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A Qualitative Study of Transgender Women and Cisgender Men Living Together in Two Recovery Homes



Oxford Houses (OH) are a peer-run sober living homes that are the largest network of recovery homes with over 2,000 in the US. They are self-run without any professional staff. The current study focused on better understanding the facilitators and barriers to OH entry for transgender individuals. The study explored ways in which transgender people found entry into the OHs and the experiences of transgender residents in OHs in comparison to cisgender residents. We conducted semi-structured interviews of 7 transgender women and 7 cisgender men, using grounded theory methodology. Participants reported fear and apprehensions upon entry into OH due to participants initially feeling that OHs may be similar to past settings that were not sensitive to their needs and gender identity. However, the participants reported diminished fear and comfort shortly after transitioning into OHs. Though discrimination was brought up, it appears that participants could work through minor issues by means of discussion and boundary setting. Both groups of participants followed similar paths in addiction and recovery. Salient themes including familial connections within the house are discussed.
Beasley et al. Arch Addict Rehabil 2017, 1(2):104-111
Volume 1 | Issue 2
*Corresponding author: Leonard A Jason, Center for Com-
munity Research, DePaul University, 990 W Fullerton Ave,
Suite 3119, Chicago, USA, E-mail:
Received: July 26, 2017; Accepted: December 28, 2017;
Published online: December 30, 2017
Citation: Beasley C, Callahan S, Stecker E, et al. (2017)
A Qualitative Study of Transgender Women and Cisgender
Men Living Together in Two Recovery Homes. Arch Addict
Rehabil 1(2):104-111
Copyright: © 2017 Beasley C, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source
are credited.
Research Article Open Access
Page 104
Archives of Addiction and Rehabilitation
A Qualitative Study of Transgender Women and Cisgender
Men Living Together in Two Recovery Homes
Christopher Beasley1, Sarah Callahan2, Emily Stecker3, Michael Dekhtyar4, Charmaine
Yang-Atian4, Frank Ponziano4, Brandon Isler4 and Leonard A Jason4*
1University of Washington, Tacoma, USA
2University of Illinois, Chicago, USA
3Washington College, USA
4Center for Community Research, DePaul University, USA
Oxford Houses (OH) are a peer-run sober living homes that are the largest network of recovery homes with over 2,000 in
the US. ey are self-run without any professional sta. e current study focused on better understanding the facilitators
and barriers to OH entry for transgender individuals. e study explored ways in which transgender people found entry
into the OHs and the experiences of transgender residents in OHs in comparison to cisgender residents. We conducted
semi-structured interviews of 7 transgender women and 7 cisgender men, using grounded theory methodology. Partici-
pants reported fear and apprehensions upon entry into OH due to participants initially feeling that OHs may be similar to
past settings that were not sensitive to their needs and gender identity. However, the participants reported diminished fear
and comfort shortly aer transitioning into OHs. ough discrimination was brought up, it appears that participants could
work through minor issues by means of discussion and boundary setting. Both groups of participants followed similar
paths in addiction and recovery. Salient themes including familial connections within the house are discussed.
Addiction, Oxford house, Recovery homes, Transgender, Grounded theory
Research on the eectiveness of substance abuse re-
covery programs for transgender individuals is scarce
[1,2]. e term transgender is used to describe individ-
uals whose gender with which they identify diers from
the sex to which they were assigned at birth, whereas
the cisgender term is used to describe individuals whose
gender identity aligns with the sex to which they were
assigned at birth. Substance use is a health concern for
transgender individuals across various regions of the
US [3-10]. Service provider insensitivity may serve as
barriers to transgender people seeking service and pro-
vision for their addictions [11]. Among the few studies
that have focused on transgender men and women with
substance addictions [12], accessibility to sensitive sub-
stance use treatment is oen dicult to achieve [13].
Specic research highlighting transgender individ-
ual’s experiences in recovery settings is limited, but the
eorts of Lyons, et al. [2] have uncovered issues related
to stigma and inclusivity that transgender individuals in
residential recovery settings may experience. is is con-
sistent with research on transgender microaggressions
that occur on both systematic and individual levels, in
which transgender individuals report increased levels of
vigilance within environments that are discriminatory.
