Drug & Alcohol Service and Usage

Extract from the Transgender Project conducted in Central Sydney Area Health Service by Jill Hooley & Rochelle Evans

(The Gender Centre advise that this article may not be current and as such certain content, including but not limited to persons, contact details and dates may not apply. Where legal authority or medical related matters are cited, responsibility lies with the reader to obtain the most current relevant legal authority and/or medical publication.)

The Transgender Project conducted in Central Sydney Area Health Service by Jill Hooley, Project Officer, and Researcher Rochelle Evans, sought reasons for the non-accessing of health services by transgender people.

Thirteen tranys [16% of the sample] reported seeking to use drug and alcohol services. Eleven [12%] of these respondents used services and two reported not completing detoxification programs. Of the thirteen who approached the service, five respondents or [41%] of respondents felt they were treated with respect and sensitivity. Three [or 24%] disagreed or strongly disagreed that they were treated with respect and sensitivity. Four [or 30% of the thirteen were not sure that they had been treated with respect and sensitivity. 52% of the thirteen were therefore either unsure or in disagreement with the notion that services threatened them with respect and sensitivity. Most respondents who did not use these services expected respectful treatment. Two respondents had difficulty finding a place near their homes to obtain dean needles.

Seven [or 53%] of the thirteen who used D&A services, believed that these services did not understand transgender issues and 38% of the thirteen were not sure. This response was the largest expression by transgender of the likelihood or reality of specific health services failing to understand transgender issues. Therefore, it may be said with caution, that drug and alcohol services are probably seen as most likely to be discriminatory by and toward transgender. Anecdotal data confirms these perceptions to some degree and show the experiences of numerous transgender within these services to be discriminatory, unresponsive to their needs and very difficult.

These services appear to be without any adequate education about issues of transgender, gender and sexuality, or the ability to help address these for clients, as part of social relations of marginality which help to produce low self worth and coexist with or result in, drug abuse, unsafe sex and self abuse.

Transgender Experiences of Drug & Alcohol Services

Transgender using drug and alcohol detoxification institutions have reported experiencing isolation and misunderstanding, due to discrimination by other patients, who are almost invariably men. There is a perceived urgent need for education of staff about trany issues, in hospital detoxification units, among transgender spoken with during research. In addition to this, detox units are predominantly oriented toward servicing users of narcotics and alcohol, rather than drugs such as ecstasy and amphetamine, which are the substances primarily used by transgender in the context of their subculture, and gay or queer subculture. This study, however, reveals a quarter possibly, using alcohol excessively, and some marijuana.

The sub cultural context in which use or addiction occurs among transgender, thus often differs from heterosexual or "mainstream" cultures. Issues, such as those of discrimination, gender and erotic practices; relationships of power and abuse, specific to the sub cultural context, dynamics of transgenders' use, therefore need addressing in drug and alcohol treatment and healing processes.

Also, the levels of dereliction are not as great for transgender users, and the issues specifically different, compared to users of alcohol and narcotics, who appear mostly to be from the "heterosexual community".

There are also reports of negative, discriminatory or abusive attitudes toward transgender, [in relation to tranys' gender behaviour and/or perceived sexualities] by numerous patients, who are overwhelmingly men. This discrimination may extend to transgender workers in detoxification units, and has done so. Transgender workers have also experienced discrimination from Staff.

Building 82, the detoxification unit at R.P.A.H., has had only one transgender person use its services in the past twelve months and perhaps two, over the past two years. The management at this unit has awareness of transgender people's issues although adequate education by transgender people has not, according to the study's understanding, been adequately updated or carried out for twelve months or more. There remains the issue of the oppressive sense of confinement and isolation felt by transgender in detoxification environments and the restrictions imposed on personal movement. One transgender using this service saw staff there as perceptive, totally accepting find caring.

The experience of trany workers in detoxification units reported, is that a great lack of understanding towards tranys occurs. This comes in the form of abuse of trany workers and patients sense of gendered self and hence, the invalidation of their very identities or existence. Some discrimination encountered by tranys here, is replicated in rehabilitation programs. Two units heard causing anguish, stress and acting in a discriminatory fashion were The Buttery and Gorman House. Jarrah house has a rigid two gender policy which excludes transgender people on the basis that children are present in the unit. Issues of gender and sexuality are reportedly, totally unaddressed in rehabilitation units and assumptions of heterosexuality and a rigid two gender model, all prevail, silencing issues critical to transgenders' esteem, growth and recovery.

