Sometimes a problem can be sitting there as plain as day, but it takes someone else pointing it out for you to realize that it actually exists.
That’s what happened for Cash Stone, LADC, an outpatient addiction counselor at Hazelden Betty Ford in St. Paul.
“One day I was stopped in the hallway by an employee who was giving a tour of our facility to a young man,” Stone recalled. The young man, a potential client, wanted to know if Hazelden offered any services designed specifically for the LGBTQ+ community.
“I said,” recalled Stone, whose preferred pronouns are they/them/theirs, “‘We don’t have anything specific, but we do have many LGBTQ+ clients. If you decide to come here, I can try to make sure you get into a group with a few people you can relate to.’”
That promise led Stone to further investigation of Hazelden’s LGBTQ+-friendly treatment options. While there were plenty of Hazelden staff, including Stone, who identify as LGBTQ+, Stone said that they quickly realized that “we actually didn’t have many queer clients in the building.” This realization felt important, like there was a programming — and clientele — gap, and a change needed to happen. Soon.
So Stone, a take-charge kind of person, jumped into action.
“I talked with our clinical director,” Stone recalled. “I said, ‘This is a really important and underserved population that we should be reaching.’ There are much higher levels of addiction in the LGBTQ+ community, and there is a huge LGBTQ+ community in the Twin Cities. I said, ‘We need to have a program here.’ This would be an ‘If we build it they will come-type situation.’”
With support from higher-ups at Hazelden Betty Ford, it was decided that the organization would launch a new LGBTQ+ intensive outpatient support group at their St. Paul location. Stone volunteered to step down from their manager role to lead the group.
“I’m obviously queer identified and I have a great deal of understanding of the historical trauma that LGBTQ+ folks have experienced,” Stone said. Plus, after six years managing recovery programs for Hazelden, Stone was ready for a career refresh: “I love counseling,” they said. “It’s my passion. I was ready to get back into it full time.”
Hazelden’s new LGBTQ+ intensive outpatient support group launched June 6. Stone explained that it has already attracted a small but growing group of members.
“Reaction has been positive,” Stone said. “I’ve had so many people come up to me and reach out via email or phone messages saying how very much needed this group and these services are for the community. The group participants say they enjoy the group immensely. Everybody understands and they don’t have to explain what they’re talking about. It’s really a safe space.”
A real need
It took Jon Hartman years to find the safe space he needed to finally achieve lasting sobriety.
“I’m a member of the LGBTQ+ community,” Hartman said. “I went to seven treatments before I finally got sober. It wasn’t until the seventh treatment, which was designed specifically for the LGBTQ+ community, that I got much traction.”
With each trip to a new treatment program, Hartman said he’d start with the hope that he could make the changes he needed to make to say sober. But it didn’t take long for him to realize that he was usually the only LGBTQ+ client in room. That realization usually left him feeling alone or disconnected from the group.
“The first times I went to treatment, I would go and I would feel good about the fact that I was in a group and taking it seriously,” Hartman said, “but then I would realize that I wasn’t actually connecting much with the other people. They weren’t peers or friends that I would want to hang out with after I finished treatment. To me that felt important.”
Hartman now works as an addiction program supervisor at Hazelden Betty Ford in St. Paul. He understands that the people struggling with the disease of addiction often feel isolated from the rest of the world: He felt that way almost all of the time. “Not having peers in the groups I was attending only increased those feelings,” he said. “That made it hard to make the changes stick.” When he got out of treatment, he’d feel lonely and desperate for company. He’d eventually end up hanging out with his LGBTQ+ friends at the bar or at parties, and his addictive behaviors would start up again.
Even when straight members of Hartman’s recovery groups did their best to help him feel welcome and accepted, he said he often still felt he had to spend a lot of his time explaining his lifestyle and day-to-day struggles to stay sober. His LGBTQ+ friends needed no explanation to understand these issues.