Microaggressions are seemingly commonplace instances
of discrimination in which negative sentiments are com-
municated toward oppressed groups of people through
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Citation: Beasley C, Callahan S, Stecker E, et al. (2017) A Qualitative Study of Transgender Women and
Cisgender Men Living Together in Two Recovery Homes. Arch Addict Rehabil 1(2):104-111
Beasley et al. Arch Addict Rehabil 2017, 1(2):104-111
for transgender residents from their cisgender roommates,
how they are similar, and what intergroup dynamics occur
in the homes, and what changes in social support network
demographics occur aer living with diverse groups. In
summary, this preliminary study explored the experiences
of transgender residents in comparison to cisgender resi-
dents living in OHs.
Sampling and recruitment
e research team established a purposive sample
of transgender and cisgender residents at two Hawai-
ian OHs. ese OHs were chosen because these were
the only OH settings where there is a specic history
of transgender and cisgender residents living together.
ese settings are unique because OHs are separated
based on sex assigned at birth. An OH recruiter connect-
ed the research team with a resident of one of these OHs.
e method of snowball sampling was used to recruit
additional interviewees based on the recommendations
of participants at the time of the interview. Participants
were recruited in 2011 and 2012 via telephone and two
initial letters sent to each house by the two DePaul based
research assistants to explain the purpose of the inter-
views. Interviews were open to all individuals living in
the OH. As an incentive for participating, the two par-
ticipating OHs were given coee makers worth $60. IRB
approval was obtained from DePaul University.
Data collection
Participants were interviewed on a one-by-one basis
by the research assistants following a semi-structured
interview guide based on the research questions adapt-
ed from Alvarez, et al. [23] protocol for interviews con-
ducted with Latino/a residents. e DePaul research
team eld tested a brief version of the protocol with a
cisgender female and a homosexual, African Ameri-
can male from the Midwest who have resided in OHs.
Based on these two pilot interviews, our nal questions
for the current study included: What was your support
network like before you came to OH? What were your
thoughts and feelings as you decided to join the house?
What was your initial experience in OH like? How did
you feel about transgender/cisgender individuals before
you came to OH? How do you feel about transgender/
cisgender individuals now? What do you think are some
of the reasons why transgender individuals may or may
not be coming to OH?
Participants were explained the nature of the re-
search, how the research would be used, and given in-
formed consent at the beginning of each interview. Be-
fore the interview took place, participants were informed
of the purpose of the research, how long the interview
verbal, behavioral, or environmental cues [14]. Microag-
gressions for transgender individuals continue to consis-
tently occur within health care settings, and oen times
transgender people seeking gender-arming health care
are met with further discrimination [15,16]. One study
described microaggressions experienced by transgender
people from police ocers, health care workers and oth-
ers, and methods of coping with microaggressions. e
transgender participants oen felt anger and betrayed,
and this resulted in them being vigilant and cautious of
their surroundings.
In the context of addiction recovery, many transgen-
der individuals seek recovery programs aer being incar-
cerated, and additional community-based supports need
to be identied [17]. One potential community-based
support is a network of more than 2,000 mutual-help
residential recovery homes called Oxford House (OH).
OHs are self-sucient, democratically-run recovery
homes, in which residents are responsible for manage-
ment and housekeeping, and all residents must main-
tain sobriety and pay their share of house expenses. Past
research [18,19] showing the eectiveness of OH has
allowed the organization to be listed on e Substance
Abuse and Mental Health Services Administrations Na-
tional Registry of Evidence-based Programs and Practic-
es [20].
OH research has found that people who live in an OH
are less likely to relapse, be incarcerated, and be with-
out employment as compared to individuals that are
not provided OHs [21]. Recovering people from various
backgrounds report positive experiences in OH, includ-
ing: residents who live with both mental illness and sub-
stance abuse, Caucasians, African Americans, and both
biological sexes [21,22]. In addition to studies on the
eectiveness of OH, other research has explored mecha-
nisms through which recovery is gained in these settings
[19]. In addition, research has been conducted on Lati-
no/a experiences in OH [23], Americans Indians in OH
[24], and hearing impaired OH residents [22]. Still, less
is known about individuals whose gender identities do
not align with the sex they were assigned at birth in the
OH experience.
e current study explored issues related to facilitators
and barriers of entry to OH for transgender individuals,
including: ways in which transgender people found entry
into the OH; fears of transgender individuals entering OH;
and whether discrimination occurs in OH directed toward
transgender individuals. As such, the goals of this study are
to understand the transgender resident’s lived experiences
by better understanding the barriers which may prevent
access to recovery resources and to understand the role
of OHs in assisting transgender individuals through their
recovery. It is still unclear how the OH experience diers
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Beasley et al. Arch Addict Rehabil 2017, 1(2):104-111
should take, what they would be asked if they agreed to
the study, the risk, the benets, and how their conden-
tiality would be protected. Participants were informed
that they could discontinue the research at any time. e
interviews lasted anywhere from an hour to two hours in
length. All interviews were taped, recorded in English,
and transcribed verbatim by members of the research
team and undergraduate research assistants. All names
of people and institutions involved were redacted to pro-
tect the identity of people living in the OHs. e analy-
sis was conducted using methods described in Odo and
Hawelu [25] in order to manage the analysis of the inter-
view transcripts.
