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The Intersection Between Gender Variant Individuals and Drug Use

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Very little research has been done on any facet of life that affect transgender individuals’ mental health. This paper will explore literature regarding the stigma around drug addiction and the impacts of stigma, including the stigma towards transgender individuals, on mental health. It will also present a pilot study with a limited population sample to explore the intersection between substance abuse and gender variance and suggest studies to better serve the transgender community going forward.
The Intersection Between Gender Variant Individuals and Drug Use:
Where Do We Go From Here?
Kyle Aaron Reese
Kingsborough Community College
Author Note
Written for Sociology 3100 Honors Project under the mentorship of Dr. Stuart Parker
Very little research has been done on any facet of life that affect transgender individuals’ mental
health. This paper will explore literature regarding the stigma around drug addiction and the
impacts of stigma, including the stigma towards transgender individuals, on mental health. It
will also present a pilot study with a limited population sample to explore the intersection
between substance abuse and gender variance and suggest studies to better serve the transgender
community going forward.
Keywords: transgender, gender variant, addiction, drug abuse, mental health, stigma
The Intersection Between Gender Variant Individuals and Drug Use:
Where Do We Go From Here?
Very little research has been done on any facet of life that affect transgender individuals’
mental health. Thus, there is widespread conjecture, and inevitably misinformation, that
contributes to the stigma of the mental health and medical treatment of this grossly underserved
community. To compound this, there is excessive social stigma painting drug users as criminals
which contributes to the severity of the drug addiction phenomenon. This pilot study explores
the intersection between gender variant individuals and drug abuse and will attempt to plot out
future possible studies concerning the wellbeing of members of the transgender community.
Literature Review
Johann Hari begins Chasing the Scream with a beautifully, however infuriatingly,
illustrative narrative of the origins of the drug war in the United States. The war on drugs has
been pervasive in the memories of the recent generations and has been violent and bloody. The
focus has been on cutting down crime and the outcome has been the criminalization of a group of
people that desperately need the help of medical and mental health practitioners rather than the
institutional furthering of their stigma. The first laws prohibiting all psychoactive substances
that are not prescribed by a doctor were passed in 1914. Ten years earlier, a very young Harry
Anslinger, the first person to be appointed to a position to fight the war on drugs federally,
witnessed his first drug withdrawals in the form of a woman’s screams in a barn. This man took
the drug war by the horns in the 1930’s and made it a very ugly and deadly thing.
Anslinger was clearly very deeply affected by his experience as a child, and this began
his desire to fight addiction. However, as he grew up, he developed racial biases which
profoundly clouded his judgement, and which he used to manipulate legislators and the general
public towards his agenda. Because of this, the drug war as we know it has deep roots in
institutionalized racism. Anslinger went so far as to comment that when a black man uses
marijuana, he is sent in to a crazed rage and is incredibly dangerous; therefore, marijuana must
be eradicated and these people must be put away. He even went so far as to say that marijuana
and “Satanic” jazz music made white women sleep with black men, which was a direct threat to
white men who were in charge of the legislation and law enforcement. Propaganda was created
on this basis, and the prison system was drastically expanded and altered to accommodate this
Racially biased anti-marijuana propaganda from Harry Anslinger’s campaigns
Today, the remnants of Ansligner’s war on drugs can be seen internationally, as his
policies were adopted by many countries with United Nations membership. In the US, it still
affects everything from immigration policy to Joe Arpaio’s horribly managed jail system, where
women who have been convicted of drug crimes, often simple possession charges, are sometimes
left in steel cages in the Arizona desert for days until they die.
Unexpectedly, Hari tells the story of a transgender man named Chino in Brooklyn that he
befriends in the second part of his book. Chino’s story explores everything from his childhood
exposure to drug culture, to his struggle with gender identity and how that affected his mental
health and drug use. Chino, like many in the transgender community, experienced familial and
societal rejection which has been shown to cause a lot of mental health problems. Because of
this and his upbringing, Chino fell into the American drug use lifestyle of using and selling,
wound up in the prison system, and had a very difficult time getting himself out of it. He
managed to, however, and now runs an organization working to shut down juvenile detention
centers around the country in an effort to stop the institutionalization process from beginning in
The effects of social environment are further illustrated in Bruce Alexander’s “Rat Park
Study” (Alexander et. al.). In this study, the researcher first put rats into bare cages and made
available food and two water bottles; one with fresh water and one infused with morphine. The
rats in this isolated situation with choose the morphine and die of malnutrition. In the second
part of the study, a set of rats was kept in isolated conditions, and another set was kept in
colonies. The colonies were group living situations, where the rats had free access to food,
water, physical activity, and social activity; mothers were also allowed to nurture their young. A
bottle with morphine was also made available. These rats chose fresh water over morphine. The
isolated rats exhibited the expected behavior with the morphine, but when later placed into the
colonies and allowed to integrate into those rat societies, they too began to choose the fresh
It would appear that the Rat Park Experiment shows that material conditions (open areas
with access to exercise and social situations) and institutions (the social structure of rats, in this
case) play a huge role in developing the system that created addiction as we know it. This
experiment does need to be replicated for more conclusive results, and further non-experimental
studies would be helpful in humans to further explore the effects of stigma and social systems on
drug use, though it seems that Portugal is off to a great start with its new public policy on
Portugal implemented what has been considered a radical new drug policy in 2010.
