Transgender Women at Higher Risk than Transgender Men for Substance Use: Social Work

Overview: Guided by the minority stress model, we analyzed the potential differences between transgender women and men in their substance use outcomes. We discuss implications of our findings in clinical and macro practice and the importance of incorporating training related to transgender experiences and substance use outcomes in social work curriculum.Proposal text: Transgender people in the United States experience high levels of violence and discrimination (James et al., 2016). The Minority Stress Model (Meyer, 2003) posits that higher discriminatory and violent events experienced by LGBTQ people can be associated with poorer mental health outcomes, leading to self-medication through substance use (Gonzales et al., 2017). Among transgender people, women experience higher rates of violence and discrimination than men (Davidson & Halsall, 2016; Grant et al., 2011). Yet, despite within-group differences, studies have often aggregated both transgender men and women, obfuscating potentially unique experiences of the two groups. One of the only studies examining substance use patterns between transgender men and women found transgender men to have significantly higher levels of substance use than transgender women (Gonzalez et al., 2017). This current study advances the literature by further examining potential differences between transgender women and men in their substance use outcomes using a clinical diagnosis rather than self-report.

Data are obtained from the 2017 Patient Characteristics Survey, a biennial survey of public mental health facilities in the state of New York (Office of Mental Health, 2018). Data include patients’ demographics, health, and substance use patterns as reported by mental health providers between October 23 - 29, 2017. Only adults identifying as transgender were included in the current analysis (Nf 1,435). The sample was majority transgender men (53.51%), white (54.88%), and non-Hispanic (79.77%). Logistic regression was conducted to examine differences between transgender women and men in their smoking status, substance use disorders (SUD), and alcohol use disorders (AUD). Race and ethnicity were examined as covariates.

Overall, 35.8% of participants reported smoking while 19.2% and 13.7% were diagnosed with SUDs and AUDs, respectively. Relative to transgender men, transgender women were 1.51 (p < 0.02) and 1.77 (p < 0.02) times more likely to be diagnosed with AUDs and SUDs, respectively. Transgender women were also 1.38 (p < 0.02) times more likely to smoke than transgender men.

This research underscores the importance of social work educators to not shy away from incorporating transgender experiences in both clinical and macro classroom curriculum. Despite their ever-increasing visibility in our society and the emphasis of behavioral health curriculum on special populations, not enough social workers are being trained in the potentially unique substance use needs of transgender people. In practice classes, discussions could include the importance of substance use screening and prevention efforts that consider minority stress as well as gender-related risk factors in mental health care settings for early detection and improved prognosis. Further, incorporating theories such as the Minority Stress Model could help in educating social workers on the relationship between distal and proximal stressors experienced by transgender people and poorer behavioral health outcomes in the overarching transgender community and within. Macro level classes could incorporate specific ways to advocate on behalf of people who are transgender in curriculum. This could include prevention strategies that target discriminatory and violent experiences of transgender people including policy initiatives banning anti- transgender discrimination in housing and employment as a means of reducing minority stress.