Data analysis
is study used a grounded theory methodology,
which is a way to develop a model that emerges from the
participant’s experience and lived lives. Since our goal
was to understand the signicance among the partici-
pant’s entries and OH experiences, analysis followed a
more constructivist approach [26], which allows the pro-
cess to unfold from the collection and interpretation of
data, and the model to be directed and developed by the
mutual experience of the participants and researchers.
rough an analysis of specic participant responses
to the research questions, we developed a code book from
emerging themes salient in the data. We initially began
coding with a line-by-line analysis of the participants ex-
periences in the OHs, and then we began naming concepts
[26] based on the participants’ responses, which then led
to relationships between categories that emerged from the
data. Next, researchers individually coded the responses
of the participants using grounded theory techniques de-
scribed above. We came to code book consensus by dis-
cussing the dierences of our interpretation of the data,
thus reaching common ground. e process of reaching
agreement took using reexivity [27] to understand our
own experiences and the participants through becoming
close to the data and doing our best to step outside our bi-
ases. Reexivity was done by keeping written notes, gath-
ering input from our team, and getting acquainted with
the nuances of the participants’ response style.
e nal sample included 7 transgender women and
7 cisgender men. e average age of the transgender
women was 41.4, and the average age of the cisgender
men was 39.0. Four of the transgender women had life
partners and three were single. Likewise, 1 cisgender
man had a life partner, 1 was divorced, 1 was separated,
and 4 were single. Four of the transgender women had
High School diploma/GED; 1 had a vocational degree;
and 2 did not have a High School/GED diploma. Five of
the cisgender men had a High School diploma/GED, 1
had an Associate’s degree, and 1 had a Bachelor’s degree.
ree transgender women grew up in rural areas, 2 in
suburban, and 2 in urban areas, and the distribution of
where the cisgender men grew up was identical to that of
the transgender women. e average stay of all partici-
pants in OH was approximately 12 months.
How do transgender individuals nd entry into OH?
Participants reported being referred to OH. How-
ever, the source of referral was varied over our pool of
participants; the referral most salient in our study was
from drug treatment. Drug treatment in this study can
be mandated (when individual is ordered by a collater-
al) or volunteer treatment (when individual goes on own
will), but none-the-less their knowledge and inuence to
join OH came while in treatment for substance abuse.
e following quotes from residents illustrate this point:
When I was introduced in the Oxford Houses, I was
in the drug treatment program.
Oxford House is very popular with some of the drug
treatment programs because they feel comfortable
that’s why, and that’s they wanna come and live here
and I have a lot of phones calls from the ATS pro-
gram, ATS is a Salvation Army program for um peo-
ple coming out of jail or prison and they go inside
there, or the people who want to get o drugs, they
go get clean from over there and aer they nish the
program, they have to go look for housing, but they
still have to report to the program, they have classes
like twice a week, some of them once a week because
they’re already transitioning out of society from the
program. at program is a pretty good program and
you know the Oxford Houses, they deal with the Ox-
ford Houses a lot as far as nding a place for clients
that are transitioning out of the program.
I came through my treatment center.
[House name] is best house, all the programs, the
drug treatment programs here in Hawaii, know this
house has T-girls in it, a lot of the boys that transition
out of the drug treatment program, you know they
suggest to come to this house and live here.
Drug court
Around half of the participants indicated hearing
about OH while involved with drug court; some report-
ed drug court as a direct referral. Participants also talk-
ed about drug court as being related to their probation
or parole status. is referral source typically represents
mandated treatment. e following quotes from resi-
dents illustrate this referral:
Um, actually, I was on probation. I was living at home
with my mom, and, um, they terminated me from
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Citation: Beasley C, Callahan S, Stecker E, et al. (2017) A Qualitative Study of Transgender Women and
Cisgender Men Living Together in Two Recovery Homes. Arch Addict Rehabil 1(2):104-111
Beasley et al. Arch Addict Rehabil 2017, 1(2):104-111
that we must, we needed to get into those houses or else
we have to stay in the YMCA, I didn’t wanna live in a
YMCA. I wanted to live more in a house setting.