Instead of criminalizing drugs, it has completely legalized them. When a doctor finds out that a
patient is addicted, instead of immediately cutting them off they write them a prescription for
whatever will keep them safely comfortable, ensure them that their housing and employment are
secure, and allow the patient to decide when, if ever, they would like to stop using. This
completely removes the anxiety of addiction that often leads drug users to use more frantically,
thus overdosing or increasing their tolerance and dependency. They can continue their lives
normally. This policy also distributes clean syringes, as the substances are all prescribed.
Portugal reports staggering numbers as a result, perhaps the most so in the reduction of
new HIV cases. In 2006, there were about five hundred new cases attributed directly to injecting
illicit substances. In 2018, there were thirty-six. Also substantial is the decrease in overdose
deaths; from ninety-four in 2008 to the lowest of nineteen in 2011. Likewise, the crime rates
have drastically decreased, as drugs are easily available and the need for black market substances
no longer exists (Santos).
HIV diagnoses attributed to injecting in Portugal, 2006-2016 (Santos)
Overdose deaths in Portugal, 2008-2016 (Santos)
Of course, there are biological and physiological components to addiction. Addiction as
we know it is a complicated phenomenon that stems from a mix of broken social systems,
biological predispositions, and physiological changes that occur in the brain after repeated
exposure to a substance (Kandel). However, as there is very little research on gender variance,
there is very little research on the social aspects of addiction (James, et. al.). The people at the
intersection of these issues are being done a great disservice; we as a society do not understand
how to help them.
Two individuals were interviewed with the same set of questions (pg. #14) regarding
their upbringing, drug use history, and experience with gender variance. The participants were
informed that the interviews would be recorded for the purpose of transcription, then destroyed,
and their identities kept confidential; both agreed. Participant 1 was met in person, and
Participant 2 was met with over Facebook video messenger. The interviews were recorded,
transcribed, and destroyed. There is no numerical date, therefore this is a qualitative study. As
this was a pilot study, it was very limited. The sample was very small with only two
participants, both assigned male at birth.
Participant 1 is a genderqueer drag performer in New York City who was assigned male
at birth. They use them and they pronouns. They had a cultured childhood and were raised with
their immediate family and were close to their grandparents. They went to public school but
took solace playing the violin and preferring spending time with girls over boys. They realized
in college that they liked makeup and heels offstage as well as during performances. Their
friends know about their gender identity as do their family, but it’s not talked about within the
family due to the participant’s discomfort in discussing sexuality or gender identity with them.
Participant 1 would like to do more to express their gender identity but doesn’t feel safe after
Trump’s election.
Participant 1’s drug use started with night life and gender expression on stage as drug use
is ingrained in the gay culture they experienced. It was easy to get drugs as a well-known
performer. The participant went on a weeklong bender following a birthday, which ended in an
episode of suicidal ideation, self-harm, and a hospital stay. They did eventually go back to using
but found themself in some precarious situations and had to reassess. They cut off all contacts
and connections to drugs. Friendships did become distant during drug use, and visits to an ill
family member were put off because of this.
Post drug use, Participant 1 still is afraid of missing out; “why can’t I use but you can?”
They cheated once for a friend’s going away party but hasn’t used since then. They still see drug
use when performing but actively does not pay attention to it. The participant is now a high-
achieving student. Their relationship with themselves has improved through Zen Buddhism.
The participant does not regret drug use because they wouldn’t have made the decisions to
become successful without it. Their goals for the future include to simply be happy.
Participant 2 is non-binary, female-leaning, and assigned male at birth, living in Ohio.
She uses she and her pronouns. Her family was not accepting of her sexuality or and kind of
gender variance when she was younger. She was bullied at school and knew she was different at
a young age. She did identify her gender difference when she was quite young but rejected this
for a very long time. She was influenced by a transgender character on a TV show to come out
as transgender. Her family is still not accepting her gender identity in adulthood. She has a
supportive circle of friends and husband. She would like to do more to express her gender
identity but finds this difficult due to larger shoe and dress size, financial stressors, and not
feeling safe in the political and social climates.
