Treating Trans

Treating the Transgender population for drugs and alcohol addiction begins with understanding the humanity of Trans individuals. If we do not see someone as human, how can we treat them as such? Transgender, non-binary, and gender non-conforming individuals struggle with addiction just as any other person. Trans people struggle with higher rates of addiction than the general population. Most drug and alcohol treatment facilities are built and structured within the gender binary including gendered bathrooms, sleeping quarters, groups, policies and forms. The binary culture of treatment facilities makes it challenging for Transgender individuals to get help. Trans people are often turned away from treatment facilities because their gender expression and identities are outside the binary.


I often ask leading questions around accessibility of treatment facilities to engage a dialogue about Trans inclusion. The conversation goes as follows:


ME:  “Are you accepting of LGBTQ identified people at your facility?”

THEM:  (90% of the time) “YES!” and “OF COURSE!”

ME: “Great! So, where do you place Transgender clients?”

…. And then it comes… the dreaded silence, followed by the even more dreaded answer…

THEM:  “It depends, have they had THE surgery?”  

…“THE SURGERY” that they are talking about is most often Gender Affirming Surgery…

To which I kindly reply:  “Have you asked ALL your clients to strip down and confirm surgery or not?”


The dialogue either ends there because the clinical worker has no response. In rare cases, the clinician may engage further in conversation opening up an opportunity for education.


The only thing that Trans individuals have in common is the fact that they are Trans.  Some Trans people choose to take hormones and/ or have surgery. Some Trans people may only take hormones. Some may just have surgery. Some Trans people are perfectly accepting of the body in which they were born and assigned. Transgender is not just about fitting into one gender or another. You see, we need to start looking at gender as fluid, as changing, as socialized, as personal.


In the treatment world, especially in hospital settings and using the medical model, we conflate gender and sex assigned at birth.  It is assumed that a person that comes to treatment identifies their gender with the sex they were assigned at birth. Paperwork upon entering treatment has one of two boxes to check, male or female. There is no room for someone to define their own identity.


The question I get most often is “Well, if we don’t put that on the intake, then how do we know what unit to put them in?”  To this I say, if someone is opening up and coming out to you as Trans identified, how about letting them decide where they feel most comfortable.


Treatment is not about just getting sober. Treatment is about finding safety and being safe enough to even begin the recovery process. So my question to the treatment facilities of the world is, is your center safe and accepting for EVERYONE, including Trans people? And if you are not sure, what parts of your facility need improvement? Do you have gender-neutral bathrooms for example? Is your staff trained properly? And by staff I mean ALL staff, from facility maintenance to Nurses to Techs to CEO’s.


Trans people make up .5% of the general population. The rate of violence against Trans people is 400 times that of the general population. The rate of suicide attempts amongst Trans people is 41% compared to 1% of the general public. 60% of hate crimes toward the LGBTQ community are aimed at Trans women of color.  What is one life worth to you and your facility? When you say that you are open to treating everyone, make an effort to do so. And if you don’t know how, there are people and places to help. You may have someone who is Trans identified in your facility or on your caseload this very moment. How will you open yourself to being the first safe place someone can disclose this information? And how will you address it going forward? The ultimate decision is up to you, what is that one life worth?