[e recruiter] goes to the treatment programs and
recruits people when they come out of jail or some
of them are nishing up treatment. He has a list of
houses that are open bed space and the clients has to
make, they have to go and call and nd out if there’s
an opening, if they can get into that house, if they can
get into and have an interview with the house, in or-
der to get into that certain house.
What barriers do transgender individuals have as
they try to access OH?
Another revealed theme was barriers that impede
transgender people from moving into OH. Even though
individuals were referred, they reported a belief that the
OH may be similar to previous experiences at institu-
tions that were not best suited for their needs. e fol-
lowing quote from a transgender resident illustrates the
participant’s experience:
I think that a t girl, you know, really, doesn’t come
from a place where they’re accepted, and the only place
where they nd acceptance is on the streets, unfortu-
nately. And, you know, they start doing drugs, and you
just get caught up in that lifestyle that you’re out their
all the time. And, they don’t, the sad thing is they don’t
know anything better than that because that’s where
they feel accepted.
Fears and apprehension
All participants reported fears or apprehension while
attempting to make the transition into OH. Individuals
talked about being scared of living in a new environment
compared to the way they used to live in active addiction.
Quotes from residents illustrate this theme:
Before I went in it (Oxford House) I was kind of
scared because I was only twenty at that time.
I was kinda skeptical at the beginning because um, I
never lived with drug addicts or alcoholics.
Um, some of them don’t want to come into recovery,
they’re afraid.
Participants’ reported being scared of living with
strangers and the change of living apart from their fami-
ly. For example, transgender residents stated:
Cause I know, like, for the rst time, of course, it’s
kind of scary, cause, you know, you don’t know what’s
gonna happen or you don’t know how they’re gonna
treat you and stu.
I was scared shitless. I had no idea what it was going
to be like living in a house full of total strangers.
probation. ey put me into drug court, and drug
court placed me in this Oxford House.
I was in drug court back in 2000, and they referred me
to a house. And because of that I went into the Oxford
House, and then I also had a couple of relapses. And
then I had to leave. And then I just gured out that I
always come back here because I’m o of probation,
and I don’t need to be here. I’m not here by court, or
I’m not here by anything.
I’m here on my own will, and it’s because I like the com-
radery that we have here. You know, I like the support.
I’m on parole, and I denitely don’t want to go back
to my old ways or live in the street.
Transition from prison or jail
Participants in this study also indicated that they
found OH through referral sources while incarcerated.
Participants talked about the need for sober housing
transitioning out from prison. ey reported how OH
has provided an environment that has allowed for a new
start. e following quotes from transgender residents
help speak to this transition process:
A lot of t girls that come out of jail and go into drug
treatment programs, they go to a house where the t
girls live, they suggest that, or the counselors, or case
managers suggested they come to this house because
it’s well known, with all the probation ocers, parol-
ing oce, the drug treatment programs, their coun-
selors, the case managers, it’s well known.
ere were girls that were coming out of jail, so I told
them like, you know, just try and get in because it’s
the good, the kind sobriety and, you know. It’s cheap.
You can just do what you’re doing. You don’t have to
worry about where you’re gonna stay and stu like
that. Just abide by the rules. If you guys want a better
life then stop using. Come to an Oxford House.
I needed a place because I’m transitioning out from
OH recruiter
A common theme that emerged from our study was
the involvement of the OH recruiter. Recruiters work
under a grant from the state to recruit residents into OH.
Along with recruiting, they have other responsibilities
such as keeping track of how many residents move in
or out of OH and for how long they stay. ey also keep
track of demographics such as ethnicity and age. Recruit-
ers help get new houses started and aid in nding rental
properties for OH residents. e following quotes from
residents illustrate this theme:
ey told me these houses were given by [recruiter] and
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Houses and (cuts out) thing is when we do go to, like,
um, chapter meetings, you know, they do kind of seg-
Many of the participants talked about a barrier that
exists between transgender individuals and the access to
resources. When asked what was most positive in their
in their transition experience to OH, many mentioned
that it addressed this barrier. Transgender participants
indicated that most OH residents harbored a spirit of
inclusiveness and hospitality despite gender identity dif-
ferences. Some transgender residents spoke in light of
the economical utility that OH provided; and indicated
that OH allowed them to have a comfortable and aord-
able place to live with roommates with similar goals such
as being sober, getting a job, and going to college. is
speaks to the concerns that transgender individuals have
regarding access to resources. Here are some of the voic-
es from our transgender participants reecting how OH
has helped:
It’s easy that I live here because the rent is cheaper
than getting a place on your own or having to move
in with roommates that are kind of sketchy.
