Building Bridges

LGBT Populations: 

A Dialogue on Advancing Opportunities for 

Recovery from Addictions and 

Mental Health Problems 

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Substance Abuse and Mental Health Services Administration

Center for Mental Health Services

www.samhsa.gov 
Acknowledgements

This report was prepared for the Substance Abuse and Mental Health Services 

Administration (SAMHSA), U.S. Department of Health and Human Services (HHS) by

Irene Saunders Goldstein under contract number 283-07-7302 with SAMHSA. 

Catherine D. Nugent served as Government Project Officer.

Disclaimers

The views, opinions, recommendations, and content of this publication are those of the

participants of the dialogue meeting on LGBT populations and recovery from addictions 

and mental health problems. They do not necessarily reflect the views, opinions, or

policies of SAMHSA or HHS. Any mention of nonfederal resources does not constitute 

endorsement by SAMHSA or HHS.

Public Domain Notice

All material appearing in this document is in the public domain and may be reproduced or 

copied without permission from SAMHSA. Citation of the source is appreciated. However, 

this publication may not be reproduced or distributed for a fee without specific written 

authorization of the Office of Communications, SAMHSA, HHS.

Electronic Access and Copies of Publication

This publication may be downloaded or ordered at store.samhsa.gov, or by calling

SAMHSA at 1-877-SAMHSA-7 (1-877-726-4747) (English and Spanish). 

Recommended Citation

Substance Abuse and Mental Health Services Administration. (2012). Building Bridges:

LGBT Populations: A Dialogue on Advancing Opportunities for Recovery from 

Addictions and Mental Health Problems. HHS Pub. No. (SMA 13-4774. Rockville, MD: 

Substance Abuse and Mental Health Services Administration. 

Originating Office

Center for Mental Health Services, Substance Abuse and Mental Health Services 

Administration, 1 Choke Cherry Road, Rockville, MD 20857. 

HHS Publication No. (SMA) 13-4774. 

Printed in 2013 

i
iii

Contents

1.0 Overview ..........................................................................................................1

2.0 Dialogue Themes and Findings ....................................................................5 

2.1 In Their Own Words ...............................................................................5 

2.2 Major Themes ..........................................................................................7

2.2.1 Family Rejection and Family Acceptance ...............................7 

2.2.2 Coming Out.............................................................................8

2.2.3 LGBT-Related Stress..............................................................9

2.2.4 Intersection of LGBT with Other Identities.............................10

2.2.5 Trauma......................................................................................10

2.2.6 Suicide ..................................................................................11

2.2.7 Invisibility of LGBT Individuals and Groups...........................12

2.2.8 LGBT Across the Lifespan ....................................................13

2.3 Person-Level Factors Related to Recovery ...................................14 

2.3.1 Person-Level Factors That Promote Recovery ....................14 

2.3.2 Person-Level Factors That Impede Recovery ......................16 

2.4 System and Contextual Factors Related to Recovery ..........................17 

2.4.1 System-Level Factors That Promote Recovery.....................18 

2.4.2 System-Level Factors That Impede Recovery .....................19 

3.0 Recommendations for Action .....................................................................21 

3.1 Participants’ MajorRecommendations....................................................21 

3.2 Participants’ Strategic Recommendations ............................................21 

3.2.1 Training and Technical Assistance .......................................21 

3.2.2 Treatment and Recovery Supports .......................................22 

3.2.3 Data Collection andQuality...................................................24 

3.2.4 Partnerships ..................................................................... .........24

3.2.5 Trauma and Justice Issues ...................................................25 

3.2.6 Public Awareness.......................................................................25

4.0 Milestones in the LGBT Mental Health Consumer Movement ..............27

Appendix A. Glossary .......................................................................................29
iv

Building Bridges: LGBT Populations

Appendix B. U.S. Department of Health and Human Services: Actions to Improve the

Health and Well-Being in Support of Lesbian, Gay, Bisexual, and

Transgender Communities..................................................................32

Appendix C. LGBTQ Inclusive Action Steps in SAMHSA’s 

Strategic Initiatives ....................................................................................37

Appendix D. Resources and References ................................................41 

D.1 U.S. Department of Health and Human Services Resources.............41 

D.2 Private-Sector Resources ...................................................................43 

D.3 References and Related Publications ..................................................55 

Appendix E. Dialogue Participants....................................................................62

Pins and Nails by Trois Lyric .......................................................................65 

Substance Abuse and Mental Health Services Administration

An agency of the U.S. Department of Health and Human Services, the Substance Abuse

and Mental Health Service Administration (SAMHSA) leads the Nation’s efforts to reduce

the impact of substance abuse and mental illness on America’s communities. SAMHSA’s

goal is a high-quality, self-directed, satisfying life integrated in a community for all

Americans. This life includes:

• Health. Overcoming or managing one’s disease(s) or symptoms—for example,

abstaining from use of alcohol, illicit drugs, and non-prescribed medications if one

has an addiction problem—and, for everyone in recovery, making informed, healthy

choices that support physical and emotional wellbeing.

• Home. A stable and safe place to live that supports recovery.

• Purpose. Meaningful daily activities, such as a job, school, volunteerism, family

caretaking, or creative endeavors, and the independence, income, and resources to

participate in society.

• Community. Relationships and social networks that provide support, friendship,

love, and hope.

To accomplish this goal, SAMHSA targets its efforts to improve the supports, services,

and systems that prevent mental illness and substance abuse, and that facilitate

treatment and recovery for those at risk for, or who have, mental and/or substance use

disorders. 
Building Bridges: LGBT Populations

Page Intentionally Left Blank

v 
1.0 Overview

I’m a gay alcoholic. Those two labels have informed my life. At age 

15 I went to the library in our home town and looked up every 

reference the card catalog had on homosexuality. I learned that I was 

psychologically abnormal, that I was illegal, that I was immoral, and 

that I was unacceptable.

Although lesbian, gay, bisexual, and transgender (LGBT) adults in the United States

typically are well adjusted and mentally healthy, the Institute of Medicine (IOM) (2011) 

reports that LGBT populations are at substantially greater risk for substance use and 

mental health problems. For example, according to the Substance Abuse and Mental 

Health Services Administration’s (SAMHSA) Center for Substance Abuse Treatment 

(SAMHSA, 2001; Prairielands Addiction Technology Transfer Center [ATTC], 2007): 

• LGBT people are more likely to use alcohol and drugs and to continue heavy 

drinking into later life. In addition, they are more likely to have higher rates of 

substance use disorders and less likely to abstain from using alcohol and drugs. 

• Gay men, lesbians, and male-to-female transgender persons experience 

methamphetamine use as a significant problem.

Despite limited research on LGBT mental health concerns, studies that compared mental 

health problems between LGBT populations and the general public reveal similar 

disparities: 

• Gay men are at greater risk for suicide attempts and completions (Stall, Valdiserri, & 

Wolitski, 2008).

• Depression affects gay men at higher rates, often with more severe problems for 

men who remain “in the closet” (Berg, Mimiaga, & Safren, 2008; Bostwick, Boyd, 

Hughes, & McCabe, 2009).

• Women with same-sex partners have higher rates of major depression, simple 

phobias, and posttraumatic stress disorder (Cochran, Gilman, Hughes, et al., 2001).

• Bisexual men and women report consistently higher levels of depression and 

anxiety; some studies show rates similar to lesbians and gay men, while other 

studies show higher rates (Dobinson & Steele, 2008). 

• Rates of depression and suicide attempts among both male-to-female and femaleto-male transgender persons are higher than for nontransgender populations 

(Clements-Nolle, Guzman, Katz, & Marx, 2001; Mathy, 2003).

• A multistate study of high school students found a greater likelihood of engagement 

in “unhealthy risk behaviors such as tobacco use, alcohol and other drug use, 

1 
Building Bridges: LGBT Populations

sexual risk behaviors, suicidal behaviors, and violence” among LGB students and 

students who report having sexual contact only with persons of the same or both 

sexes, than by heterosexual students and students who report having sexual 

contact only with the opposite sex (Centers for Disease Control and Prevention 

[CDC], 2011a). 

• “Adverse, punitive, and traumatic reactions from parents and caregivers in response

to the children’s LGB identity” closely correlate with LGB adolescents’ use of illegal

drugs, depression, and suicide attempts (Diaz, Huebner, Ryan, & Sanchez, 2009).

Conversely, recent research links accepting family attitudes and behaviors toward

their LGBT children—such as advocating for their children when they are mistreated

because of their LGBT identity or supporting their gender expression—with

significantly decreased risk and better general health in adulthood (Ryan, Russell,

Huebner, Diaz, & Sanchez, 2010).

LGBTQI2-S: Note on Language

Over the course of the dialogue, participants emphasized the importance of 

understanding the distinct components of the LGBT population—lesbian, gay, bisexual, 

and transgender. In recent years, usage of this acronym has evolved in widening circles 

to LGBTQI2-S, where Q represents queer or questioning; I represent intersex; and 2-S

refers to the Native American term that means two spirits. (See appendix A for definitions 

of these and other relevant terms.) The abbreviation LGBT is intended to communicate 

both inclusiveness and within-group differences (Keystone Pride Recovery Initiative, 

2009). Although LGBT groups’ experiences and issues resemble each other in some 

respects—notably, the enduring trauma of negative stereotypes—it is incorrect to 

assume that the groups’ characteristics are congruous. For example, participants 

highlighted important distinctions between the issues of sexual orientation experienced 

by LGB people and the issues of gender identity experienced by transgender individuals. 

In addition, transgender people, whether male-to-female or female-to-male, may be 

heterosexual, homosexual, or bisexual, and should not be assumed to be gay. Moreover, 

participants advised that a portion of the LGBT population identifies as neither male nor 

female, necessitating an understanding of fluidity of gender in discussions of sexual 

orientation and gender identity. Consistent with language used by the U.S. Department of 

Health and Human Services (HHS), this report uses the term LGBT.

General health studies reveal additional vulnerabilities among LGBT populations:

• Although multiyear U.S. data show relatively stable annual HIV infections, CDC

(2011b) has asserted that an “alarming increase among young, black gay and

bisexual men requires urgent action.”

2 
A Dialogue on Advancing Opportunities for

Recovery from Addictions and Mental Health Problems

• LGBT populations experience higher rates of victimization than the general 

population (Herek 2009; Willis, 2004; Houston & McKirman, 2007).

Importantly, despite some recent advances in understanding and acceptance, LGBT 

individuals remain subject to the traumas of negative stereotyping, rejection, 

marginalization, and discrimination—all of which impede help-seeking behaviors. To 

compound the problem, LGBT individuals with mental health problems, addictions, or 

both, may experience additional forms of prejudice and discrimination related to each of 

those conditions. A study of members of sexual minorities with major mental illnesses

shows, for example, that a significantly higher percentage of the LGBT group than the 

control group expressed dissatisfaction with mental health services. The investigators 

suggest that perceptions of heterosexism and homophobia are likely contributory factors

in the subject’s dissatisfaction (Avery, Hellman, & Sudderth, 2001). 

Within this context, SAMHSA’s Center for Mental Health Services hosted a formal 

dialogue in 2011 in which participants discussed and translated their personal lived 

experience into recommendations to advance opportunities for recovery (see sidebar) 

from mental health and addiction problems among members of the LGBT community. 

Most participants were people in recovery from mental and substance use disorders, who 

self-identified as LGBT persons, and they were joined by allies and activists concerned

with the recovery needs of LGBT people. The group reflected diversity in sexual 

orientation and gender identity, as well as age, race, ethnicity, geography, and 

occupation. They included policy makers, administrators of public and private service 

systems, treatment providers, advocates and activists, directors of community-based and

consumer- and peer-led organizations, researchers, trainers, consultants, and family 

members, among others. 

Recovery: Note on Language

SAMHSA defines recovery from mental disorders and substance use disorders as: 

A process of change through which individuals improve their health and wellness, live a 

self-directed life, and strive to reach their full potential. 

SAMHSA has adopted a series of 10 guiding principles of recovery: Recovery emerges 

from hope; is person-driven; occurs via many pathways; is holistic; is supported by peers 

and allies; is supported through relationships and social networks; is culturally based and 

influenced; is supported by addressing trauma; involves individual, family, and 

community strengths and responsibilities; and is based on respect (SAMHSA, 2011a).

3 
Building Bridges: LGBT Populations

This LGBT dialogue was part of an ongoing series of dialogue meetings spanning 15 

years at which consumers of mental health services have discussed issues of mutual 

concern with representatives of the systems with which they interact. The composition of

this dialogue group reflected SAMHSA’s commitment to bring together stakeholders from 

the substance use disorders treatment and recovery arena and the mental health arena 

as an integrated and unified behavioral health field. (See SAMHSA’s guide to replicating 

participatory dialogues in the community [Bluebird, 2000].) 

SAMHSA convened the dialogue to develop and/or enhance partnerships among people 

in recovery, to identify specific factors at the individual and systems levels that can 

promote or hinder recovery for LGBT individuals, and to help participants gain a better 

understanding of a variety of perspectives and experiences in advancing recovery for 

LGBT individuals. In addition, by convening a range of stakeholders to address 

collaboratively the critical need for improving services, supports, and systems designed 

to address the mental health and addiction recovery needs of LGBT individuals, 

SAMHSA anticipated that the suggestions and recommendations summarized in this 

monograph would serve as a starting point for individuals and organizations interested in 

taking concrete action to improve recovery opportunities for LGBT individuals. To offer 

greater context, appendix B summarizes federal government actions and 

recommendations regarding LGBT populations, and appendix C describes SAMHSA’s 

action steps related to LGBT populations proposed to advance the agency’s strategic 

initiatives. Appendix D presents selected resources and references, and appendix E lists 

dialogue participants.

4 
2.0 Dialogue Themes and Findings

I’m a person living with bipolar disorder. I’ve been in recovery from 

addictions to drugs, alcohol, and cigarettes for more than 10 years now, 

and I tested HIV-positive in 1988. I’m a suicide attempt survivor, trauma 

survivor, and a hate crime survivor with scars.

I consider myself a MESSS: I have Medical, Emotional, Social, 

Spiritual, and Sexual needs—although the last S is silent.

Dialogue participants introduced themselves by sharing stories of their personal journeys 

as individuals who self-identify as lesbian, gay, bisexual, and/or transgender; queer, 

questioning, intersex, and/or two spirit; as individuals in recovery from mental health 

issues, addictions, trauma, and/or suicide attempts; and/or as other stakeholders with an 

interest in advancing recovery opportunities for LGBT populations. They described 

aspects of their lived experience, presented in their own words in section 2.1, and in the 

process introduced themes that echoed throughout the dialogue. Section 2.2 presents 

background briefs on selected major themes that are intended to illuminate features of 

the LGBT experience. Sections 2.3 and 2.4 present a more detailed discussion of 

individual-level and system-level factors that dialogue participants considered to promote 

or hinder recovery from behavioral health problems. 

2.1 In Their Own Words

Many dialogue participants recalled the pain of family conflict and rejection . . . 

. . . I spent so much of my life in trauma, in dysfunctional families. So much of 

my life I spent being black, being female, being two-spirited. In some places it 

was not even okay to be seen and not heard. 

. . . I went into foster care around age 17 because my father and I were having 

a lot of trouble, especially with him knowing I was gay. I didn’t want to be 

home, and he gave me up to the state. I was homeless after I got out of foster 

care until this year.

. . . and others related stories of unconditional parental acceptance. 

. . . I first came out to my parents, and I was blessed that they were supportive 

of me.

. . . I grew up in a traditional home. My father thought I would go to college and 

meet a husband. I did not. I came out of high school and met a wife. But I was 

accepted and loved, as was my partner. 

5 
Building Bridges: LGBT Populations

Many LGBT people experience the trauma and discrimination that arise—with longlasting effects—from negative stereotypes. 

. . . Experiencing trauma is something that we probably all have in common. 

When you combine that with issues like race, ethnicity, and poverty, the trauma 

really gets complicated.

. . . I was convinced that all gay people were destined to have HIV, and I also 

believed that every gay person in America was addicted to drugs and was an 

alcoholic. So I became most of those things.

. . . Many clients wanted to talk about LGBT issues, but as a counselor I 

couldn’t talk about who I was because I would have been fired.

. . . Five years ago I was reincarnated, reborn; I had the operation done in 

Thailand. I raised my youngest daughter myself since she was 2 years old—

she’s 26 now. I wasn’t out, and counselors told me that if I came out as a trans 

person, and state officials learned about it, they would take my daughter away.

Some dialogue participants observed that the short-hand “LGBT” terminology neglects 

the breadth of sexual orientation and gender identity among members of these 

communities. . . 

. . . Many bisexuals are in heterosexual relationships, and many people of 

transgender experience identify as heterosexual. This is an important caveat in 

addressing treatment issues and recovery. 

. . . In LGBT, the T is only loosely connected to the lesbian/gay/bisexual 

community. Transgender is a gender issue, and a lot of trans people don’t want 

to be connected with LGB because that’s considered more a sexual orientation 

issue. 

In recovery participants have found their lives transformed . . .

. . . Integrating myself—with my ethnic identity, with my sexual orientation, with 

my spirituality—has been the cornerstone of my work. Being able to do that 

has become a strength in many ways for me, including professionally.

. . . LGBT people aren’t just particularly vulnerable people who have special 

needs. They also have tremendous contributions to make if they’re treated like 

everybody else.

