Outcomes Measures for Sexual Outcomes Measures for Sexual Minority Patients in an Opioid Minority Patients in an Opioid

Treatment ProgramTreatment Program

C. John-Hull, S. Kritz, M. Chu, C. Madray, C. John-Hull, S. Kritz, M. Chu, C. Madray, G. Dominguez, C. Bowers, R. Sumpter, G. Dominguez, C. Bowers, R. Sumpter,

J. Mitchell, L.S. Brown J. Mitchell, L.S. Brown

Addiction Research and Treatment Corp, Brooklyn, NY Addiction Research and Treatment Corp, Brooklyn, NY 1120111201

Submitted as R-21 application in response to NIDA PA-06-Submitted as R-21 application in response to NIDA PA-06-218: 218:

Health Research with Diverse Populations Health Research with Diverse Populations

ABSTRACTABSTRACTStudies of sexual minorities have overwhelmingly been Studies of sexual minorities have overwhelmingly been cross-sectional and descriptive. Some of the findings are: cross-sectional and descriptive. Some of the findings are: (1) increased risk for mental health and substance abuse (1) increased risk for mental health and substance abuse problems; (2) different substances of abuse; (3) problems; (2) different substances of abuse; (3) engagement in riskier sexual practices; and, (4) unique engagement in riskier sexual practices; and, (4) unique healthcare access issues as compared to heterosexuals. healthcare access issues as compared to heterosexuals. The Addiction Research and Treatment Corporation is the The Addiction Research and Treatment Corporation is the largest non-hospital based Opioid Treatment Program in largest non-hospital based Opioid Treatment Program in New York State, serving more than 3,000 patients New York State, serving more than 3,000 patients annually. We provide a wide range of healthcare and annually. We provide a wide range of healthcare and social services to patients throughout Brooklyn and social services to patients throughout Brooklyn and Manhattan. On the basis of anonymous surveys, there is Manhattan. On the basis of anonymous surveys, there is clearly an interest in having programs geared towards this clearly an interest in having programs geared towards this population. In response to a NIDA R-01 Program population. In response to a NIDA R-01 Program Announcement (PA-06-218), we propose to do a pre and Announcement (PA-06-218), we propose to do a pre and post-intervention study that evaluates sexual minority post-intervention study that evaluates sexual minority patients participating in specialized groups in the patients participating in specialized groups in the following outcomes measures: (1) substance abuse; and, following outcomes measures: (1) substance abuse; and, (2) quality of life. These particular outcomes were chosen (2) quality of life. These particular outcomes were chosen because they will provide sufficient data for statistical because they will provide sufficient data for statistical analysis of significance, which is lacking in studies of this analysis of significance, which is lacking in studies of this population. population.

ACKNOWLEDGEMENTSACKNOWLEDGEMENTS PATIENTS AND PATIENTS AND

STAFF OF THE STAFF OF THE ADDICTION ADDICTION RESEARCH AND RESEARCH AND TREATMENT TREATMENT CORPORATION, A CORPORATION, A COMMUNITY-COMMUNITY-BASED BASED SUBSTANCE SUBSTANCE ABUSE SERVICE ABUSE SERVICE AGENCYAGENCY

ACKNOWLEDGEMENTSACKNOWLEDGEMENTS

•There are no financial interests or There are no financial interests or disclosures to report for any of the disclosures to report for any of the authors involved in this projectauthors involved in this project

BACKGROUNDBACKGROUND

Studies of sexual minority substance Studies of sexual minority substance abusers have been largely cross-abusers have been largely cross-sectional and descriptivesectional and descriptive

Longitudinal studies have been Longitudinal studies have been virtually non-existent virtually non-existent

ARTC provides substance abuse ARTC provides substance abuse treatment to a predominantly (90%) treatment to a predominantly (90%) racial/ethnic minority population that racial/ethnic minority population that includes sexual minorities includes sexual minorities

STUDY DESIGNSTUDY DESIGN

Prospective, longitudinal studyProspective, longitudinal study

Pre-post implementation Pre-post implementation evaluation evaluation

2-year timeline2-year timeline

STUDY POPULATIONSTUDY POPULATION

Sexual minorities, which can include…Sexual minorities, which can include…LesbiansLesbians