While in the Oxford House I found a job.
Now I don’t need a nancial support cause I’m able
to take care of myself as far as food, groceries, etc.
And getting a job has enabled me to continue on with
my therapist, through my psychologist, and I haven’t
relied on very many people like in the past where I
would’ve before because now I know the avenues to
take, I know what roads to take and I don’t need to
rely on anybody. I’m pretty much self-sucient.
It’s cheap. You can just do what you’re doing. You
don’t have to worry about where you’re gonna stay
and stu like that. Just abide by the rules. If you guys
want a better life then stop using. Come to an Oxford
I want to get my associate’s degree (working toward
her associate degree).
OH rules
Participants also reported fear about adjusting to the
rules of OH. Structure is a component of the day-in and
day-out life of OH residents. ey talked about being ap-
prehensive about the structure that OH provided which
required that residents stay sober, nd a job, contribute
to chores, and pay their fair share of rent; all of which
can be intimidating rules for new residents. Paradoxical-
ly, participants indicated that aer a week or two of be-
coming residents, they adapted to the rules and became
grateful for the structure OH provided, as illustrated by
the following quotes from residents. Additionally, al-
I was kinda scared at rst because, um, and me coming
out of a family home and stu and being put into jail and
then coming out of jail and then having to go into a pro-
gram, it was just, like, overwhelming, but I got over it.
Another concern discussed by transgender partici-
pants was the fear of gender “dierences” in regards to
having roommates that identied as cisgender, who may
not understand their gender expression. e following
quotes from transgender residents illustrate these con-
Well, when I, when I found out that I had to come to
the clean and sober house my initial thoughts were: I
don’t want to be here, I want to be at home with my
family, kinda scared, didn’t know what to expect, I
didn’t want to live in a house with thirteen other guys,
um, yeah it was just a little, in the beginning it was a
little overwhelming.
I was scared to come because, you know, living in a
house full of men and being the way that I was, you
know, it’s kind of dierent.
Participants reported fear of being discriminated
against in the OH based upon past experiences while in-
carcerated or while in other rehabilitative services such
as substance abuse treatment programs. e following
quote from a transgender resident illustrates this con-
Well, my experiences with living with straight guys
would only be when I would be locked up in jail. Be-
cause you know, I used to get hit on all the time, I
used to, you know, just, so that in itself is a mind trip.
So, just, (cut out) of that, and just that playing that
over and over in my head in a house setting where
there are no guards, where there are no safe place for
me to go it just kind of messed with me a little bit.
Transgender residents reported subtle discrimination
in regards to their initial entry into OH, mostly in the
form of micro-aggressions [14] when cisgender residents
would refer to them as male. e following quotes from
transgender residents illustrate these concerns:
Um, the part that, you know, you’re, you’re, kinda
like, forced to live with all these people and then you
have to abide by the rules, and then, you know, you
have some, sometimes there was kinda like, some
people, like, in my rst house were kinda homopho-
bic I guess you can say. ey wasn’t OK with, um,
I have, um, friends that are in drug court, and, you
know, they’re also in clean and sober, I mean, Oxford
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Beasley et al. Arch Addict Rehabil 2017, 1(2):104-111
I move[d] into the house because I wanted to make
a change.
I knew I needed help and…so I tried to get myself
into a treatment center.
Connectedness and helping others: Transgender
residents seemed to benet from community connected-
ness within the transgender community in terms of con-
nectedness and mental health. Mentoring/helping and
experiencing mutual acceptance others was mentioned
by several transgender individuals:
I can help my sisters here, too.
e straight males treat me at [as] me.
I get the same respect back as how I give them.
ree cisgender residents mentioned:
…every guy that’s in [Oxford House] has accepted
every transgender individual or homosexual individ-
ual that’s been in this house.
…now I’m someone who gives social support.
…I’ve got nothing to worry about…
Two transgender individuals said:
To tell you the truth…Oxford Houses are a safe ha-
…everything is just…coming back together again.
Several mentioned experiencing a familial connection
within the house. Two transgender residents stated:
…they call us auntie.
We’re all like a secondary family…
A cisgender individual said:
ey are just like my sisters.