6 
A Dialogue on Advancing Opportunities for

Recovery from Addictions and Mental Health Problems

. . . My partner’s and my lives are built on and about recovery and what that 

means, both in our personal lives and also in the contributions we make 

through our jobs and to the world in general. 

. . . Following an internship in an LGBT center, I knew I wanted to dedicate my 

life to working with adults in the experience of coming out. 

And many LGBT persons have begun to enjoy the fruits of their advocacy and progress 

in achieving equal rights . . . 

. . . I worked at the National Council on Alcoholism as a volunteer, and that 

began a life’s career. I’ve been in a number of these settings, and each time 

I’ve had the experience of finally being with my “family” and recognizing how 

fortunate I am to have a family of mentors and role models. 

. . . I have bipolar disorder. I’m disabled, but I work part time. I am sober from 

crystal meth. I’m HIV-positive. My BiPolarBear.us website is about learning, 

and I cycle in race events around the country to raise awareness. I’ve had 

stories about me in three publications. The best medicine is when I get an 

email from a stranger saying, “I read your article, and it’s nice to know that I’m 

not alone.”

2.2 Major Themes 

In reflecting upon their personal life experiences, dialogue participants raised a number 

of core themes related to LGBT individuals’ particular vulnerabilities and experiences that 

affect their behavioral health as well as their overall health and wellness. This section 

provides background on some of these themes as context for the dialogue participants’ 

recommendations (discussed in section 3.0). 

2.2.1 Family Rejection and Family Acceptance

LGBT individuals frequently experience alienation due to lack of acceptance and support 

from their families of origin. Alienation and isolation often create emotional distress, 

especially for young people who may lack other sources of support, and in turn can 

become risk factors for mental health problems (lowered self-esteem and depression, for 

example) and use of alcohol or drugs to self-soothe or feel part of a peer group. 

7 
Building Bridges: LGBT Populations

Rejection of LGBT family members differs from the norm in many cultural groups for 

which family support is a major source of affirmation and resiliency. Conversely, families 

that offer acceptance to their LGBT children bestow an important protective factor

against suicide, depression, and substance use disorders in early adulthood (Ryan, 

Russell, Huebner, et al., 2010). 

Some LGBT individuals make a conscious choice to separate from their family of origin 

as a positive step to enhance self-determination, personal identity, and selfesteem. Others leave home because they perceive themselves to be unsafe among 

family members who reject LGBT identities in ways that may be psychologically or 

physically damaging, or both. Giving up family and the support system connected with 

staying at home may represent the lesser of two evils for some LGBT persons. Still 

others leave home when their families “kick them out.” By contrast, however, many LGBT 

individuals have redefined what family means to them and have created families of 

choice: nontraditional families that offer a source of strength and personal affirmation.

2.2.2 Coming Out

Coming out—the individual process by which a person recognizes, accepts, and shares 

with others one’s sexual and/or gender identity─can be a difficult, emotion-laden 

undertaking. As noted above, many LGBT individuals struggle with prejudice, 

discrimination, family disruption, and other traumas as they make decisions to come out, 

and this process places LGBT individuals at especially high risk for suicide, drug and 

alcohol use, depression, and physical abuse. LGBT young people who come out also 

may experience homelessness and increased vulnerability to harassment, bullying, or 

violence in school. Of course, not all LGBT people come out, but even not coming out 

can exact an emotional toll in dealing with the dissonance of “passing” as heterosexual 

and perhaps enduring the consequences of substance use to reduce anxiety 

(Prairielands Addiction Technology Transfer Center, 2007). For many LGBT persons, 

coming out is an ongoing process, not just a single event. 

. . . Most of us make a conscious choice almost every day about whether or not 

to disclose our LGBT identity. We may decide to come out to some people, 

perhaps family members or friends, but not to others, such as work colleagues 

or people we’ve just met.

Age, race, ethnicity, education, socioeconomic status, geography, marital status, and 

parenthood also may affect the pattern or timing of an individual’s coming-out process. 

See also the discussion in section 2.2.4 on the intersections between LGBT and several 

of these demographic factors. 

8 
A Dialogue on Advancing Opportunities for 

Recovery from Addictions and Mental Health Problems

Many health providers in practice today learned during their professional training that the 

sexual orientation of LGB individuals was deviant or pathological. Previous editions of 

the Diagnostic and Statistical Manual for Mental Health Disorders (DSM) (e.g., DMS IV,

American Psychiatric Association, 2000) described gender identity disorder as a mental 

disorder. 

However, in describing gender-related conditions, the recently release DSM -5 (American 

Psychiatric Association, 2013) uses the term gender dysphoria to refer to “the distress 

that may accompany the incongruence between one’s experienced or expressed gender

and one’s assigned gender.” The DSM-5 goes on to explain that, although not all 

individuals experience distress as a result of such incongruence, many are distressed if 

they are not able to receive hormones and/or surgery to change their physical 

appearance to be congruent with their experienced or expressed gender. The current 

term, gender dysphoria, “is more descriptive than the previous DSM-IV term gender 

identity disorder and focuses on dysphoria as the clinical problem, not identity per se” 

(American Psychiatric Association, 2013, p. 451.).

Participants reported that some health professionals and organizations marginalize—and 

some even prefer not to treat—LGBT persons. Keenly aware of this attitude, many LGBT 

individuals do not disclose their LGBT status to health care providers, and transgender 

individuals in particular may hesitate to use mainstream health care services. Reluctance 

to seek healthcare often results in late diagnosis and suboptimal treatment outcomes for 

LGBT individuals. Moreover, seeking professional or legal help for interpersonal violence 

equates with coming out (Elliot, 1996, cited in SAMHSA, 2001), a barrier that may 

impede identification of LGBT victims or perpetrators of interpersonal violence. 

2.2.3 LGBT-Related Stress 

A growing body of evidence reveals that stress experienced by LGBT persons negatively 

affects their mental health and their willingness to seek and access care (Warren & 

Barber, 2009), and their vulnerability to substance use disorders (Eliason, 2010). The 

minority stress model developed by Meyer (2003) identifies a constellation of stressors 

that affect LGBT individuals: identity stress related to concealment and/or disclosure of a 

stigmatized identity and negative internalized identity, expectations of rejection and

discrimination, and the experience of violence and threat of violence, including 

continuous vigilance. While many use the broader term minority stress (e.g., Warren & 

Barber, 2009), some focus on LGBT-related stress both to emphasize those stressors 

experienced by LGBT individuals (Eliason, 2010) and perhaps to distinguish those 

stressors from other stressors experienced by ethnic minorities or people with disabilities. 

The higher prevalence of anxiety, depression, and substance use found among LGB 

populations results from additive stress related to “nonconformity with prevailing sexual 

orientation and gender norms” (IOM, 2011, p. 21). LGBT health experts agree that 

9 
A Dialogue on Advancing Opportunities for 

Recovery from Addictions and Mental Health Problems

discrimination, isolation, and other social pressures increase the risk for LGBT 

individuals, particularly LGBT youth, to use drugs and alcohol to reduce and cope with 

stress (Meyer, 2003; Eliason, 2010).

Evidence has emerged that racial/ethnic-related minority stressors, both within LGBT 

communities and in society at large, interact with LGBT-specific minority stressors 

(Frazer & Warren, 2010). See also the discussion in section 2.2.4 on LGBT intersections 

with other identities.

2.2.4 Intersection of LGBT with Other Identities

Individual and group identities are complex. In describing its “intersectional” approach to 

understanding LGBT health, the IOM (2011) indicates that identities are “shaped not just

by race, class, ethnicity, sexuality/sexual orientation, gender, physical disabilities, and 

national origin, but also by the confluence of all of those characteristics.” Other observers 

have recognized additional intersections, including age and immigrant status (Keystone, 

2009), substance abuse and dependence, mental health, HIV/AIDS status, aging, 

education, criminal justice, homelessness, violence prevention, and social isolation 

(Frazer & Warren, 2010). 

The IOM (2011) observes that the experiences of LGBT persons within their racial and 

ethnic communities affect their ultimate health outcomes by mediating such variables as 

the process of coming out, their use of supports, and the extent to which they affiliate 

with the LGBT community. Effects of race, ethnicity, and education are likely to be more 

significant for low-income than middle-class nonwhite LGB individuals. Geography, too, 

may play a role in LGBT health disparities in rural areas or areas with fewer LGBT 

people, where they “may feel less comfortable coming out, have less support from 

families and friends, lack access to an LGBT community, and have less access to 

providers” who can offer culturally competent treatment (IOM, 2011, p. 16). 

2.2.5 Trauma

Trauma negatively affects LGBT individuals in multiple ways. Many young people 

contend with the emotional wounds inflicted by rejection by family members and 

schoolmates, and LGBT people of any age may suffer from the effects of prejudice, 

discrimination, heterosexism, homophobia, and internalized homophobia. Childhood 

abuse, adult abuse, and interpersonal violence, along with hate crimes, leave both 

physical and emotional scars. Even just the fear of violence or anti-LGBT harassment 

can inflict trauma (SAMHSA, 2001; Prairielands ATTC, 2007). Invisibility may also 

represent a form of trauma or may exacerbate it (see section 2.2.7). 

Research shows that trauma has serious implications for mental health, alcohol and 

substance use, and related risk-taking behaviors (CDC, 2006). Research shows also that 

10
A Dialogue on Advancing Opportunities for 

Recovery from Addictions and Mental Health Problems

hate crimes based on sexual orientation bias have more serious and long-lasting 

psychological effects than other crimes because of the link to core aspects of the victim’s 

identity and community (Herek, Gillis, & Cogan, 1999).

Because individuals who have been traumatized find it more difficult to focus on their 

physical well-being, behavioral health problems can exacerbate other health challenges 

faced by LGBT people, including hepatitis C and HIV/AIDS. Moreover, anti-LGBT 

prejudice often impedes survivors of violence, their partners, and their family members 

from calling on police, prosecutors, courts, or mainstream victim service agencies for 

help (National Coalition of Anti-Violence Programs, 2005). 

Domestic violence among gay couples is underreported, but as with all couples, there is 

a connection between domestic violence and alcohol and drug use. Gay people 

subjected to physical and sexual abuse in their youth have greatest risk for alcohol and 

drug use (Island & Letellier, 1991, cited in SAMHSA, 2001).

Transgender individuals are likely to experience some form of discrimination, 

harassment, violence, or a combination, at some point in their lives. The first major U.S. 

study on violence and discrimination against transgender people found that more than 

50% have experienced some type of harassment or violence, or both, during their lives, 

and 25% reported experiencing a physically violent incident (Lombardi, Wilchins, 

Priesing, & Malouf, 2001). 

2.2.6 Suicide 

The Suicide Prevention Resource Center (SPRC) (2008) reports that LGB youth are from 

one and a half to seven times more likely to report having attempted suicide than their 

non-LGB peers, while transgender youth also likely have higher rates of suicidal 

behavior. SPRC cautions, however, that it is impossible to know the exact suicide rate of 

LGBT youth because sexual and gender minorities are often hidden and even unknown, 

particularly in this age group. According to CDC (2007), suicide is the third leading cause 

of death among young people 15 to 24 years old in the United States, and more than 

4,000 youth die by suicide each year. Many more young people engage in suicidal 

thoughts, devise plans to kill themselves, or attempt to take their own lives.

Among adults, as noted in section 1.0, gay men are at greater risk for suicide attempts 

and completions, and rates of depression and suicide attempts among transgender 

persons are higher than for nontransgender populations. In fact, a study of a diverse 

group of transgender and gender nonconforming participants conducted by the National 

Gay and Lesbian Task Force and the National Center for Transgender Equality found 

that a “staggering” 41% of respondents reported attempting suicide, compared to just 

1.6% of the general population (Grant, Mottet, and Tanis, 2011). 

11
A Dialogue on Advancing Opportunities for 

Recovery from Addictions and Mental Health Problems

According to SPRC (2008), risk and protective factors play an important role in helping to 

explain suicidal behavior. SPRC observes that “LGB youth generally have more risk 

factors, more severe risk factors, and fewer protective factors than heterosexual youth.” 

In many cases “LGB youth lack important protective factors such as family support and 

safe schools,” and many LGB young people “appear to experience depression and 

substance abuse.” Some risks are unique to LGB youth, for example, self-disclosure of 

their sexual orientation at an early age. 

Stigma and discrimination against LGBT individuals directly relate to risk factors for 

suicide. For example, “discrimination has a strong association with mental illness, and 

heterosexism may lead to isolation, family rejection, and lack of access to culturally 

competent care” (SPRC, 2008). Additional risk factors for suicide attempts include 

“previous suicide attempt, depressed mood, eating problems, conduct problems, early 

sexual debut, number of sexual partners, pubertal timing, self-concept, alcohol and drug 

use, atypical gender roles, loneliness, peer relations, social support, parental attachment, 

parental monitoring, and suicidal behavior among family and friends” (Wichstrøm & 

Hegna, 2003).

2.2.7 Invisibility of LGBT Individuals and Groups 

In contrast with members of other racial and ethnic minorities, social stigma often renders 

LGBT individuals invisible to their families, to others in the community, to each other, to 

society in general, and to behavioral healthcare providers and researchers. Some 

families view LGBT behavior as rebellion against their traditional values and against the 

family itself, rather than as a part of an individual’s identity, and they withdraw their love 

and support. LGBT young people often proceed invisibly through their schooling, fearful 

of shunning, bullying, harassment, and violence by their peers. Because openly 

identifying as LGBT may jeopardize acceptance by both their families and their ethnic 

communities, many youth of color hide their sexual orientation and thus may appear 

even less visible than their white LGBT peers (SAMHSA, 2001).

LGBT people often choose to be invisible in the workplace, where they may fear that selfdisclosure will trigger expectable social and economic consequences, and in the social 

realm negative stereotypes and homophobia make it difficult to establish mutual support 

with other LGBT individuals. This isolation often leads LGBT people to socialize in gay 

bars and clubs, which in turn may lead many to develop substance use disorders. 

Mental health providers in both inpatient and outpatient settings who deliver services to 

both LGBT adults and youth typically fail to recognize the need for treatment plans that 

reflect their client/consumers’ unique needs. This lack of recognition signals, especially to 

LGBT youth, that “their feelings and self-concepts are invalid and unimportant” and may 

contribute to their sense of isolation (Lucksted, 2004, p. 125). 

12
A Dialogue on Advancing Opportunities for 

Recovery from Addictions and Mental Health Problems

Certain institutional practices ignore LGBT populations. Importantly, U.S. census 

enumerations do not inquire about sexual orientation. Lesbians, gay men, and bisexual 

adults who do not live together in a same-sex relationship remain invisible in census 

data, and it is impossible to identify transgender people. In the behavioral health arena,

intake forms for residential treatment programs typically ask for marital status—ignoring 

the existence of same-sex (and other) unmarried couples—and some mental health

programs do not consider significant others of the same gender to be family members 

(Lucksted, 2004). Omission of reference to LGBT in such contexts reinforces feelings of 

invisibility, a sense of isolation, and the belief that “I am the only one in the world who 

has these feelings.” 

. . . No one ever asks how the elephant in the living room feels when others act 

as if he does not exist.

2.2.8 LGBT Across the Lifespan

The experiences and needs of LGBT people differ across the lifespan, and youth and 

elders may be particularly vulnerable. Young people may experience harassment and 

bullying in school because of their actual or perceived sexual orientation or gender 

identity, or they may be subject to family rejection. They may run away from home and 

then find themselves homeless and/or involved in drug use or in sex work to support 

themselves. LGBT youth who remain at home may experience greater difficulty with 

schoolwork, sexual abuse, and alcohol and drug use than their heterosexual peers. And, 

because minority LGBT youth are particularly vulnerable to family and peer rejection, 

many conceal their sexual orientation. Many have no clear role models for how to be gay 

(SAMHSA, 2001).

Some LGBT youth may “use alcohol and drugs to deal with stigma and shame, deny 

same-sex feelings, or help them cope with ridicule or antigay violence.” In addition, LGBT 

youth face the challenge of learning to manage a stigmatized identity, an “extra burden 

that makes [them] more vulnerable for substance abuse and unprotected sex, and can 

intensify psychological distress and risk for suicide” (SAMHSA, 2001, p. 100).

In LGBT culture young adults need not seek relief from negatives in order to be drawn 

into substance use and abuse. LGBT teens frequently enter “gay society” through bars 

and clubs, where other patrons may encourage them to drink and use drugs.

. . . For some of us, alcohol and drugs were keys that opened doors into a 

world we had not known existed. We no longer were unique and isolated 

freaks, but members of a large, underground, “outlaw” culture where we felt 

accepted and valued—often for the first time.

13
A Dialogue on Advancing Opportunities for 

Recovery from Addictions and Mental Health Problems

Aging LGBT individuals commonly face the dual challenge of actual discrimination and 

the fear of discrimination, for example, when they contemplate moving into a retirement 

residence or in their dealings with health and social service networks (IOM, 2011). Like 

all elder persons, LGBT individuals who are aging may need to rely more heavily on 

formal supports, services, and systems for assistance—for example, with housing 

(providing home-based care required for LGBT individuals to remain in their homes as 

long as possible), nutrition, health, transportation, socialization, financing, and other 

important needs. Many aging LGBT people feel they must hide their sexual or gender 

identity and return to the closet at a time when their needs are significantly increasing 

and when it is important for service providers to be able to accept the LGBT individual for 

who he or she is, as well as to provide culturally competent services.