GaysGays

BisexualsBisexuals

TransgenderTransgender

IntersexIntersex

ARTC’s patient population is 48% Hispanic and ARTC’s patient population is 48% Hispanic and 42% 42%

African AmericanAfrican American

PRELIMINARY ACTIVITIESPRELIMINARY ACTIVITIES

Needs assessment surveys of Needs assessment surveys of stakeholders:stakeholders:

Sexual minority patientsSexual minority patients

Treatment staff (medical, counseling, social Treatment staff (medical, counseling, social service and case management staff)service and case management staff)

The surveys indicated clear interest by The surveys indicated clear interest by patients and staff in having programs for patients and staff in having programs for sexual minorities, and willingness by both sexual minorities, and willingness by both to participate in a research project to participate in a research project

HYPOTHESESHYPOTHESES

Participation by sexual minorities Participation by sexual minorities in specialized groups will result in specialized groups will result in:in:

Decreased substance abuse Decreased substance abuse

Improved Quality of LifeImproved Quality of Life

CURRICULUMCURRICULUM

MedicalMedical

Hormone therapy for transgender Hormone therapy for transgender patients patients

Referral for cosmetic and sex Referral for cosmetic and sex reassignment surgery reassignment surgery

LGBTI-specific healthcare services, LGBTI-specific healthcare services, including HIV-related servicesincluding HIV-related services

CURRICULUMCURRICULUM

Clinical (Psychological): Clinical (Psychological):

Process of “coming out”Process of “coming out”

Behavior modification interventions Behavior modification interventions to promote healthy lifestyle skills (i.e. to promote healthy lifestyle skills (i.e. HIV prevention and intervention to HIV prevention and intervention to promote safer sex/harm reduction)promote safer sex/harm reduction)

CURRICULUMCURRICULUM

Clinical (Psychological): Clinical (Psychological):

Definition of “self” as a sexual Definition of “self” as a sexual minorityminority

Building self acceptance and self-Building self acceptance and self-esteem; dealing with societal esteem; dealing with societal discrimination and stigma; issues discrimination and stigma; issues surrounding LGBTI Pride Week surrounding LGBTI Pride Week

CURRICULUMCURRICULUMSubstance Abuse: Substance Abuse: Drugs of abuse by LGBTI patientsDrugs of abuse by LGBTI patients

Relapse prevention; identifying triggersRelapse prevention; identifying triggers

Legal: Legal: Transgender legal rights issues (i.e. Transgender legal rights issues (i.e.

legal name change)legal name change)

Parenting; legal issues concerning child Parenting; legal issues concerning child custody and child abusecustody and child abuse

Housing issues and homelessness Housing issues and homelessness

MEASURESMEASURES

Substance AbuseSubstance Abuse

Serial toxicology screens and Serial toxicology screens and Composite International Diagnostic Composite International Diagnostic Interview (CIDI) assessments Interview (CIDI) assessments

Quality of LifeQuality of Life

Serial World Health Organization Quality Serial World Health Organization Quality of Life (WHOQOL) – BREF assessmentsof Life (WHOQOL) – BREF assessments

DomainDomain MeasureMeasure Data SourceData Source

Substance Substance AbuseAbuse

Toxicology screensToxicology screens Patient chartPatient chart

BreathalyzerBreathalyzer Patient chartPatient chart

CIDICIDI Patent Patent interviewinterview

Quality of LifeQuality of Life WHOQOL-BREFWHOQOL-BREF Patient Patient interviewinterview

DOMAINS, MEASURES DOMAINS, MEASURES & DATA SOURCES & DATA SOURCES

DATA ANALYSISDATA ANALYSIS

Quantitative analysis of each Quantitative analysis of each study measurestudy measure

Categorical variables: chi-Categorical variables: chi-square tests for statistical square tests for statistical significancesignificance

CURRENT STATUSCURRENT STATUSScientific Review Group (SRG) review: Scientific Review Group (SRG) review:

Not scored; SRG recommended Not scored; SRG recommended inclusion of control groupinclusion of control group

ARTC analysis of SRG review: Logistics ARTC analysis of SRG review: Logistics of control group deemed not of control group deemed not appropriate; too few subjects in each appropriate; too few subjects in each armarm

Next Steps: Submit to CSAT under Next Steps: Submit to CSAT under Targeted Capacity Expansion grant Targeted Capacity Expansion grant program in early 2008 program in early 2008