Professional and mutual-help recovery programs
exist to facilitate and maintain sobriety for those in re-
covery from these addictions, including the mutual-help
recovery housing system of OH. However, little is known
about minority cultures in these homes or even more
broadly of transgender individuals in recovery from
psychoactive substances. e current study provided a
grounded theory inquiry of transgender and cisgender
individuals living together in OH. e research exam-
ined the initial experiences of these individuals in OH,
their ongoing experiences, their intergroup dynamics,
and changes in the composition of their social support
networks as a function of OH residency. Several emerg-
ing themes examined included their experience of entry
into OH, fears and apprehensions, barriers, meeting ba-
sic needs and social support before and aer entering OH
though OH explicitly does not let members of opposite
sexes assigned at birth live together, transgender resi-
dents feel comfortable referring to their home as co-ed:
I just obey the rules. You know, do your chore, all this
kind of stu; I go to work every day. So, it’s pretty
I was kinda scared at rst because, um, I had to abide
by the rules.
Well, actually, like the second week that I was here
and I got used to the Oxford rules, and, you know, be-
coming closer with my house mates, then it, then my
view shied, and I just, just had a dierent outlook on
Oxford House.
I call them family now, you know. e, it’s, um, co-ed
here now because we have the, you know, the transgen-
ders and the, the, the men. So, the rst thing is just to ac-
climate myself with the surrounding and know about the
rules, especially the rules. You know, and to, I mean, to
adhere to the rules because I don’t want to get kicked out.
What are the benets of oxford house for trans-
gender individuals?
Sobriety is priority: For all residents of the house, so-
briety was mentioned as a key part of living in the OHs,
as indicated in the quote below by a transgender indi-
We’re all here to get sober. We’re all here to do our
A cisgender individual commented:
…we’re all addicts so we all-you know-share the same
problem and,…we call each other on our shit and…we
help out each other whenever we can.
To maintain their sobriety, consequences were em-
phasized by transgender and cisgender residents as being
of importance. As an example, one transgender resident
…what has really kept me sober is just knowing that
I could not fake being high in front of these people…”.
A cisgender individual mentioned:
…if I didn’t get into trouble, I wouldn’t be in this po-
Seeking a setting with normalcy and stability: Seek-
ing normalcy/stability also was mentioned by many, and
one cisgender individual elaborated by saying:
I already knew basically that there were gonna be
rules and…I was just all up for it.
e following quotes were by transgender individu-
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Beasley et al. Arch Addict Rehabil 2017, 1(2):104-111
those who felt respected in treatment had positive expe-
ere are several limitations in this study. A test of re-
liability was not conducted. In addition, the small sample
size and use of only Hawaiian houses limits the general-
izability of the results, although we do not know of other
OHs that service this group. Another limitation of this
study relates to whether the results can be generalized to
all the transgender people living in other recovery homes
in the US. In addition, there is a need for more research
regarding how gender plays a role in recovery as well as
how gender plays a role in the OH environment and re-
covery eorts by individuals. We need more information
about interactions between cisgender and transgender
residents within the OH. For example, how initial ex-
periences change over time, and how these interactions
aect the relationships and social networks/support
systems of cisgender and transgender individuals aer
leaving OHs. Finally, longitudinal data is needed to help
us understand how intergroup/contact theory allows us
to understand how this exposure aects established and
new relationships for either cisgender or transgender
OH residents.
Future research should not only address these limita-
tions but also expand on answers to research questions
posed in this study as well as unexpected themes. For ex-
ample, additional inquiry could further illuminate ways
in which past experiences of transgender residents in
recovery might hinder entry into other systems as well
as the role peers in diusing apprehension and fears.
Moreover, future studies should examine the potential
inuence of family roles in the recovery home environ-
ment. For homes with transgender residents, such in-
quiry should pay particular attention to gender-related
roles. Lastly, comparative research should be conducted
to compare family roles in gender segregated recovery
homes to those in which gender is not segregated.
In conclusion, in response to the barriers that prevent
transgender individuals from entering into treatment for
substance abuse [5,6], a number of initiatives for equal
rights have been instituted, and one of these involves re-
covery homes like OHs. It is important that the perspec-
tives of transgender individuals are examined [11] and
recovery homes like the ones proled in this study might
provide excellent recovery settings for transgender indi-
viduals. While there are limitations to the current study,
it advances knowledge about a topic that scholarly in-
quiry has largely ignored-the experiences of transgender
people in recovery from alcohol and other drugs. In par-
ticular, it identies multiple pathways to entry that shape
residents’ fear-laden expectations, transgender residents
prioritization of sobriety and stability, and family roles
that may contribute to their experiences and outcomes.
