Transcript Session 5: To Working With Lesbian, Gay, Bisexual and

Module 10
Clinical Issues with
Transgender Individuals
A Provider’s Introduction to
Substance Abuse for Lesbian,
Gay, Bisexual, and
Transgender Individuals
First Edition
Unifying science, education and services to transform lives.
Clinical Issues
With Transgender Individuals
Learning Objectives



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Understand “transgender”
Be familiar with research & data
Be aware of clinical issues
Understand treatment implications
Power Point Slide # 10-1, n36
A Provider’s Introduction to Substance Abuse for LGBT Individuals
Module 5 -12 Clinician’s Guide
Unifying science, education and services to transform lives.
Review of Terms

Gender: femaleness or femininity and maleness or
masculinity

Gender Role: masculine or feminine behaviors

Gender Identity: inner sense of oneself, a person’s
self-concept, in terms of gender

Sexual Orientation: distinct from gender identity,
describes one's attraction to, sexual desire for, lust
for, romantic attachments to others; lesbian, gay,
bisexual, heterosexual.
Power Point Slide # 10-2, n37
A Provider’s Introduction to Substance Abuse for LGBT Individuals
Module 5 -12 Clinician’s Guide
Unifying science, education and services to transform lives.
An umbrella term that came from the
transgender communities in the 1990s and
includes the spectrum and continuum of gender
identities, expressions, and roles that challenge
or expand the current dominant cultural values
of what it means to be male or female.
Power Point Slide # 10-3, n38
A Provider’s Introduction to Substance Abuse for LGBT Individuals
Module 5 -12 Clinician’s Guide
Unifying science, education and services to transform lives.

Transsexuals
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Cross-dressers
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Drag Queens and Drag Kings

Bigender, Androgyny, Nongendered, GenderQueer
Power Point Slide # 10-4, n39
A Provider’s Introduction to Substance Abuse for LGBT Individuals
Module 5 -12 Clinician’s Guide
Unifying science, education and services to transform lives.
Research and Data
In a recent (1999, 2000) San Francisco study by Dr.
Kristin Clements at the San Francisco Department of
PublicHealth AIDS Office:

HIV prevalence among MTF persons was 35% and
65% among African-American MTFs.

Injection drug use was 34% among MTF transgender
individuals and18% among FTM transgender individuals.

55% of MTF individuals reported they had been in
alcohol or drug treatment sometime during their lifetimes.
.
Power Point Slide # 10-5, n40
A Provider’s Introduction to Substance Abuse for LGBT Individuals
Module 5 -12 Clinician’s Guide
Unifying science, education and services to transform lives.
Research
A study from Hollywood, California, (Reback and
Lombardi1999) reported that the drugs most commonly
used by MTF transgender individuals were alcohol,
cocaine/crack, and methamphetamine
Other recent studies of transgender health risks in urban
areas around the country , including Boston, New York
City, Washington D.C., Chicago, Los Angeles and
Houston, show similar results with higher rates of
substance abuse in general and higher rates of
substance abuse with HIV prevalence, particularly
among transgender sex workers.
.
Power Point Slide # 10-6, n41
A Provider’s Introduction to Substance Abuse for LGBT Individuals
Module 5 -12 Clinician’s Guide
Unifying science, education and services to transform lives.
Clinical Issues and
Implications for Treatment
1.
2.
3.
4.
Issues about
appearance,
"passing" and body
image
History of hiding or
suppressing gender
identity
Lack of family and
social support
Isolation and lack of
connection to
positive, proactive
transgender
community resources
5.
Hormone therapy and
use or injection history
6.
Stigma and
discrimination
7.
Employment problems
8.
Relationship/child
custody issues
Power Point Slide # 10-7, n42
A Provider’s Introduction to Substance Abuse for LGBT Individuals
Module 5 -12 Clinician’s Guide
Unifying science, education and services to transform lives.
TREATMENT DO'S AND DON'TS
DO’S
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Use the proper pronouns based on client’s selfidentity when talking to/about transgender
individuals.
Get clinical supervision if they have issues or
feelings about working with transgender individuals.
Allow transgender clients to continue the use of
hormones when they are prescribed. Advocate that
the transgender client using “street” hormones get
immediate medical care and legally prescribed
hormones.
Take required training on transgender issues.
Power Point Slide # 10-8, n43
A Provider’s Introduction to Substance Abuse for LGBT Individuals
Module 5 -12 Clinician’s Guide
Unifying science, education and services to transform lives.
TREATMENT DO'S AND DON'TS
DO’S

Find out the sexual orientation of all clients.
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Allow transgender clients to use bathrooms and
showers based on their gender self-identities and
gender roles.
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Require all clients and staff members to create and
maintain a safe environment for all transgender
clients. Post a nondiscrimination policy in the waiting
room that explicitly includes sexual orientation and
gender identity.
Power Point Slide # 10-9, n44
A Provider’s Introduction to Substance Abuse for LGBT Individuals
Module 5 -12 Clinician’s Guide
Unifying science, education and services to transform lives.
TREATMENT DO'S AND DON'TS
DON’TS
 Don’t call someone who identifies as a female “he or him”
or call someone who identifies as male “she or her”.
 Don’t project transphobia onto the transgender client or
share transphobic comments with other staff members or
clients.
 Never make the transgender client choose between
hormones and treatment and recovery.
 Don’t make the transgender client educate the staff.
 Don’t assume transgender women or men are gay.
 Don’t make transgender individuals living as females use
male facilities or transgender individuals living as males
use female facilities.
 Never allow staff members or clients to make transphobic
comments or put transgender clients at risk for physical
or sexual abuse or harassment.
Power Point Slide # 10-10, n45
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