2.3 Person-Level Factors Related to Recovery

During the dialogue meeting, participants discussed factors that foster or hinder LGBT 

individuals’ recovery from addictions and mental health disorders. Sections 2.3.1 and 

2.3.2 identify factors that affect the individual person, while section 2.4 presents a 

discussion of system-level factors.

2.3.1 Person-Level Factors That Promote Recovery 

Participants identified person-level factors that contribute to wellness and recovery. 

These factors related primarily to a range of personal strengths and qualities, the ability 

to develop and experience acceptance and belongingness, sufficient resources to 

sustain a good quality of life, appropriate treatment and recovery supports, and volunteer 

and advocacy activities. 

Personal strengths. Participants acknowledged the personal qualities they have 

cultivated and from which they have drawn strength. The courage to come out (see 

section 2.2.2) played a particularly critical role in participants’ recovery. 

. . . It takes courage for people to come out with their LGBT-ness and their 

mental health and addiction issues.

. . . I have been clean for 17 years. I didn’t get clean until I was 30. I didn’t 

come out until then, and that may have gone hand in hand with my recovery.

Participants attributed their recovery also to a sense of personal empowerment, the 

ability to develop and integrate their authentic identity and experiences, engagement in 

creative activities, and achievement of self-validation. 

14
A Dialogue on Advancing Opportunities for 

Recovery from Addictions and Mental Health Problems

. . . Self-validation, that moment when I didn’t need anybody else to say that I 

was OK, that I was valued, that I deserved to exist and have a life—when I just 

knew it for myself, that was when I felt that I was really in recovery.

• Sense of acceptance and inclusion. Participants emphasized the value of 

fellowship, interdependence, meaningful positive relationships, and reconciliation 

and the restoration of broken relationships. Their recovery has been enhanced by 

the acceptance of their LGBT identity and orientation by family members and others 

(see section 2.2.1), and by support from peers.

The most important element in my recovery has been my 29-year relationship 

with my partner.

. . . When I got sober, I got a job at our tribal alcohol program because I knew 

how to type. My journey began there with unconditional acceptance by my 

tribe. I had never experienced that before in my life. 

• Economic stability. Problems with mental health and substance use disorders may 

place LGBT individuals (as they do for the general population) at risk for limited

education or occupational opportunities. Dialogue participants asserted the 

importance to their recovery of education, employment and/or a meaningful 

vocation, a sustainable standard of living and stable housing, affordable healthcare 

and health insurance that covers medications, and the reassuring presence of an 

economic safety net.

Treatment and recovery supports. Dialogue participants identified the importance of 

appropriate, effective treatment and recovery supports to facilitate recovery from 

addictions and mental health problems. Specific issues they cited include access to an 

array of affordable, recovery-oriented treatment services; trauma-informed treatment and 

recovery support services; services given by well-trained, culturally competent, and 

accepting service providers, including both LGBT and non-LGBT professionals; trusted 

peers who serve as coaches in the recovery process; access to high-quality general 

health care; recovery support services provided by certified peer specialists and/or other 

appropriately trained peers; self-inventory of personal assets; meditation and other 

holistic practices; and personal plans for maintaining recovery, such as the Wellness 

Recovery Action Plan (WRAP).

. . . We’ve been doing equity work for a long time. I embrace my identity as a 

queer activist. We’re in the bright days now. We have some incredible 

opportunities, and we have a lot more work to do.

15
Building Bridges: LGBT Populations 

. . . Now I can see that all my focus has been on substance abuse, with mental 

health as an add-on—and how much I need to think about what I can do to 

make mental health stand out more for me and other people.

2.3.2 Person-Level Factors That Impede Recovery 

Participants also identified person-level factors that impede recovery. A history of 

trauma—including rejection by significant individuals as a consequence of prejudice, and 

the experience of victimization and violence—represented an overarching theme (see 

also section 2.2.5). Other factors included unmet basic needs, issues of socialization, 

and issues related to treatment.

Negative stereotypes and discrimination. Participants cited long lists of impediments 

to recovery based on homophobia and negative stereotypes of “LGBT-ness.” Highlights 

include rejection, lack of love, abandonment by family of origin, and fear of disclosure. 

. . . Young people with mental health and substance abuse challenges in 

public systems fear that if they disclose about LGBT, it becomes official public 

information, stamped on their file, and passed to foster care providers, group 

homes, and teachers. Young people lose the ability to protect themselves and 

to self-disclose—and this fear stops them from reaching out to service 

providers. 

Other factors include lack of supportive relationships, isolation, and invisibility (see 

section 2.2.7). Feelings of shame and guilt, low self-esteem, lack of a feeling of 

authenticity, and internalized oppression also impede recovery. Some participants had 

endured their families’ persistent limited or negative expectations for themselves and 

their life prospects, and they felt the need, in the face of gay bashing, to suppress anger 

and defensiveness. Failure to deal well with multiple social identities and oppressions 

(see sections 2.2.3 and 2.2.4) represents another barrier to recovery. Especially 

detrimental to LGBT youth are limited positive media portrayals and role models for 

LGBT individuals.

. . . Hearing the statement “people like you cannot . . .” has been a barrier 

throughout my life.

. . . People say, “You’re a gay man, therefore blah blah blah.” But I respond, “If 

you’re going to put a label on me, you’d better list all the ingredients, because 

I’m not just a gay man.” A gay man is not just a single entity.

16
A Dialogue on Advancing Opportunities for 

Recovery from Addictions and Mental Health Problems

• Victimization and violence. Participants asserted that potent impediments to

recovery include victimization due to both real and perceived gender differences and

sexual orientation, bullying, LGBT-related stress (see section 2.2.3), and hate

crimes.

. . . I’m a hate crime victim with scars.

. . . In my city I’m called a faggot when I walk down the street, and my best 

friend was egged recently on the way home from a gay bar. These things still 

happen. 

Economics. Poverty and the lack of safe and stable housing represent difficult 

challenges to recovery from mental health and substance use disorders in the general 

population, as well as the LGBT community. 

Treatment issues. Although treatment concerns may seem more appropriate in a 

discussion of systems issues, their effect also is felt personally. Participants identified 

such treatment issues as adverse impacts on recovery, including lack of access to a 

range of treatment services for substance use, mental health, or co-occurring disorders;

lack of coordination among mental health, addiction, and general healthcare services; 

lack of access to trauma-informed care; prejudiced, hostile providers whose approach 

and behavior discourage help seeking; and lack of access to recovery supports. HIV 

treatment settings that miss clients’ needs for mental health services impede recovery for 

LGBT individuals, as do lack of services and understanding in many rural, frontier, and

other communities. 

Healthcare providers have potential to cause harm by hiring LGBT-identified staff 

persons to whom all perceived LGBT clients are referred, thus allowing other staff to 

remain culturally incompetent. Moreover, being openly LGBT does not in itself represent 

an adequate credential to treat LGBT persons—some providers have not resolved their 

own issues.

2.4 System and Contextual Factors Related to Recovery 

Participants also identified system-level and contextual factors that contribute to or 

impede recovery from mental health problems and addictions in the LGBT community. In 

general, system refers to various governmental jurisdictions as well as communities and 

society as a whole. As noted above, dialogue participants acknowledged that individuals 

often experience personally many of the systemic and societal issues they identified, 

highlighting the complexity involved in addressing these issues.

17
Building Bridges: LGBT Populations

2.4.1 System-Level Factors That Promote Recovery 

System-level factors that participants assert promote recovery relate principally to 

culturally competent, trauma-informed, integrated treatment and recovery support 

services provided by well-trained professionals and peers; public awareness; and social 

inclusion. 

Service delivery issues. Dialogue participants acknowledged the important role that 

clinical treatment and peer-provided supports can play in promoting recovery for LGBT 

individuals with behavioral health problems. Participants indicated that clinical treatment 

and recovery support services should be more available and accessible, and should be 

grounded in a strengths-based approach. Participants emphasized the importance of

delivering culturally appropriate, evidence-based, and best practices for LGBT 

populations. They also mentioned the importance of an integrated focus on recovery 

from co-occurring mental health and substance use problems; primary care referrals to 

mental health and addictions services for persons with HIV/AIDS in a manner that 

safeguards privacy and confidentiality; referrals to general healthcare resources by 

behavioral health services providers; healthcare reform that expands insurance coverage 

for behavioral health disorders; systematic suicide prevention efforts and supports; a 

range of recovery support services, including peer-operated services; and communitybased organizations that provide quality services. In addition, participants acknowledged 

the value of measurement and evaluation of recovery-oriented services, practices, and 

programs, and research that confirms the effectiveness of grassroots practices.

Awareness, education, and training. Participants asserted the need for a broad array 

of educational and training activities to help promote recovery opportunities for LGBT 

individuals. These include multimedia public awareness campaigns, including the use of 

social media; video and other technology-driven resources and projects to reduce 

underage drinking, for example, programs that promote self-esteem, coping skills, and 

life skills; training on LGBT issues for law enforcement officers, corrections and juvenile 

justice officers, child welfare and elder facilities workers, and workers in other systems 

that intersect with mental health and substance use services; language and education 

that acknowledge the complexity of the adverse issues that impact LGBT populations; 

coalition building in communities; and positive media portrayals of LGBT individuals 

. . . From a media standpoint—because that’s the best way to reach today’s 

youth—if we were depicted as positive products of society and positive citizens 

altogether, and not shown as a big second class, that would give us a better 

opportunity to defeat some of the obstacles that we find ourselves confronting.

. . . We need to put ourselves out there in the media and tell our stories. 

18
Building Bridges: LGBT Populations

• Social inclusion. Dialogue participants asserted the importance of activities that 

promote social inclusion as an instrument in recovery. These may include 

community drug- and alcohol-free events, networks, and social settings that engage 

LGBT persons and promote recovery; peer-operated organizations that promote 

acceptance of LGBT individuals; and advocacy for inclusion and effective treatment 

for LGBT populations. 

2.4.2 System-Level Factors That Impede Recovery 

Although some systemic factors promote recovery from mental health problems and 

addictions in the LGBT community, certain institutional and societal factors represent 

barriers. Participants placed particular emphasis on issues related to societal LGBT 

prejudice and discrimination, and to suboptimal treatment services provided to LGBT 

individuals. 

Negative stereotypes and discrimination. Participants observed that negative media 

depictions of the LGBT community and mainstream political considerations that deny 

attention to the needs of LGBT populations impede recovery.

Discrimination against members of the LGBT community takes a number of forms: 

discrimination against LGBT individuals in the mental health consumer world, 

discrimination within some LGBT communities against racial and ethnic minorities and 

persons who are HIV-positive, and discrimination by providers who, on principle, do not 

serve LGBT people.

. . . I never felt safe to be gay in the mental health world, and I never felt safe to 

be crazy in the gay world. 

. . . When I do supervision and training with budding clinicians or interns, some 

say, “I don’t want to work with someone who is LGBTQ because of my values.” 

LGBT-related stress (some prefer the term minority stress) (see also section 2.2.3), 

considered to result from a history of systematic denial, prejudice, and discrimination 

focused on a particular group of people, denies people access and functioning. 

. . . Minority stress has many impacts, including trauma, and results in 

physiological effects of trauma similar to being in a fire, plane crash, or war. 

Treatment and systems of care. A large number of treatment issues impede 

recovery for LGBT individuals. Participants reported that many administrators and 

substance use treatment workers have had inadequate training to deal with LGBT 

issues respectfully, supportively, and openly, and many mental health workers have 

19
Building Bridges: LGBT Populations

had no training on LGBT issues, especially in state-operated and veterans care 

facilities, in Indian Country, and particularly on transgender issues. 

Governmental jurisdictions and researchers have collected sparse data on LGBT 

populations, resulting in a limited evidence base on programs and practices that aim 

to improve the behavioral health of LGBT persons, and on numbers of LGBT 

persons who require services. The invisibility of LGBT populations (see section 

2.2.7) plays a role in engendering a lack of culturally appropriate services and 

hinders access to supportive peers also seeking recovery. LGBT individuals often 

have limited awareness of local resources for treatment and support, and 

organizations and communities engage in insufficient outreach to make care 

accessible. LGBT youth typically lack confidentiality protections in public healthcare 

and allied systems, increasing their vulnerability to the perils of inadvertent 

disclosure, and rural communities often lack the infrastructure to provide confidential 

HIV treatment and care. The absence of outreach in HIV clinics, bars, and other 

LGBT settings to motivate engagement in mental health and addiction treatment 

services represents another barrier to recovery.

. . . We need free brochures on mental health in the gay community for gay 

people to pick up in HIV/AIDS clinic waiting rooms.

Other challenges to LGBT individuals’ recovery include the socioeconomic factors that 

also affect the general population, such as poverty, as well as the need to train and 

retrain multiple generations of caregivers regarding inclusion and cultural considerations. 

Moreover, conflicts exist between decision makers and grassroots providers and others 

on behavioral health issues relevant to LGBT populations, and conflict also exists within 

the LGBT community regarding the legitimacy of some of its components.

. . . There’s conflict within our LGBT community about who belongs, what we’re 

supposed to believe, what’s OK and what’s not, and who we’re supposed to 

support. For example, it’s easier to get legislation passed to support LGB 

issues if you drop your emphasis on transgender.

20
3.0 Recommendations for Action

I’m here today because recovery works. After I had 2 years clean, I 

was working in the sex industry—that’s all I thought I had to offer. 

A gender identity project took a major risk in bringing people from the 

community into the project to run it. At that time it was unheard of not 

to pathologize trans people or give them a voice to discuss their 

issues. 

Dialogue participants proposed a series of recommendations to SAMHSA and other 

stakeholders for concrete actions to advance recovery opportunities for LGBT people. 

Stakeholders include mental health consumers and/or people in recovery from 

addictions, policy makers at all levels, systems administrators, researchers, practitioners, 

providers, and foundations, among others. These recommendations relate to policies, 

programs, practices, training and technical assistance, public awareness, and other 

efforts. 

3.1 Participants’ Major Recommendations 

• Incorporate language in SAMHSA’s contracts and grant programs to require or 

suggest, as appropriate, a focus on LGBT populations where appropriate. 

• Promote cultural competence regarding LGBT populations and issues.

• Improve data collection among LGBT populations and evaluation of programs and 

practices targeted toward LGBT populations, as well as mainstream programs that 

serve LGBT clients. 

• Implement SAMHSA’s LGBT Action Steps (see appendix C). 

3.2 Participants’ Strategic Recommendations 

3.2.1 Training and Technical Assistance 

• Convene an expert panel to develop culturally competent curricula for healthcare 

providers.

• Provide ongoing training and technical assistance to promote implementation of 

LGBT best practices for behavioral health workers. 

• Encourage academic institutions to incorporate studies on substance use and 

mental health disorders among LGBT populations as required coursework in 

professional training programs. 

21
Building Bridges: LGBT Populations

• Educate diverse stakeholders in cultural competence on LGBT issues─for example, 

workers in public mental health, substance use, child welfare, and other social 

services agencies; primary care providers; workers in corrections and juvenile 

justice systems; school system personnel; university/college teachers; religious and 

faith-community organizations; and community-based organizations. 

• Develop training and materials to equip community organizers and human services 

organizations and practitioners to engage effectively in outreach to LGBT 

populations.

• Disseminate evidence-based anti-bullying curricula and training programs for 

teachers, coaches, and others who work with children and young people. 

• Create LGBT-related educational materials for delivery via webinars and face-toface technical assistance. 

• Design and offer peer-to-peer training on LGBT-related issues.

• Include a focus on mental health in the update and revision of SAMHSA’s (2001) “A 

Provider’s Introduction to Substance Abuse Treatment for Lesbian, Gay, Bisexual, 

and Transgender Individuals,” the Spanish-language version (Caribbean Basin and 

Hispanic ATTC, 2010), and the English-language training guide (Prairielands ATTC, 

2007). 

• Update and synthesize existing informational resources.

• Involve LGBT survivors of suicide attempts in developing educational materials for 

the public.

3.2.2 Treatment and Recovery Supports

• Ensure access to culturally competent mental health and substance use disorders

prevention, treatment, and recovery support services nationwide. 

• Address recovery from mental health and substance use disorders in an integrated 

fashion.

• Amplify suicide prevention efforts targeted to LGBT populations. 

• Establish a student loan forgiveness program for service providers in underserved 

areas.

• Promote and support peer models of recovery support, including models tailored 

specifically to meet the needs of LGBT populations spanning the life cycle.

• Promote a variety of recovery models, acknowledging the many pathways to 

recovery. 

• Advocate for deletion of transgender from future versions of the DSM. 

. . . One of the biggest problems for the trans community is that transgender 

appears in the DSM as sexual identity disorder. That really causes problems. 

Every time I’ve gotten counseling for depression and anxiety, they call it being 

transgender. For me, anxiety and depression come from not being accepted in 

society—it’s not an issue of mental illness.

22
A Dialogue on Advancing Opportunities for 

Recovery from Addictions and Mental Health Problems

• Offer training for providers on transgender as a diverse and complex experience for

an individual seeking treatment.

