Advertisement

Substance Use and Recovery in the Transgender and Gender Nonconforming (TGNC) Older Adult Community

  • Stacy Agosto
  • Kristin Reitz
  • Kelly DuchenyEmail author
  • Tatyana Moaton

Abstract

Overall, rates of substance use are higher in the LGBT community than in the heterosexual population [1]. Although little research exists regarding the specific substance use patterns and rates of use in the TGNC older adult community, available evidence supports higher rates of substance use in the transgender community when compared with cisgender peers [2, 3]. The chapter discusses factors that may contribute to problematic substance use by TGNC older adults, including isolation, stigma and discrimination, minority stress, regret, physical health, lack of affirmative care and chronic pain, and violence [4, 5, 6, 7]. Resilience and strengths of TGNC older adults that may contribute to successful recovery and treatment of substance use disorders are also explored. Guidance for affirmative treatment of substance use disorders within the TGNC older adult community is provided with discussion about some evidence-based practices that have been studied with the TGNC adult population.

Keywords

Substance use Transgender TGNC Older adult Recovery Substance use disorder Aging 

References

  1. 1.
    Substance Abuse and Mental Health Services Administration (SAMHSA). Top health issues for LGBT populations information & resource kit. HHS Publication No. (SMA) 12-4684. Rockville: Substance Abuse and Mental Health Services Administration; 2012, Benotsch, Non medical prescription drug use.Google Scholar
  2. 2.
    Carmel TC, Erickson-Schroth L. Mental health and the transgender population. J Psychosoc Nurs Ment Health Serv. 2016;54(12):44–8.  https://doi.org/10.3928/02793695-20161208-09.CrossRefPubMedGoogle Scholar
  3. 3.
    Zelle A, Arms T. Psychosocial effects of health disparities of lesbian, gay, bisexual and transgender older adults. J Psychosoc Nurs. 2015;53(7):25–30.Google Scholar
  4. 4.
    American Psychological Association (APA). Guidelines for psychological practice with transgender and gender nonconforming people. Am Psychol. 2015;70(9):832–64.CrossRefGoogle Scholar
  5. 5.
    Bockting W. The impact of stigma on transgender identity development and mental health. In: Kreukels BPC, Steensma TD, de Vries ALC, editors. Gender dysphoria and disorders of sex development. New York: Springer; 2014. p. 319–30.CrossRefGoogle Scholar
  6. 6.
    Hendricks ML, Testa RJ. A conceptual framework for clinical work with transgender and gender nonconforming clients: an adaptation of the minority stress model. Prof Psychol Res Pr. 2012;43(5):460–7.CrossRefGoogle Scholar
  7. 7.
    James SE, Herman JL, Rankin S, Keisling M, Mottet L, Anafi M. The report of the 2015 U.S. transgender survey. Washington, DC: National Center for Transgender Equality; 2016.Google Scholar
  8. 8.
    NIDA. Health consequences of drug misuse. 2017, March 23. Retrieved from https://www.drugabuse.gov/related-topics/health-consequences-drug-misuse on 2018, April 26.
  9. 9.
    NIDA. Drugs, brains, and behavior: the science of addiction. 2014, July 1. Retrieved from https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction on 2018, May 6.
  10. 10.
    Fredriksen-Goldsen KI, Kim H, Shiu C, Goldsen J, Emlet CA. Successful aging among LGBT older adults: physical and mental-health related quality of life by age group. Gerontologist. 2015;55(1):154–68. https://doi.org/10.1093/geront/gnu081. Epub 2014 Sep 11.CrossRefGoogle Scholar
  11. 11.
    Gonzalez CA, Gallego JD, Bockting WO. Demographic characteristics, components of sexuality and gender, and minority stress and their associations to excessive alcohol, Cannabis, and illicit (noncannabis) drug use among a large sample of transgender people in the United States. J Prim Prev. 2017;38:419–45.  https://doi.org/10.1007/s10935-017-0469-4.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Arayasirikul S, Pomart WA, Raymond HF, Wilson EC. Unevenness in health at the intersection of gender and sexuality: sexual minority disparities in alcohol and drug use among transwomen in the San Francisco Bay Area. J Homosex. 2018;65(1):66–79.  https://doi.org/10.1080/00918369.2017.1310552.CrossRefPubMedGoogle Scholar
