Transcript of 82: How Social Workers Can Help People Who Are LGBTQIA+ Overcome Addiction
NASW Social Work Talks Podcast
Announcer:
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Greg Wright:
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 the 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 Bauce and Kyle Temple. Welcome to Social Work Talk, guys. How are you? Fine, I hope?
Kyle Temple:
Doing great.
Greg Wright:
Kind of quiet there.
Kyle Temple:
I'm doing great.
Greg Wright:
Okay, great, great, great. Well, I'm hoping that all of the gas prices there aren't like too high because here they're like up to around $4 but I heard out there where you are, it's a whole lot worse.
Kyle Temple:
Yeah, we're at about $6 plus, but we're always ahead of the rest of the country.
Greg Wright:
Yeah. Always, always.
Kyle Temple:
Yeah.
Greg Wright:
Yeah. Let's just jump into this. I'm wondering how'd you actually get into social work and then end up in a substance abuse area of it?
Kyle Temple:
Sure. Yeah. So for me, this is actually a second career. I worked in the corporate for-profit world for about 25 years and was in a variety of industries, but I just found myself when I turned 40-ish, just realizing that my professional life was not in alignment with my personal values and what I wanted to do professionally. And actually I was working with a therapist at the time for my own therapy and kind of doing an inventory of what I wanted to do, what I saw myself doing and it was at that point that I was like, "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 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 I call it shorthand to be able to connect with folks with a similar lived experience and be able to do so in shorthand so that they don't have to teach me as much about their experience because we have a shared identity.
And in that process I had envisioned myself 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 in 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 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.
Greg Wright:
Yeah. Thank you.
Kyle Temple:
And I love it. I should say.
Greg Wright:
Rio, you are a intern there. So could you tell us what your role is at the foundation?
Rio Bauce:
Yeah, so my name's Rio Bauce, I'm a clinical intern at the Stonewall Project. And a lot of the work that interns we do is through providing support to some of the clients. At the Stonewall Project, we provide individual and group counseling. And ultimately we are kind of part of the building blocks of the foundation. One of the things I really like about the Stonewall Project is 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 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.
Rio Bauce:
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 one of the things that we practice at Stonewall is harm reduction and meeting people where they're at. And I think that when you ask the role of the intern, I think a lot of what we do is to educate ourselves on the different substances that are used in the LGBTQ 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.
Rio Bauce:
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 toward making this 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.
Greg Wright:
Yeah. So there is data out there that says people who are LGBTQ are more prone to have a substance abuse issue or an alcoholism issue. And I was wondering are the factors that actually cause that, Kyle?
Kyle Temple:
In our program and with our approach, we like to say people use drugs for reasons, which is contrary maybe to some of the thinking that's out there around some sort of moral failing, or even 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 histories of complex trauma, socialization. I've worked with clients 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 they still have their possessions when they wake up in the morning. Meth is a way to push off hunger as well. And so we see folks that are using for a variety of reasons.
Kyle Temple:
And if you think about the way that LGBTQ folks are marginalized within our culture and within our society, it's really easy to understand how folks might turn to coping mechanism that by the way many, many, many people use 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 start to understand that drug use makes a lot of sense in certain ways.
Kyle Temple:
There's also a social component and a historical component where members of the queer community were only allow out to congregate in kind of back alley areas of 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 if you consider that bars are the site of community congregation and often organization and connection with other community members you're placed in the locus of alcohol and other substance use by virtue of that alone.
Greg Wright:
Yeah, absolutely. Oftentimes I've read that as far as a methamphetamine that it's a social drug and it's also like a sex drug. So it's interesting that you are telling us that there are other reasons besides that why folks use it.
Kyle Temple:
Absolutely.
Greg Wright:
So that's a new one. Tell us more, both of you about Stonewall Project and how it actually reaches the folks out there and who funds it and how did you end up there? Rio first, since you're the intern, I'm going to let you answer that first.
Rio Bauce:
Not really, I feel like Kyle ... answering this. I mean, I could take a stab at it, but Kyle will be able to fill the gaps. I know a lot of our funding at Stonewall in particular, I mean, we receive funding from a variety of sources, but large chunk comes from the Department of Public Health, Community, Behavioral Health Services. And then we also get some from other programs like the Center of Excellence, where we serve HIV-positive patients from Ward 86 and then another part of funding, which is what we call HIV Prevention.