. . . The experience of transgender is still widely viewed as an illegitimate 

experience. Persons seeking treatment need to be engaged with empathy, 

support, education, acknowledgment. A clinician need not be an expert on the 

subject in order to meet clients where they are in their own process. They need 

resources to offer to clients, who then have responsibility for gaining more 

knowledge.

• Disseminate culturally competent LGBT practices and recovery support approaches

in partnership with faith-based and human services organizations.

• Conduct a scan to identify policies that impede or promote recovery, for example,

housing regulations that prohibit unmarried cohabitation as an impediment to

recovery, policies that promote health insurance coverage for domestic partners as

a support.

• SAMHSA convene a workgroup to develop and present LGBT training, resources,

and education for behavioral health audiences to identify best practices and models.

• Promote and support peer recovery supports and services with a specific focus on

LGBT individuals.

• Establish peer-run warm lines operated by peers trained in LGBT issues.

• Encourage and support involvement of LGBT consumers/peers in policy and service

delivery discussions and decisions.

. . . Consumers must be at every table that has anything to do with mental 

health and substance abuse treatment.

• Using community organizing strategies, reach out to engage LGBT people in

recovery.

. . . The best ways to meet gay men today are on the Internet and hidden in 

disclosed bars. So how do you find gay people to enhance recovery 

opportunities? Through community engagement strategies, our coalition 

convinced all 35 gay bars in my state to institute an alcohol abuse prevention 

program. 

• Develop and implement social inclusion programs.

• Advocate for systems and services providers to develop a broad definition of family

to be inclusive of the range of experiences of LGBT clients/consumers.

• Providers consider questions such as: Who has the authority to make decisions for

a consumer’s welfare (for example, as the partner of a young gay man)?

23
Building Bridges: LGBT Populations 

• Mandate all federally funded HIV/AIDS/sexually transmitted disease programs and

services to screen for substance use and mental health disorders, and to provide

appropriate education and counseling.

3.2.3 Data Collection and Quality

. . . A growing body of research in LGBTQ communities reveals connections 

between family rejection, isolation, and minority stress on one hand, and 

mental health, mental illness, recovery, and substance abuse on the other.

• Convene an expert panel, as recommended by the National Coalition for LGBT

Health, on data collection issues, including strategies for data collection at national

and program levels.

. . . Outcome data is necessary to demonstrate what makes care more 

effective and provides better outcomes.

• Develop guidelines and training to address privacy and confidentiality issues in

collecting LGBT data at the program level.

• Allocate resources toward development of LGBT evidence-based practices and

service-to-science initiatives.

• Identify, evaluate, and add to SAMHSA’s National Registry of Evidence-based

Programs and Practices (NREPP) local, effective programs that target LGBT

populations.

• Collect data on suicide among adolescents in LGBT communities.

3.2.4 Partnerships

• Promote public/private partnerships involving LGBT consumer, provider, research,

and policy experts, and mainstream behavioral health including SAMHSA and

experts at the local level.

• Foster collaboration between SAMHSA and the National Network to Eliminate

Disparities in Behavioral Health (NNED) to address the intersection of racial/ethnic

and LGBT disparities.

• Community-based organizations develop collaborative partnerships based on

common issues, thus strengthening their ability to secure foundation funding.

• Through public/private partnerships, SAMHSA promote an externally developed

LGBT resource center (on the order of CSAT’s Addiction Technology Training

Centers [ATTCs] or National Clearinghouse for Alcohol and Drug Information).

• Develop a resource to educate individuals and organizations to investigate, identify,

and secure private funding for LGBT support organizations.

24
A Dialogue on Advancing Opportunities for 

Recovery from Addictions and Mental Health Problems

3.2.5 Trauma and Justice Issues

• Identify LGBT-relevant resources to promote trauma recovery and disseminate 

through NNED, National Coalition of Antiviolence Programs, ATTCs, and other

mechanisms. 

• In promoting evidence-based practices for trauma recovery in LGBT populations, 

use and expand on current research on LGBT-related/minority stress (see section 

2.2.3) and intersectional disparities (see section 2.2.4) in LGBT populations.

• Convene a dialogue among members of the LGBT community and personnel from 

criminal justice with a focus on trauma and LGBT issues.

3.2.6 Public Awareness 

• Promote communities’ use of SAMHSA’s Strategic Prevention Framework to identify 

problems related to LGBT populations in the community and tailor approaches to 

address them.

• Replicate the LGBT recovery dialogue in communities nationwide to promote 

increased understanding, respect, and social inclusion (Bluebird, 2000). 

• Educate and train young people to serve as the next generation of advocates. 

. . . Before I came here, I didn’t have a fire in me for the LGBT cause, but this 

dialogue has lit a fire within me and created something that will continue.

• Advocate for legal sanctions against discrimination on the basis of sexual identity 

and gender identification.

• Advocate for support of marriage equality, a policy that promotes recovery.

• Educate individuals and organizations to engage social media (e.g., YouTube, 

Facebook, personal websites, podcasts, blogs) to promote recovery for all 

individuals, including LGBT persons.

• Encourage members of the LGBT recovery community to tell their stories of 

recovery in a variety of media and venues.

• Create and disseminate brochures to HIV clinics, primary health clinics, gay 

community centers, and other settings that help LGBT people access help for 

mental health and substance use disorders.

• Engage social and mainstream media to portray positive images of LGBT people, 

including LGBT people in recovery.

• Mount a media campaign for suicide prevention and behavioral health promotion 

targeted at LGBT populations.

• Engage LGBT champions to serve as role models for recovery.

• Establish an “LGBT Recovery Hero Award” for SAMHSA’s Voice Awards program,. 

25
Building Bridges: LGBT Populations 

. . . When I contemplate recovery, I need to have an image in my mind to hope 

for. If I tell my mom what’s going on, she needs to have an image of success—

and we don’t have that. 

• Promote observances by community organizations and individuals of SAMHSAsponsored National Recovery Month and National Wellness Week.

26
4.0 Milestones in the LGBT Mental Health Consumer 

Movement

Consumer activist Mark A. Davis offered highlights of the history of LGBT mental health 

consumers’ struggles to come out within a closeted movement. He emphasized that the 

recommendations that emerged from the LGBT dialogue meeting have their roots in this 

history of milestones in the U.S. up to the time of the Dialogue Meeting. 

June 28, 1969. The historic Stonewall Revolution—riots that ensued following a New 

York City police raid on the Stonewall Inn, a gay club—marked the start of the LGBT civil 

rights movement. A year later, on June 28, 1970, the first Gay Pride marches took place 

in Los Angeles, Chicago, and New York.

1973. Homosexuality as a disorder was deleted from the Diagnostic and Statistical 

Manual of Mental Disorders (DSM). 

1981. The Centers for Disease Control published documentation of a new illness from 

which a small number of homosexual men had died. The disease later became known as 

HIV/AIDS.

1983. The People With AIDS Self-Empowerment Movement articulated the Denver 

Principles, in which they proclaimed, in effect: “We’re people living with, not dying from, 

AIDS.” 

1989. In South Carolina at the 1989 Alternatives Conference (a national conference 

organized by and for mental health consumer/survivors), a small group of individuals 

tried to hold a gay and lesbian caucus, but the facility would not make a room available to 

them. 

1991. A small group at the Alternatives Conference in Berkeley, California, met in a 

rooftop “classroom” with grass and trees, which inspired the term “Fruit and Nut Bar,” a 

tongue-in-cheek self-description. Since that time LGBT people at Alternatives 

Conferences have identified themselves with rainbow ribbons attached to their 

nametags.

1992. The Zappalorti Society, the first LGBT peer-run mental health support group, was 

founded at the LGBT Center in New York. The support group has met continuously since 

that time.

27
Building Bridges: LGBT Populations

1992. The Alternatives Conference in Philadelphia featured an LGBT track with 

workshops and caucuses held for the first time out of the closet. 

1990s–early 2000s. The Pink & Black Society consisted of support groups in the 1990s 

and early 2000s. The society’s name recalls the Nazi symbols for the homosexual and 

transvestite populations (pink triangles) and for asocial groups, which included inmates in 

asylums (black triangles).

2001. The first LGBT Depression and Bipolar Support Alliance (DBSA) chapter was 

established in Oklahoma City.

2001. In Baltimore, the nonprofit organization for LGBTQ individuals with mental health 

issues and concerns called Hearts and Ears established a consumer-run drop-in center 

and office. In collaboration with professionals, consumers, and diverse communities, the 

organization sponsored a 2003 Mission Possible conference that brought attention to 

issues important to LGBT mental health and addiction communities.

2003. Pinks and Blues Philadelphia was established as a mutual self-help, support, and 

resource exchange group for adults living with mental health issues who are LGBT. 

2006. At the Alternatives Conference in Portland, Oregon, delegates issued a 

proclamation on the critical need to address the crisis of death by suicide across all 

LGBT generations and to save the lives of LGBT people of all cultures, demographics, 

and communities across America.

2008. The Commonwealth of Pennsylvania established the Keystone Pride Recovery 

Initiative to make recommendations for policy, training, data collection, evaluation, 

resources, and culturally affirming services. The initiative became the first LGBT 

Statewide Consumer Network to receive SAMHSA funding to support cultural 

competence training in the provision of behavioral health services to LGBTQI individuals.

2010 and 2011. New York City’s LGBT E/Quality Conferences focused on LGBT mental 

health issues.

2012. SAMHSA sponsored a dialogue meeting on LGBT issues in Washington, DC.

Many other milestones have advanced the rights and addressed the needs of people 

with mental health and addiction issues in LGBT communities across America.

Note: Mark A. Davis received SAMHSA’s 2009 Voice Consumer Leadership Award for 

his leadership on LGBT issues. 

28
Appendix A. Glossary

The terms in this glossary are presented to facilitate an understanding of the discussion 

in this dialogue. Many other resources offer differing definitions for these terms. Unless 

otherwise indicated, the definitions here appear on the lgbthealthchannel website.*

Bisexual. Bisexuality is the capacity to be romantically and/or sexually attracted to 

individuals of more than one sex. The term bisexual may be used to describe selfidentity, behavior, or both. It may be used to describe a person’s past, present, or 

potential range of romantic and/or sexual attraction. Bisexual people may be 

monogamous, nonmonogamous, or celibate, and may never have had sex with men, 

with women, or with anyone at all. 

Coming out (also called coming out of the closet or being “out”). Refers to the process 

during which a person acknowledges, accepts, and in many cases appreciates his or her 

sexual orientation or gender identity/expression. This often involves sharing of this 

information with others. The process of coming out to oneself and to others is unique for 

every individual (Youth Pride, 2010). 

Gay. Gay is often used interchangeably with homosexual to describe sexual orientation 

and practice between people of the same sex. It is also used to refer inclusively to the 

LGBT community (e.g., gay pride day). However, gay is used more commonly to 

describe men whose predominant or sole attraction is to men, but some women also use 

the term for themselves as an alternative to the word lesbian. Someone who identifies as 

gay may have sex with someone of the same sex, the opposite sex, or may not have 

sex. 

Gender. Gender is a social role that is mandated by society and culture; it is an identity. 

Gender, because it is usually associated with sex, is frequently assumed by the dominant 

culture to be certain and unchangeable. The practice of thinking and behaving outside of 

a socially proscribed gender, like man or woman, is common in the LGBT community and 

the reasons are typically social and/or political. 

Gender identity. Gender identity refers to one’s basic sense of being a man, woman, or 

other gender (such as transgender) (Bockting, 1999). 

Heterosexual. Heterosexual, or straight, people are attracted primarily or exclusively to 

people of the opposite sex. Some heterosexual people are attracted to people of the 

same sex but have sex only with the opposite sex. Others who consider themselves 

heterosexual may have sex with men and women, and still others may not have sex. 

* website: http://www.healthcommunities.com/lgbt-health/overview-of-lgbt-terms.shtml 

29
Building Bridges: LGBT Populations

Homosexual. Homosexual people are attracted primarily or exclusively to people of the 

same sex. The term may be used to refer to gay men, lesbian women, or bisexual men 

and women. Some homosexual people are attracted to people of the opposite sex but 

have sex only with the same sex. Others who consider themselves homosexual may 

have sex with men and women, and still others may not have sex.

Intersexual/intersex. The terms intersexual or intersex refer to those who possess 

biological characteristics of both sexes or sexual anatomy that is indeterminable. 

Lesbian. A lesbian woman is primarily attracted to women. She may have sex with only 

women, with men and women, or with no one. Some women who have sex with only 

women resist the term lesbian due to stigma. Alternatively, some bisexual women may 

use the word lesbian in order to identify with the lesbian community for political reasons. 

LGBT-related stress. See minority stress. 

Minority stress. Minority stress refers to the chronic stress experienced by LGBT 

individuals related to stigmatization, marginalization, and lack of institutional and social 

supports within a predominantly heterosexual society (Warren & Barber, 2009). Some 

people prefer the term LGBT-related stress.

Queer. Although queer is used frequently as a derogatory term for homosexual people, 

some members of the LGBT community use it positively to refer to themselves or their 

community. It can refer to the whole spectrum of sexuality/gender experiences, including 

lesbian, gay, bisexual, and transgender. Queer is sometimes a preferred label for those 

who feel that other sexuality/gender labels are not suitable. However, not everyone finds 

the term empowering; some resist it because of its derogatory use among homophobic 

people. 

Questioning. Questioning refers to persons who are uncertain about their sexual 

orientation and/or gender identity (Poirier, Francis, Fisher, et al., 2008). 

Recovery. Recovery is a process of change through which individuals improve their 

health and wellness, live a self-directed life, and strive to reach their full potential. 

(SAMHSA, 2011)

Sexual orientation and preference. Sexual orientation refers to one’s sexual response 

to others. It may be homosexual, heterosexual, bisexual, or lesbian. Some people prefer 

to say sexual orientation over sexual preference, because preference implies that 

attraction is a choice instead of an innate characteristic. For others, sexual preference is

acceptable or preferred, because it implies that primary sexual attraction is a choice. In 

either case, a person’s preferred term may be fueled by social or political reasons. 

30
A Dialogue on Advancing Opportunities for 

Recovery from Addictions and Mental Health Problems

Regardless, sexual orientation is a component of character and is different from sexual 

behavior; as some people are psychologically attracted to both sexes but have sex with 

only one.

Transgender. Transgender refers to people who for various reasons adopt a gender 

identity that is incongruent with their physical anatomy or with the gender status imposed 

on them by dominant culture (i.e., man, woman). Transgender also refers to people who 

alter their sexual anatomy through surgery, hormone use, or natural methods. The term, 

therefore, includes non-, pre-, and post-operative transsexuals (people in transition to 

another sex) and transvestites (people who wear clothes conventionally associated with 

the opposite sex). 

Transgender people may consider themselves to be gay, lesbian, bisexual, transsexual, 

heterosexual, or none of these. They may identify explicitly with being male or female, a 

man or a woman, or they may not identify with any of these. A related word used by 

some people in the LGBT community is gender queer, which generally refers to someone 

who resists male or female labels. 

Two spirit (2-S). Adopted in 1990 at the third annual spiritual gathering of GLBT Natives, 

the term derives from the northern Algonquin word niizh manitoag, meaning two spirit, 

and refers to the inclusion of both feminine and masculine components in one individual 

(Anguksuar, 1997).

31
Appendix B. U.S. Department of Health and Human Services: 

Actions to Improve the Health and Well-Being of Lesbian, Gay, 

Bisexual, and Transgender Communities

Appendix B summarizes efforts by the U.S. Department of Health and Human Services 

(2011) to improve the lives of LGBT people and presents recommendations for future 

action. The recommendations were developed in response to the Presidential 

Memorandum on Hospital Visitation, which, in addition to addressing the rights of 

patients to designate visitors regardless of sexual orientation or gender identity, directed 

the HHS Secretary to explore additional steps HHS could take to improve the lives of 

LGBT people.

For too long, LGBT people have been denied the compassionate services they deserve. 

That is now changing. HHS continues to make significant progress toward protecting the 

rights of every American to access quality care, recognizing that diverse populations 

have distinctive needs. Safeguarding the health and well-being of all Americans requires 

a commitment to treating all persons with respect while being sensitive to their 

differences.

Summary of Actions

• Equal Employment Opportunity Policy. In March 2011, Secretary Sebelius 

updated HHS’s equal employment opportunity policy, which already prohibited 

discrimination based on sexual orientation, to explicitly protect against unfair 

treatment of employees and applicants for employment based on gender identity 

and genetic information. 

• Nondiscrimination Policy. On April 1, 2011, the Secretary issued a new policy 

explicitly requiring HHS employees to serve all individuals who are eligible for the 

Department’s programs without regard to any nonmerit factor, including race, 

national origin, color, religion, sex, sexual orientation, gender identity, disability 

(physical or mental), age, status as a parent, or genetic information. 

• Hospital Visitation. The President’s Memorandum on Hospital Visitation directed 

HHS to initiate rulemaking to ensure that hospitals receiving Medicare or Medicaid 

payments respect the rights of patients to designate visitors, regardless of sexual 

orientation, gender identity, or any other nonclinical factor. On November 17, 2010, 

HHS issued the final rule affirming those rights. 

