Population at Risk Studies conducted by Hazelden Betty Ford Foundation's Butler Center for Research indicate that LGBTQ individuals are more likely to have a history of trauma and are more likely to suffer from a number of mental health issues than non-LGBTQ individuals. As shown in the accompanying chart, a statistical analysis of adult patients attending residential treatment at Hazelden Betty Ford Foundation reveals that LGBTQ patients are significantly more likely to have a co-occurring mental health diagnosis. In addition, LGBTQ patients are significantly more likely to have suffered past sexual abuse (48 percent versus 15 percent) and physical abuse (51 percent versus 28 percent). "Terminally different" and "terminally alone" Buster Ross describes living with active addiction as feeling "terminally different" and "terminally alone." And for LGBTQ individuals who struggle with addiction to alcohol or other drugs, those feelings of isolation and ostracism are too often compounded by the cumulative trauma of rejection, humiliation, physical and emotional violence and shame. The collective effect? An increased risk of addiction and co-occurring mental health disorders for LGBTQ individuals (see chart). "Trauma is in the water for LGBTQ people," says Ross. "It's the repeated lack-of-safety experience that comes from a lifetime spent adapting and developing in a culture with forces that can be unaccepting and antagonistic." As director of Hazelden Betty Ford Foundation's LGBTQ-Integrative Program, Ross has been instrumental in developing addiction treatment programs and services that are affirming, supportive, and true to Twelve Step practices of respect and acceptance. The approach has deep and healing roots. "From the very start, Alcoholics Anonymous and the Twelve Steps have been about including everyone," says Ross. "Love and tolerance are the heart of recovery. What gets straight people sober and what gets LGBTQ people sober is the same thing—community, honest communication and mutual support." "Integrative" refers to evidence-based addiction treatment practices that involve LGBTQ and straight patients together in much of the same core programming, including education about sexual health. Within a predominantly heterosexual treatment setting, LGBTQ patients are able to experience a level of acceptance, validation and trust essential to addiction recovery. "Our peer-based model of care makes room for everyone," says Ross. "We don't segregate LGBTQ people into an entirely separate program. Recovery is about breaking out of isolation." The LGBTQ-Integrative Program is offered at Hazelden's centers in Newberg and Beaverton, Oregon, and expanding to the Betty Ford Centers in Rancho Mirage and Los Angeles, California. Additionally, LGBTQ services and support groups are offered throughout the Hazelden Betty Ford Foundation national system of care, including Hazelden's adolescent and young adult center in Plymouth, Minnesota.