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Treating Trans

March 2, 2015
by Beck Gee, MA, LADC
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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

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?





"NALGAP: The Association of Lesbian, Gay, Bisexual, Transgender Addiction Professionals and...

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