alcohol – Page 9 – Matters of Substance

In many big cities, the main social scenes of lesbian, gay, bisexual, transgender and questioning (LGBTQ) communities centre on gay clubs and bars. These spaces allow individuals, who may feel socially isolated, a safe venue to express themselves outside the heteronormative (heterosexuality as the perceived norm) spaces of daily living. In recent years, the selection of safe social spaces for LGBTQ has increased, but clubs and bars still remain a cornerstone. As such, many LGBTQ people see going to these bars and clubs as a cultural norm. Unfortunately in many cases, social spaces such as these may foster and incorporate the use of alcohol and recreational drugs into that cultural norm.

Research shows sexual minorities have greater substance use rates than the general population. Since 2008, we have coordinated the Centre for Addictions Research of BC’s High Risk Population Surveys, a project interviewing active drug users in Victoria and Vancouver. Last year we published a paper based on this data in the journal Culture, Health & Sexuality examining substance use and sexual identity. Would sexual identity signal increased substance use in a group of active users, or would the fact they were already using drugs cancel out sexual identity’s predictive effect?

What we found was that even among active substance users, sexual identity was still a strong predictor for certain types of drugs. Mainly, the social drugs of alcohol, ecstasy and ketamine were found to be more likely used by lesbian, gay and bisexual (LGB)-identified than straight-identified participants. In addition, LGBs reported greater negative impacts to areas such as finances, health, and social lives from ecstasy and ketamine than straight participants. The social nature of these substances leads one to think back to the social spaces that dominate the LGBTQ communities and how many revolve around the use of alcohol and associated substances. Even among active users, the resilient effect of sexual identity remains.

Tremendous strides are continually being made in expanding the options for LGBTQ to meet and socialize in venues that are welcoming and safe outside of the club and bar scene. Success has been experienced by Vancouver Coastal Health through their ‘CALL Out!’ project as well as the Trans Youth Drop-in, strengthening socialization and engagement in these communities. As well, local queer resource centres such as QMUNITY in Vancouver continue to foster social connections for all ages through a variety of groups and activities. As the focus on bars and clubs as the main spaces for socialization continues to diffuse, along with the increasing social acceptance of LGBTQ individuals, it will be interesting to see whether sexual identity remains a predictor for substance use in the future.

Authors: Clifton Chow, Research Affiliate, Centre for Addictions Research of BC; Kate Vallance, Research Associate, Centre for Addictions Research of BC

**Please note that the material presented here does not necessarily imply endorsement or agreement by individuals at the Centre for Addictions Research of BC

So, what does the small print at the bottom of your rental agreement say? What if it specified that you could not use alcohol or any substances as a condition of renting? Would you sign anyway, knowing there are not a lot of places you can afford to rent? Maybe that doesn’t matter because you don’t use drugs and alcohol at all, not even a drink now and then. But what if you have friends over — could they have a beer or glass of wine? Very few of us are expected to be abstinent in the privacy of our own homes; rather, we are expected to pay our rent (or mortgage) and respect our neighbours.

We would guess that few rental agreements would have such fine print. However, it is common for social housing programs to only accept people if they are abstinent. While this was the norm for a long time, the Housing First policy is now challenging that thinking. Housing First supports housing as a right and promotes the provision of housing that does not require or expect abstinence. This policy combines the provision of housing with a philosophy of harm reduction. There is a lot of evidence to support harm reduction strategies. There is also considerable evidence that a harm reduction approach to housing (Housing First) is effective in helping people who have been homeless to maintain their housing, maintain supports and access services according to their needs without causing harm to others1.

What does this look like? In Seattle, at 1811 Eastlake, men who were previously homeless with severe alcohol dependency were provided with housing and allowed to drink in their rooms. People living in regular rental units may access harm reduction services in the community to reduce and prevent harms from alcohol or other drug use. For those in social housing complexes, harm reduction services might be provided onsite. For example, managed alcohol programs located in housing programs provide people who are dependent on alcohol with regulated doses of alcohol. (A MAP program evaluation report for Thunder Bay MAP can be found at www.carbc.ca). The Dr. Peter Centre in Vancouver provides harm reduction supplies, onsite supervised injection services and housing for people who are HIV positive.

What does a community need to move housing programs towards a Housing First model that incorporates harm reduction? First, there has to be an available and adequate supply of affordable housing; that is the foundation. Second, an important principle of harm reduction is to actively engage people who are affected by substance use and homelessness in planning housing programs. Third, the public, housing agencies and healthcare providers need to know about and have access to harm reduction education. Lastly, Housing First and other housing programs need clearly developed harm reduction policies so that everyone is clear on the organization’s approach.

So, does every housing program need to incorporate harm reduction? Probably not, but everyone has the right to live by the same rules. Most of us already live in housing where we decide whether or not we consume substances in our home. So why not grant everyone the same choices and rights? Housing First shows us it can be done without endangering the rights of others.

Authors: Dr. Bernie Pauly, CARBC Scientist and Associate Professor, School of Nursing; Dan Reist, CARBC Assistant Director, Knowledge Exchange; and Lynne Belle-Isle, CARBC Graduate Student.

1. Pauly, B., et al., Housing and harm reduction: What is the role of harm reduction in addressing homelessness? International Journal of Drug Policy, 2013. 24(4): p. 284-290.

**Please note that the material presented here does not necessarily imply endorsement or agreement by individuals at the Centre for Addictions Research of BC

Tag: alcohol

Social Space, Sexual Identity and Substance Use

Should We Ban Drinking at Home?