  13. 13.
    Benotsch EG, Zimmerman E, Cathers L, McNultye S, Piercef J, Heckg T, Perrina PB, Snipes D. Non-medical use of prescription drugs, polysubstance use, and mental health in transgender adults. Drug Alcohol Depend. 2013;132:391–4.CrossRefGoogle Scholar
  14. 14.
    Ippolito J, Witten TM. Aging. In: Erickson-Schroth L, editor. Trans bodies, trans selves, a resource for the transgender community. New York: Oxford University Press; 2014. p. 476–500.Google Scholar
  15. 15.
    Wilson C, Moulton B. Loneliness among older adults: a national survey of adults 45+. Prepared by Knowledge Networks and Insight Policy Research; 2010. Washington, DC: AAR Retrieved from: http://assets.aarp.org/rgcenter/general/loneliness_2010.pdf.
  16. 16.
    Gruskin E, Byrne K, Kools S, Altschuler A. Consequences of frequenting the lesbian bar. Women Health. 2007;44(2):103–20.CrossRefGoogle Scholar
  17. 17.
    Reisner SL, White Hughto JM, Gamarel KE, Keuroghlian AS, Mizock L, Pachankis J. Discriminatory experiences associated with posttraumatic stress disorder symptoms among transgender adults. J Couns Psychol. 2016;63(5):509–19.CrossRefGoogle Scholar
  18. 18.
    Borges G, Walters EE, Kessler RC. Associations of substance use, abuse, and dependence with subsequent suicidal behavior. Am J Epidemiol. 2000;151(8):781–9.CrossRefGoogle Scholar
  19. 19.
    Voss WD, Kaufman E, O’Connor SS, Comtois KA, Connor KR, Ries RK. Preventing addiction related suicide: a pilot study. J Subst Abus Treat. 2013;44(5):565–9.CrossRefGoogle Scholar
  20. 20.
    Conner KR, Pinquart M, Gamble SA. Meta-analysis of depression and substance use among individuals with alcohol use disorders. J Subst Abus Treat. 2009;37(2):127–37.CrossRefGoogle Scholar
  21. 21.
    Grant JM, Mottet LA, Tanis J, Harrison J, Herman JL, Keisling M. Injustice at every turn: a report of the National Transgender Discrimination Survey. Washington, DC: National Center for Transgender Equality and National Gay and Lesbian Task Force; 2011.Google Scholar
  22. 22.
    Reisner SL, Pardo ST, Gamarel KE, Hughto JMW, Pardee DJ, Keo-Meier CL. Substance use to cope with stigma in healthcare among U.S. female-to-male trans masculine adults. LGBT Health. 2015;2(4):324–32.CrossRefGoogle Scholar
  23. 23.
    NIDA. The neurobiology of drug addiction. 2007, January 2. Retrieved from https://www.drugabuse.gov/neurobiology-drug-addiction on 2018, May 6.
  24. 24.
    Meyer IH. Prejudice, social stress, and mental health in lesbian, gay and bisexual populations: conceptual issues and research evidence. Psychol Bull. 2003;129:674–97.  https://doi.org/10.1037/0033-2909.129.5.674.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Rood BA, Reisner SL, Surace FI, Puckett JA, Maroney MR, Pantalone DW. Expecting rejection: understanding the minority stress experience of transgender and gender non-conforming individuals. Transgender Health. 2016;1(1):151–64.CrossRefGoogle Scholar
  26. 26.
    Blosnich JR. The intersectionality of minority identities and health. In: Kauth MR, Shipherd JC, editors. Adult transgender care, an interdisciplinary approach to training mental health professionals. New York: Routledge; 2018. p. 30–43.Google Scholar
  27. 27.
    Anderson SC. Substance use disorders in lesbian, gay, bisexual, and transgender clients: assessment and treatment. New York: Columbia University Press; 2009.CrossRefGoogle Scholar
  28. 28.
    Mereish EH, O’Cleirigh C, Bradford JB. Interrelationships between LGBT-based victimization, suicide, and substance use problems in a diverse sample of sexual and gender minorities. Psychol Health Med. 2014;19(1):1–13.CrossRefGoogle Scholar
  29. 29.
    Chen Y, Tryon GS. Dual minority stress and Asian American gay men’s psychological distress. J Community Psychol. 2012;40:539–54.CrossRefGoogle Scholar
  30. 30.
    Cook-Daniels L. Understanding transgender elders. In: Harley DA, Teaster PB, editors. Handbook of LGBT elders. New York: Springer; 2016. p. 285–308.CrossRefGoogle Scholar
  31. 31.
