources. Thanks for listening! If you liked this episode, please subscribe to NASW Social Work Talks on your favorite podcast app. And please leave us a review at Apple Podcasts.

This episode is brought to you by the University of the Pacific's Diabetes Essentials Certificate Programs. Welcome to Social Work Talks. I am Greg Wright. The nation is grappling with an opioid addiction crisis, but what many may not know is that the problem may be greater in the LGBTQ community. According to the Centers for Disease Control and Prevention, people who are LGBTQ have higher rates of substance abuse and are more likely to be heavy drinkers into later life. To learn more about why this is so and how social workers can help, we are talking to two social workers from the San Francisco AIDS Foundation who are on the front lines of the addiction crisis. They are Rio Botch and Kyle Temple. Welcome to Social Work Talks, guys. How are you?

Fine, I hope. Doing great. Kind of quiet there. I'm doing great. Okay, great, great, great. Well, I'm hoping that all of the gas prices there aren't too high because here they're like, up to around, like, four, like, dollars, but I heard out there where you are, it's a whole lot worse, so. Yeah, we're at about six dollars plus, but we're always ahead of the rest of the

country. Yeah, always, always. Yeah, so. Yeah, so let's just, like, jump into this. I'm, like, wondering, how did you, like, actually get into, like, social work and then end up in a substance um, abuse area of it? Sure. Um, yeah. So for me, this is, uh, this is actually a second career. Um, I, uh, I worked in the corporate for-profit world for, uh, about 25 years and, um, was in a variety of, um, industries. Um, but, uh, I just found myself, uh, when I turned 40 ish, um, just, um, realizing that my, like my professional life was not in alignment with my personal values and what I wanted to do professionally. Uh, and, um, I was actually, I was working with a therapist at the time as a, you know, for my own therapy and kind of doing an inventory of what, you know,

what I wanted to do, what I saw myself doing. And it was at that point that I was like, ah, I love talking to people and I love learning and I love exploring. And that was kind of how I decided that I wanted to go into, yeah, I went to school and in that, you know, I really connected, I identify as gay and really connected with the idea that the LGBTQ community broadly is underserved and really needs folks with lived experience to be able to come in and do the work in a way that, um, I call it, um, uh, I call it shorthand, you know, to be able to connect with folks with a similar lived experience and be able to do so in shorthand so that, um, they don't have to teach me as much about, uh, their experience because we have a shared identity. Um, and in

that process, you know, I, I, I had envisioned myself in a, you know, in a private practice somewhere, working with individuals. And I just realized the need for community behavioral health support. I'm also HIV positive. I've been living with HIV for 21 years and have been really interested in working in the HIV community. And San Francisco AIDS Foundation, of course, is an HIV organization. And if you dig a little deeper into HIV prevention and treatment, you realize that there's a huge overlap and intersection with substance use and alcohol use. And it just made sense for me in that way to get involved in the work that I'm currently doing. And I should say I'm a licensed clinical social worker, but I am the senior director for the Stonewall Project, which is San Francisco AIDS Foundation's substance use treatment program.

We use a harm reduction approach, and we can get into that later. But what we do is we work with folks on an individual and group basis, providing support around substance use and alcohol use. Yeah, thank you. And I love it. That's great. Gio, you are an intern there. So could you tell us what your role is at the foundation? Yeah, so my name is Rio Bauch. I'm a clinical intern at the Stonewall Project. And a lot of, you know, a lot of the work that interns we do, you know, is through providing support to some of the clients at the Stonewall Project. we provide individual and group counseling. And ultimately, you know, we are kind of part of the building blocks of the foundation. And there's a, you know, one of the things I really like about

the Stonewall project is, you know, one of the directors, his job is dedicated to training new cohorts of interns that are going out in the world. And I think that, you know, being in this field for a relatively short amount of time, that a lot of the skills that I've developed in the last seven or eight months at the Stonewall Project are the kind of skills that we need in behavioral health and community mental health, because there is a really large need. If you walk around San Francisco, even outside of our offices, you can see that there are people that are in need of substance use services of people that could benefit from coming here and seeing us. And as Kyle kind of mentioned earlier, you know, one of the things that we practice at Stonewall is,