The participant’s family was very controlling and overbearing when she was younger,
which she attributes to driving her to a bad relationship with a drug dealer. Eventually,
methamphetamines became entwined with sex; she becomes desperate for sex as if she is starved
for oxygen. She still struggles with meth use and subsequently unsafe sex. Her friends and
husband are concerned but supportive; her husband is very loving, and they are in an open
polyamorous marriage. Both she and her husband state that she is harder on herself than anyone
else. Her ideal future includes living with her husband and another polyamorous transgender
couple on a ranch, running an “occult witchy shop.” The participant states that the future is hard
to fathom because of self-worth issues. She is seeing a therapist and they are trying to figure out
what fuels her addiction so that she can heal.
Though the sample size for this pilot study was very small, it provided great information
and the participants were unexpectedly willing to discuss some very heavy, personal issues.
There were some mutual themes from both participants. Both were assigned male at birth, were
bullied at school and had some familial difficulties as a result of their sexuality and gender
expression. Both participants would like to express their gender identity more often than they
do, but don’t feel safe because of the political and social climates. Both participants also drew a
parallel from how they were treated and made to feel about their gender identity to their drug
use, without being prompted. Therefore, it would seem that social stigma has played or is
playing a role in these individuals’ struggles with substances. Because this study was so limited,
conclusions cannot be drawn outside of this scope, and extensive additional research needs to be
done on the issue and how to address it. This is why it is so paramount that these studies be
It is of note to mention that participant 2’s decision to come out based on a television
character further shows that visibility and acceptance lessen the stigma and thus reduce the pain
that has been holding gender variant individuals back. When transgender and gender
nonconforming people have enough acceptance in society that we can watch a prominent
character on a show such American Horror Story transition from male to female, under the
mentorship of a character played by pop icon Lady Gaga, they are much more likely to gain the
confidence to start moving towards self-actualization.
Future Studies
Very little research has been done on transgender and gender variant individuals, and so
much research beyond drug use needs to be done in order to understand how to help this group
best. Gender identity is not included on the US Census, so there is no definitive answer to how
many people identify as transgender or any variation of nonbinary. This is thought to be due to a
lack of understanding and certainly acceptance by government officials and leads to a slew of
statistical problems. There can be no definitive longitudinal studies on issues such as the rate of
suicidal ideation before and after transition. These numbers are currently unknown, despite
many mental health practitioners reporting the numbers from their own patients returning to the
levels of the non-gender variant population after a transgender client has undergone and settled
into their realized gender (Frank). Again, this is where cohesive, large-scale studies are
important. Understanding the scale of and factors going into the suicidal ideation of transgender
individuals could help practitioners treat their patients more effectively, and help educators
develop programs similar to the ones already in place for suicide prevention for gender
conforming individuals and those of different demographics.
Other studies could include how different family systems, social circles, generational
influences, and societies in different geographical locations affect the decisions and mental
health of transgender individuals. There is also a wide array of variations in the partner choices
of transgender people, including but not limited to their partners’ own gender identities. Some
people retain their apparent sexual preference through their transition and some do not, for a
plethora of different reasons. Both participants interviewed expressed a desire to find stability in
their relationships, which is a common theme in the transgender community at large and should
be explored as well, as this seems difficult to attain for gender variant individuals but shown to
be vitally helpful in the mental health of gender conforming individuals. Additionally, each
individual expressing a gender different than what they’ve been assigned at birth does not make
the same decision on the course of their transition; some opt for the entirety of sex reassignment
surgery and some only transition socially with no medical intervention. Documenting the
reasoning behind these decisions would also assist providers in providing the best care possible
for their patients.
To obtain quantitative data in future studies such as the one regarding the rates of suicidal
ideation before and after transition, a self-reported survey could be helpful. More helpful,
however, would be a collaboration between mental health and perhaps medical providers where
these providers, with the permission of their patients, kept reports on the rates of their own
patients and reported back to a research committee. This committee would then compile the data
however deemed appropriate, certainly into “before” and “after” categories; but also perhaps by
direction of transition (female to male, male to female), age group, location, and so on. Archival
research is always helpful to set up a foundation for a study, but there is very little valid, reliable
research to work off of. At this time, experimental studies are not appropriate as they would
interfere with an already fragile group of people and put them further at risk.
Bias and stigma are pervasive factors in many struggles in the lives of just about
everyone, gender variant and gender conforming alike. They are social constructs created by
systems that evolve over long periods of time that serve a purpose in our various societies. This
phenomenon led to the racist foundation of the United States drug war led by Harry Anslinger,
the remnants of which we are still fighting today. The drug war affects every demographic but
tends to hit disenfranchised minorities the hardest. One of these minorities in the transgender
community, which is one of the least understood populations in the country and world. The level
of bias and stigma towards this demographic further compounds the pressure to fall into the
habits of drug addiction, and the lack of understanding due to the lack of research does these
individuals a great disservice.
