Cascadia Expanding LGBTQQ Addiction and Mental Health Services

By Daniel Borgen, PQ Monthly

On February 11, Cascadia Behavioral Healthcare announced plans to increase their alcohol and drug treatment services to Portland’s LGBTQQ community. “The LGBTQQ population is greatly underserved and requires a culturally-specific approach,” according to CEO Derald Walker. “Cascadia has offered services to the community through the Triangle Project for 30 years. Our plan is to expand the Triangle model.”

The Triangle Project is staffed by certified counselors who are members of the LGBTQQ community. It offers a safe place for sexual minorities to explore personal and societal issues as well as offering support and treatment for addictions of all types. Services include individual and group counseling, alcohol and drug treatment, mental health services, diversion and DMV certification, and ongoing recovery support.

Few dispute our community’s occasional over-reliance on substances to “celebrate,” and the queer population tends to be more prone to addiction and substance abuse than our heteronormative counterparts. “In reading what others have written regarding the high rate of prevalence of substance abuse and the causes for it among Lesbian, Gay, and Bisexual identified people, I can only agree,” says Emma Nichols, addictions counselor and Triangle team member. “I agree with the dynamics underlying the vulnerabilities towards addictive behavior, such as bars and celebrations where substance use is a big part of those activities. Also, the stress of oppression will seek relief, healthy or unhealthy. Among the trans population, however, determining how widespread the use of psychoactive chemicals and behavioral addiction is becomes more problematic.”

For example, according to Cascadia, transgender is studied as “disease outcome,” rather than as a population of persons with their own particular health determinants and concerns. Also, trans folk are far more likely to be studied as vectors of HIV and other STIs. ) (Editor’s note: This should have originally been attributed to ALEXIS DINNO, SCD, MPM, MEM professor of epidemiology at PSU. Our apologies for the confusion.)

Acknowledging that services are needed in a queer-specific, queer-friendly environment gets a little tricky, according to Nichols. “At one extreme there are those individuals who are so deeply in the pre-discovery stage of their gender expression or have internalized an intolerant and negative social dynamic of their immediate social influence group that they are unable to admit to themselves, much less others, that their internal gender experience is in direct conflict with the conceptions of the significant people in their lives. It would be surprising to find anyone at that stage of discovery anywhere near anything which might even passingly indicate even the slightest hint that they are anything other than a member of the social binary to which they were mandated to be. It is conceivable that someone of this mind would go out of their way to avoid a ‘queer-friendly environment.’ And it would not be uncommon for somebody in that state to moderate that significant internal stress with chemicals, or behaviors such as hypermasculinity. At the other extreme are those individuals who have fully realized who they are and live confidently in that knowledge. Oddly enough, much of the motivation to distort an untenable reality is eliminated for persons in that level of self-actualization.

However, for many people in the community, going to a provider who has little awareness of trans, or queer, experience will certainly have an increased chance of a negative experience. And there are many providers that are actively hostile to the LGBT community, though they advertise themselves as compassionate and healing. And for those people referred to in the previous paragraph, should they encounter one of these providers, the potential for serious adverse consequences it not small; think reparative therapy and suicide.”
Another benefit of receiving services at a LGBTQ welcoming, safe, and knowledgeable environment is that those individuals, if they are able to attend groups more specific to their respective expressions, then there is the empowerment of connection, shared experience and developing a common language and culture. At this time there is an evolution in the social construct, and I would say especially as it applies to the trans* population, this is the early stages of defining and redefining, on our own terms, what our culture and tribe are going to be. There is much more power of liberation when it involves the people who are struggling for that victory working as a collective.”


Cascadia provides a critical safety net for about 12,000 people each year who struggle with mental illness, addictions, and who as a community are disproportionately impacted by physical health issues, poverty and homelessness, and other disparities. Cascadia provides a continuum of crisis intervention, a range of residential treatment, supportive housing, homeless services, and independent housing, integrated mental health and addictions outpatient services, and much more. For more on Cascadia, including more perspectives from staff members, stay with PQ online. Or visit them at