is harm reduction and meeting people where they're at. And I think that the, you know, when you ask like the role of the intern, I think a lot of, you know, what we do is to educate ourselves on the different substances that are used in the LGBT community, and then also ways in which we can empower our clients to make changes that work toward their goals and ultimately allow them to live healthy and fulfilling lives. And so I think that there's still a lot of work to be done, but I think we have a lot of great organizations like the San Francisco AIDS Foundation and many others in San Francisco that really help, you know, toward making this, you know, the city a better place to

live for more people and also just allows a lot of members of our community who are typically underserved to receive services that they really need. Yeah, so there is data out there that, like, says, like, people who are LGBTQ are more prone to have a substance abuse issue or an alcoholism issue. And I was wondering, what are the like factors that actually cause that, Kyle? You know, in our program and with our approach, we like to say people use drugs for reasons, which is, you know, contrary maybe to some of the thinking that's out there around, you know, some sort of moral failing or even a medical, you know, a medical approach to substance use and issues related to substance use.

The way that we think about it, again, is that people are using drugs for reasons. And those reasons can be, you know, histories of complex trauma, social isolation. You know, I've worked with clients who have, you know, who have pointed to methamphetamine use as a way to make sure that their things aren't stolen as they're living outside and trying to stay up all night to make sure that, you know, that they still have their possessions when they wake up in the morning. Meth is another, you know, is a way to push off hunger as well. And so we see folks that are using for a variety of reasons. And if you think about, you know, if you think about the way that LGBTQ folks are marginalized within our culture and within our society, it's, it's really easy to

understand how folks might turn to coping mechanisms that, by the way, many, many, many people use. And, you know, and most people do not use in a way that inhibits their quality of life to a significant degree. But again, if you're thinking about the ways that LGBT folks are marginalized and set aside and don't have access to quality care, in many instances, you know, you start to understand that drug use makes a lot of sense in certain ways. There's also a social component and a historical component where members of the queer community were only allowed to congregate in kind of back alley areas of, you know, various cities and such where they couldn't be seen and were kind of tucked away. And often that was in a bar. And so, you know, if you consider

that bars are the site of community congregation and often organization and connection with other community members, you know, you're placed in the locus of alcohol and other substance use by virtue of that alone. Yeah, absolutely. So, but I've oftentimes have read that as far as um, a methamphetamine that it's, um, a social drug and it's also like a sex drug. So it's, um, interesting that you, um, are telling us that, you know, it actually, there are, um, other reasons besides that, why folks use it. So that's, um, that's, um, a new one. Uh, like, tell us more, both of you, um, about the, uh, Stonewall, like project and like how, um, it actually reaches the folks out there and who funds it and how did you um end up there

all right geo first since you're the um intern i'm gonna let you answer that first oh really i feel like kyle i mean um i could i mean i could take a stab at it but kyle will be able to fill in the gaps um i mean we we a lot of our i know like a lot of our funding at uh at stonewall in particular i mean we receive funding from a variety of sources um but you know a large chunk comes from the department of public health community behavioral health services um and then we also get some from other programs like the center of excellence uh where we serve hiv positive patients from ward 86 um and then another part of funding which is what we call hiv prevention um and i

think like a lot of our you know a lot of our clients are i think are self-referred um who when they, you know, when they see, oh, you know, I'd like some help with a particular substance, they might come to us or, you know, or hear from a community partner as well. I mean, I think that a lot of our, I mean, my limited experience with my clients, I think that like a lot of people try abstinence-based programs or they might be in residential treatment centers. And for some people, those places provide really excellent care and can be the perfect, you know, antidote to whatever they're experiencing. But a lot of our clients have also, you know, the clients that I've worked with, you know, have reported like, oh, you know, this absent-based program didn't