(limited social support, lack of access for services, tran-
sient/street lifestyle). While our focus in this article was
on the transgender experience, the attitudes of cisgender
individuals were important to include in order to better
understand their acceptance of transgender individuals
in the OHs. Both cisgender and transgender participants
expressed many similar themes regarding fears about en-
tering the OHs and the support they experienced once
they lived in these residences.
e ndings of this study revealed that transgender
individuals found their way into OH primarily through
health and criminal justice systems. ese include refer-
ral from drug treatment centers and mandated treatment
such as drug court, probation, and from prison. OH re-
cruitment eorts seemed to collaborate with the above
agencies to recruit transgender individuals into OH.
Participants reported hearing about OH from sta at the
agency of referral and from mutual transgender individ-
uals while receiving intervention services. Such referrals
are particularly noteworthy given transgender residents’
negative experiences with other health and criminal jus-
tice systems.
ese experiences appeared to shape transgender par-
ticipants’ expectations of what their experiences in OH
would be like. Transgender participants in this study ap-
proached the decision to enter OH with apprehensions
and a number of fears, mainly regarding the fear of living
in a new environment with strangers who might not un-
derstand their transgender identity. Prior to OH entry,
transgender participants reported fear of discrimination
based on their past experiences with other intervention
organizations. Participants reported that past experi-
ences with institutions, such as jail, were not sensitive to
their identity and needs and feared OH may be similar.
However, this study found that once the partici-
pants were in OH, their gender identity was respected
in most circumstances, and that discrimination occurred
on a micro level, oen not being intentional, and was
worked out through discussions and boundary setting.
Transgender women view the roles of women in society
as being nurturers and communicators, and OHs may
give them opportunities to reinforce those traits within
the household. Our ndings suggest that transgender
women and cisgender men go through similar experi-
ences in recovery. Both groups may benet from living
together in a structured environment. A sense of family
within the home may lead to reinforcement of positive
self-concept. is is compatible with ndings from Ly-
ons, et al. [2], who conducted semi-structured interviews
with 34 transgender individuals. ose with prior addic-
tion treatment had experiences that varied according to
whether their gender identity was accepted. ose who
experienced stigma le treatment prematurely whereas
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Citation: Beasley C, Callahan S, Stecker E, et al. (2017) A Qualitative Study of Transgender Women and
Cisgender Men Living Together in Two Recovery Homes. Arch Addict Rehabil 1(2):104-111
Beasley et al. Arch Addict Rehabil 2017, 1(2):104-111
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In 2016, two Oxford House (OH) recovery homes were established for the Suquamish Tribal reservation. A group of researchers interviewed house members and key individuals responsible for the creation of these two unique OHs. Because American Indians are an at‐risk population for substance use disorders, our study explored whether an OH‐type recovery home model could be successfully adapted to this population, given the specific nature of tribal cultures. Findings indicated that the residents, composed of both American Indians and non‐American Indians, found these OHs to be supportive of recovery in general and with the values of American Indians. The tribal community's positive attitudes toward these recovery homes may have been due to similarities between the Suquamish Tribal Government and OH's democratic structures, with all individuals having a voice in the decision making process. The overall findings suggest that these types of culturally modified recovery settings on American Indian tribal lands could be an important resource for individuals dealing with substance use disorders.
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While considerable research has been undertaken on addiction treatment, the experiences of transgender individuals who use drugs are rarely explored in such research, as too often transgender individuals are excluded entirely or grouped with those of sexual minority groups. Consequently, little is known about the treatment experiences in this population. Thus, we sought to qualitatively investigate the residential addiction treatment experiences of transgender individuals who use illicit drugs in a Canadian setting. In-depth semi-structured interviews were conducted with 34 transgender individuals in Vancouver, Canada between June 2012 and May 2013. Participants were recruited from three open prospective cohorts of individuals who use drugs and an open prospective cohort of sex workers. Theory-driven and data-driven approaches were used to analyze the data and two transgender peer researchers aided with the coding and the interpretation of data in a process called participatory analysis. Fourteen participants had previous experience of addiction treatment and their experiences varied according to whether their gender identity was accepted in the treatment programs. Three themes emerged from the data that characterized individuals' experiences in treatment settings: (1) enacted stigma in the forms of social rejection and violence, (2) transphobia and felt stigma, and (3) "trans friendly" and inclusive treatment. Participants who reported felt and enacted stigma, including violence, left treatment prematurely after isolation and conflicts. In contrast, participants who felt included and respected in treatment settings reported positive treatment experiences. The study findings demonstrate the importance of fostering respect and inclusivity of gender diverse individuals in residential treatment settings. These findings illustrate the need for gender-based, anti-stigma policies and programs to be established within existing addiction treatment programs. Additionally, it is vital to establish transgender and/or LGBTQ specific treatment programs as recommended by the participants in this study.