The participants in this pilot study provided a wealth of information on their own lives
and the pressures of society on them to fit into the “norm.” It is very difficult to be oneself as a
gender variant individual because of the political and social environment, and it feels unsafe to
express one’s true gender. This seems to culminate in a tendency towards mental health and
drug abuse issues, and both expressed they used as a direct result of how they were treated due to
their gender nonconformity.
The participants not only provided information about themselves and the relationship
between gender variance and drug use; they shed light on directions for more research. There
are so many more subjects that need to be addressed in order to understand and serve gender
variant individuals the way that everyone else is, and so many different methods to do so.
Pilot Study Interview Questions
Name (to be stuck from record):
Preferred pronouns:
Gender Identity:
Sex assigned at birth (if provided):
Section one: Bio
1) What were things like when you were younger? Who did you grow up with?
2) What kind of school did you go to? How did you relate to other kids?
Section two: Gender identity
1) Did you ever feel like you were different? What were some things that made you feel
this way?
2) What finally made you decide to transition? If you didn’t transition, or aren’t going to,
what made you decide to acknowledge your gender identity?
3) Did you come out to your family and friends? What was that like for you? What was
their reaction? How are those relationships now?
4) How do you feel about how you express your identity now? Are there things you wish
you did more of?
Section three: Drug use
1) What was going on around the time that you started using drugs? What were you
2) Describe your first drug use experience. Where were you? Who were you with? What
were you feeling? What were you thinking? What happened afterwards?
3) What plan did you have for your drug use? Did you ever seek treatment?
4) How are your relationships with your family and friends now?
5) How is your relationship with yourself now?
6) How do you see your ideal future?
Alexander, Bruce K., Beyerstein, Barry L., Hadaway, Patricia F., Coambs, Robert B. (1980)
Effect of Early and Later Colony Housing on Oral Ingestion of Morphine in Rats.
Pharmacology Biochemistry & Behavior, 15. Pp. 571-576.
Frank, Nathaniel. (2018) The Pentagon Is Wrong. Gender Transition Is Effective. The New
York Times.
Hari, Johann. (2015). Chasing the Scream. London: Bloomsbury.
James, N., Gutleizer, S., Reese, K., Ragoonath, E., Tariq, I., Ahmed, J., Florez, C. (2019)
Politics of Identity: The Identity of an Addict. Brooklyn: Xi Kappa - Phi Theta Kappa,
Kingsborough Community College.
Kandel, Eric. (2018) The Disordered Mind: What Unusual Brains Tell Us About Ourselves.
New York City: Farrar, Straus and Giroux.
Santos, Ana S. (2018) Portugal Drug Report 2018. European Monitoring Centre for Drugs
and Drug Addiction.
ResearchGate has not been able to resolve any citations for this publication.
Male and female rats were raised from weaning either in isolation or in a large colony. At 65 days of age, half the rats in each environment were moved to the other. At 80 days, the animals were given continuous access to water and to a sequence of 7 solutions: 3 sweet or bitter-sweet control solutions and 4 different concentrations of morphine hydrochloride (MHCl) in 10% sucrose solution. Rats housed in the colony at the time of testing drank less MHCl solution than isolated rats, but no less of the control solutions. Colony-dwelling rats previously housed in isolation tended to drink more MHCl solution than those housed in the colony since weaning, but this effect reached statistical significance only at the lowest concentration of MHCl. These data were related to the hypothesis that colony rats avoid morphine because it interferes with complex, species-specific behavior.
The Pentagon Is Wrong. Gender Transition Is Effective. The New York Times
  • Nathaniel Frank
Frank, Nathaniel. (2018) The Pentagon Is Wrong. Gender Transition Is Effective. The New York Times.
Politics of Identity: The Identity of an Addict
  • N James
  • S Gutleizer
  • K Reese
  • E Ragoonath
  • I Tariq
  • J Ahmed
  • C Florez
James, N., Gutleizer, S., Reese, K., Ragoonath, E., Tariq, I., Ahmed, J., Florez, C. (2019) Politics of Identity: The Identity of an Addict. Brooklyn: Xi Kappa -Phi Theta Kappa, Kingsborough Community College.
The Disordered Mind: What Unusual Brains Tell Us About Ourselves
  • Eric Kandel
Kandel, Eric. (2018) The Disordered Mind: What Unusual Brains Tell Us About Ourselves. New York City: Farrar, Straus and Giroux.
European Monitoring Centre for Drugs and Drug Addiction
  • Ana S Santos
Santos, Ana S. (2018) Portugal Drug Report 2018. European Monitoring Centre for Drugs and Drug Addiction.