really work for me. And if it doesn't work for me, I'm not really allowed to participate. And so I that's where stonewall kind of comes in um because we don't require people to do something that is not what they're coming in and wanting to do um you know the motto meet people where they're at isn't just a motto it's really like how we approach our clients is you know the very first questions we ask them are what do they want to do why are they here and i think that that really promotes a lot of success because as we form our treatment goals and the clients see our counselors, they're not feeling like we're pushing them to do something that they don't want to do. In fact, we're collaborating with them to do something that they want to do. And I think that

in my time here so far, that just seems to work a lot better than I think a program that, you know, if a certain person comes into a program and doesn't have the same goals as the program, I mean, that really, we miss a lot of people that could really benefit from services. And I think, you know, in the context of like, you know, working with a marginalized community that's so used to being turned away from services, and then you also work with vulnerable populations or people who, you know, may be at risk of homelessness or people who have fewer resources. I mean, they're so used to being turned away from services that I think a lot of clients, when they come to Stonewall, you know, it may be the first time that they've ever received services that someone's not telling them what they need to do in order to be there. And I think that's really powerful.

Yeah. Earlier, Kyle had, like, mentioned a harm reduction approach. Am I right, Kyle? It's like, that's the actual, like, term that you had used. I've heard it's quite a controversial one. There are social workers who are supportive of it and then others who aren't. So if you could explain it a bit better to our listeners, I would much appreciate that, Kyle. Thank you. Sure. I call this an elevator pitch for harm reduction because it's actually quite complex, right? But the basic idea of it is that

we're not interested in whether or not somebody is using drugs. What we're interested in is whether or not it's causing them harm and harm as defined by the client, right? And so we look at the harm that substance use or other issues that the client is experiencing as having on their quality of life. And then we come alongside them to figure out ways to reduce harm. You're thinking in a, if you're talking about like an HIV specific context, which of course, San Francisco AIDS Foundation, our mission is about eradicating HIV. So what is what does drugs have to do with that? Well, drug use, there's a there's a very robust overlap between drug use and HIV transmission. And part of that is because of the, again, putting us back in bars where alcohol is used the way

other people use alcohol as a social lubricant, reducing, you know, barriers to engaging with other people. There is definitely a strong sex link with meth for LGBTQ folks. And when we're thinking about, obviously, sex is a main form of transmission for HIV. If you use meth, you shouldn't have to get HIV, right? There are ways to use meth where you're not going to have an increased risk of HIV transmission. If you're smoking weed, you shouldn't have negative impacts that are going to last the rest of your life. There are ways to do that. There are ways to inject drugs that are not going to result in abscesses or infections or HIV or hepatitis C transmission. So we're really focusing on what is it that we can do to reduce the harm with the way

that anybody is going to live their life and really try and push aside any notion of stigmatization or marginalization of any kind of drug use. Again, I don't care if you want to use meth all day, every day. What I care about is that you're going to be able to be as safe as possible while you're making the decisions that you make about your life and you are the expert in your life. And to me, that's what harm reduction is. It's, um, it's really about, and you can apply it to anything. You can apply it to the way that you consume food, right? Um, everybody likes cookies. Uh, if I eat too many cookies, uh, I am going to get sick to my stomach. And, um, over time, I'm going to put on unwanted body weight. Um, that doesn't mean that I can't have cookies.

It just means that I have to be really intentional and knowledgeable about the way that I'm eating cookies. And I use that as an example because cookies are not stigmatized, right? Meth is stigmatized. If we talk about, well, you can use less meth or you can use meth more safely, there's still that stigma underneath it that a lot of people are fighting, our clients included, right? We have folks that are coming in and they're like, what are you here for? And they tell us, well, I want to be abstinent. And you start to dig a little bit deeper into that. And it's really not about wanting to be abstinent. They don't want to wake up having done something that they didn't intend to do the night before. They don't want to run the risk of becoming HIV