Rio Bauce:
And I think a lot of our clients I think are self-referred when they say, I'd like some help with a particular substance, they might come to us or hear from a community partner as well. I mean my limited experience with my clients, I think that a lot of people try abstinent 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 antidote to whatever they're experiencing. But the clients that I've worked with have reported like, "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 think that's where Stonewall kind of comes in because we don't require people to do something that is not what they're coming in and wanting to do.
Rio Bauce:
The motto, meet people where they're at, isn't just a motto it's really how we approach our clients. The very first questions we ask them are what do they want to do? Why are they here? And I think that really promotes a lot of success because as we form our treatment goal 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.
Rio Bauce:
And I think that just in my time here so far, that just seems to work a lot better than I think if a certain person comes into a program and doesn't have the same goals as the program we miss a lot of people that could really benefit from services. And I think in the context of working with a marginalized community that's so used to being turned away from services, and then you also work vulner populations or people who maybe 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 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.
Greg Wright:
Yeah. Earlier Kyle had mentioned a harm reduction approach. Am I right, Kyle? That's the actual 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.
Kyle Temple:
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 are 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 is 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 quality of life. And then we come alongside them to figure out ways to reduce harm.
Kyle Temple:
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 does drugs have to do with that? Well, drug use there's a very robust overlap between drug use and HIV transmission. And part of that is because of again, putting us back in bars where alcohol is used, the way other people use alcohol as a social lubricant, reducing 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.
Kyle Temple:
If you use meth, you shouldn't have to get at 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.
Kyle Temple:
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 really about... And you can apply it to anything. You can apply it to the way that you consume food, right? Everybody likes cookies. If I eat too many cookies, I am going to get sick to my stomach and over time I'm going to put on unwanted body weight. 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?
Kyle Temple:
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 in 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.
Kyle Temple:
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.
Kyle Temple:
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 inappropriate ways. And that happens all day every day. And so what we try to do is the opposite of that.
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Greg Wright:
Gotcha. Rio, I wanted to ask how many clients are you serving? And I wanted to kind of get a cross section of the folks that you are actually helping. I mean, is it from all rungs of society? Is it a certain like class or race? Let us know.
Rio Bauce:
Yeah, that's a great question. Every counselor and intern has sort of a different caseload sort of depending on their unique needs and schedules. Probably between my individual and group clients I would say that I serve probably between five and 15 clients in a given week. And I think one of the interesting things when you mentioned cross sections is we are trying at Stonewall to reach more and more people. One of the challenges I think that's happened during the pandemic in mental health, unfortunately, is that mental health challenges have increased dramatically and social isolation has increased dramatically.
Rio Bauce:
And so at Stonewall, we've recognized this and we've seen this and during the pandemic we've continued to operate services safely and remotely. 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.
Rio Bauce:
And talking about my own clients, 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 recently 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. 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 continuing to try to increase the diversity of the clients that we serve. And we have many people who are seeking services and we're getting people in 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 being here at Stonewall Project is the opportunities to serve lots of different people.
Rio Bauce:
And as Kyle kind of mentioned earlier, 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 what being a social worker means is helping people, meeting people where they're at, trying to practice ethical standards, try to really look at and be intentional about what the client needs, using multidimensional assessment, using your clinical impressions. But I think at the end of the day is really that idea of just really listening to clients. And I think that when you listen to them, it doesn't matter they can come in from any walk of life, but if you're there and you're empathetic and you're listening to them, I think that you can really be of service in some way. And so I think that's sort of been my experience over the last seven months here at Stonewall Project.
Greg Wright:
Kyle, I was wondering if you want to add anything at all to that?
Kyle Temple:
Oh yeah, for sure. We see folks ranging from high profile, high pressure jobs, living in the hills in the Castro, as well as folks that slept on the sidewalk last night and haven't had anything to eat in two days and every kind of circumstance and situation in between. Again, 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, are not 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. 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 mass transit station, that is where I have to live my life. That is where I do everything associated with my life.
Kyle Temple:
And folks that are lacking in privacy and other resources are at higher risk of exposure to enforcement mechanisms within our culture. And again, we all know that people use drugs, they use plenty of drugs, illicit drugs and prescription drugs in all kinds of ways that they are 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.
