Treating Trans

Many thanks to our friends at NALGAP – the National Association of Lesbian, Gay, Bisexual, Transgender Addiction Professionals and their Allies, for all of their support & collaboration they have participated in with PRIDE Institute over the years. This is a blog they posted that was written by one of  our clinicians this month.


Treating Trans

Treating the Transgender population for drugs and alcohol addiction begins with understanding the humanity of Trans individuals. For the purpose of this article I will be using Trans to describe all individuals whose gender identity fit under the transgender umbrella. For an explanation of terminology and glossary of transgender identities, please refer to Fact Sheet.

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, and policies. 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 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. Or in rare cases, the clinician may engage further in conversation opening up an opportunity for enlightenment and 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: changing, socialized, personal.

In the treatment world, particularly in hospital settings which use the medical model, we conflate Gender and Sex Assigned at Birth. It is assumed that a person that presents for treatment identifies their gender with the sex they were assigned at birth. Paperwork upon entering treatment most often has one of two boxes to check: male or female. This offers 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 cannot solely be about getting sober. Treatment needs to address safety, what it is like to feel safe, and trusting one is safe enough be who they are. When safety is addressed, then recovery can begin. My question to the treatment facilities of the world would be: 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. 69% of Trans people have experienced homelessness. The rate of suicide attempts amongst Trans people is 41% compared to 1% of the general public. 57% of Trans people report their family not speaking to them because they are Trans. 53% of hate crimes toward the LGBTQ community are aimed at Trans women of color (Human Rights Campaign, Antiviolence Project, American Foundation of Suicide Prevention).

All of these horrifying statistics bring us back to the real questions at hand: 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 up to being the first safe person or place someone can disclose this information?



Bio: Beck is currently the Assistant Clinical Director of PRIDE Institute in Minneapolis Minnesota. PRIDE Institute has served the LGBT community for substance abuse and co-occurring mental health treatment for over 29 years. Beck is also on the Board of Directors of NALGAP: The Association of LGBT Addiction Professionals and their Allies. They speak nationally on LGBTQ and addiction. Beck’s passion lies within the Trans Community, Social Justice and Advocacy.