P2P, A Safe Place for Queer and Trans Substance Recovery

By Britni de la Cretaz 03/02/16

Pieces to Pathways provides peer-run and peer-led substance recovery services. For the LGBTQ community, by the LGBTQ community.

P2P, A Safe Place for Queer and Trans Substance Recovery

In Toronto, two sober friends got to talking and realized that there was a massive gap in support services for people in their community. Geoff Delfin and Tim McConnell met in recovery circles and have known each other for over seven years. But they realized that when members of their community—young, LGBTQ-identified folks—would ask them for recommendations to programs or treatment options, there was nowhere that they felt comfortable referring them to. So Delfin and McConnell decided to fill that gap in service themselves—and Pieces To Pathways (P2P) was born.

P2P is “a peer-led initiative creating Canada’s first substance use support program for LGBTTQQ2SIA youth 16 to 29 years old in Toronto.” The acronym LGBTTQQ2SIA stands for Lesbian, Gay, Bisexual, Transsexual, Transgender, Queer, Questioning, Two Spirit, Intersex, and Asexual, but Delfin, 28, assures me over the phone, “That’s not an exclusive or exhaustive list.” The hope is that P2P can provide substance use services to a group of people who don’t often find safe, supportive, and identity-affirming treatment. Delfin, who uses they/them pronouns, says, “Generally, people don’t feel comfortable accessing services because they have to explain their identity, explain what it means to be trans, and explain their pronouns,” even before dealing with the concerns that brought them into treatment in the first place. “Work and labor is put on the participant, and they’re just trying to access services,” explains Delfin.

One of the key findings of their research, conducted during a needs assessment in January-March 2015, was that 65.8% of those surveyed stated they wanted LGBT-specific services delivered by LGBTQ people themselves. Their solution is something that Delfin sees as “a very simple idea”— substance use support for queer and trans youth that is peer-run and peer led, meaning that everyone who works there needs to have lived experience as being queer and trans, as well as lived experience with substance use or recovery. “We want to deliver services that people are actually asking for,” Delfin says.

While this might seem obvious, research has shown that this is not the case.

Finding out what the community really needs

P2P’s research was the first of its kind in Canada. Delfin explains that there’s little to no research on queer and trans substance use generally—add youth into the equation, and they were entering brand new territory. They received funding from the Ministry of Health’s Toronto Central LHIN (Local Health Integration Network), and sponsorship from Breakaway Addiction Services to conduct a needs assessment. What they found was staggering.

Compared to the 2012 Canadian Alcohol and Drug Use Monitoring Survey (CADUMS), P2P found that their sample, which included 640 LGBTTQQ2SIA-identified youth, had up to 26.4 times higher substance use rates than those in the general population. Delfin attributes this to a variety of factors, including queer party culture, trauma (which LGBTQ people are more likely to experience), and the effects of marginalization on a person.

What they also found, that was incredibly concerning, was that out of people who had previously accessed services, 65.1% found their identity negatively impacted their experience. This was confirmed by the interviews P2P conducted with 28 different service providers in Toronto, which found that only 29% said their services were available to LGBTTQQ2SIA-identified youth who use substances.

It's because of this that many people don't feel comfortable disclosing their identity at all. “People have higher rates of substance use, and then when they do access services and they share their queer or trans identity, it doesn’t actually help them,” Delfin explains.

Filling the gaps

Based on their research, P2P submitted a report and pitched a full blown program to their funders. They’re now in their second phase of funding, which expires March 31, 2016. Since September 2015, they have been working on initial program development and creating a program model, using peer working groups to help determine what their community would like to see in groups. Delfin says that most of their staff is trans and most of the people who they’re engaging with are trans as well. 

Their first two support groups, which use motivational interviewing as a general framework, launched in January 2016. They are currently running one harm-reduction group, which has ten members, and one abstinence group, which has five. “People just want to have options,” Delfin says. Participants can choose what group best fits their goals at the present time. “Some people in the harm reduction group have said they want to be sober in the future, but it isn’t realistic now.” This model of group variety helps P2P meet their participants where they’re at now, making them more likely to engage in treatment services.

But what has become clear in the two months they’ve been running their groups is that there is a need for more diverse harm reduction groups, says Delfin. Since harm reduction can look different to different people, it may be useful to put people in groups based on their goals so that group members don’t trigger each other. “Someone may want to stop using particular substances, but still want to keep using others,” Delfin explains. “On the flip side, someone else may really just want to work on moderating or controlling their use, or be able to use more safely.”

Looking to the future

P2P has big goals for the future. Their funding runs out on March 31, so they’re hoping the report they present to their funders will earn them money to continue their work.

“The ultimate goal is full-fledged queer and trans support substance use support services for youth in Toronto,” says Delfin. And that includes providers outside of P2P, too. They’re looking to transform the entire substance use services community. “We’ve developed a framework to be able to assess organizations’ LGBT accessibility and friendliness, and we’re working with Renascent Treatment Center to put out recommendations and get places to put out some changes.” They acknowledge that “a lot of organizations want to do a good job and make services accessible to queer and trans people, but they don’t know how to.” 

“Sometimes, they think they’re doing the right thing and it still negatively impacts the service user.” With these new recommendations, P2P hopes to change that.

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Britni de la Cretaz is a freelance writer, baseball enthusiast, and recovered alcoholic living in Boston. Follow her on Twitter at @britnidlc.