The Mighty Logo

Mental Health and Addiction Treatment Needs in the Trans Community

The most helpful emails in health
Browse our free newsletters

In today’s U.S., nearly 9 in 10 Americans (87%) know someone who is gay. Far less people (around 30%) know some who is transgender.

However, what is far less well known or understood is how severely the U.S. trans community, around 2 million people, is affected by disproportionately higher rates of mental health disorders and substance addiction, when compared to the general population.

The increased public visibility of transgender celebs like Laverne Cox, Jazz Jennings, and the stars of the hit Netflix series “Pose” has helped to bring some basic level of general awareness.

Unfortunately, it’s not enough.

“Discrimination, stigma, poverty, and violence pose significant harms to the physical, mental, and behavioral health of transgender adults.” – Sharita Gruberg

Transgender: A Day in the Life…

Very few average Americans are aware of how nearly every aspect of a transgender’s daily life is a personal battle simply to be treated like everyone else — the next job candidate, the next hospital patient, or the next person in the grocery store queue.

The harsh reality is the transgender community in the U.S. continues to face unacceptable levels of verbal and physical discrimination and harassment in every single area of their lives.

The sad, yet inevitable consequence of this?

Extremely high rates of mental health issues and the use and abuse of hard illicit drugs— notably, heroin, cocaine and methamphetamine (meth) — and other addictive substances, like alcohol and marijuana, across every age group.

What Does “Transgender” Mean?

“Transgender and gender non-conforming” (TGNC) is an umbrella term referring to individuals whose gender identities are opposed to their assigned sex at birth. The term includes transgender men, transgender women, non-binary individuals, gender-fluid, and genderqueer individuals.

“Minority Stress” — Society’s Mistreatment of Transgender People

According to medical experts, many of the individual cases seen in the transgender community of either a mental health disorder, a substance use disorder, or a co-occurring disorder (the presence of both at the same time) can be attributed to the theory of “minority stress.”

The theory states that transgender people — living in a majority heterosexual culture — continue to face high levels of discrimination, victimization, harassment, and maltreatment every single day.

This treatment results in prolonged stress on a daily basis. Obviously, it has a deeply profound effect.

Did you know?

Transgender people are more likely than anyone else in the U.S. to be the victim of murder or assault.

Over 40% of trans teenagers and 51% of trans adults, unable to cope with either their family’s or society’s rejection, attempt suicide — many with fatal results.

There are so many prohibitive barriers to standard healthcare for the trans community many do not even consider going to their doctor. Therefore, they are driven to “self-medicate” through the abuse of drugs and alcohol, severely worsening their physical and mental wellbeing.

Transgender Mental Health and Drug and Alcohol Addiction

According to Sharita Gruberg, co-author of “Protecting and Advancing Health Care for Transgender Adult Communities” (August, 2021), “Discrimination, stigma, poverty, and violence pose significant harms to the physical, mental, and behavioral health of transgender adults.”

Transgender Mental Health

When it comes to mental health, people who identify as transgender have higher rates of mental health disorders and behavioral issues, such as depression and anxiety, than those in the general population.

Even now, in 2022, they continue to experience barriers to accessing the treatment they need, such as the actual refusal of insurance by healthcare insurers, and the refusal of care by healthcare providers.

What is Gender Dysphoria?

One of the reasons that depression and anxiety is more prevalent in the transgender community is “gender dysphoria,” where some transgender people are psychologically affected by the “sex-related physical characteristics” with which they were born.

Gender dysphoria is medically defined as “the marked incongruence between their experienced or expressed gender and the one they were assigned at birth.”

Those with gender dysphoria include those people that wish to have some form of medical treatment to help them feel less distressed. Contrary to public perception, only around 10% of transgender people wish to have genital surgery or medical transitioning.

The vast majority are content with less invasive procedures, such as hormone treatment, facial feminization, and male chest reconstruction.

Transgender Drug and Alcohol Addiction

Poor mental health and substance use are often intrinsically linked. The presence of both a mental illness and a substance use disorder (SUD) is known as co-occurring disorder (or dual diagnosis).

Transgender individuals use and abuse marijuana, methamphetamines, heroin, and prescription opioids at higher rates than people who identify as heterosexual.

Substance abuse is even more widespread among transgender women than other women in the general population. One study found they were nearly four times more likely to abuse hard drugs and alcohol.

Common Discriminating Factors in the Transgender Community

Using data and findings from the 2015 U.S. Trans Study, and the later “The State of the LGBTQ Community in 2020” report from the American Center of Progress, here’s a statistical look at the various discriminatory aspects of life as a U.S. trans person:

School Life (K–12):

  • Verbally harassment: 54%
  • Sexual assault: 13% / Physical assault: 24%
  • 17% left school as a result

Family / Home Life:

  • 10% of those who come out as trans to their immediate family report that a family member was violent towards them, and 8% were kicked out of the house.

Work Life:

  • 30% of employed transgender people report being fired, denied a promotion, or experienced another form of mistreatment in the workplace.

General Life:

  • 62% of transgender people experience various forms of discrimination.
  • Around 1 in 4 (20-30%) experienced moderate to severe problems when buying or renting a home, and obtaining official identification documents.