Rehabilitation programs present a series of issues n regard to [mis]management and lack of sensitivity and education; one of these is social/drug and alcohol worker surveillance, the disciplining and controlling of transgenders' gender and personal practices and sexualities. There is an urgent need for education programs among workers for transgender to be understood and their needs met. Currently, there is no provision for addressing issues about gender and power, about erotic practices, or about issues of abuse, arising out of past experience or sex work and possibly destructive personal effects, specifically for transgender. One transgender told the project officer of a staff's counseling behaviour, their gaze, the lack of privacy given her and the sheer intrusiveness of workers, while she was attending to her usual personal habits.

This kind of treatment may not occur if workers were transgender adequately skilled and trained to deal with the issues, or alternatively, if adequate education issues based programs which explicitly confronted and addressed issues of transgender phobia among workers, were in place and effective. Education strategies effectively implemented by transgender liaison officers within these services may address these issues partially. This is unlikely to be sufficient however, to provide the kind of trany specific quality care, for which skilled trany workers would be better equipped, and in a supportive transgender controlled environment.

The inappropriateness of men working in D&A who were given the task of tending to trany's needs, the expectation of sharing space with groups predominantly made up of men suggest to tranys that staff cannot comprehend trany's oppression and do not treat their identities, behaviours and needs sensitively. Men are especially confronted by trany's gender behaviour, which may stir men's rigid gender beliefs, misogynist transphobic or homophobic fears. An atmosphere and structure of this kind; a lack of needs provision, underlying fear and discrimination by workers and fellow patients, is less than conducive to treatment and cure; all combine to deter, or have discouraged several tranys, from using or completing detoxification programs.

Anecdotal findings suggest a considerable qualification of D&A counselors and a lack of their being able to understand transgender issues. The privileging of a specific moralistic way of treating D&A issues, as per 12 step programs, was referred to as a problem by transgender who are attendees of these programs. Along with these problems, with a de-emphasis on harm reduction in some D&A treatment programs criticism of 12 step programs, with embedded assumptions of heterosexuality and the absence of any education, [let alone informed education about trany issues]: all shape a rigid and inappropriate environment for tranys trying to help themselves through detox, recovery and rehabilitation. Transgenders using D&A services found the Bourke St. D&A service, which has understanding of a gay, lesbian and transgender client group, to be more knowledgeable, empathic and validating, than "mainstream" services.

Health gain requires transgender-specific services

The Gender Centre operates a secondary needle exchange outlet and produced a video entitled "Shattered Illusions". The effectiveness of the latter in community H.I.V. education appears negligible.

Transgenders' Patterns of Drug Use & Required Action

Perkins recommendation, that special transgender substance abuse services be established in each state of Australia, still awaits implementation. Perkins found that tranys consumed large quantities of drugs, legally and otherwise. 15% of Perkins sample of tranys used heroin [with only 2% of the population reporting having tried it], 16% used currently used amphetamine, 40% currently used marijuana and 41% smoked between 10 and 30 cigarettes per day.

In this study reports of usage over the past six months of all these substances were lower. Seven or [8%] used heroin or cocaine, seven [or 8%] used amphetamine, twenty [or 23%] used marijuana and alcohol consumption may be excessive for 16 respondents. This indicates some harmful instances or levels of substance abuse within the community, which tranys may fail to address. Experiences of the project worker within the community and during research indicate higher and more widespread substance abuse than transgenders are prepared to disclose or articulate. The project officer observed very destructive health outcomes through drug use as antidotes to unbearable personal and social difficulties of transgender. Drug use by sex workers, often a way of coping with circumstances, appears to be underestimated in the project's findings. Some sex workers who were approached to do or who completed the questionnaire were very cautious about disclosure of drug use.

Forty two respondents to this study reported smoking 10 to 25 cigarettes per day.

Along with violence, discrimination, medical GRS procedures and sexual assault, cigarette smoking appears as the largest general [and cardiovascular] possible health problem in this study.

Organisation, support, initiatives and training and resources need to be focused in the area of D&A education by the transgender community/service organisation, using prevention and treatment orientations, which a focus on building esteem, affirmation of gender choices an practices of individual transgender, through innovative peer based support and education. Use of substances is inextricable from issues of discrimination and marginality. A D&A service for transgender people specifically was seen as appropriate by some transgender, difficulties faced in "mainstream" service provision. Links with these services may be created by transgender liaison, officers deployed within C.S.A.H.S., to provide transgender education and best practice models. These may be developed and used by our own community/service organisation, following recommendations arising, consultation with transgender and their representatives.

Health gain may require trany specific quit smoking strategies.

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