“It could feel exhausting,” Hartman said of his time in recovery. “Sometimes, just when I felt like I was about to make an important point, I had to slow down and explain, or even censor myself. It got in the way.”
Stone said that Hartman’s struggles to find a comfortable space in recovery groups isn’t uncommon.
“In group settings, queer people, when they are talking about the context of their lives, tend to do a lot of educating of the straight people in the group,” Stone said. “When you’re spending time educating straight individuals about the very basic contexts of being queer, you’re missing the larger salient points of recovery.”
Say if a client in a recovery group wants to talk about their experience on gay dating apps. “If the client says something like, ‘I’m on Grindr,’” Stone said, “and some of the straight folks in the group ask, ‘What’s Grindr?’ Then the client has to pause and explain, ‘It’s a gay hookup app.’ Then the LGBTQ+ client starts to think, ‘This so far from what I wanted to talk about in the first place.’ The moment is lost.”
In an LGBTQ+-focused recovery group, members speak the same language, Stone said.
“All of those things are understood. You don’t have to explain yourself in greater detail. Everyone is responding with the same level of understanding.”
When Hartman finally found a treatment group specifically designed for the LGBTQ+ community, at PRIDE Institute in Minneapolis, he said, “I felt like I was in recovery programming with good friends. I finally started to get that sense of, ‘I found my people.’ It made recovery easier, made it more fun. It wasn’t like I went to group and was watching my words or positioning stuff in a polite way. I could finally talk about what I wanted to talk about. It was so freeing.”
In the years since he’s been sober Hartman has met many LGBTQ+ people whose recovery journey lasted as long — or even longer — than his did: “For a lot of people in our community I think that type of experience is pretty common. Many of us need to find people we identify with as we find our way to treatment.”
In recent years, Hazelden executives have come to the understanding that population-specific programming can be more effective for many groups of people, Hartman said.
“We are starting to recognize the need to meet different populations where they are at,” he said. “We have a recovery track for people in the legal profession. We do specific programming for health care providers. Many of our groups are divided by gender. We’re starting to realize that different populations need different solutions.”
John Engebreth, executive director of Hazelden Betty Ford’s Minnesota outpatient programs, said that before his organization launched the LGBTQ+-specific support group, they made a point of hiring staff that reflected the community.
“Short of having a specific track within our services for LGBTQ+ patients, what we’ve tried to do is to have a diverse staff that treats all patients with respect,” he said. “We don’t want to reinforce any shame or difficulties that our clients have had in their lives.”
When Stone suggested starting an LGBTQ+-specific group, Hazelden leaders were enthusiastic. It fell in line with the organization’s move toward providing more safe recovery spaces for members of underserved communities.
“There are so many opportunities for cisgender people to have a traditional recovery experience in the Twin Cities,” Engebreth said. That’s not the same for LGBTQ+ people. “The more recovery options that can be available for queer communities the better. That population needs more options. Options are good.”
Higher addiction rates
Rates of addiction are higher in the LGBTQ+ community than in other groups, Stone said. According to the National Institute on Drug Abuse, LGBTQ+ people are more than twice as likely as heterosexual adults (39.1 percent vs. 17.1 percent) to have used illicit drugs in the past year. Nearly a third of LGBTQ+ adults used marijuana in the past year, compared to 12.9 percent of heterosexual adults, and about one in 10 LGBTQ+ adults misused prescription pain relievers, compared to 4.5 percent of heterosexual adults.
Stone said that much of the higher rate of substance abuse in the LGBTQ+ community can be chalked up to a cultural focus on drugs and alcohol as an escape from the stress and trauma of a life lived on the margins of society.
“Drugs and alcohol make you feel better when you are inundated with fear and are living with a great deal of risk in your day-to-day life,” Stone said. “Alcohol and other drugs are a mental sanctuary when you are dealing with that much stress.” And much of LGBTQ+ life has historically been centered around gay bars and party culture, Stone added. “It’s sort of a perfect combination — the trauma and the fear in the outside world and the camaraderie and the authenticity of being together with a queer community. To this day very much of queer culture is imbedded in the use of alcohol and drugs.”