• Advance Directives. The President’s Memorandum also called for new guidelines 

to facilitate hospitals’ compliance with existing regulations allowing patients to

designate who they want to make medical decisions on their behalf through

advance directives. The Centers for Medicare and Medicaid Services is on track to 

issue these guidelines in the coming months. 
Building Bridges: LGBT Populations 

• Internal LGBT Coordinating Committee. To ensure effective coordination of 

LGBT-related policies and the consideration of LGBT concerns throughout HHS’s 

activities, Secretary Sebelius established an internal committee of senior 

representatives from each operating and staff division of the Department and named 

Assistant Secretary for Aging Kathy Greenlee, Assistant Secretary for Health 

Howard Koh, and Acting Assistant Secretary for Children and Families David 

Hansell to co-chair this committee. The committee will produce an annual report on 

the Department’s key accomplishments and upcoming initiatives. 

• Institute of Medicine Study on LGBT Health. The National Institutes of Health 

(NIH) funded a study by the Institute of Medicine (IOM) to identify research gaps 

and opportunities related to LGBT health and outline a research agenda. The results 

of this study, announced on March 31, 2011, will assist HHS in enhancing its 

research efforts. 

• Healthy People 2020. Every 10 years, HHS develops national, science-based 

objectives for promoting health and preventing disease for the following decade. In 

2010, for the first time, a formal workgroup was formed to examine the scientific 

literature and propose objectives regarding LGBT health. This initiative is part of 

HHS’s overall effort to strengthen LGBT data. 

• National HIV/AIDS Strategy. On July 13, 2010, Secretary Sebelius joined the 

President and Jeffrey Crowley, director of the Office of National AIDS Strategy, in 

announcing the National HIV/AIDS Strategy, a rigorous effort to increase access to 

care and lower the number of new HIV cases in the United States by 25 percent 

within the next five years. The strategy seeks to reduce HIV-related health 

disparities with a specific focus on high-risk populations, including LGBT 

populations. 

• Affordable Care Act. The health care law is helping to improve access to care for 

all Americans, including individuals in the LGBT community. Studies have shown 

that health disparities related to sexual orientation and gender identity are due in 

part to lower rates of health insurance coverage and a lack of cultural competency in 

the health care system. As HHS implements the Affordable Care Act, it will pay 

close attention to the unique rights of LGBT populations and continue to include 

LGBT health experts on Affordable Care Act and other advisory boards, as 

appropriate.

• Tobacco Control. The 2009 Family Smoking Prevention and Tobacco Control Act 

authorizes the Food and Drug Administration (FDA) to regulate the content, 

marketing, and sale of tobacco products. These efforts, combined with tobacco 

cessation initiatives across HHS, have the potential to save millions of lives, 

particularly among high-risk populations, including LGBT populations. On November 

10, 2010, HHS released a Department-wide strategic action plan to reduce tobacco 

use. To address higher smoking rates among LGBT individuals, this plan

emphasizes the need for more research and calls for the increased development of 

evidence-based, population-specific treatments and interventions. HHS will continue 

to work toward meeting these needs. 

33
A Dialogue on Advancing Opportunities for 

Recovery from Addictions and Mental Health Problems

• Aging Services. In 2010, HHS funded the nation’s first national technical 

assistance resource center to support public and private organizations serving the 

unique needs of LGBT older adults. HHS also published a toolkit for providing 

respectful and inclusive services for diverse communities, including LGBT 

populations. 

• Anti-bullying Efforts. Last year, HHS collaborated with five other departments—

Education, Agriculture, Defense, Interior, and Justice—to establish a federal task 

force on bullying. HHS also announced an unprecedented, cross-departmental 

National Action Alliance for Suicide Prevention with a wide range of public and 

private partners to coordinate suicide prevention efforts, particularly among at-risk 

groups, such as LGBT youth. On March 10, Secretary Sebelius participated in the 

White House Conference on Bullying Prevention to further highlight the importance 

of making schools and communities safe for all students. HHS also launched a new 

website— www.StopBullying.gov—which contains a specific section for LGBT 

youth. Additionally, the Secretary recorded a video, It Gets Better, at 

, encouraging young people to reach out for help to overcome 

bullying by their peers. 

www.ItGetsBetter.org

• Runaway and Homeless Youth Services. In contrast to previous years, HHS now 

requires that all organizations serving runaway and homeless youth be equipped to 

serve LGBT youth, who represent a disproportionate segment of this population. 

HHS also allows homeless and runaway youth providers to apply for funds to 

primarily serve LGBT youth. Moreover, HHS has begun the process of improving 

data collection among homeless and runaway LGBT youth through the Runaway 

Homeless Youth Information Management System.

Future Recommended Actions 

HHS is moving forward with the following actions. HHS will continue to work in close 

coordination with LGBT community advocates in improving services and responding to 

people with respect while being sensitive to their differences. 

1. Later this year HealthCare.gov, HHS’s innovative new on-line tool called for by the 

Affordable Care Act, will provide additional information of specific relevance to 

LGBT populations. In particular, the website will allow LGBT consumers to identify 

health insurance policies available to them that include coverage of domestic 

partners. 

2. HHS will conduct outreach to organizations that serve LGBT communities to make 

them aware of available funding opportunities and, in Funding Opportunity 

Announcements, highlight programs that may particularly benefit LGBT populations. 

34
Building Bridges: LGBT Populations

3. The Department will continue to work toward increasing the number of federally 

funded health and demographic surveys that collect and report sexual orientation 

and gender identity data, consistent with the President’s support for evidence-based 

policies. In collaboration with other agencies throughout HHS, the Centers for 

Disease Control and Prevention (CDC) is leading an effort to develop and test 

questions on sexual orientation and gender identity. The Office of the Assistant 

Secretary for Health is also reviewing existing LGBT data and will generate 

baselines and targets addressing LGBT health disparities through the Healthy 

People 2020 initiative. This process will include meetings with LGBT data experts 

and stakeholders to provide transparency and opportunities for input. 

4. HHS will continue to evaluate ways its programs can ensure equal treatment of 

LGBT families. For example, HHS will advise states and tribes that federal law 

allows them to treat LGBT couples similarly to non-LGBT couples with respect to 

human services benefit programs such as Temporary Assistance for Needy 

Families and child care. The Centers for Medicare and Medicaid Services will also 

notify states of their ability to provide same-sex domestic partners of long-term care 

Medicaid beneficiaries the same treatment as opposite-sex spouses in the contexts 

of estate recovery, imposition of liens, and transfer of assets. This includes not 

seizing or imposing a lien on the home of a deceased beneficiary if the same-sex 

domestic partner still resides in the home. It also includes allowing Medicaid 

beneficiaries needing long-term care to transfer the title of a home to a same-sex 

domestic partner, allowing the partner to remain in the home.

5. HHS will encourage new and existing health profession training programs, including 

behavioral health (e.g., mental health, substance abuse, and HIV) programs, to 

include LGBT cultural competency curricula. The lack of culturally competent 

providers is a significant barrier to quality health care for many LGBT people, 

particularly those who identify as transgender. HHS’s Health Resources and 

Services Administration will also convene professional groups that represent LGBT 

health providers and students to identify challenges and opportunities for training 

LGBT providers and to isolate strategies geared toward increasing culturally 

competent care for LGBT patients. In consultation with LGBT communities, HHS will 

develop cultural competency goals and promote the use of cultural competency 

curricula inclusive of LGBT populations in future grants guidance. Moreover, to 

improve the capacity of practitioners in addressing behavioral health needs, HHS’s 

Substance Abuse and Mental Health Services Administration will utilize existing 

federal and national training and technical assistance networks to support the 

adoption of behavioral health training materials. 

6. HHS will provide guidance on the array of training and technical assistance 

available to state child welfare agencies to support LGBT youth, caregivers, and 

foster and adoptive parents.

35
A Dialogue on Advancing Opportunities for 

Recovery from Addictions and Mental Health Problems

7. HHS will continue to address discrimination, harassment, and violence against all 

individuals, including LGBT individuals, through domestic violence and other 

violence prevention programs. This includes recognizing LGBT populations as 

underserved communities in 2011 and 2012 Funding Opportunity Announcements 

under the Family Violence prevention and Services Program and, where 

appropriate, identifying LGBT populations as target populations for populationspecific grants. HHS will integrate an even stronger component focusing on LGBT 

youth in all anti-bullying initiatives and continue working with the White House and 

Departments of Education, Agriculture, Defense, Interior, and Justice to ensure that 

states, schools, and the general public are aware of the resources available. 

36
Appendix C. LGBTQ Inclusive Action Steps in SAMHSA’s 

Strategic Initiatives 

SAMHSA’s eight Strategic Initiatives reflect the agency’s priorities. Through its Strategic 

Initiatives, SAMHSA focuses its limited resources on areas of urgency and opportunity. 

Under each Strategic Initiative, action steps have been identified to address the needs of 

LGBT populations. These are listed below.

Strategic Initiative 1: Prevention of Substance Abuse and Mental Illness

1.1.2.8 - Support best practice guidelines for health and behavioral health providers to prevent 

and reduce family rejection of LGBTQ youth problems associated with rejection, such as 

homelessness, behavioral health disorders, risky sexual behavior, and suicide. 

1.1.2.9 - Ensure a focus on communities and populations facing behavioral health disparities, 

especially racial and ethnic minorities, Tribes, and LGBTQ youth. 

1.1.3.6 - Enhance and increase tobacco cessation efforts for LGBTQ individuals with mental 

and substance use disorders. 

1.2.1.5 - Collaborate with the National Institute of Alcohol Abuse and Alcoholism (NIAAA) to 

provide technical assistance and increase use of screening and brief interventions and 

improve pathways to treatment and recovery services particularly for girls, Native Hawaiian 

and Pacific Islander youth, and other groups that have documented high or increasing rates of 

underage drinking.

1.2.2.1 - In conjunction with the Centers for Disease Control and Prevention (CDC) and 

NIAAA, develop and implement a national awareness campaign focused on excessive drinking 

by adults, with a special focus on populations at higher risk, and coordinate with related efforts 

such as the U.S. Department of Agriculture (USDA) dietary guidelines.

1.3.1.4 - Develop and encourage culturally specific programs that promote strong sense of 

self and appropriate help-seeking among African American, American Indian and Alaska 

Native, Asian American, Native Hawaiian and Other Pacific Islander, Hispanic, and LGBTQ 

youth. 

1.3.2.2 - Ensure the National Suicide Prevention Lifeline program is adequately resourced and 

increase the visibility and accessibility of suicide prevention services in partnership with States, 

Territories, Tribal entities, communities, rehabilitation agencies, private and public health care 

providers, representatives of secondary and higher education, and military, faith-based, and 

LGBT organizations. 

1.3.2.3 - Increase access to suicide prevention resources by collaborating with behavioral 

health, educational, faith-based, military, and LGBT organizations. 

1.3.2.4 - Implement and develop a strategic plan to educate parents, health practitioners, 

school officials, community leaders, youth, State, Territorial, and Tribal leaders, first 

responders, employers, faith-based organizations, LGBT organizations, and the public about 

suicide warning signs that are specific to different cultures and communities, and preventive 

actions they can take to help someone contemplating a suicide.

37
Building Bridges: LGBT Populations 

Strategic Initiative 1: Prevention of Substance Abuse and Mental Illness

1.3.2.6 - Increase awareness of suicide prevention and the suicide hotline among 

populations at higher risk for suicide identified by the National Action Alliance for 

Suicide Prevention, including LGBTQ youth, American Indians and Alaska Natives 

(AIs/ANs), and military veterans. [National Suicide Prevention Lifeline (1-800-273-

TALK)]

Strategic Initiative 2: Trauma and Justice

2.3.2.1 - Develop a dissemination, training, and technical assistance strategy using 

SAMHSA trauma centers to move established trauma-focused interventions beyond 

specific grantees and more broadly into child-serving systems. Through this strategy, 

identify and address barriers to access for trauma-specific treatments. Ensure that this 

strategy is inclusive of diverse racial, ethnic, socioeconomic, and LGBT communities. 

2.4.3.3 - Collaborate with the Racial and Ethnic Disparities Issue Team of the 

Coordinating Council on Juvenile Justice and Delinquency Prevention to identify areas 

in which behavioral health issues contribute to disproportionate minority contact 

(especially among Hispanic/Latino, African American, and LGBTQ youth) and use 

SAMHSA’s current grant portfolio to support services to reduce disproportionate 

minority involvement in the justice system. 

Strategic Initiative 3: Military Families

3.2.2.2 - Explore the lessons learned from Operation Immersion and assess its 

potential as a model and its applicability to improving recovery for the diverse ethnic; 

racial; and lesbian, gay, bisexual, transgender, and questioning (LGBTQ) people 

within the military. 

3.3.1.3 - Develop a behavioral health guide for racial and ethnic minorities and the 

LGBTQ population about the challenges and the strategies for coping with their 

realities in the military. 

3.3.1.4 - Explore possibility of using SAMHSA technical assistance centers for training 

and technical assistance to support resilience and promote emotional health for the 

diverse racial, ethnic, and LGBTQ populations in the military. 

4.2.2.1 - Work in concert with the USICH (United States Interagency Council on 

Homelessness) and other federal partners in implementing the Federal Strategic Plan 

to Prevent and End Homelessness, including a focus on populations especially 

vulnerable to homelessness (e.g., minorities, LGBTQ youth, and veterans). 

38
A Dialogue on Advancing Opportunities for 

Recovery from Addictions and Mental Health Problems

Strategic Initiative 4: Recovery Support

4.2.2.7 - Collaborate with stakeholders (e.g., advocacy groups, nonprofits, foundations, 

businesses, and national minority and LGBT organizations) in efforts to increase 

recovery support services and housing opportunities for people who are homeless or at 

risk of being homeless upon leaving institutional settings, such as prisons, mental 

health facilities, and nursing homes. 

4.3.3.3 - Conduct Webinar seminar series in collaboration with SAMHSA’s Office of 

Behavioral Health Equity to raise awareness of issues associated with employment and 

educational outcomes for diverse communities.

Strategic Initiative 5: Health Reform

5.1.2.2 - With the expanded eligibility provisions in the Affordable Care Act, develop 

strategies to increase the enrollment of diverse racial, ethnic, and LGBT groups. 

5.1.5.1 - Develop outreach materials for consumers and providers, including materials 

specifically geared to diverse racial, ethnic, and LGBT groups. 

5.1.5.4 - Hold regular meetings with groups representing a broad and diverse range of 

behavioral health stakeholders, including people in recovery, racial and ethnic 

minorities, Tribes, the LGBT health organizations, and others. 

5.2.1.2 - Develop and implement an information and training strategy with SAMHSA 

staff and other HHS agencies that focuses on disparities in behavioral health care 

access, quality, and outcomes for ethnic, racial, and LGBTQ individuals. 

5.2.3.4 - Develop a joint data-driven CMS/SAMHSA technical assistance effort 

targeting behavioral health care disparities for diverse racial, ethnic, and LGBT groups. 

5.4.1.2 - Identify information gaps, develop strategies to obtain additional information, 

including data on racial and ethnic minorities and LGBTQ populations participating in 

the behavioral health system, and collect and analyze the information to address these 

gaps. 

5.4.3.3 - Meet with stakeholders, including representatives from racial and ethnic 

minority, and LGBT stakeholder groups, to review service models. 

Strategic Initiative 6: Health Information Technology

6.3.5.3 - Assess the effectiveness and utility of the demonstration project and develop 

future steps as appropriate to include additional behavioral health provider and facility 

locations to the system with potential linking to crisis centers nationally with HER 

referrals and patient information protocols in place, consistent with SAMHSA and 

ONC privacy and security standards using NWHIN-CONNECT gateway.

39
Building Bridges: LGBT Populations 

Strategic Initiative 7: Data, Outcomes, and Quality

7.2.1.7 - Include sexual identity questions in SAMHSA’s national surveys and program 

evaluations, building on the Intra-Agency Agreement with the National Center for 

Health Statistics Sexual Identity Question Design and Development Center.

Strategic Initiative 8: Public Awareness and Support

8.2.1.4 - Develop a common set of metrics to benchmark SAMHSA Web performance 

for multiple audiences, including racially and ethnically diverse end users and lesbian, 

gay, bisexual, transgender, and questioning (LGBTQ) populations. 

8.3.1.3 - Use research gathered from consumers, family, and community members 

from racially and ethnically diverse groups and LGBT communities to inform content 

development priorities for each Initiative. 

8.3.2.1 - Establish a standard approach for involving individuals in recovery from 

mental or substance use disorders, racially and ethnically diverse individuals, Tribes, 

and members of the LGBT community in all aspects of SAMHSA’s outreach 

capabilities, including SAMHSA news, news releases, social media, and Web site, in 

serving diverse groups of stakeholders. 

8.5.1.1 - Provide ongoing training opportunities for key mainstream and diverse 

audiences, including consumers, peers, persons in recovery, providers, LGBTQ 

populations, and researchers on discrimination reduction and social inclusion. 

8.5.1.5 - Develop impact statement tools that can be used to examine programs and 

policies for impact on the social inclusion of people in recovery and those traditionally 

affected by disparities, including LGBTQ populations. 

8.5.1.6 - Through a systematic outreach effort, develop a network of consumers, 

families, and persons in recovery from diverse perspectives, including racial and 

ethnic minority, disability and LGBTQ groups. 

8.5.4.1 - Identify best communications channels for engagement and engage various 

provider groups, including strategic outreach to LGBT communities and those 

traditionally affected by disparity, to identify common priorities related to social 

inclusion. 