positive. They don't want to run the risk of falling out of care, medical care for HIV. So oftentimes, though folks might come in and they have an intention around being abstinent, what we find is that more times than not, that has to do with what is out there in the popular culture around the antidote to any kind of substance use. We teach and we get a million messages a day that says, if you're using drugs and alcohol, the only thing that you can do to solve those problems is to quit. And what we do is we recognize the fact that there are millions of people in this country that regularly use drugs and alcohol and are not having significant impairments on their quality of life. And so let's clean the slate and let's look at this

about what is it that you're really trying to accomplish here. And I think in doing that, we open the doors to folks that, as Rio said, and I think Rio, you did a great job before, as Rio said, get turned away from other services and are underserved or have services that are not culturally aware enough to be able to serve in appropriate ways. And that happens all day, every day. And so what we try to do is the opposite of that. Social workers often help people with diabetes, but how are you keeping up with it all? Do you know the current language and psychosocial approaches that actually decrease distress, the cultural considerations, and about all the medications, technology, and target numbers?

The online self-paced Diabetes Essentials for Clinicians program is approved by NASW for 100 credits and is taught by interdisciplinary experts to improve your competency. Visit go.pacific.edu slash diabetes essentials to get started. gotcha Rio um I wanted to ask um how many clients are you serving and I wanted to kind of get um a cross-section of the folks that you um are actually helping I mean is it from um all like rungs of like society um is it um a certain like class um or race let us know yeah that's that's a Great question. You know, every, every counselor and intern has sort of a different caseload, sort of depending on their unique needs and schedules. You know, probably between my individual and, and group clients, I would say that I serve probably between five and 15

clients in a given week. And, you know, I think one of the, one of the interesting things when you, you know, you mentioned cross sections is, you know, we are trying at Stonewall to reach more and more people. One of the challenges I think that's happened during, you know, the pandemic and mental health, unfortunately, is that mental health challenges have increased dramatically and social isolation has increased dramatically. And so at Stonewall, we've recognized this and we've seen this. And, you know, during the pandemic, we've continued to operate services safely and remotely. And, you know, even as we are speaking now, we're making big advances in returning back to more in-person services for the clients that really need them.

And, you know, talking about my own clients, I know that, you know, I serve clients that I have Spanish speaking clients. I have English speaking clients. I have clients who are older, younger. I have clients who are immigrants. I have a client who just, you know, recently, you know, came here several years ago. And I just find that a lot of the beauty in, I think, serving clients at Stonewall is there's not one type of client. We, you know, all of our clients do identify as gay, bi, or trans men. And at the same point, within that, there's so much diversity. And as we speak, we're, you know, continuing to try to increase the diversity of the clients that we serve. and we have um many people who are seeking services and and we're getting people in to to see counselors and we're helping people move through the program and meet their goals and so

i think that's one of the really great things um you know being here at the stonewall project is the opportunities to serve um lots of different people and as kyle kind of mentioned earlier you know, every client kind of has like, there's a unique approach that has to be applied to each client because every client is a different person and they know their experience in a way that nobody else does. And I think that when you look back at, you know, what being a social worker means, right, is helping people, meeting people where they're at, trying to, you know, practice ethical standards try to um you know really look at and be intentional about what the client needs right um using multi-dimensional assessment using your um you know clinical impressions but i think

at the end of the day is really that idea of yeah just really listening to clients and i think that you listen to them it doesn't matter um you know they can come in with uh from any walk of life but if you're there and you're empathetic and you're listening to them i think that you you know you can really be of service in some way and so i think that that's um yeah that's sort of been my my experience over the the last seven months here at the stonewall project uh kyle um i was wondering if you want to add anything at all to that oh yeah for sure we see folks um you know we see folks ranging from uh high profile high pressure jobs um living in the hills in the castro um as well as folks that uh you know slept on the sidewalk last night and haven't had anything to