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A needs assessment of transgender people was conducted in Chicago in 2001 to assess their HIV risks, health and social service needs, and barriers to care. One hundred and eleven transgender individuals, 78 male-to-females (MTFs) and 33 female-to-males (FTMs), participated in the study. Fourteen percent of respondents reported being HIV-positive; they were all male-to-female and the majority was of color. Risk factors for HIV included unprotected sex and willingness to have high-risk sex in the future. Respondents experienced high levels of violence. Two-thirds of respondents had thought of attempting suicide. Respondents reported a high need for health and social services, particularly MTFs and people of color.
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This study compared the characteristics and outcomes of four ethnic groups living in mutual help recovery homes. The sample consisted of 524 Caucasian, 305 African American, 31 Latino/a and 17 American Indian (AI) participants. This article includes a short review of relevant literature on AIs and substance use, provides an analysis of characteristics and outcomes of four ethnic groups and includes a discussion of the implications of the findings for knowledge of patterns of use among AIs. The AIs were more likely to report being on parole or probation and being referred for aftercare by the legal system. Additionally, AIs reported greater disharmony within their recovery residences than Caucasians, but there were no significant ethnic differences in baseline length of stay in Oxford House, length of alcohol or drug sobriety or substance use outcomes 4 months after the baseline assessment.
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Semi-structured interviews were conducted with 12 Latino/a residents of a mutual help residential recovery program (Oxford House) in order to elicit their experiences of the program's therapeutic elements. A model of recovery emerged from the analysis including several themes supported by existing literature: personal motivation and readiness to change, mutual help, sober environment, social support, and accountability. Consistent with a broad conceptualization of recovery, outcomes included abstinence, new life skills, and increased self-esteem/sense of purpose. Most participants were the only Latino/a in their Houses; however, cultural differences did not emerge as salient issues. The study's findings highlight potential therapeutic aspects of mutual-help communal recovery programs and suggest that English-speaking, bicultural Latinos/as have positive experiences and may benefit from participating in these programs.
Background: Low levels of medical care engagement have been noted for HIV-positive people leaving systems of incarceration in the United States. Substance misuse frequently co-occurs with criminal justice involvement in individuals who are living with HIV. Methods: We analyzed data from in-depth interviews with 19 HIV-positive individuals who were currently or formerly incarcerated in order to elucidate challenges faced in accessing care and maintaining HIV treatment regimens when cycling out of (and often back into) custody. Our thematic analysis used an ecosocial framework to describe participants' shifts between substance use treatment, medical care, and criminal justice systems. Results: Dominant themes included the dramatic increase in HIV-treatment-related autonomy required following release from jail because of differences in care delivery between custody-based and community-based care systems; the important, but temporary stabilization provided by residential substance use treatment programmes; and the inconsistency of substance use treatment approaches with chronic care models of disease management. Conclusion: Enhanced integration of criminal justice, medical care, and substance use treatment institutions in planning for reentry of HIV populations may ease the impact of the dramatic shifts in context that often dissuade linkage and retention. This integration should include coordination with custody release processes, periodic assessments for active substance misuse in HIV treatment settings, support for (re)establishing health-promoting social networks, and options for long-term, residential substance use treatment programmes.
Objective: To qualitatively describe the level of HIV risk behaviors and access to HIV-prevention and health services among transgendered individuals in San Francisco. Methods: Eleven focus groups were conducted with 100 Male-To-Female and Female-To-Male transgendered individuals. Focus groups were transcribed, reviewed, and comments were coded into categories that emerged naturally from the data. Unduplicated comments were enumerated and summarized. Findings: HIV risk behaviors such as unprotected sex, commercial sex work, and injection drug use were common. Low self-esteem, economic necessity, and substance abuse were cited as common barriers to adopting and maintaining safer behaviors. Many individuals did not access prevention and health services because of competing priorities and the insensitivity of service providers. Participants' recommendations for improving services include hiring transgendered persons to develop and implement programs and training existing providers in transgender sensitivity and standards of care.