1. Unifying science, education and service to transform lives Module 10 Clinical Issues with Transgender Individuals A Provider’s Introduction to Substance Abuse for Lesbian, Gay, Bisexual, and Transgender Individuals First Edition

2. Unifying science, education and services to transform lives. A Provider’s Introduction to Substance Abuse for LGBT Individuals Module 5 -12 Clinician’s Guide Clinical Issues With Transgender Individuals Learning Objectives Understand “transgender” Understand “transgender” Be familiar with research & data Be familiar with research & data Be aware of clinical issues Be aware of clinical issues Understand treatment implications Understand treatment implications Power Point Slide # 10-1, n36

3. Unifying science, education and services to transform lives. A Provider’s Introduction to Substance Abuse for LGBT Individuals Module 5 -12 Clinician’s Guide Review of Terms Gender: femaleness or femininity and maleness or masculinity Gender: femaleness or femininity and maleness or masculinity Gender Role: masculine or femininebehaviors Gender Role: masculine or feminine behaviors Gender Identity: inner sense of oneself, a person’s self-concept, in terms of gender Gender Identity: inner sense of oneself, a person’s self-concept, in terms of gender Sexual Orientation: distinct from gender identity describes one's attraction to, sexual desire for, lust for, romantic attachments to others; lesbian, gay, bisexual, heterosexual. Sexual Orientation: distinct from gender identity, describes one's attraction to, sexual desire for, lust for, romantic attachments to others; lesbian, gay, bisexual, heterosexual. Power Point Slide # 10-2, n37

4. Unifying science, education and services to transform lives. A Provider’s Introduction to Substance Abuse for LGBT Individuals Module 5 -12 Clinician’s Guide umbrella spectrum and continuumof gender identities, expressions, and roles An umbrella term that came from the transgender communities in the 1990s and includes the spectrum and continuum of gender identities, expressions, and roles that challenge or expand the current dominant cultural values of what it means to be male or female. Power Point Slide # 10-3, n38

5. Unifying science, education and services to transform lives. A Provider’s Introduction to Substance Abuse for LGBT Individuals Module 5 -12 Clinician’s Guide Transsexuals Transsexuals Cross-dressers Cross-dressers Drag Queens and Drag Kings Drag Queens and Drag Kings Bigender, Androgyny, Nongendered, Gender- Queer Bigender, Androgyny, Nongendered, Gender- Queer Power Point Slide # 10-4, n39

6. Unifying science, education and services to transform lives. A Provider’s Introduction to Substance Abuse for LGBT Individuals Module 5 -12 Clinician’s Guide Research and Data In a recent (1999, 2000) San Francisco study by Dr. Kristin Clements at the San Francisco Department of PublicHealth AIDS Office : HIV prevalence35% and 65% HIV prevalence among MTF persons was 35% and 65% among African-American MTFs. Injection drug use was 34% 18% Injection drug use was 34% among MTF transgender individuals and18% among FTM transgender individuals. 55% 55% of MTF individuals reported they had been in alcohol or drug treatment sometime during their lifetimes.. Power Point Slide # 10-5, n40

7. Unifying science, education and services to transform lives. A Provider’s Introduction to Substance Abuse for LGBT Individuals Module 5 -12 Clinician’s Guide Research drugs most commonly used by MTF transgender individuals were alcohol, cocaine/crack, and methamphetamine A study from Hollywood, California, (Reback and Lombardi1999) reported that the drugs most commonly used by MTF transgender individuals were alcohol, cocaine/crack, and methamphetamine similar results with higher rates of substance abuse in general and higher rates of substance abuse with HIV prevalence, particularly among transgender sex workers. Other recent studies of transgender health risks in urban areas around the country, including Boston, New York City, Washington D.C., Chicago, Los Angeles and Houston, show similar results with higher rates of substance abuse in general and higher rates of substance abuse with HIV prevalence, particularly among transgender sex workers.. Power Point Slide # 10-6, n41

8. Unifying science, education and services to transform lives. A Provider’s Introduction to Substance Abuse for LGBT Individuals Module 5 -12 Clinician’s Guide Clinical Issues and Implications for Treatment 1. Issues about appearance, "passing" and body image 2. History of hiding or suppressing gender identity 3. Lack of family and social support 4. Isolation and lack of connection to positive, proactive transgender community resources 5. Hormone therapy and use or injection history 6. Stigma and discrimination 7. Employment problems 8. Relationship/child custody issues Power Point Slide # 10-7, n42

9. Unifying science, education and services to transform lives. A Provider’s Introduction to Substance Abuse for LGBT Individuals Module 5 -12 Clinician’s Guide TREATMENT DO'S AND DON'TS DO’S Use the proper pronouns based on client’s self- identity when talking to/about transgender individuals. Use the proper pronouns based on client’s self- identity when talking to/about transgender individuals. Get clinical supervision if they have issues or feelings about working with transgender individuals. Get clinical supervision if they have issues or feelings about working with transgender individuals. Allow transgender clients to continue the use of hormones when they are prescribed. Advocate that the transgender client using “street” hormones get immediate medical care and legally prescribed hormones. Allow transgender clients to continue the use of hormones when they are prescribed. Advocate that the transgender client using “street” hormones get immediate medical care and legally prescribed hormones. Take required training on transgender issues. Take required training on transgender issues. Power Point Slide # 10-8, n43

10. Unifying science, education and services to transform lives. A Provider’s Introduction to Substance Abuse for LGBT Individuals Module 5 -12 Clinician’s Guide TREATMENT DO'S AND DON'TS DO’S Find out the sexual orientation of all clients. Find out the sexual orientation of all clients. Allow transgender clients to use bathrooms and showers based on their gender self-identities and gender roles. Allow transgender clients to use bathrooms and showers based on their gender self-identities and gender roles. Require all clients and staff members to create and maintain a safe environment for all transgender clients. Post a nondiscrimination policy in the waiting room that explicitly includes sexual orientation and gender identity Require all clients and staff members to create and maintain a safe environment for all transgender clients. Post a nondiscrimination policy in the waiting room that explicitly includes sexual orientation and gender identity. Power Point Slide # 10-9, n44

11. Unifying science, education and services to transform lives. Prairelands ATTC Toolbox TrainingModule 5 – 12 Clinician’s Overview DON’TS Don’t call someone who identifies as a female “he or him” or call someone who identifies as male “she or her”. Don’t project transphobia onto the transgender client or share transphobic comments with other staff members or clients. Never make the transgender client choose between hormones and treatment and recovery. Don’t make the transgender client educate the staff. Don’t assume transgender women or men are gay. Don’t make transgender individuals living as females use male facilities or transgender individuals living as males use female facilities. Never allow staff members or clients to make transphobic comments or put transgender clients at risk for physical or sexual abuse or harassment. Power Point Slide # 10-10, n45 TREATMENT DO'S AND DON'TS