It is estimated that 30 percent of the LGBT population struggles with some form of addiction whether drugs, alcohol, sex or gambling.  Contrast that figure with the estimate that approximately 9 percent of the general population is impacted by addiction and it’s not hard to see that addiction is epidemic in the LGBT community.  Nowhere is this more prevalent that in the transgender community where rates of addiction tend to be even higher.  While most addiction research has focused largely on gay men and lesbians, and less so the bisexual community, it’s important to put equally as much focus on the transgender community.  When working with the transgender community, it is important to remember a few key things:

The educated use of terminology is vitally important so a few key elements are:

    1. Transgender is an umbrella term used to cover the gamut of sexual expressions including transgender individuals, drag queens/kings and those who present in a more androgynous fashion.
    2. Gender Identity is the gender with which one identifies.  An individual may present physically as a male but identify as female (MTF) or an individual may present physically as a female but identify as male (FTM).
    3. Sexual Orientation is the sex or gender that a person is attracted to.  Gender Identity and Sexual Orientation are not the same thing.  It’s important as a provider to ask the client how they wish to identify.
    4. Sex refers to the biological characteristics of a person at birth.
    5. Gender refers to how a person views themselves in the world – i.e. male, female or some combination.

Best treatment practices should involve a variety of trans-specific elements including:

    1. Body image – What it means to be male and what it means to be female should be examined.  Gender dysphoria – the discontent someone may feel due to the sex they were born as or the gender roles associated with that sex – can be quite prevalent.  Messages that are portrayed by the social media related to gender roles can be troubling to the community and cause mixed messages.  Additionally, if someone in the trans community had any surgical procedures, scarring or changes in appearance, this can cause additional stress to an individuals body image.
    2. Grief and Loss – There can be multiple levels to grief/loss that someone in the trans community experiences.  Rejection by friends/family, loss related to the person’s physical attributes, doubt dissatisfaction and/or regret related to surgery may add deeper layers to a persons grief/loss.  These are all conversations that should be had while engaging in counseling.
    3. Sexual concerns – How to have conversations with others around being what it means to be sexually engaged is important.  When engaging in treatment, it’s important to have frank conversations with a trans individual so they can then learn how to have these conversations with others.  Make sure to have these conversations with sensitivity as it is important.
    4. Social Isolation – It’s important to find ways for those in the trans community to be engaged with others.  Social isolation could be a driving factor in someone’s addiction particularly if the person has learned to conceal areas of their life from others such as being a trans individual.  It’s important to connect others in the trans community through support groups, 12-step meetings of through therapists specializing in working within the LGBT community.  Connection helps someone feels as if they aren’t alone in the world.

Substance abuse – It’s not enough for a treatment program to say they are welcoming to the trans community.  Successful treatment means developing a deep understanding of the multiple factors that drive a trans person’s addiction and then working through those multiple treatment issues to deliver the strongest evidence-based treatment.

 


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    Last reviewed: 20 Jan 2014

APA Reference
Zacharias, J. (2014). Treating Addiction in the Transgender Community – What You Need to Know. Psych Central. Retrieved on August 21, 2014, from http://blogs.psychcentral.com/true-colors/2014/01/treating-addiction-in-the-transgender-community-what-you-need-to-know/

 

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