By Erin Beck, Writing for the “When All Are Counted” Project
Where do members of the LGBTQI+ population in West Virginia go if they want substance use disorder treatment or to live in a recovery residence with other queer West Virginians experiencing a substance use disorder?
Where do they go if they also want that program to be led by other LGBTQI+ West Virginians who understand their struggle most acutely?
After all, even though substance use treatment may be hard to come by in some areas, straight and cisgender West Virginians aren’t likely to feel discomfort talking about their orientation and gender identity in substance use treatment spaces, which are supposed to be safe and nonjudgmental.
After reaching out to West Virginians in the treatment and recovery community across the state, I haven’t been able to find any medical treatment facilities or recovery residences specifically operated by and composed of LGBTQI+ people. And according to West Virginia Department of Health and Human Resources Deputy Secretary of Mental Health and Substance Use Disorders Christina Mullins, the state doesn’t track this data.
There are facilities that would, of course, accept members of that group, and facilities made up of very kind people, including queer people and allies, depending on the facility, with their hearts in good places and addiction expertise.
But in our LGBTQI+ focus groups, we’ve learned that the marginalized group wants more spaces geared specifically at the queer community to feel safe, listened to, and understood, according to researchers working on the “When All Are Counted” Project who have reported preliminary findings to the project team. LGBTQIA+ people don’t want to feel exposed. The “When All Are Counted” Project focus groups have also found people worry about being treated differently in health settings.
In 2020, 6.7% of gay, lesbian and bisexual women reported misusing opioids (prescription opioids or heroin use) in the past year, compared to 3.6% of the overall adult population, according to the National Institutes of Health. And research shows people who are LGBTQ have higher rates of mental health problems, and some research shows queer-specific programs are likely to be more successful.
But despite my best efforts, I couldn’t find any LGBTQI+ specific treatment facilities in the state. I did find some related services.
Jennie Hill is a queer Charleston woman who runs yoga classes at recovery residences and for incarcerated people. She has been sober for about 12 years. She is the executive director of Laotong Yoga, a yoga services organization offering evidence-based, trauma-informed yoga, meditation and mindfulness training. Until 2022, she was the assistant director of the West Virginia Alliance of Recovery Residences (WVARR), and she did note that certified recovery residences are required to have nondiscrimination clauses.
Jennie said when she went to substance use disorder treatment at Prestera’s mental health center in Huntington, her group went to an LGBTQI+ 12-step group there that Jennie called “life-changing.”
“Because I felt like these are my people,” she said. “It helped me feel connected to the 12-step fellowship. It made me want to continue in my recovery and made me feel like I belong somewhere. There was a big group of us that were in treatment together that all really enjoyed going to those meetings.”
NIH, which has limited data on the problem, but did mention on its website that there may be better outcomes for gay and bisexual men in specialized programs, added “in one study, only 7.4 percent of programs offered specialized services for LGBT patients.”
Research on SUD program success among trans people is also limited, NIH says, but the organization adds that “Current research suggests that treatment should address unique factors in these patients’ lives that may include homophobia/transphobia, family problems, violence, and social isolation.”
When Jennie moved to Charleston, she went to regular 12-step meetings and found some queer support. But even though 12-step programs encourage reliance on a higher power, she found meetings too “churchy.” She went ten years making it work. But she saw a need for a queer-specific group, and her sponsor told her, “You don’t have to wait for someone else to do this.” She also noted that those groups are common in other states.
And Jennie noted that as the pandemic began, many people in 12-step programs were enthusiastic about developing Zoom meetings to continue their fellowship online. She saw the opportunity to start an LGBTQI+ 12-step meeting about two and a half years ago.
“And so we started the LGBTQ meeting on Zoom during COVID,” she said. “And that way, people from Huntington and from across the state were able to jump on and spend time together.”
She said she widely promoted the program, which is “friendly” toward the queer community, but doesn’t prohibit other members, and was encouraged by the response.
Some 12-step members elsewhere thought it was breaking the 12-step tradition of gaining members by “attraction versus promotion.”
But in the “When All Are Counted” Project’s focus groups though, we’ve learned many people don’t know where to turn for help, according to researchers who have reported preliminary findings to the project team.