eat in two days. And every, you know, every kind of circumstance and situation in between. Again, you know, I'll just say substance use and alcohol use in our culture in the United States is vast. And most people who are using drugs and alcohol are not seeking treatment and are not homeless or not, you know, otherwise marginalized or disenfranchised or disempowered within our culture. I think one of the big differences from my perspective is issues related to access and to privacy. You know, if I own my own home, I can use whatever substances I want in the safety of my home. If I'm without housing, if I can't go home because my parents have kicked me out because i'm gay and i'm basically taking shelter in the you know in the mass transit station

that is where i have to live my life that is where i do everything associated with my life and folks that are you know lacking in privacy and other resources um are at higher risk of um you know exposure to enforcement mechanisms within our culture and again we all know that people use They use plenty of drugs, illicit drugs and prescription drugs in all kinds of ways that they're not supposed to be using it according to law. The people that are most endangered from a legal perspective are those that cannot do so in private. yeah and so um i wanted to like ask you um also um about like stigma i mean um there's been um a lot more um in the media like now um about um addiction there are shows like um a euphoria on hbo where um addiction is like out there so are you seeing more um um awareness of it now Or is it really as badly like stigmatized as it's always been?

I mean, this is anecdotal. I don't have data to back this up, but I would say it's as stigmatized as it's always been. Especially here in San Francisco, our mayor just declared a state of emergency in the Tenderloin neighborhood, which is basically where historically the city has fenced, you know, folks with, you know, that are going against the societal grain into. Right. And so folks have been corralled into this area and then it gets over policed. And, you know, people just think of the Tenderloin as kind of this wasteland and all the people that are living in it are disposable. They don't matter. And, You know, stigma kills. It always has killed. It will always kill. And I think the way that we think about drug use in this country is inherently stigmatizing. And it's as bad as it has ever been. Yeah. So I'm wondering, though, in the LGBTQ, in that community, is there, like, more awareness of it? Like, are folks who have an issue with it, are they more likely now at this point to seek help?

Rhea, do you want to offer some thoughts here? sure yeah i can i can jump in um you know greg i think that's i think that's a really really important question because i think a lot of um you know when when you're in the work and practice of trying to um help people with their substance use goals it's really important to reflect on like are more people uh you know seeking services or are things kind of getting better. You know, I think in the same way that Kyle said, I think data about, like, how that's happening now is, I imagine, very limited. I do think it's important to put this in the context of, you know, we're in a pandemic, we're still in a pandemic, and that a lot of people have,

like that rates of substance use increased dramatically in 2020 um and if you look around and you walk around our offices the tenderlin is there yes there's drug use there but as kyle said there's also drug use everywhere in all walks of society and oftentimes um you know we don't see that right or you see you're able to sort of see where people on the streets are using substances but you're not seeing people who live in multimillion dollars houses that are using substances. So I can't say whether more people are seeking services. I certainly think that there's more awareness in general, I think, about how we use substances. I know just through looking at the communities that I belong to within the LGBT community, that there's more

of an emphasis on helping people and taking care of people who've, you know, maybe drunk too much alcohol or that there's more evolving consciousness on getting people help who've clearly, you know, have had too many drinks or have had too many drugs. And I think that that speaks a lot to the, you know, the beauty of human beings of helping one another and taking care of each other. And think that that is really uh really beautiful but i think i think i would say that there's still a lot of work that needs to be done as kyle mentioned the amount of stigmatization within our community around substances is alarming and i think that the way that people um view this problem is dehumanizing because um when we refer to like people using substances and all these different

derogatory ways it has an impact and i think that oh and it has an impact on how we actually you know solve the problem but it also really impacts the people who are using drugs because it's it's like the there's already a challenge with the particular substance and then there's this crazy amount of stigma. And then, you know, even the way that people talk about it. I mean, I hear people refer to people living on the streets who might be using drugs, not even as human beings. And that I think always, you know, brings me a lot of sadness to hear because I think everyone in our community is a human being. Everyone in our community deserves the dignity to, um, to receive treatment and receive respect. And, and I think that, um, while there may be some