    Porter KE, Brennan-Ing M, Chang SC, Dickey LM, Singh AA, Bower K, Witten TM. Providing competent and affirming services for transgender and gender nonconforming older adults. Clin Gerontol. 2016;39(5):366–88.CrossRefGoogle Scholar
  32. 32.
    Witten TM. It’s not all darkness: robustness, resilience, and successful transgender aging. LGBT Health. 2014;1(1):24–33.CrossRefGoogle Scholar
  33. 33.
    Blumea AW, Schmalinga KB. [Abstract]. Regret, substance abuse, and readiness to change in a dually diagnosed sample. Addict Behav. 1998;23(5):693–7.CrossRefGoogle Scholar
  34. 34.
    Dragon CN, Guerino P, Ewald E, Laffan AM. Transgender Medicare beneficiaries and chronic conditions: exploring fee-for-service claims data. LGBT Health. 2017;4(6):404–11.CrossRefGoogle Scholar
  35. 35.
    NIDA. Common comorbidities with substance use disorders. 2018, February 27. Retrieved from https://www.drugabuse.gov/publications/research-reports/common-comorbidities-substance-use-disorders on 2018, May 9.
  36. 36.
    Hinkin CH, Barclay TR, Castellon SA, Levine AJ, Durvasula RS, Marion SD, Myers HF. Drug use and medication adherence among HIV-1 infected individuals. AIDS Behav. 2007;11(2):185–94.CrossRefGoogle Scholar
  37. 37.
    Campbell ANC, Tross S, Caslyn DA. Substance use disorders and HIV/AIDS prevention and treatment intervention: research and practice considerations. Soc Work Public Health. 2013;28(0):333–48.CrossRefGoogle Scholar
  38. 38.
    CDC. HIV/AIDS surveillance report, vol. 19. Atlanta: US Department of Health and Human Services; 2007.Google Scholar
  39. 39.
    High KP, Brennan-Ing M, Clifford DB, Cohen MH, Currier J, Deeks SG, Deren S, Effros RB, Gebo K, Goronzy JJ, Justice AC. HIV and aging: state of knowledge and areas of critical need for research. A report to the NIH Office of AIDS Research by the HIV and Aging Working Group. J Acquir Immune Defic Syndr (1999). 2012;60(Suppl 1):S1–18.Google Scholar
  40. 40.
    Heath J, Lanoye A, Maisto SA. Behavior among older men who have sex with men: a review and critique of the current literature. AIDS Behav. 2012;16(3):578–89.CrossRefGoogle Scholar
  41. 41.
    Fredriksen-Goldsen KI, Kim H-J, Emlet CA, Muraco A, Erosheva EA, Hoy-Ellis CP, Goldsen J, Petry H. The aging and health report: disparities and resilience among lesbian, gay, bisexual, and transgender older adults. Seattle: Institute for Multigenerational Health; 2011.Google Scholar
  42. 42.
    Rachlin K, Green J, Lombardi E. Utilization of health care among female-to-male transgender individuals in the United States. J Homosex. 2008;54(3):243–58.CrossRefGoogle Scholar
  43. 43.
    Sage Publications. Improving the lives of transgender older adults. 2012. Retrieved from https://www.sageusa.org/resources/publications.cfm?ID=13 on 2018, April 26.
  44. 44.
    Murariu D, Holland M, Gampper TJ, Campbell CA. Illegal silicone injections create unique reconstructive challenges in transgender patients. Plast Reconstr Surg. 2015;135(5):932e–3e.CrossRefGoogle Scholar
  45. 45.
    Wilson E, Rapues J, Jin H, Raymond HF. The use and correlates of illicit silicone or “fillers” in a population-based sample of transwomen, San Francisco, 2013. J Sex Med. 2014;11(7):1717–24.  https://doi.org/10.1111/jsm.12558.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Rudd RA, Seth P, David F, Scholl L. Increases in drug and opioid-involved overdose deaths — United States, 2010–2015. MMWR Morb Mortal Wkly Rep. 2016;65:1445–52.  https://doi.org/10.15585/mmwr.mm655051e1.CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Yarns BC, Abrams JM, Meeks TW, Sewell DD. The mental health of older LGBT adults. Curr Psychiatry Rep. 2016;18(6):60.CrossRefGoogle Scholar
  48. 48.
    Kenagy GP. Transgender health: findings from two needs assessment studies in Philadelphia. Health Soc Work. 2005;30(1):19.CrossRefGoogle Scholar
  49. 49.
    Kenagy GP, Bostwick WB. [Abstract]. Health and social service needs of transgender people in Chicago. Int J Transgenderism. 2008;8(2–3):57–66.Google Scholar
  50. 50.
    Houston E, McKirnan DJ. Intimate partner abuse among gay and bisexual men: risk correlates and health outcomes. J Urban Health. 2007;84(5):681–90.CrossRefGoogle Scholar
  51. 51.