Support for the Charleston-based meeting slowed after the promotional push during the pandemic, but Jennie also noted that a smaller meeting is more comfortable for some. Members feel like they have a “home away from home,” she said, although she’d like to see more members, and noted that the group meets Tuesdays from 6 p.m. to 7 p.m. at St. Mark’s United Methodist Church in Charleston.
Jennie said the problem with getting more LGBTQI+ treatment programs started is in part due to the patriarchy.
“Even in 12-step programs, it can be that same kind of space where there’s cisgender heterosexual men who feel like they’re in charge and that people should listen to them,” she said. “And whether or not they are home group members, or run the meeting, is beside the point. Just their presence and some of the things that they say or do can be intimidating, or even microaggressions to people that are marginalized, not just queer people, but also BIPOC people.” Even being a woman can be challenging, she said.
Merriam-Webster defines “microaggression” as “a comment or action that subtly and often unconsciously or unintentionally expresses a prejudiced attitude toward a member of a marginalized group (such as a racial minority).”
Meetings, Jennie said, “should be safe spaces for anyone to go in to share about their experience with alcoholism or addiction, and to get better. They should be welcomed at every meeting. But the reality is that we are in Southern West Virginia.”
It took Jennie nearly a decade to feel heard enough to start the LGBTQI+ 12-step program, although she does think it’s become easier for women to assume leadership roles in recent years, in large part thanks to other women who paved the way.
Jennie also noted that drug use is intertwined with the criminal justice system. She noted that 85% of people behind bars in the United States of America have an untreated substance use disorder or were convicted of a crime involving drugs, according to the National Institutes of Health. And she also pointed to higher incarceration rates. The 2011-2012 National Inmate Survey confirmed that gay, bisexual or lesbian people are incarcerated at a rate over three times that of the total adult population: 1,882 per 100,000 lesbian, gay, and bisexual people are incarcerated, compared with 612 per 100,000 U.S. residents aged 18 and older. This disparity is largely driven by queer women.
Information on trans and nonbinary people’s involvement with the criminal justice system is more limited, but according to a 2020 NBC investigation, out of 4,890 transgender state prisoners tracked in 45 states and Washington, D.C., NBC News was able to confirm only 15 cases in which a prisoner was housed according to their lived gender. Thirty-five percent of transgender people who had spent time in prison in the previous year reported being sexually assaulted, according to a 2015 report by the Department of Justice.
More efforts to help
The WVARR works to assure certified recovery residences in West Virginia abide by guidelines, such as a code of ethics and guaranteed rights for residents. According to Emily Birckhead, executive director of the WVARR, the group is working to collect information about the extent of need among the LGBTQI+ population.
“The WV Alliance of Recovery Residences (WVARR) is a nonprofit contracted by the WV DHHR to oversee a certification process for recovery residences,” she said. “WVARR is currently onboarding recovery residences across the state into a new resident-based data collection platform that will collect demographic information about current residents, assign recovery capital scores to each resident, and recommend recovery planning goals to better support them in their recovery journeys.
“This data does include questions about both gender identity and sexual orientation, but we don’t currently have enough data collected to speak definitively about the number of LGBQTIA+ folks that recovery residences in West Virginia are currently serving or how they’re doing. We hope to have more information on this population, and other perceivably underserved populations, within the next year.”
Olivia Qualls, who runs EKY Mutual Aid with her partner Misty Skaggs, offers naloxone, an overdose treatment drug, as well as HIV testing and other services, at Pride and other events.
“We run off of our cell phones and our iPads from our living rooms,” she said.
They work in the tri-state area: lower Ohio, western West Virginia and eastern Kentucky.
“Most of these areas are poor areas, hollers, people in trailers, multiple generations of poverty, trauma,” she said. “And so in turn, that also creates multiple years of drug usage … to cope with not being able to get mental care as well.”
She also has nowhere to refer people who want treatment guaranteed to be led by people with similar life experiences. Trans people who are sent to the wrong facilities are also vulnerable to sexual assault.
She said, “Many LGBTQI+ people end up not seeking care because they don’t feel safe or there’s been a history of violence when they did seek care.”