Stone said that it took years to come to a point where they felt comfortable in their identity. The trauma and stress of being a person who does not fit traditional gender definitions leads many people to substance abuse, Stone said. A group like this one could play an important role in many people’s lives.
“I am a non-binary person,” Stone said. “I am trans-masculine and it is impactful to hear public debate on which bathroom I’m allowed to use and what may or may not happen to me as a result of that. It is something I think about every time I go into a public restroom. I’m very well equipped with coping skills and am able to navigate through all of those complexities. But it has taken a lot of hard work on my part to do that. People need help to get to that point.”
Hazelden’s LGBTQ+ program is designed to be an intensive outpatient program.
“We call it a long-engagement program for outpatient services,” Stone explained. At the beginning, the group meets four days a week for three hours a day. “Eventually, they go down to three days a week then two days a week then one day a week. The pace is determined by the client.” As group leader, Stone’s role is to be in conversation with clients about what level of engagement will help them in their recovery process. “The goal is to have someone wade into the deep end at a pace they are happy with,” Stone said.
Intensive outpatient programs are designed to be long-term. “On average, people tend to stay four to six months,” Stone said, “but it’s not uncommon for us to have people who stay on for over a year.”
The group focuses on topics that are important to members of the LGBTQ+ community.
“We discuss relationships and the relationship between relationships and chemical use,” Stone said. “We get into the issue of sex and chemical use. We talk about family of origin and family of choice. The coming-out process is big. We also address issues of bisexual invisibility, that concept that bisexuals are perceived as heterosexual unless they are in a relationship with someone of the same gender. And we talk about queer, non-binary body-image issues and identity development, which is also really big for this population.”
By entering the arena of LGBTQ+ addiction treatment, Hazelden runs the risk of upsetting existing programs like the 30-year-old PRIDE Institute or Latitudes, a small LGBTQ+-focused residential and outpatient treatment center in St. Paul.
Hartman said that he thinks there is room for more recovery programs focused on the LGBTQ+ population. “We have a big LGBTQ+ community in the Twin Cities,” he said. “I don’t think we’re competing or cannibalizing by starting up this program. We’ll be offering an alternative, a different type of programming, a different environment.”
Stone added that there is no shortage of people in the Twin Cities who could benefit from LGBTQ+-focused recovery services. Nationwide, Stone said, “Specialized recovery services for the LGBTQ+ population aren’t very common. The Twin Cities is very fortunate to have the Pride Institute, which was for a long time the only LGBTQ+-specific treatment program in the country. But you need to have more than one option for treatment services. Not every program fits the needs of every person. Sometimes you need a different experience.”
Hartman said that many clients may be drawn to the new program because Hazelden Betty Ford has a reputation as a national leader in the recovery industry. Staff needs to work even harder to make sure that the program lives up to the organization’s reputation.
“It would be easy for Hazelden to rest on its laurels,” Hartman said. “We have to be up-to-date on evidence-based practice. People will come for the name, but they won’t stay here for the name. We need to provide programming that stands up to its name. Cash has put a lot of work into developing a program that is worthy of respect. ”
The staff at Hazelden’s St. Paul site is well qualified to take on this challenge, Stone said.
“We are incredibly fortunate at the St. Paul site to have very robust mental health services. We have psychiatry, we have addiction medicine doctors in addition to our addiction-treatment programming. We have the ability here to really wrap services around someone who needs them. We’ve very unique in that regard. Many addiction-treatment programs don’t have a robust level of support.”
Engebreth said that he believes that adding this new treatment program to the mix of options already available in the Twin Cities can only serve to make the local recovery community stronger.
“A person might want a fresh start somewhere else,” Engebreth said. “They might have struggled to find their place in another program.” Or maybe they need a refresh in their journey to lasting sobriety. “That’s why having more options is better. We’re all working to the same goal: To help people find recovery from addition.”