    Testa RJ, Sciacca LM, Wang F, Hendricks ML, Goldblum P, Bradford J. Effects of violence on transgender people. Prof Psychol Res Pract. 2012;43(5):452–9.CrossRefGoogle Scholar
  52. 52.
    Nuttbrock L, Bockting W, Rosenblum A, Hwahng S, Mason M, Macri M, Becker J. Gender abuse, depressive symptoms, and substance use among transgender women: a 3-year prospective study. Am J Public Health. 2014;104(11):2199–206.CrossRefGoogle Scholar
  53. 53.
    Singh AA, Hays DG, Watson LS. Strength in the face of adversity: resilience strategies of transgender individuals. J Couns Dev. 2011;89(1)  https://doi.org/10.1002/j.1556-6678.2011.tb00057.x.CrossRefGoogle Scholar
  54. 54.
    Fuhrmann M, Craffey B. Lessons learned on the path to filial maturity. Charlston: Createspace; 2014.Google Scholar
  55. 55.
    Bockting WO, Miner MH, Swinburne Romine RE, Hamilton A, Coleman E. Stigma, mental health, and resilience in an online sample of the US transgender population. Am J Pub Health. 2013;103(5):943–51.CrossRefGoogle Scholar
  56. 56.
    Macmaster SA. Harm reduction: a new perspective on substance abuse services. Soc Work. 2004;49(3):356–63.CrossRefGoogle Scholar
  57. 57.
    Marlatt GA, Blume AW, Parks GA. Integrating harm reduction therapy and traditional substance abuse treatment. J Psychoactive Drugs. 2001;33(1):13–21.CrossRefGoogle Scholar
  58. 58.
    Little J. Harm reduction in therapy groups: engaging drinkers and drug users in a process of change. J Groups Addict Recover. 2006;1(1):69–93.Google Scholar
  59. 59.
    Center for Substance Abuse Treatment. Substance abuse treatment: group therapy. Treatment Improvement Protocol (TIP) Series, No. 41. HHS Publication No. (SMA) 123991. Rockville: Substance Abuse and Mental Health Services Administration; 2005.Google Scholar
  60. 60.
    Senreich E. Are specialized LGBT program components helpful for gay and bisexual men in substance abuse treatment? Subst Use Misuse. 2010;45(7/8):1077–96.CrossRefGoogle Scholar
  61. 61.
    Stevens S. Meeting the substance abuse treatment needs of lesbian, bisexual and transgender women: implications from research to practice. Subst Abus Rehabil. 2012;3(Suppl 1):27.CrossRefGoogle Scholar
  62. 62.
    Hopwood RA, Witten TM. Spirituality, faith and religion: the TGNC experience. In: Singh AA, Dickey LM, editors. Affirmative counseling and psychological practice with transgender and gender non-conforming clients. Washington, DC: American Psychological Association; 2017. p. 213–30.Google Scholar
  63. 63.
    Empson S, Cuca YP, Cocohoba J, Dawson-Rose C, Davis K, Machtinger EL. [Abstract]. Seeking safety group therapy for co-occurring substance use disorder and PTSD among transgender women living with HIV: a pilot study. J Psychoactive Drugs. 2017;49(4):344–51.CrossRefGoogle Scholar
  64. 64.
    Connors GJ, DiClemente CC, Velasquez MM, Donovan DM. Substance abuse treatment and the stages of change: selecting and planning interventions. New York: Guilford Press; 2013.Google Scholar
  65. 65.
    Quello SB, Brady KT, Sonne SC. Mood disorders and substance use disorder: a complex comorbidity. Sci Pract Perspect. 2005;3(1):13.CrossRefGoogle Scholar
  66. 66.
    Hopwood RA, Dickey LM. Mental health services. In: Erickson-Schroth L, editor. Trans bodies, trans selves: a resource for the transgender community. New York: Oxford University Press; 2014. p. 291–305.Google Scholar
  67. 67.
    Ducheny K, Hendricks ML, Keo-Meier CL. TGNC-affirmative interdisciplinary collaborative care. In: Singh AA, Dickey LM, editors. Affirmative counseling and psychological practice with transgender and gender non-conforming clients. Washington, DC: American Psychological Association; 2017.Google Scholar
  68. 68.
    Nuttbrock LA. [Abstract]. Culturally competent substance abuse treatment with transgender persons. J Addict Dis. 2012;31(3):236–41.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Stacy Agosto
    • 1
  • Kristin Reitz
    • 1
  • Kelly Ducheny
    • 1
    Email author
  • Tatyana Moaton
    • 2
  1. 1.Behavioral Health ServicesHoward Brown Health CenterChicagoUSA
  2. 2.Human ResourcesHoward Brown Health CenterChicagoUSA

Personalised recommendations