40
Appendix D. Resources and References 

D.1 U.S. Department of Health and Human Services Resources 

Substance Abuse and Mental Health Services Administration 

http://www.samhsa.gov

Center for Mental Health Services

The Center for Mental Health Services leads the national system that delivers 

mental health services in order to provide the treatment and support services 

needed by adults with mental disorders and children with serious emotional 

problems. 

Participatory Dialogues: A Guide to Organizing Interactive Discussions on 

Mental Health Issues Among Consumers, Providers, and Family Members. 

(Bluebird, 2000). Available at

http://www.akmhcweb.org/Docs/SAMHSADialogue.pdf

Center for Substance Abuse Prevention 

The Center for Substance Abuse Prevention provides national leadership in the 

federal effort to prevent alcohol, tobacco, and other drug problems.

Top Health Issues for LGBT Populations Resource Kit. (SAMHSA, 2012).

Available at http://www.store.samhsa.gov/shin/content/SMA12-4684/SMA12-

4684.pdf

Center for Substance Abuse Treatment 

The Center for Substance Abuse Treatment promotes the quality and availability of 

community-based treatment services for substance use disorders for individuals and 

families who need them. 

A Provider’s Introduction to Substance Abuse Treatment for Lesbian, Gay, 

Bisexual, and Transgender Individuals. (SAMHSA, 2001). Available at

http://www.kap.samhsa.gov/products/manuals/pdfs/lgbt.pdf

Trainer Guide: A Provider’s Introduction to Substance Abuse Treatment for 

Lesbian, Gay, Bisexual, and Transgender Individuals. 1st ed. (SAMHSA, 2007). 

Available at http://www.nalgap.org/PDF/Resources/TrainerGuide1stEd.pdf

Una introducción para el proveedor de tratamiento de abuso de sustancias para 

lesbianas, gays, bisexuales e individuos transgénero [A provider’s introduction to 

substance abuse treatment for lesbian, gay, bisexual, and transgender 

individuals]. (SAMHSA, 2010). (Spanish). Available at 

http://www.attcnetwork.org/regcenters/productdetails.asp?prodID=555&rcID=16

41
Building Bridges: LGBT Populations 

Homeless Resource Center 

http://www.homeless.samhsa.gov/Channel/LGBTQ-153.aspx 

The Homeless Populations: LGBTQI2-S pages of SAMHSA’s Homeless Resource 

Center website links to numerous resources on homelessness among LGBT 

populations.

Administration on Children and Families Children’s Bureau 

Child Welfare Information Gateway

http://www.childwelfare.gov

Child Welfare Information Gateway connects child welfare and related professionals 

to comprehensive information and resources to help protect children and strengthen 

families. The gateway features the latest on topics from prevention to permanency, 

including child abuse and neglect, foster care, and adoption. A search for LGBT on 

the Child Welfare Information Gateway website yields several dozen resources 

related to child welfare and LGBT issues.

Centers for Disease Control and Prevention

http://www.cdc.gov

Health Risks Among Sexual Minority Youth. (CDC, 2011). Available at 

http://www.cdc.gov/healthyyouth/disparities/smy.htm

Lesbian, Gay, Bisexual, and Transgender Health. This website provides information 

and resources on health issues and inequities affecting LGBT communities for both 

professional and general public audiences, including links to other sources. See 

http://www.cdc.gov/lgbthealth

Compendium of HIV Prevention Interventions with Evidence of Effectiveness. (CDC, 

1999, rev. 2007). CDC’s HIV/AIDS Prevention Research Synthesis Project identified 

effective interventions to reduce sex- and drug-related risk behaviors or improve 

health outcomes. Some target LGBTs; others target groups likely to include LGBTs. 

Available at http://www.cdc.gov/hiv/resources/reports/hiv_compendium

Institute of Medicine

http://www.iom.edu

The National Institutes of Health asked the Institute of Medicine to evaluate current 

knowledge of the health status of LGBT populations, to identify research gaps and 

opportunities, and to outline a research agenda to help NIH focus its research in this 

area. 

42
A Dialogue on Advancing Opportunities for 

Recovery from Addictions and Mental Health Problems

The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a 

Foundation for Better Understanding. (IOM, 2011). Available at http://www.iom.edu

/Reports/2011/The-Health-of-Lesbian-Gay-Bisexual-and-Transgender-People.aspx

National Institute on Alcohol Abuse and Alcoholism

http://www.niaaa.nih.gov

Social Work Curriculum on Alcohol Use Disorders: Module 10G: Sexual Orientation 

and Alcohol Disorders. (National Institute on Alcohol Abuse and Alcoholism, 2005). 

Available at http://pubs.niaaa.nih.gov/publications/social/ContentsList.html

D.2 Private-Sector Resources

Advocates for Youth

http://www.advocatesforyouth.org

Advocates for Youth creates programs and policies that help young people make 

informed, responsible decisions about their sexual and reproductive health. Spanishlanguage information is available at http://ambientejoven.org

American Lung Association

http://www.lung.org

Smoking Out a Deadly Threat: Tobacco Use in the LGBT Community. (American 

Lung Association, 2010). Available at

http://www.lung.org/assets/documents/publications/other-reports/lgbt-report.pdf

American Psychological Association

www.apa.org

APA’s LGBT Concerns Office offers many resources that promote beneficial change in 

society for LGBT people at http://www.apa.org/pi/lgbt/about/annual-report.aspx

Arizona Division of Behavioral Health Services LGBTQ Advisory Committee 

Training Webinar Series

A series of training webinars on a broad range of LGBTQ behavioral health topics has 

been recorded and archived. Available at 

http://www.azdhs.gov/bhs/pdf/LGBTQSeriesRecordings.pdf

43
Building Bridges: LGBT Populations

Association for Lesbian, Gay, Bisexual, and Transgender Issues in Counseling

http://www.algbtic.org

The Resources section of the association’s website provides links to bibliographies on 

counseling LGBT clients. The Competencies area includes links to translations in French, 

Turkish, Chinese, Japanese, and Romanian. English-language competencies for working 

with transgender clients also are available.

Association of Gay and Lesbian Psychiatrists

http://www.aglp.org

The Association of Gay and Lesbian Psychiatrists’ website archives its newsletters 

published since 2002, and the Referrals tab opens a searchable membership directory.

http://www.biPolarBear.us

This website offers a list of resources for LGBT communities in selected areas 

nationwide.

Campus Pride

http://www.campuspride.org

This nonprofit organization works to create a safer college environment for LGBT 

students. 

2010 State of Higher Education for Lesbian, Gay, Bisexual, and Transgender People. 

(Blanken, Weber, Blumenfeld, et al., 2010. Available at 

http://www.campuspride.org/Campus%20Pride%202010%20LGBT%20Report%20Summ

ary.pdf 

Casey Family Programs

Gay, Lesbian, Bisexual, Transsexual, and Questioning Guidebook Learning Plan. 

(Balsam, Nollan, Hoskins, et al., 2007). Developed to help develop life skills 

teaching curriculum and individual learning plans related to GLBTQ issues, this 

guidebook is based on and a companion to the Casey Life Skills GLBTQ 

Assessment Supplement. Available at http://www.caseylifeskills.org/pages/lp

/GLBTQ%20Guidebook%206%2028%2007.pdf

44
A Dialogue on Advancing Opportunities for 

Recovery from Addictions and Mental Health Problems

Center for American Progress

http://www.americanprogress.org/issues/culture/lgbt 

The Center for American Progress offers a variety of LGBT advocacy, education, 

research, and services resources. In the website’s Media & Progressive Issues section, a 

number of documents relating to LGBT social justice topics are archived under the 

heading Gay & Transgender Issues.

On the Streets: The Federal Response to Gay and Transgender Homeless Youth. 

(Quintana, Rosenthal, & Krehely, 2010). Based on available data sources, this

report offers a blueprint for considering and addressing homelessness among gay 

and transgender youth. Available at http://www.americanprogress.org/issues/2010

/06/pdf/lgbtyouthhomelessness.pdf

CenterLink: The Community of LGBT Centers

http://www.lgbtcenters.org 

This coalition links centers that provide local-level support, activities, and meeting space 

for the LGBT community. Many centers offer programs specifically designed for LGBT 

youth, and some offer substance abuse prevention, treatment, or both.

Center of Excellence for Transgender Health

University of California at San Francisco 

http://www.transhealth.ucsf.edu

The Center of Excellence for Transgender Health aims to increase access to 

comprehensive, effective, and affirming health care services for trans and gender-variant 

communities.

Primary Care Protocol for Transgender Patient Care. (University of California–San 

Francisco, 2001). San Francisco, CA: University of California, Department of Family 

and Community Medicine.

Children of Lesbians and Gays Everywhere (COLAGE) 

http://www.colage.org

COLAGE, an association by and for people of all ages who have one or more parents 

who is LGBTQ, posts on its website resources for children and their LGBTQ parents, a 

bookstore, and online activities.

45
Building Bridges: LGBT Populations

Consortium of Higher Education LGBT Resource Professionals

http://www.lgbtcampus.org/ 

The consortium’s directory offers contact information for approximately 200 LGBT studies 

programs at institutions of higher education, which represent potential partners in 

prevention activities.

Family Acceptance Project

http://www.familyproject.sfsu.edu 

A community research, intervention, and education initiative, the Family Acceptance 

ProjectTM studies the effects of family acceptance and rejection on the health and wellbeing of LGBT youth. Results will be used to help families provide support for LGBT 

youth; develop appropriate interventions, programs, and policies; and train for training. 

Gay and Lesbian Medical Association 

http://www.glma.org

The Gay and Lesbian Medical Association (GLMA), a nonprofit membership organization 

of 2,000 medical professionals, works to end homophobia in healthcare. The website 

presents a range of health-related information for patients, providers, students, and 

others. 

Healthy People 2010: Companion Document for Lesbian, Gay, Bisexual, and 

Transgender Health. (Gay and Lesbian Medical Association and LGBT health 

experts, 2001). This document provides information on LGBT health disparities and 

on addressing systemic challenges to overcome them. Separate chapters discuss 

HIV/AIDS, mental health, sexually transmitted diseases, substance abuse, tobacco 

use, and violence prevention. Available at 

http://www.glma.org/_data/n_0001/resources/live/HealthyCompanionDoc3.pdf

GayData.org

http://www.gaydata.org 

GayData.org, maintained by the Program for Lesbian, Gay, Bisexual and Transgender 

Health at Drexel University School of Public Health, serves as a no-cost, open-access 

clearinghouse for the collection of sexual orientation and gender identity data and 

measures. The website links to key LGBT-related data sources and abstracts of 

significant journal articles reporting data analysis results for LGBT mental health and 

substance abuse, and has guidelines for incorporating LGBT questions into data 

instruments.

46
Building Bridges: LGBT Populations

Gay, Lesbian, and Straight Education Network

http://www.glsen.org

The Gay, Lesbian, and Straight Education Network (GLSEN) seeks to develop school 

climates where difference is valued for the positive contribution it makes to creating a 

more vibrant and diverse community. GLSEN supports community-based chapters and 

Gay-Straight Alliances in many schools. The group sponsors the biennial National School 

Climate Survey. 

Gay-Straight Alliance (GSA) Network 

http://www.gsanetwork.org

GSA Network, a youth leadership organization, helps GSAs in schools connect with each 

other and with other community resources. The website’s Resources section links to 

several national reports on LGBT bullying and harassment in schools.

Gender Education and Advocacy

http://www.gender.org 

This nonprofit organization provides education and advocacy on transsexual and 

transgender issues.

GLBT National Help Center

http://www.glnh.org

The GLBT National Help Center’s web portal links to hundreds of LGBT-related public 

and private resources and enterprises, with an online locator to produce by-topic lists by 

ZIP code from a 15,000 item database. The center offers toll-free telephone services and 

online peer-support chat utilities. Although alcohol, tobacco, drugs, and substance abuse 

are not topic headings in the center’s resource database, its health category is likely to 

include professionals and programs in a given area who provide substance abuserelated services. 

GLBT National Youth Talkline

Teenage and young adult volunteers provide free telephone and email peer counseling, 

and referrals to resources in the National Help Center database. Access 

http://glbtnationalhelpcenter.org/talkline/index.html

47
Building Bridges: LGBT Populations

Human Rights Campaign

http://www.hrc.org

The Human Rights Campaign advocates for social justice for LGBT people. The Issues 

tab on its home page leads to posted resources on a variety of topics (e.g., aging, health, 

military, work place).

Hunter College Institute for LGBT Social Science and Public Policy, Roosevelt 

House Public Policy Institute

http://www.hunter.cuny.edu/the-lgbt-center/

The Center for Lesbian, Gay, Bisexual, and Transgender Social Science and Public 

Policy supports credible social science research on LGBT issues to inform policy 

decisions; to disseminate findings to inform public opinion and promote LGBT social, 

health, and political equity; and to provide LGBT policy academic training and practicum 

opportunities for Hunter students. 

A Blueprint for Meeting LGBT Health and Human Services Needs in New York 

State. (Frazer & Warren, 2010). New York, NY: Empire State Pride Agenda 

Foundation, New York State LGBT Health and Human Services Network, and 

Institute for LGBT Social Science and Public Policy at Hunter College.

International Lesbian, Gay, Bisexual, Transgender, and Queer Youth and Student 

Organisation

http://www.iglyo.com 

This worldwide network of LGBTQ student groups advocates for LGBTQ rights and 

publishes reports, newsletters, and campaigns, and hosts a blog.

It Gets Better Project

http://www.itgetsbetter.org 

The It Gets Better Project offers brief videotaped messages of hope for LGBTQ youth 

who may have been bullied or harassed and may be contemplating suicide. Messages 

are produced and posted online by individual and group volunteers, accessible on the 

project’s website or http://www.YouTube.com . 

It Gets Better: Coming Out, Overcoming Bullying, and Creating a Life Worth Living. 

(Savage & Miller, 2012). New York: Penguin Books.

48
A Dialogue on Advancing Opportunities for 

Recovery from Addictions and Mental Health Problems

Keystone Pride Recovery Initiative

The Pennsylvania Department of Public Welfare, Office of Mental Health and Substance 

Abuse Services, LGBTQI Workgroup (later known as the Keystone Pride Recovery 

Initiative) met to compile recommendations to address disparities in behavioral health 

care and behavioral health outcomes.

Issues of Access to and Inclusion in Behavioral Health Services for Lesbian, Gay, 

Bisexual, Transgender, Questioning, and Intersex Consumers: Recommendations 

to the Pennsylvania Department of Public Welfare’s Office of Mental Health and 

Substance Abuse Services. (Keystone, 2009). Available at 

http://www.parecovery.org/documents/OMHSAS_LGBTQI_Recommendations.pdf

LGBT TRISTAR

http://www.lgbt-tristar.com 

This technical assistance provider has issued a series of best practices papers that 

include information likely to help in designing effective prevention for this population. 

Some documents are archived at http://www.gilgerald.com

Los Angeles Gay & Lesbian Center: Model Program for LGBT Youth in Foster Care

www.lagaycenter.org 

The website provides details on a $13.3 million, 5-year grant awarded by the 

Administration on Children, Youth, and Families to create a model program for LGBTQ 

youth in the foster care system.

NALGAP: Association of Lesbian, Gay, Bisexual, and Transgender Addiction 

Professionals and Their Allies

www.nalgap.org

NALGAP is dedicated to the prevention and treatment of alcoholism, substance abuse, 

and other addictions in LGBT communities. 

Prevention Policy Statement & Guidelines. (NALGAP, 1994). Available at 

http://www.nalgap.org/PDF/Resources/NALGAP_94_Prev_Policy_Guidelines.pdf

Nathan Kline Institute Center of Excellence in Culturally Competent Mental Health

http://www.ssrdqst.rfmh.org/cecc 

The NKI Center of Excellence in Culturally Competent Mental Health aims to eliminate 

racial and ethnic disparities in the availability, accessibility, and quality of behavioral 

health care services through the development of culturally competent services.

49
Building Bridges: LGBT Populations

LGBTQ Cultural Profile. (Warren & Barber, 2009). Available at http://www.ssrdqst.

rfmh.org/cecc/index.php?q=node/84 

National Alliance on Mental Illness (NAMI) 

http://www.nami.org

NAMI engages in support, education, advocacy, and research regarding mental illness. 

NAMI’s Multicultural Action Center offers a range of resources on LGBT issues, 

described and available at

http://www.nami.org/Template.cfm?Section=Resources&Template=/ContentManagement

/ContentDisplay.cfm&ContentID=55813 . Examples include:

A Mental Health Recovery and Community Integration Guide for GLBTQI 

Individuals: What You Need to Know (brochure)

GLBTQI Mental Health: Recommendations for Policies and Services. (2009).

National Center for Cultural Competence

http://www.gucchd.georgetown.edu/nccc 

Practice Brief 1: Providing Services and Supports for Youth Who Are Lesbian, Gay, 

Bisexual, Transgender, Questioning, Intersex, or Two-Spirit. (Poirier, Francis, 

Fisher, et al., 2008). This publication is geared to policy makers, administrators, and 

providers seeking to learn more about LGBTQI2-S youth and how to develop 

culturally and linguistically competent programs and services to meet their needs 

and preferences. Available at http://www11.georgetown.edu/research/gucchd/

nccc/documents/lgbtqi2s.pdf 

National Center for Transgender Equality 

http://www.transequality.org

The National Center for Transgender Equality is a nonprofit, social justice organization 

dedicated to advancing the equality of transgender people through advocacy, 

collaboration, and empowerment.

