Studies indicate that members of the LGBTQ+ community experience substance use and co-occurring mental health disorders at twice the rate of the general population. Listen in as host William C. Moyers talks with clinician Princess Drake, PsyD, about related risk factors including historical trauma and the fear of "not being accepted for who you are." Drake discusses the importance of person-centered, culturally competent addiction treatment and inclusive peer recovery support communities. Read the podcast transcript below or listen and subscribe on iTunes, Google Play or watch on YouTube. 0:00:14 William MoyersWelcome to another interview in this series of Let's Talk podcasts. Brought to you by the Hazelden Betty Ford Foundation. I'm your host, William C. Moyers, and each podcast I sit down with an expert to discuss the issues that are at the essence of Hazelden Betty Ford's mission. From prevention of substance use and cutting-edge research to treatment, recovery support, and how technology is increasingly becoming a force of hope, help, and healing for people, families, and communities to overcome addiction. We are recording this podcast in the midst of the pandemic of coronavirus. And this requires us to take precautions here in the studio. That means that our guest, Dr. Princess Drake, and I are in separate rooms. But our focus is the same today. LGBTQ and substance use. Dr. Drake is a mental health practitioner at Hazelden Betty Ford and serves as our adjunct professor at the Hazelden Betty Ford Graduate School of Addiction Studies. Among her many other academic and professional accomplishments, she has her Doctorate in Clinical Psychology at Florida School of Professional Psychology. She earned it in 2018. Dr. Drake, welcome to our podcast today. 0:01:23 Dr. Princess DrakeThank you so much for having me. 0:01:25 William MoyersTell me where does your passion for this subject come from, the subject of LGBTQ and substance use? 0:01:31 Dr. Princess DrakeWell my passion first started when I recognized that a lot of the people who serve in our minority and special populations such as the LGBTQ+, don't get a lot of attention when it comes to specifically their struggles when it comes to substance use. And so where I found my passion is when I first started my internship here at Hazelden. Where I saw that there was a need for a lecture for this particular patient to know that we care about them, that we want to make sure that they get the best care. 0:01:59 William MoyersNot only that but why is that clinically important to patients? 0:02:03 Dr. Princess DrakeClinically it's important because we recognize that we're not just serving the patient for their substance use but we're serving the whole person. And so that means we take into account that there may be different struggles and there may be specific things that we need to talk about within their substance use treatment. To make sure that they get all the care they need. 0:02:21 William MoyersAnd priorities among priorities—what would be the priorities in that dynamic? 0:02:26 Dr. Princess DrakeRecognizing that sometimes a patient may come in with issues that has nothing to do with their sexual orientation. And/or their gender identity. And for us as clinicians to make sure that we ask those questions. We don't want to ever assume. And so if either whether it is or whether it's not, it's still gonna be important to their overall care and continuing care. 0:02:46 William MoyersAnd what about those tools that a practitioner needs to address these issues in that community? 0:02:51 Dr. Princess DrakeSo, one of the things we wanna make sure is that we're up on the latest research when it comes to the LGBTQ+ community population. That also includes being current on certain media. So for instance this past week, Congress passed to where there's a ban on not giving or taking away opportunities for the LGBTQ+ community when it comes to jobs. That's important when we think about their continuing care. Knowing that there's literature such as Lust, Men, and Meth so it's a book that really focuses in on methamphetamine use and the gay community when it comes to men. 0:03:27 William MoyersOf course you mentioned the Supreme Court decision this week and the importance of that and we're here in June of 2020. It's also Pride month and certainly there's more awareness than perhaps ever before about all the important issues that are as relevant to the LGBTQ community as other issues are in other communities. Why do you think it's important to acknowledge the historical aspect of the population? 0:03:52 Dr. Princess DrakeThat's a great question. So one of the things I always like to focus on in the lecture is that in 1969 we had the Stonewall Riots. And if anyone's familiar with Stonewall, it was where people who identified as LGBTQ+ found a safe haven. Which was a bar. And so we're dealing with people who have a substance use issue. And so recognizing the historical relevance of if they only found a haven in a bar, now it's even more important to make sure that they feel welcome in our AA and NA meetings. That they feel comfortable in treatment as well. 0:04:22 William MoyersSo how do you do that? 0:04:24 Dr. Princess DrakeYou offer the best services in terms of recognizing the struggle within the LGBTQ+ community. Recognizing the historical value of what happened with Stonewall and those people seeking equality. Not only at home but even in treatment. Treatment is often a microcosm of what the culture of our society provides. And so when they come to treatment, they could feel welcome. They know that they're gonna get equal amount of treatment and the services that they need. 0:04:53 William MoyersHow does your own perspective, the many perspectives that you have, how does all of that factor into not only your passion but the work that you do? 0:05:03 Dr. Princess DrakePersonally recognizing that I have individuals in my family and as friends who not only identify as LGBTQ+ but are in recovery themselves. And so I often ask them, you know, what is it that I can be providing as a clinician for patients to know that I care and not just in a superficial way. And some of the things they often tell me is being aware of the current research. Asking such things as like their pronouns. 'Cause pronouns are very important. So knowing—I know identifies as I use she, her, and hers, and then also recognizing that some people don't. And so being able to ask those specific questions when I'm doing my assessment, or when I'm providing continuing care, is important. 