increasing levels of wariness, I really think we have, um, a lot of work, a lot of good work to be done. Um, but certainly a lot of work to be done to, to continue addressing these problems with our community. Yeah. Um, that's, um, a very good point, Rio, that you said that, um, there needs to be a lot more work done. A final question for you is, in an ideal world, how should our lawmakers, how should our society address this issue? Rio first, and after that, Kyle. Gosh, that is a million-dollar question. I think one thing that lawmakers would be really helpful. I mean, I'm, I'm very lucky to be part of an intern cohort where we have the resources within the foundation to train, you know, substance use counselors who

will be, you know, the new generation of, of counselors and clinicians. And I think that that's a great thing. And I think there are, there's such a great need. And I think that their, you know, lawmakers investing in training new clinicians would be a great first step because we have so many clients who need help. We have more clients who are waiting to receive services than we have counselors. And that's just at our foundation. I mean, there's a lot of other community mental health centers that are just, you know, we work long hours every day trying to meet our clients where they're at meeting their needs and

we want to take on more um clients but we don't always have the capacity and so i think that like lawmakers you know shifting the focus to really investing in quality um substance use programs that prioritize harm reduction i think is is a great step i mean we're really lucky that the san francisco department of public health um you know has a very harm reduction focus and that really allows us to serve more clients than if we were um you know just an abstinent based program because we would turn away a ton of clients that need help so i think one is just investing in resources to um to train new clinicians i think that having um having that would be a great first step um and oh gosh i'm sure that there are other things but that's sort of what's on my mind right

now yeah i was wondering if you are thinking the same thing kyle um i'm just well i'm thinking about you know our location is being in san francisco and of course san francisco is held up as this kind of liberal, sometimes lefty, you know, place. So, you know, I'm, I'm thinking about how much of this can be applied across the country as we're thinking about like, what do adequate and appropriate services look like for LGBTQ identified folks? You know, and I think that's probably very, it's quite different in San Francisco than it might be from, you know, Midland, Texas, for example. But I think, I think we need to decriminalize drugs. I think we need to stop the war on drugs. I think that we need to stop marginalizing people who have issues of

quality of life issues as a result of their drug and alcohol use. And I think that we just need to, um i think that we need to start looking at people who use drugs uh and um you know and and have other situational and circumstantial positions that get stigmatized we need to start seeing them as human beings and treat them with dignity and respect the same as we would anybody else. We have a saying borrowed from Johan Hari, who has written extensively on harm reduction and the war on drugs, that the opposite of addiction is connection. The antidote to addiction is connection, right? And in this country, with the abstinence approach that we've historically taken, we tell people that are having difficulty around managing their substance and

alcohol use that in order to access services, you have to abstain. Abstinence is not a realistic objective of somebody who, you know, is living on the street and is using meth to stay up at night so that their stuff doesn't get stolen and suppress hunger. You know, so what are the other alternatives to abstinence in that? And I think that if we can, if we can stop thinking that all drugs are inherently bad and all drug use is a moral failure and start seeing people as human beings who deserve dignity and respect that we will go a long way to resolving some of the societal, the broader societal issues that we have. And we haven't talked about overdose deaths here, but San Francisco had 700 overdose deaths in 2021. And that's according to the latest data.

More people died of overdose deaths in San Francisco than did from COVID. And yet, it's still treated as, you know, we've recently got this public health emergency, but it's really taking a stance of like, we're going to round you up and we're going to get you off the streets and we're going to force you into treatment. And I just don't, I do not believe that that works for the majority of folks. yeah thank you thank you um it's really been um a pleasure um i've learned um a lot and i thank you for being our guest on social work talks podcast gentlemen you have been listening to nasw social work talks a production of the national association of social workers we encourage you to visit nasw's website for more information about our efforts to enhance the professional growth and development of our members, to create and maintain professional standards, and to advance sound social policies. You can learn more at www.socialworkers.org. Don't forget to subscribe to NASW Social Work Talks wherever you get your

podcasts. Thanks again for joining us. We look forward to seeing you next episode.