ARQ2: Question B8 - Relationship between substance use and/or mental health and Part B items

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Do you use alcohol and/or other drugs to cope with any of the issues we mentioned? Are your mental health concerns related to any of the issues we mentioned? not at all a little somewhat a lot

If yes... in what ways?

Relevance/intent

This item assesses the relationship between the aforementioned issues and substance use/mental health concerns, to find if the client uses substances to deal with these issues or if these issues are related to mental health problems.

Empirical and anecdotal evidence suggests that specific factors in the lives of LGBTTTIQ people are linked to substance use and/or mental health concerns. These factors include:

• having bars as the predominant social outlets
• finding friends in bars and falling into a heavy-using peer group
• developing an identity and “coming out” as LGBTTTIQ
• not accepting an LGBTTTIQ identity as a positive aspect of self
• carrying the burden of keeping up a secret identity
• being pathologized by the medical/psychological community
• experiencing racism, sexism, classism, ableism, heterosexism or genderism
• wanting to escape the restrictive sexual norms surrounding HIV infection
• losing family support
• lacking social support
• being denied housing, employment or appropriate health care
• being HIV-positive
• having a history of childhood adversity related to LGBTTTIQ identity
• experiencing trauma
• experiencing domestic violence (e.g., same-gender partner abuse).

Additional probes

If so, under what circumstances?

When you were faced with the issues we just discussed (e.g., coming out to your family, feeling socially isolated), how did you cope?

Client perceptions

“For me, it was relevant to my using more because of the harassment I received for being gay, and just needing to wind down at times and to escape.”

“I self-injure. I’m a cutter. As you can see, I am covered in scars. When I was young, I couldn’t come out, so there was this whole secrecy thing. And so I’d cut because I was trying to express myself and let people know that I was hurting.”

“I was 21 years old and went into a mental health facility due to an overdose of sleeping pills as a result of sexual abuse. As I was going through treatment, I realized I was also struggling with coming out. I found the mental health system beneficial in helping with that. I found it was a domino effect. Issues around coming out were impacting other aspects of my life.”

Therapist/counsellor perceptions

“I ask about their coming-out process and look at potential links between drug and alcohol abuse onset or increases in that when they came out.”

“I can’t imagine how one would go through that journey of transitioning and coming out as trans without some kind of response, like depression, anxiety, panic attacks. They strike me as healthy responses to the insane culture that says ‘Your body does not work. It’s not right.’”

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Asking the Right Questions 2

• Acknowledgments
• Introduction
• Using the manual
• Background information:
  • Part A — Client Questionnaire
  • Part B — Conversation Guide
    • B1: Discrimination — homophobia, biphobia, transphobia
    • B2: Coming out and transitioning
    • B3: Openness about sexual orientation/gender identity
    • B4: Family issues
    • B5: Involvement in the community
    • B6: Body image and aging
    • B7: HIV concerns
    • B8: Relationship between substance use and/or mental health concerns and Part B items
• Counsellor competence
• Resources
• References
• Appendix

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