Injustice at Every Turn: A Report of the National Transgender Discrimination 

Survey. (Grant, Mottet, Tanis, et al., 2011). Washington, DC: National Center for 

Transgender Equality and National Gay and Lesbian Task Force. Executive 

summary available athttp://transequality.org/PDFs/Executive_Summary.pdf

50
A Dialogue on Advancing Opportunities for 

Recovery from Addictions and Mental Health Problems

National Coalition for LGBT Health

http://www.lgbthealth.net 

The National Coalition for LGBT Health is committed to improving the health and wellbeing of LGBT individuals through federal advocacy focused on research, policy, 

education, and training. The coalition lists member organizations’ links in its About Us 

web pages and posts categorical lists of links in its Resources & Research pages. 

The National Gay and Lesbian Task Force

http://www.thetaskforce.org

The National Gay and Lesbian Task Force trains activists, equips state and local 

organizations with the skills needed to organize broad-based campaigns to defeat antiLGBT referenda and advance pro-LGBT legislation, and builds the organizational 

capacity of the movement. Its Policy Institute provides research and policy analysis, and 

publishes fact sheets on employment, health concerns, and mental health issues. The 

Transgender Civil Rights Project provides legislative, policy, and strategy assistance, 

including evaluation of legislative and policy language, to activists and organizations 

working to pass trans-inclusive or transgender-friendly laws and policies.

Lesbian, Gay, Bisexual, and Transgender Youth: An Epidemic of Homelessness. 

(Ray, 2006). New York: National Gay and Lesbian Task Force Policy Institute and 

the National Coalition for the Homeless.

National LGBT Tobacco Control Network

http://www.lgbttobacco.org

This network supports local tobacco control advocates in eliminating tobacco health 

disparities for LGBT individuals. Within the Guidelines and Best Practice area of its 

Resources web pages are community assessments and other documents useful in 

developing substance abuse prevention for LGBTs.

National Network to Eliminate Disparities in Behavioral Health

http://nned.net/

To address disparities in behavioral health care, the National Network to Eliminate 

Disparities (NNED) in Behavioral Health (with support from SAMHSA and in partnership 

with the National Alliance of Multi-ethnic Behavioral Health Associations) supports 

information sharing, training, and technical assistance among organizations and 

communities dedicated to the behavioral health and well-being of diverse communities. 

51
Building Bridges: LGBT Populations

The NNED works with network members to coordinate the sharing of community-based 

knowledge and training of cultural, indigenous, and community-based best practices, 

foster new collaborative partnerships to grow and spread “pockets of excellence,” 

leverage resources through partnering and collaborative initiatives, research and design 

new practices and adapt existing practices, and collectively advance political will. 

National Resource Center for Permanency and Family Connections, Silberman 

School of Social Work at Hunter College

http://www.nrcpfc.org

The Resources on LGBTQ Children and Youth pages of the center’s website include

numerous articles, reports, information packets, and other publications; videos; archived 

online trainings; slide presentations; and links to additional resources pertaining to the 

welfare of children who are LGBTQ.

Parents, Families, and Friends of Lesbians and Gays

http://www.pflag.org

Parents, Families, and Friends of Lesbians and Gays (PFLAG) promotes the health and 

well-being of gay, lesbian, and bisexual persons and their families and friends through 

support, education, and advocacy.

www.PinkandBlues.info

Pink and Blues offers guidance in starting local LGBT peer-run mental health support 

groups. Pink and Blues’ discussion groups supplement, but do not substitute for, 

professional treatment. The group does not offer quick fixes or cures, and is inclusive of 

people living with any mental illness diagnosis, both professionally or self-proclaimed. 

Pink and Blues focuses on personal recovery and is not a therapy group. The goal is for 

participants to explore styles of recovery and to avoid unhealthy dependency on others. 

Pink and Blues promotes independence, self-determination, suicide prevention, and 

choice. We value safety and respect in our personal/professional lives and in LGBTQI-2S

communities.

Rainbow Heights Club

http://www.rainbowheights.org

Rainbow Heights Club, a psychosocial support and advocacy program in Brooklyn, New 

York, serves LGBT individuals living with mental illness, provides socialization, support, 

peer advocacy, and a safe place for individuals to take the next step on the road to 

emotional recovery and mental wellness. Rainbow Heights Club’s PRIDE Training 

Program provides trainings to mainstream care providers and consumers in how to meet 

the needs of LGBT people in recovery. 

52
A Dialogue on Advancing Opportunities for 

Recovery from Addictions and Mental Health Problems

Red Circle Project 

http://www.apla.org/health-and-wellness/hiv-education/red-circle-project.html

The Red Circle Project targets American Indian gay men (also known as two-spirit 

individuals). The website links to other two-spirit organizations, research relating to this 

population, and training documents for working with women and men who are American 

Indian and identify as two-spirit or LGBT. 

Safe Schools Coalition 

http://www.safeschoolscoalition.org/safe.html

The Safe Schools Coalition, an international partnership supporting LGBT youth and 

promoting safer school environments, links to resources from its website’s home page. 

Services and Advocacy for Gay, Lesbian, Bisexual, and Transgender Elders 

(SAGE)

http://www.sageusa.org 

SAGE, a nonprofit organization dedicated to serving and advocating for LGBT seniors, 

has pioneered programs and services, provided technical assistance and training to 

expand opportunities for LGBT older people across the country, and provided a national 

voice on LGBT aging issues.

Suicide Prevention Resource Center

http://www.sprc.org 

Suicide Prevention Among LGBT Youth: A Workshop [Kit] for Professionals Who 

Serve Youth. (Suicide Prevention Resource Center, 2011). Available at http://www.

sprc.org/LGBTYouthWorkshopKit.asp 

Trans Youth Family Allies

http://www.imatyfa.org

Trans Youth Family Allies empowers children and families by partnering with educators, 

service providers, and communities to develop supportive environments in which gender 

may be expressed and respected. The website offers content and links focused on 

suicide prevention and preventing violence directed at LGBTQ youth. 

The Trevor Project

http://www.thetrevorproject.org

The Trevor Helpline is a nationwide, around-the-clock crisis and suicide prevention 

helpline for LGBT and questioning youth.

53
Building Bridges: LGBT Populations

University LGBT/Queer Programs

http://www.people.ku.edu/~jyounger/lgbtqprogs.html#res

This web-based directory identifies LGBT study programs, student groups, and other 

resources at numerous colleges and universities, with some information for persons 

interested in obtaining degrees in related subjects. The site may be helpful in locating 

academic resources and partnerships for prevention. 

University of San Francisco Center for AIDS Prevention Studies (CAPS)

http://www.caps.ucsf.edu 

CAPS issues factsheets on AIDS-related topics, including drug use, many of which are 

published in Spanish as well as English. Available at caps.ucsf.edu/resources/fact-sheets

Williams Institute, UCLA Law School

http://williamsinstitute.law.ucla.edu/

The Williams Institute advances sexual orientation law and public policy through rigorous, 

independent research and scholarship, and disseminates findings to judges, legislators, 

policymakers, media, and the public. 

Best Practices for Asking Questions About Sexual Orientation on Surveys. (Badgett 

& Goldberg, 2009). Los Angeles, CA: Sexual (SMART), Williams Institute, UCLA 

Law School. Available at 

http://www.palmcenter.org/files/active/0/SMART_FINAL_Nov09.pdf

World Professional Association for Transgender Health

http://www.wpath.org

A professional organization focused on the understanding and treatment of gender 

identity disorders, the World Professional Association for Transgender Health (WPATH) 

publishes a professional journal and Standards of Care (available in English, Spanish, 

and Croatian). These and links to other resources on transgender and intersex health are 

accessible on the WPATH website.

YES Institute 

http://www.yesinstitute.org

The YES Institute aims to prevent suicide through communication and education about 

gender and orientation.

54
A Dialogue on Advancing Opportunities for 

Recovery from Addictions and Mental Health Problems

D.3 References and Related Publications 

American Lung Association. (2010). Smoking out a deadly threat: Tobacco use in the 

LGBT community. Retrieved February 23, 2012, from 

http://www.lung.org/assets/documents/publications/lung-diseasedata/solddc_2010.pdf

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental 

disorders. (4th ed., text rev.). Washington, DC: American Psychiatric Association.

American Psychiatric Association (2013). Diagnostic and statistical manual of mental 

disorders (4th ed.). Washington, DC: American Psychiatric Association.

American Psychological Association. (2011). Promoting good practices for mental health 

facilities in working with LGBT clients with serious mental illnesses. Retrieved 

November 21, 2011, from http://www.apa.org/pi/lgbt/resources/promoting-goodpractices.aspx

Anderson, F. (2000). In J. Poulin, Collaborative social work. Itasca, IL: F. E. Peacock 

Publishers, Inc.

Anguksuar, L. R. (1997). A postcolonial perspective on western [mis]conceptions of the 

cosmos and the restoration of indigenous taxonomies. In S. E. Jacobs, W. Thomas, 

& S. Lang (Eds.), Two-spirit people: Native American gender identity, sexuality, and 

spirituality (pp. 217–222). Chicago, IL: University of Illinois Press. 

Avery, A. M., Hellman, R. E., & Sudderth, L. K. (2001). Satisfaction with mental health 

services among sexual minorities with major mental illness. American Journal of 

Public Health, 91(6), 990–991. 

Badgett, L., & Goldberg, N. (Comps. and Eds.). Best practices for asking questions about 

sexual orientation on surveys. (2009). Los Angeles, CA: Williams Institute, UCLA 

Law School. Retrieved February 25, 2012, from 

http://www.palmcenter.org/files/active/0/SMART_FINAL_Nov09.pdf

Balsam, K. F., Nollan, K. A., Hoskins, R., & Downs, R. (2007). Gay, lesbian, bisexual, 

transsexual, and questioning guidebook learning plan. Washington, DC: Casey 

Family Programs. Retrieved February 23, 2012, from

http://lifeskills.casey.org/pages/lp/GLBTQ%20Guidebook%206%2028%2007.pdf

Berg, M. B., Mimiaga, M. J., & Safren, S. A. (2008). Mental health concerns of gay and 

bisexual men seeking mental health services. Journal of Homosexuality, 54(3), 293–

306. Retrieved February 13, 2012, from 

http://www.ncbi.nlm.nih.gov/pubmed/18825866

Bluebird, G. (2000). Participatory dialogues: A guide to organizing interactive discussions 

on mental health issues among consumers, providers, and family members. DHHS 

Pub. No. SMA 00-3472. Rockville, MD: Substance Abuse and Mental Health 

Services Administration, Center for Mental Health Services. Retrieved February 25, 

2012, from http://akmhcweb.org/Docs/SAMHSADialogue.pdf

Blumenstein, R. (2003). Branded-T. Available at www.branded-t.com

Bockting, W. O. (1999, October/November). From construction to context: Gender 

through the eyes of the transgendered. SIECUS Report, 1, 3–7.

55
A Dialogue on Advancing Opportunities for 

Recovery from Addictions and Mental Health Problems

Bostwick, W. B., Boyd, C. J., Hughes, T. L., & McCabe, S. E. (2009). Dimensions of 

sexual orientation and the prevalence of mood and anxiety disorders in the United 

States. American Journal of Public Health, 100(3), 468–475. Retrieved February 13, 

2012, from http://www.ncbi.nlm.nih.gov/pubmed/19696380

Bye, L. L., Greenwood, G. L., Gruskin, E. P., Matevia, M., & Pollack, L. M. (2007). 

Disparities in smoking between the lesbian, gay, and bisexual population and the 

general population in California. American Journal of Public Health, 97(8), 1496–

1502. Retrieved February 13, 2012, from 

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1931451/

Caribbean Basin and Hispanic ATTC. (2010). Una introducción para el proveedor de 

tratamiento de abuso de sustancias para lesbianas, gays, bisexuales e individuos 

transgénero [A provider’s introduction to substance abuse treatment for lesbian, 

gay, bisexual, and transgender individuals]. (Spanish). Available at 

http://www.attcnetwork.org/regcenters/productdetails.asp?prodID=553&rcID=1

Centers for Disease Control and Prevention. (1999, rev.). Compendium of HIV 

Prevention Interventions with Evidence of Effectiveness. Atlanta, GA: Centers for 

Disease Control and Prevention, HIV/AIDS Prevention Research Synthesis Project. 

Retrieved February 23, 2012, from 

http://www.cdc.gov/hiv/prevention/research/compendium/index.html

Centers for Disease Control and Prevention. (2006). Adverse Childhood Experiences 

Study. Atlanta, GA: Centers for Disease Control and Prevention. Retrieved February 

13, 2012, from http://www.cdc.gov/nccdphp/ace/index.htm

Centers for Disease Control and Prevention. (2007). Web-based Injury Statistics Query 

and Reporting System (WISQARS). Retrieved March 19, 2012 from 

http://www.cdc.gov/injury/wisqars/index.html

Centers for Disease Control and Prevention. (2011a). Sexual identity, sex of sexual 

contacts, and health risk behaviors among students in grades 9–12 in selected 

sites—Youth Risk Behavior Surveillance, United States, 2001–2009. Morbidity and 

Mortality Weekly Report Surveillance Summary. Retrieved November 17, 2011, 

from http://www.cdc.gov/mmwr/preview/mmwrhtml/ss6007a1.htm

Centers for Disease Control and Prevention. (2011b). New multi-year data show annual 

HIV infections in U.S. relatively stable: Alarming increase among young, black gay 

and bisexual men requires urgent attention. (Press release). Retrieved February 13, 

2012, from http://www.cdc.gov/nchhstp/newsroom/HIVIncidencePressRelease.html

Centers for Disease Control and Prevention. (2011c). Health risks among sexual minority 

youth. Retrieved February 23, 2012, from http://www.cdc.gov/healthyyouth/

disparities/smy.htm

Clements-Nolle, K., Guzman, R., Katz, M., & Marx, R. (2001). HIV prevalence, risk 

behaviors, health care use, and mental health status of transgender persons:

Implications for public health intervention. American Journal of Public Health, 91(6), 

915–921.

56
A Dialogue on Advancing Opportunities for 

Recovery from Addictions and Mental Health Problems

Cochran, S. D., Gilman, S. E., Hughes, M., Kessler, R. C., Mays, V. M., & Ostrow, D. 

(2001). Risk of psychiatric disorders among individuals reporting same-sex sexual 

partners in the National Comorbidity Survey. American Journal of Public Health, 91, 

933–939. 

Diaz, R. M., Huebner, D., Ryan, C., & Sanchez, J. (2009). Family rejection as a predictor 

of negative health outcomes in white and Latino lesbian, gay, and bisexual young 

adults. Pediatrics, 123(1), 346–352. 

Dobinson, C. and Steele, L. (2008). Ten things bisexual people should discuss with their 

health care providers. New York: Gay and Lesbian Medical Association.

Eliason, M. J. (2010). Environmental prevention strategies to address LGBT alcohol, 

tobacco, and drug use. San Francisco, CA: LGBT-Tristar. Retrieved February 13, 

2012, from http://lgbt-tristar.com/images/Environmental_Prevention_and_LGBT_

Substance_Abuse.pdf

Elliot, P. (1996). Shattering illusions: Same sex domestic violence. Journal of Gay and 

Lesbian Social Services, 4(1), 1–8. 

Frazer, M. S., & Warren, B. E. (2010). A blueprint for meeting LGBT health and human 

services needs in New York State. New York, NY: Empire State Pride Agenda 

Foundation, New York State LGBT Health and Human Services Network, and 

Institute for LGBT Social Science and Public Policy at Hunter College.

Gay and Lesbian Medical Association and LGBT health experts. (2001). Healthy People 

2010 companion document for lesbian, gay, bisexual, and transgender (LGBT) 

health. San Francisco, CA: Gay and Lesbian Medical Association. Retrieved 

February 23, 2012, from 

http://www.glma.org/_data/n_0001/resources/live/HealthyCompanionDoc3.pdf

Grant, J. E. (2011, May-June). Address complexities in the LGBT population. Addiction 

Professional: Online Resource Guide 2011. Retrieved November 21, 2011, from 

http://www.addictionpro.com/ME2/dirmod.asp?sid=&nm=&type=Publishing&mod=

Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F87F791&tier=

4&id=6EB4F3AE3BFE444188F1F18B96D5D129&WA_MAILINGLEVEL_CODE= 

Grant, J. M., Mottet, L. A., Tanis, J., Harrison, J., Herman, J. L., & Keisling, M. (2011).

Injustice at every turn: A report of the National Transgender Discrimination Survey. 

Washington, DC: National Center for Transgender Equality and National Gay and 

Lesbian Task Force. Executive summary retrieved February 24, 2012, from 

http://transequality.org/PDFs/Executive_Summary.pdf

Greenwood, G. L., Paul, J. P., Pollack, L. M., Binson, D., Catania, J. A., Chang, J., et al. 

(2005). Tobacco use and cessation among a household-based sample of US urban 

men who have sex with men. American Journal of Public Health, 95(1), 145–151. 