Greg Wright:
I wanted to ask you also about stigma. I mean, there's been a lot more in the media now about addiction. There are shows like "Euphoria" on HBO where addiction is out there. So are you seeing more awareness of it now or is it really as badly like stigmatized as it's always been?
Kyle Temple:
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 folks that are going against the societal grain into. And so folks have been corralled into this area and then it gets overpoliced and people just think of the Tenderloin is kind of this wasteland and all the people that are living in it are disposable. They don't matter. And 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.
Greg Wright:
Yeah. So I'm wondering though, in the LGBTQ, in that community, is there more awareness of it? Are folks who have an issue with it, are they more likely now at this point to seek help?
Kyle Temple:
Rio, do you want to offer some thoughts here?
Rio Bauce:
Sure. Yeah. I can jump in. Greg, I think that's a really important question because I think a lot of... When you're in the work and practice of trying to help people with their substance use goals, it's really important to reflect on are more people seeking services or things kind of getting better. I think in the same way that Kyle said, I think data about how that's happening now I imagine very limited. I do think it's important to put this in the context of we're in a pandemic, we're still in a pandemic and that a lot of people have rates of substance use increased dramatically in 2020.
Rio Bauce:
And if you look around and you walk around our offices, the Tenderloin 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 we don't see that or 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 dollar houses they're using substances.
Rio Bauce:
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 substance. 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 maybe drunk too much alcohol or that there's more evolving consciousness on getting people help who clearly have had too many drinks or have had too many drugs. And I think that speaks a lot to the beauty of human beings of helping one another and taking care of each other. And I think that is really, really beautiful.
Rio Bauce:
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 view this problem is dehumanizing because when we refer to people using substances and all these different derogatory ways, it has an impact. And it has an impact on how we actually solve the problem, but it also really impacts the people who are using drugs because there's already a challenge with the particular substance and then there's this crazy amount of stigma.
Rio Bauce:
And then even the way that people talk about it, 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 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 receive treatment and receive respect. And I think that while there may be some increasing levels of awareness I really think we have a lot of work, a lot of good work to be done, but certainly a lot of work to be done to continue addressing these problems within our community.
Greg Wright:
That's a very good point, Rio that you said that there needs to be a lot more work done. Final question for you is in a ideal world, how should our society address this issue? Rio first and after that, Kyle.
Rio Bauce:
Gosh, that is a million dollar question. I think one thing that lawmakers would be really helpful I mean I'm very lucky to be part of an intern cohort where we have the resources within the foundation to train substance use counselors who will be the new generation of counselors and clinicians. And I think that's a great thing. And I think there's such a great need. And I think that 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... 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 clients but we don't always have the capacity.
Rio Bauce:
And so I think that lawmakers shifting the focus to really investing in quality substance use programs that prioritize harm reduction I think is a great step. I mean, we're really lucky that the San Francisco Department of Public Health as a very harm reduction focus, and that really allows us to serve more clients than if we were just an abstinence-based program, because we would turn away a ton of clients that need help. So I think one is just investing in resources to train new clinicians. I think that having that would be a great first step. Oh gosh, I'm sure that there are other things, but that's sort of what's on my mind right now.
Greg Wright:
Yeah. I was wondering if you are thinking the same thing, Kyle?
Kyle Temple:
Well, I'm thinking about our location as being in San Francisco and of course San Francisco is held up as this kind of liberal, sometimes lefty place. So I'm thinking about how much of this can be applied across the country as we're thinking about what do adequate inappropriate services look like for LGBTQ identified folks and I think it's quite different in San Francisco than it might be from Midland Texas, for example. But 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. I think that we need to start looking at people who use drugs 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.
Kyle Temple:
We have a saying borrowed from Johann 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 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. So what are the other alternatives to abstinence in that? And I think that 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 broader societal issues that we have.
Kyle Temple:
And we haven't talked about overdose deaths here, but San Francisco had 700 overdose death in 2021. And that's according to the latest data, more people died of overdose death in San Francisco than did from COVID. And yet it's still treated as we've recently got this public health emergency, but it's really taking a stance of 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 do not believe that works for the majority of folks.
Greg Wright:
Yeah. Thank you. Thank you. It's really been a pleasure. I've learned a lot, and I thank you for being our guest on Social Work Talks Podcast, gentlemen.
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