Transgender Mental Health and Addiction Treatment Needs

Transgender people are in more need than any other demographic to seek treatment for mental health disorders (MHDs) and substance use disorders (SUDs).

However, the necessary treatment they require isn’t always available or affordable, even if it’s actually there in the first place.

Barriers to Trans Community Medical Treatment

According to HRC Foundation Analysis and survey findings from the Center for American Progress (CAP), as published in their report “The State of the LGTBQ Community in 2020“:

1. Healthcare Insurance Coverage

Many members of the trans community are without health insurance coverage necessary to access addiction treatment— 22% of trans people, and 32% of trans people of color.

2. Healthcare Costs

Many trans Americans found it difficult to get necessary medical care because of cost: overall, at some point in their lives, 51% of trans people had avoided or postponed healthcare due to cost.

3. Discrimination by Doctors and Other Healthcare Providers

Many transgender people do not pursue medical treatment due to discrimination by doctors and other healthcare treatment providers:

  • 28% of trans people reported postponing/avoiding needed medical care when sick or injured due to discrimination

Twenty-five percent of trans people report other negative experiences:

  • 33% reported having to teach their doctor or provider about transgender people to receive appropriate care
  • 18% reported health care professionals refusing them medical treatment
  • 19% reported harsh or abusive language
  • 18% reported their doctor or provider flatly refused to see them at all

4. Discrimination by Healthcare Insurance Providers

  • 43% of transgender people denied transition surgery
  • 38% (including 52% of transgender people of color) denied hormone therapy for their transition
  • 34% reported that an insurer refused to change their records to reflect their name or gender

5. Transgender-Specific Barriers to Substance Addiction Treatment

Verbal and physical abuse from treatment center staff. If staff are not actively hostile themselves, they may refuse to take action if other clients are abusive.

Use of their birth name (and pronoun) as opposed to their chosen name, both psychologically damaging and unsupportive.

Actively required to wear only clothing or cosmetics relating to the gender they were assigned at birth. Generally, many rehabs prohibit provocative dress or makeup; however, gender expression is highly important to transgender clients.

Within inpatient (residential) treatment, being housed with members of the gender they were assigned at birth. Rehabs often do not have private rooms; dormitories are typical. It is disrespectful to force a transgender person to room with people of the opposite gender identity.

Unsurprisingly, conditions like these are not just adverse to the recovery process, they can result in a complete withdrawal of motivation and genuine participation.

How Can We Improve Mental Health and Substance Addiction Outcomes for Trans People?

Only recently have federally-funded surveys started to include and ask about sexual orientation and gender identification in the collection of data. Therefore, being in a position to look at increasing long-term trends is currently beyond even the best medical researchers and analysts.

Improving Transgender Behavioral Treatment Outcomes

Transgender and other GNC youths are more likely than their heterosexual counterparts to experience mental health issues.

Studies have shown that the provision of gender-affirming care — where transgender status is fully respected and considered in the treatment process — is associated with decreased adverse mental health outcomes among TGNC youths.

The vast majority of U.S. drug and alcohol detox and rehab centers are designed to serve the heterosexual population. Therefore, apart from being subject to stigmatic and prejudiced attitudes, trans people also face heteronormative* barriers in the structural and programmatic elements of treatment.

*Heteronormative is defined as “the attitude that heterosexuality is the only normal and natural expression of sexuality.”

One meta analysis study (where all previous studies are collated, subjected to stringent criteria, and then analyzed) of transgender addiction treatment outcomes, published in the Brain Science journal, found the following:

Specialized behavioral health and substance treatment programs must take gender preference and chosen identity into careful consideration.

The professionals providing and delivering these programs must have sufficient, effective training to enact appropriate care for trans patients —  for example, by considering the influence of minority stress.

The acknowledgment of a patient’s gender identity must be made mandatory; if a trans person’s identity is not recognized or respected, they are unlikely to enter a clinic or a drug rehab in the first place, let alone remain for the full program or experience significant benefit from it.

Furthermore, it would certainly improve rehab treatment outcomes for the trans community if the following additional measures were introduced:

Male-to-female transgender staff has proved highly successful when used. These trans staff members are both sensitive and empathetic, and can serve as positive role models (in fact, they may be the first transgender professionals the trans clients have encountered).

To maintain sobriety after treatment, recovering addicts need aftercare, such as peer support groups. Alcoholics Anonymous (AA) or Narcotics Anonymous (NA) are examples of 12-Step peer support groups, while other nonsecular support groups also offer sobriety support.

For your information (look online for appropriate meetings in your area):

Trans Umbrella Area of Narcotics Anonymous

The Rainbow Room (Alcoholics Anonymous for LGBT people, New York)

Michele Canale, Chief Executive Officer (CEO) for Modern Recovery Network, which includes Modern Recovery Services, located in Tempe, Arizona, where Michele is both the founder and Chief Executive Officer (CEO)

Getty image by Victoria Holguin

Originally published: June 9, 2022
Want more of The Mighty?
You can find even more stories on our Home page. There, you’ll also find thoughts and questions by our community.
Take Me Home