When people do ask for referrals to treatment, there are few options. She says, “I can’t tell you what’s going to happen there…”
“When you are already part of a marginalized group, you’re scared, and queer people in Appalachia, you assimilate or something very dangerous could happen,” she said. “And a lot of people already feel like they have a target on their back because they are queer presenting. And then if you add on top of that the stigma of drug use, it’s further dehumanized. You’re further dehumanized.
She thinks the group would feel safer with people “that we could see ourselves in, that we’d feel more safe around because so many of us have such a history of trauma that comes along with queer bashing,… and just being in general scared to say anything,” adding that white supremacy is increasing, and so is hatred toward trans people and drag queens, including through legislative efforts.
Along with the 12-step program and EKY Mutual Aid, I also learned about WV Health Right’s EquaHealth program, provided in partnership with Covenant House, Fairness WV, Rainbow Pride of WV, Dr. Jonathan Lucas-Neel, and CAMC’s Ryan White Program.
Lucas-Neel, a queer person himself, told me that the clinic, held every Wednesday at the Charleston East End location of Health Right, a free clinic that serves multiple counties, offers multiple, confidential services for the queer community, from gender-affirming care to HIV prevention medication. They don’t provide drug treatment there, but providers could refer patients. He also noted that Health Right provides LGBTQI+ support groups.
He said the program is about “being around other people that are living the same experiences every day and understand what you’re going through.”
The West Virginia Department of Health and Human Resources, in collaboration with West Virginia University, is also seeking information on the problem. This month, they released the results of a statewide, confidential behavioral health survey, the MATCH Survey, to be completed once every two years.
Of the 88,004 West Virginians contacted, more than 16,000 (20%) filled it out. The first survey period occurred from August 2021 – February 2022, and the second survey period will take place from August 2023 – February 2024. The survey was described as “designed to understand the health and well-being challenges facing West Virginians and identify the resources needed for our communities to improve the health of our people.”
The survey asked about health and health services and included questions about the patient’s identity, such as age, sex, race, sexual orientation and whether the person is transgender. It also asked about a list of health conditions, healthy and unhealthy behaviors, mental health, health insurance, and barriers that prevented people from getting the health care they needed.
After I recently explained the ‘When All Are Counted” Project, to improve health surveillance data in West Virginia, to WVDHHR Deputy Secretary of Mental Health and Substance Use Disorders Christina Mullins, she pointed to the MATCH survey. This was before the data was released.
“When I became Commissioner in 2018 of the Bureau for Behavioral Health, I came from the Bureau for Public Health, and I didn’t really have the same tools that I had in public health for data and to make the same decisions,” she said. “And behavioral health data tends to be a little more squishy.”
After viewing the survey online, which was released this month, I noticed some data for some small populations, like the trans population, was suppressed, meaning DHHR withheld that data either because there weren’t enough respondents to ensure the statewide applicability of the data, or to protect the identity if the number was so small it could identify someone if linked to geography.
But even though the survey asked about sexual orientation, gender identity, and drug and alcohol problems, I couldn’t use the online tool to determine if LGBTQI+ West Virginians experience higher risk and more barriers.
Dr. Summer Hartley, associate vice president for West Virginia University’s Health Affairs Institute, has overseen the survey project. She said, “We’re releasing a public use dataset in July 2023, which researchers can use to conduct more detailed analysis.”
Mullins said she first met with Dr. Jeffrey Coben to make the survey happen. Coben was named Interim Secretary of DHHR by Governor Jim Justice on December 12. He is the Associate Vice President for Health Affairs and Dean of the School of Public Health at West Virginia University.
“I think people are going to have aha moments,” Mullins said, referencing the data. “Providers are going to use it to help them write grant applications, right? But when they sit down, and they’re trying to write a needs assessment for a grant application, and they suddenly have data that they didn’t know they had, then they’re going to start learning to use the data.”
She said having the survey data has been a long-term vision of hers, although finding money and resources took time. She called it a “first step.”
“My thing with data is when you have data, you have more questions because you know what questions to ask,” she said.
Erin Beck, MPH, is a writer, poet, journalist and native West Virginian who writes for the “When All Are Counted” Project. Her writing, which often focuses on health disparities, social inequities, civil rights, and resistance and reform, has appeared in the Charleston Gazette, the state’s Goldenseal magazine and multiple other West Virginia publications. You can follow her on Facebook and Twitter.