Overview: Maria Rahmandar, MD and Cage Hall, MD PhD review the context of substance use and substance use disorders among LGBTQ+ populations, the importance of screening for substance use, and considerations for confidentiality & rapport, especially with minor patients. We also review evidence-based treatments for substance use disorders of particular relevance to LGBTQ+ patients. Pharmacologic therapies are core, often life-saving components of evidence-based treatment, especially for opioid and alcohol use disorders, and should be integrated into LGBTQ+ primary care.

Objectives:

1. Communicate with patients based on medical and public health understanding of substance use disorders in respectful and non-judgmental manner, based on accurate and non-stigmatizing terminology.

2. Treat addiction as a chronic medical illness in which relapses are a feature of the illness, and which has a social history embedded in some LGBTQ+ communities that affects risk of exposures and ability to access treatment services.

3. Provide evidence-based pharmacotherapy for alcohol, nicotine, and opioid use disorders as appropriate, including medications for acute withdrawal management and relapse prevention.

4. Discuss how harm reduction techniques can be applied to substance use recovery.