Substance use and treatment of substance use disorders in a community sample of transgender adults

• This is the first study of risks for substance use/substance use disorder (SUD) treatment in transgender men and women.
• We assessed psychosocial risk factors for substance use and SUD treatment in transgender adults.
• Substance use and SUD treatment are linked to age, education, poverty and male-to-female identity.
• Substance use and SUD treatment are linked to violence/PTSD, discrimination, housing and sex work.
• SUD treatment should incorporate psychosocial/structural approaches for transgender adults.

BackgroundTransgender people have elevated substance use prevalence compared with the U.S. general population, however no studies have comprehensively examined the relationship of psychosocial risk factors to substance use and substance use disorder (SUD) treatment among both male-to-female (MTF) and female-to-male (FTM) transgender adults.MethodsSecondary data analysis of a 2013 community-based survey of transgender adults in Massachusetts (N = 452) was conducted. Adjusted multivariable logistic regression models were fit to examine the relationship of four risk factor domains with SUD treatment history and recent substance use: (1) demographics; (2) gender-related characteristics; (3) mental health; (4) socio-structural factors. Adjusted Odds Ratios (aOR) and 95% Confidence Intervals (95% CI) were estimated.ResultsTen percent of the sample reported lifetime SUD treatment. Factors associated with significant increase in odds of lifetime SUD treatment alongside recent substance use (all p < 0.05) were: (1) older age (aOR = 1.02; 95% CI = 1.01–1.04), higher educational attainment (aOR = 3.59; 95% CI = 2.35–5.50), low income (aOR = 0.58; 95% CI = 0.39–0.86); (2) MTF identity (aOR = 3.03; 95% CI = 1.95–4.67), gender-affirming medical care (aOR = 1.99; 95% CI = 1.32–3.00); (3) intimate partner violence (aOR = 1.68; 95% CI = 1.13–2.49), posttraumatic stress disorder (aOR = 2.56; 95% CI = 1.69–3.88), depression (aOR = 2.30; 95% CI = 1.58–3.35), mental health treatment (aOR = 1.65; 95% CI = 1.11–2.45); (4) discrimination (aOR = 1.90; 95% CI = 1.22–2.95), unstable housing (aOR = 1.80; 95% CI = 1.21–2.67), and sex work (aOR = 2.48; 95% CI = 1.24–4.95).ConclusionsSubstance use and SUD treatment among transgender adults are associated with demographic, gender-related, mental health, and socio-structural risk factors. Studies are warranted that identify SUD treatment barriers, and integrate SUD treatment with psychosocial and structural interventions for a diverse spectrum of transgender adults.