Retrieved November 21, 2011, from 

http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2003.021451

Herek, G. M. (2009). Hate crimes and stigma-related experiences among sexual minority 

adults in the United States: Prevalence estimates from a national probability sample. 

Journal of Interpersonal Violence, 24(1), 54–74. Retrieved November 21, 2011, from 

http://jiv.sagepub.com/content/24/1/54

57
A Dialogue on Advancing Opportunities for 

Recovery from Addictions and Mental Health Problems

Herek, G. M., Gillis, J. R., & Cogan, J. C. (1999). Psychological sequelae of hate-crime 

victimization among lesbian, gay, and bisexual adults. Journal of Consulting and 

Clinical Psychology, 67(6), 945–951.

Houston, E., & McKirman, D. J. (2007). Intimate partner abuse among gay and bisexual 

men: Risk correlates and health outcomes. Journal of Urban Health, 84(5), 681–

690. Retrieved November 21, 2011, from http://www.ncbi.nlm.nih.gov/

pubmed/17610158 

Huygen, C. (2009, January). Reaching out to the LGBT population. Behavioral 

Healthcare, 29(1), 38–40.

IOM [Institute of Medicine]. (2011). The health of lesbian, gay, bisexual, and transgender 

people: Building a foundation for better understanding. Washington, DC: The 

National Academies Press. Retrieved November 21, 2011, from 

http://www.iom.edu/Reports/2011/The-Health-of-Lesbian-Gay-Bisexual-andTransgender-People.aspx

Island, D., & Letellier, P. (1991). Men who beat the men who love them. New York, NY: 

Harrington Park Press. 

[Keystone Pride Recovery Initiative]. (2009). Issues of access to and inclusion in 

behavioral health services for lesbian, gay, bisexual, transgender, questioning, and 

intersex consumers: Recommendations to the Pennsylvania Department of Public 

Welfare’s Office of Mental Health and Substance Abuse Services. Retrieved 

November 21, 2011, at

http://www.parecovery.org/documents/OMHSAS_LGBTQI_Recommendations.pdf

Lee, J. G., Griffin, G. K., & Melvin, C. L. (2009). Tobacco use among sexual minorities in 

the USA, 1987 to May 2007: A systematic review. Tobacco Control, 18(4), 275–282. 

Retrieved February 23, 2012, from 

http://tobaccocontrol.bmj.com/content/18/4/310.full.pdf+html

Lev, A. I. (2004). Transgender emergence. New York, NY: Hawthorne Clinical Practice 

Press. 

Lombardi, E. L., Wilchins, R. A., Priesing, D., & Malouf, D. (2001). Gender violence: 

Transgender experiences with violence and discrimination. Journal of 

Homosexuality, 42(1), 89–101.

Lucksted, A. (2004). Lesbian, gay, bisexual, & transgender people receiving services in 

the public mental health system: Raising issues. Retrieved February 23, 2012, from 

http://www.nami.org/Template.m?Section=Multicultural_Support1&Template=

/ContentManagement/ContentDisplay.cfm&ContentID=28247

Mathy, R. M. (2003).Transgender identity and suicidality: Sexual orientation, behavioral 

problems, and substance abuse. Journal of Psychology & Human Sexuality, 14, 47–

65.

McDaniel, J. S., Purcell, D. W., & D’Augelli, A. R. (2001). The relationship between 

sexual orientation and risk for suicide: Research findings and future directions for 

research and prevention. Suicide and Life-Threatening Behavior, 31(1) (Suppl.), 84–

105.

58
A Dialogue on Advancing Opportunities for 

Recovery from Addictions and Mental Health Problems

Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and 

bisexual populations: Conceptual issues and research evidence. Psychological

Bulletin, 129(5): 674–697. Retrieved November 10, 2011, from 

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2072932/pdf/nihms32623.pdf

Murg, W. (2011, June). Momentum mounts to again embrace two-spirits. Indian Country 

Today Media Network.com. Retrieved November 21, 2011, from 

http://www.indiancountrytodaymedianetwork.com/2011/06/06/momentum-mountsto-again-embrace-two-spirits-35837#ixzz1eNPedHav

NALGAP. (1994). Prevention policy statement & guidelines. Retrieved February 23, 

2012, from 

http://www.nalgap.org/PDF/Resources/NALGAP_94_Prev_Policy_Guidelines.pdf

Nathan Kline Institute Center of Excellence in Culturally Competent Mental Health. 

(2011). LGBTQ cultural profile. Lesbian gay bisexual transgender queer/questioning 

and intersex: To be noted. Retrieved August 31, 2011, from 

http://ssrdqst.rfmh.org/cecc/index.php?q=node/84

National Coalition of Anti-Violence Programs. (2005). About NCAVP. Retrieved 

November 21, 2011, from http://www.ncavp.org/about/default.aspx

National Institute on Alcohol Abuse and Alcoholism. (2005). Social work curriculum on 

alcohol use disorders: Module 10G: Sexual orientation and alcohol disorders. 

Retrieved February 23, 2012, from 

http://pubs.niaaa.nih.gov/publications/social/Module10GSexualOrientation/Module1

0G.html and

http://pubs.niaaa.nih.gov/publications/Social/Module10GSexualOrientation/Module1

0G.pdf . See also http://pubs.niaaa.nih.gov/publications/Social/main.html

New Freedom Commission on Mental Health. (2003). Achieving the promise: 

Transforming mental health care in America. Final report. DHHS Pub. No. SMA-03-

3832. Rockville, MD: Substance Abuse and Mental Health Services Administration.

Poirier, J. M., Francis, K. B., Fisher, S. K., Williams-Washington, K., Goode, T. D., & 

Jackson, V. H. (2008). Practice brief 1: Providing services and supports for youth 

who are lesbian, gay, bisexual, transgender, questioning, intersex, or two-spirit. 

Washington, DC: National Center for Cultural Competence, Georgetown University 

Center for Child and Human Development. 

Prairielands ATTC. (2007). Trainer guide: A provider’s introduction to substance abuse 

treatment for lesbian, gay, bisexual, and transgender individuals. Based on DHHS 

Publication No. (SMA) 01-3498. Rockville, MD: Center for Substance Abuse 

Treatment, Substance Abuse and Mental Health Services Administration. Available 

http://www.attcnetwork.org/regcenters/generalContent.asp?rcid=12&content=STCU

STOM3

Quintana, N. S., Rosenthal, J., & Krehely, J. (2010). On the streets: The federal response 

to gay and transgender homeless youth. Washington, DC: Center for American 

Progress. Retrieved February 24, 2012, from http://www.americanprogress.org

/issues/2010/06/pdf/lgbtyouthhomelessness.pdf

59
A Dialogue on Advancing Opportunities for 

Recovery from Addictions and Mental Health Problems

Rankin, S., Weber, G., Blumenfeld, W., & Frazer, S. (2010). 2010 State of Higher 

Education for Lesbian, Gay, Bisexual, and Transgender People. Charlotte, NC: 

Campus Pride.

Ray, N. (2006). Lesbian, gay, bisexual, and transgender youth: An epidemic of 

homelessness. New York: National Gay and Lesbian Task Force Policy Institute and 

the National Coalition for the Homeless. 

Remafedi, G., Farrow, J. A., & Deisher, R. W. (1991). Risk factors for attempted suicide 

in gay and bisexual youth. Pediatrics, 87(6), 869–875. 

Rosenberg, S., Rosenberg, J., Huygen, C., & Klein, E. (2005). No need to hide: Out of 

the closet and mentally ill. Best Practices in Mental Health: An International Journal,

1, 72–85.

Rosenberg, S., Rosenberg, J., Huygen, C., & Klein, E. (2006). Stigma, sexual orientation, 

and mental illness: A community mental health perspective. In Community Mental 

Health: Challenges for the 21st Century. Rosenberg, J., and Rosenberg, S. 

(eds.). New York, NY: Routledge.

Ryan, C. (2009). Helping families support their lesbian, gay, bisexual, and transgender 

(LGBT) children. Washington, DC: National Center for Cultural Competence, 

Georgetown University Center for Child and Human Development.

Ryan, C., Russell, S. T., Huebner, D., Diaz, R., & Sanchez, J. (2010). Family acceptance 

in adolescence and the health of LGBT young adults. Journal of Child and 

Adolescent Psychiatric Nursing, 23(4), 205–213.

Savage, D., & Miller, T. (Comps. & Eds.). (2012). It gets better: Coming out, overcoming 

bullying, and creating a life worth living. New York: Penguin Group. 

Stall, R., Valdiserri, R. O., & Wolitski, R. J. (Eds.). (2008). Unequal opportunity: Health 

disparities affecting gay and bisexual men in the United States. New York, NY: 

Oxford University Press.

Substance Abuse and Mental Health Services Administration. (2012). Top health issues 

for LGBT populations information & resource kit. HHS Publication No. (SMA) 12-

4684. Rockville, MD: Substance Abuse and Mental Health Services Administration. 

Retrieved April 2, 2012, from http://store.samhsa.gov/product/Top-Health-Issues-forLGBT-Populations/SMA12-4684?WT.ac=EB_20120328_SMA12-4684

Substance Abuse and Mental Health Services Administration, Center for Substance 

Abuse Treatment. (2001). A provider’s introduction to substance abuse treatment for 

lesbian, gay, bisexual, and transgender individuals. Washington, DC: U.S. 

Department of Health and Human Services. 

Substance Abuse and Mental Health Services Administration. (2011a). SAMHSA 

announces a working definition of “recovery” from mental disorders and substance 

use disorders. (Press release). Retrieved February 13, 2012, from 

http://www.samhsa.gov/newsroom/advisories/1112223420.aspx

Substance Abuse and Mental Health Services Administration (2011b). SAMHSA News, 

19(2).

60
A Dialogue on Advancing Opportunities for 

Recovery from Addictions and Mental Health Problems

Suicide Prevention Resource Center. (2008). Suicide risk and prevention for lesbian, 

gay, bisexual, and transgender youth. Newton, MA: Education Development Center, 

Inc. Retrieved March 19, 2012, from http://www.sprc.org/sites/sprc.org/files/library

/SPRC_LGBT_Youth.pdf

Suicide Prevention Resource Center. (2011). Suicide prevention among LGBT youth: A 

workshop for professionals who serve youth. Newton, MA: Education Development 

Center, Inc. Retrieved February 24, 2012, from 

http://www.mnschooloutreach.org/attachments/Leaders_Guide_for_Suicide_Prevent

ion_among_LGBT_Youth_Workshop.pdf

University of California–San Francisco. (2011). Primary care protocol for transgender 

patient care. Retrieved February 24, 2012, from 

http://transhealth.ucsf.edu/trans?page=protocol-00-00

U.S. Department of Health and Human Services. (2001a). Mental health: Culture, race, 

and ethnicity—A supplement to Mental Health: A Report of the Surgeon General. 

Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse 

and Mental Health Services Administration, Center for Mental Health Services.

U.S. Department of Health and Human Services. (2001b). National strategy for suicide 

prevention: Goals and objectives for action. Rockville, MD: U.S. Department of 

Health and Human Services, Public Health Service.

U.S. Department of Health and Human Services. (2011). U.S. Department of Health and 

Human Services recommended actions to improve the health and well-being of 

lesbian, gay, bisexual, and transgender communities. Retrieved February 14, 2012, 

from http://www.hhs.gov/secretary/about/lgbthealth.html

Warren, B., & Barber, M. (2009). Cultural profiles: Lesbian gay bisexual transgender 

queer/questioning and intersex. Nathan Kline Institute Center of Excellence in 

Culturally Competent Mental Health. Retrieved February 25, 2012, from 

http://ssrdqst.rfmh.org/cecc/index.php?q=node/86

Wichstrøm, L., & Hegna, K. (2003). Sexual orientation and suicide attempt: A longitudinal 

study of the general Norwegian adolescent population. Journal of Abnormal 

Psychology, 112(1), 144–151. Retrieved March 19, 2012, from 

http://psycnet.apa.org/journals/abn/112/1/144/

Willis, D. G. (2004). Hate crimes against gay males: An overview. Issues in Mental 

Health Nursing, 25(2), 115–132. Retrieved November 21, 2011, from http://www.

ncbi.nlm.nih.gov/pubmed/14726266

Youth Pride. (2010). Coming out. Retrieved February 14, 2012, from http://www.

youthprideri.org/Resources/Definitions/tabid/187/Default.aspx

61
Appendix E. Dialogue Participants

 = Planning Committee Members

Frann Anderson

Director of Performance Improvement

State of Delaware

New Castle, Delaware 

Daniel Blausey

Owner/Founder

Studio Blue: Art + Psychotherapy LLC

Boulder, Colorado

Rosalyne Blumenstein

Medical Social Worker/Therapist

Hollywood Hills, California 

Rita Cisneros

Coordinator

Pennsylvania Mental Health 

Consumers’ Association

Harrisburg, Pennsylvania

Andrew Darby

Student

University of Maryland—Baltimore 

School of Social Work

Baltimore, Maryland 

 Mark A. Davis

Agitator

Pink & Blues Philadelphia

Philadelphia, Pennsylvania

Judah Dorrington

Consultant

Dorrington & Saunders and Associates

Framingham, Massachusetts

Terry Gock

Psychologist and Agency Director

Asian Pacific Family Center, Pacific 

Clinics

Rosemead, California

Robert Hess III

Consultant

Hess III Consulting

Phoenix, Arizona 

Christian Huygen

Executive Director

Rainbow Heights Club

Brooklyn, New York

 George Marcelle

Health Communications/Marketing

ICF Macro International

Los Angeles, California 

 Stephanie Montgomery

Social Worker

East Bay Community Recovery Project

Oakland, California 

Traci Murry

Mental Health Volunteer Coordinator

Joseph, Oregon

Gary Neumann

Project Director

Montana Wyoming Tribal Leaders 

Council

Billings, Montana

62
A Dialogue on Advancing Opportunities for

Recovery from Addictions and Mental Health Problems

Darlene Nipper

Deputy Executive Director

The National Gay & Lesbian Task 

Force 

Washington, D.C.

Stephen Puibello

Sales

NY Open Center

New York, New York

 Candace Shelton

Senior Native American Specialist

Fetal Alcohol Spectrum Disorders 

Center for Excellence

Tucson, Arizona

Luther Thompson

Youth Advocate/Events Coordinator

Baltimore Homeless Youth Initiative

Youth Leaders Service Group

Baltimore, Maryland 

Barbara Warren

Lecturer and Director

Center for LGBT Social Science and 

Public Policy

Hunter College

New York, New York

Loretta Worthington

Executive Director

Rainbow Health Initiative

Minneapolis, Minnesota

Federal Employees

Edwin Craft

Senior Public Health Analyst

Center for Substance Abuse Treatment

Substance Abuse and Mental Health 

Services Administration

Rockville, Maryland

Paolo del Vecchio

Associate Director for Consumer 

Affairs

Center for Mental Health Services 

Substance Abuse and Mental Health 

Services Administration 

Rockville, Maryland 

Nancy Kennedy

Senior Public Health Advisor

Center for Substance Abuse 

Prevention

Substance Abuse and Mental Health 

Services Administration

Rockville, Maryland

Leah McGee 

Public Health Analyst

Center for Mental Health Services 

Substance Abuse and Mental Health 

Services Administration 

Rockville, Maryland 

Catherine Nugent

Senior Public Health Analyst

Center for Mental Health Services 

Substance Abuse and Mental Health 

Services Administration 

Rockville, Maryland

Bethanie Parrish

Public Health Advisor

Center for Mental Health Services

Substance Abuse and Mental Health 

Services Administration

Rockville, Maryland

63
Building Bridges: LGBT Populations

Facilitator

Rebecca Subar

Conflict and Strategy Consultant

Dragonfly Partners, LLC

Philadelphia, Pennsylvania

Writer

Irene Saunders Goldstein

writer  editor  oral historian

Arlington, Virginia

64
Pins and Nails

by Trois Lyric*

Pins and nails upon the stairs made it hard to get to you

All around me, instruments of intentional failure filled my spirits like a well at the time of a 

flood

How could you leave me to assume masculinity?

To misuse my body because I didn’t know what loving a man entailed

Because of your lacking, I grew up confusing lust with love

I’ve seemed to have lost myself

I’ve seemed to miss the head start I’ve been anticipating

Your words pulled triggers, aiming at my aspirations

So, now I stand

Here in desperation in the midst of these pins and nails

Pushing, forcing my way through the pain . . . 

Spikes and screws wedged in groove pierced my shoes, yet determination proved

I am not defined by the chalk outlines that trace the streets in which I reside nor do I 

succumb to discrimination in variation of pigmentation, furthermore, sexual 

orientation

I am not what surrounds me

Though it motivates and encourages me

To push, to force my way through the pain

Overcoming all obstacles of destruction

Transforming foreseen failures into fiction

I crown myself with royalty

My feet, they speak my poetry

In other words, my walk mirrors my state of mind

My speech divine, so with my feet I climb

In desperation to reach my destination

Like a daughter trapped with her mother’s lifeless body, I thirst, I yearn for understanding

Undermining the attempts of the adversary, I penetrate the distractions that block my 

promise

The pins and nails upon the stairs made it hard to get to you, true

Yet in still, I made it through

Persistence, determination to

Defeat the odds and win the war

They shove me from the nest, instinctively, I soar

To my calling, to my end

To you 

*Trois Lyric is the pen name of a dialogue participant.