0:05:45 William MoyersWhat do you—can you talk a little bit about the stigma around addiction and recovery? 0:05:51 Dr. Princess DrakeYes. Often times when it comes to the LGBTQ+ community, one of the things that comes up is that a lot of people don't recognize that they're gonna be twice as likely to use substances than a heterosexual or a straight individual. And with that 39.1 percent versus a straight individual, they're gonna be coming to treatment more often. And so when we know those statistics, we also know that they are more likely to have a mental health disorder. That doesn't mean that they're more prone 'cause they're no [more] prone than anyone else, but recognizing those specific factors because of the historical traumas that they've experienced. Because of the constant fear of going into the world and not being accepted for who they are. Those can add to those stressors which often times can contribute to whether they stay sober or they relapse. 0:06:39 William MoyersWhat is your counsel to patients coming out of Hazelden Betty Ford in this arena in terms of their—the importance of them finding meetings that are accommodating to the perspectives that they might have? Their own sexual orientation and otherwise? 0:06:58 Dr. Princess DrakeSo we have some great resources specifically in the Minnesota area but they're found in other states as well. You have programs like Out and Sober. Which is a place where organization that's specifically for the LGBTQ+ community where they can get together with others who are in recovery. But also recognizing that they can talk about their needs in terms of working through the Twelve Steps. There's also online directories that show specifically what groups specialize in LGBTQ+ recovery. and also just being in general that they don't always have to do that. A lot of times patients who identify as LGBTQ+ may wanna go just to a quote unquote "regular" meeting. They don't want that to be seen as something that has to be always out and in the front. 'Cause we also recognize too that some patients are not out. And so we never wanna out a patient. It is their choice when they are ready. And we wanna be able to support them no matter where they are in their process. 0:07:55 William MoyersWe talked a little bit earlier about current events, of course the current events of coronavirus, the civic strife that we're experiencing in the country now. We're as I said recording this in the summer of 2020, we've got political campaigns that are ramping up for the fall. Do you think this is a particularly difficult time for LGBTQ+ people who are in recovery? Do you think they're feeling more stress or are they no different than anybody else in that regard? 0:08:24 Dr. Princess DrakeI would say that their stress is probably equal or if not more. One of the things just because Pride month is such a huge opportunity for the community to be able to show their appreciation but also allow people to be able to express themselves and now that's gone. A lot of the Pride month festivities have gone virtual. Not only that with COVID-19, a lot of groups are now online. And so one of the things we talk about at Hazelden is creating a community of support. And if someone is already isolating, they may find it even more difficult because things are online or they're not able to reach out to people as much. And so it's even more important that specifically the LGBTQ+ community doesn't fall through the cracks. 0:09:06 William MoyersDo you have any concerns about virtual care as an alternative to what patients and people in recovery would be getting in normal times? 0:09:16 Dr. Princess DrakeI don't. I know they can be equally as effective and we have to promote it in a way to show people that it can be. It's just the new way of life right now that we're all having to go through. And so making that adjustment can be difficult. But it can still be just as effective as any other treatment. 0:09:32 William MoyersYou're an Adjunct Professor in our Graduate School, what is it that you teach there? 0:09:37 Dr. Princess DrakeI teach Individual Approaches which is I start class when we talk a lot about theories and therapeutic modalities and how that relates to substance use treatment. I also teach a class about co-occurring disorders. And so we talk about the integration of substance use and mental health. 0:09:53 William MoyersWhat about LGBTQ+ topics and the content of that? I mean a lot of clinical counselors, they're very good clinical counselors but they don't necessarily have that expertise, right? 0:10:04 Dr. Princess DrakeRight. And so what we do is when we talk about a therapeutic modality, we take into consideration the culture of considerations. Whether that be with LGBTQ+ or working with a black community or intersectionality considerations. So, if you have a patient who identifies as black but they are also gay, we have to take into consideration that they're gonna have even more stigmatization. Not only within other societies but even with their own community. If you're working with a patient who is trans, and also identifies as maybe gay or straight, then we take into consideration those aspects as well. 0:10:38 William MoyersWhat's your hope for the future? And I don't mean not just at Hazelden Betty Ford, but in the field of addiction treatment, and in the field of stigma reduction, what is your hope going forward? 0:10:50 Dr. Princess DrakeMy hope is that each and every clinician that goes through our program or any other program recognizes that cultural competency is just as important as learning any therapeutic modality or any technique. Because we are working with people. And people matter more than anything that we do. And having that therapeutic relationship is essential to any level of care and helping people stay sober. 0:11:14 William MoyersAmen! That's a perfect way to conclude our interview in this Let's Talk podcast. Thank you Dr. Princess Drake a mental health practitioner at Hazelden Betty Ford and an adjunct Professor in our Graduate School. Thank you for bringing not only your clinical expertise but clearly your passion and your keen perceptions to this topic today. 0:11:31 Dr. Princess DrakeThank you so much for having me. 0:11:33 William MoyersAnd thanks to all of you for tuning in. Be sure to keep coming back for more in our series of Let's Talk podcasts. On behalf of our Executive Producer Lisa Stangl and all of us at Hazelden Betty Ford, please stay safe and stay healthy in these times, as always.