Addiction is a widespread problem among members of the transgender community, but addiction treatment often fails to meet their needs. Despite the fact that an estimated 30 percent of transgender people—quite possibly more—suffer from some form of addiction, many treatment providers are inadequately prepared, or not prepared at all, to successfully treat transgender patients. There are all too common problems that many transgender people encounter when they seek treatment. Some may find that they are not welcomed at certain treatment programs, but many others find that the treatment programs available to them are not able to meet their unique needs and address the underlying issues that contribute to such high rates of addiction in this community.
Lack of Education About Transgender Issues, Terms
All transgender people struggle to be accepted and understood in the identity they have chosen. They are frequently misgendered, either intentionally or unintentionally, by strangers, friends and family alike. To misgender someone is to refer to that person using the gender and the name assigned at birth rather than the gender with which the person identifies. This lack of acceptance and understanding contributes to the high rates of addiction and substance abuse among transgender people. Unfortunately, these issues frequently crop up during treatment as well. Patients are often not asked about their gender or sexual orientation and are forced to correct other people’s assumptions. They may encounter ignorance about transgender issues from people who view being transgender as a lifestyle choice or even a mental illness (the DSM plans to replace the term “gender identity disorder” with “gender dysphoria,” recognizing that being transgender is not an illness, although gender identity can lead to emotional distress).
Gender Segregation Leaves Transgender People Caught in the Middle
Many in-patient rehabilitation centers are segregated by gender, which can lead to a host of problems for transgender people. The facility may insist on placing patients with others of the same sex or “assigned gender,” which can leave trans patients feeling isolated, uncomfortable and rejected. Even if a facility does place them with people of the gender with which they identify, they may encounter discomfort or even anger from fellow patients who resent their presence. In addition to those who identify as the opposite gender from the one assigned at birth, the term transgender also embraces those who do not fit within the binary gender system. Gender segregation in rehab centers creates an even more impossible situation for these individuals.
Treatment Needs to Include Trans-Specific Elements
Another obstacle to truly effective addiction treatment for trans patients is the inconsistent incorporation of elements that address issues specific to the trans experience. This includes helping trans people develop a positive body image and to grow comfortable talking about sexual concerns. Trans people are often living in bodies that have never felt comfortable to them or are in the process of adjusting to bodies that have changed due to hormones and surgery. Making sure that trans patients have access to hormone therapy during treatment is a crucial component of this. Treatment needs to address the fact that most trans people experience social isolation and often suffer the grief of estrangement from friends or family members. This isolation and the need to find community in clubs and bars often contributes to substance abuse problems. Effective treatment will help patients work through grief and to connect in healthy ways to the trans and larger LGBTQ community. The future of addiction treatment for transgender people needs to not only welcome trans patients, but also ensure that they feel understood, that they feel safe and that the issues that underlie their situation are addressed.