Prevalence and Co-occurrence of Alcohol, Nicotine, and Other Substance Use Disorder Diagnoses Among US Transgender and Cisgender Adults

Hughto, Jaclyn M. White; Quinn, Emily; Dunbar, Michael Stephen; Rose, Adam J.; Shireman, Theresa I.; Jasuja, Guneet K.

doi:10.1001/jamanetworkopen.2020.36512

Cited by 110 publications

(74 citation statements)

References 50 publications

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“…In our study, the prevalence of consumption was higher, while in the other study, the age of consumption onset was earlier in the transgender group, often in the early stages of adolescence [50]. These data, which point to greater vulnerability of the group as the result of the discrimination they are subjected to, tended to homogenise in adulthood because of the increased concern for health and a desire to stop consuming among this population [51]. Of note, when we considered tobacco use disorder in this current study, we found no differences between the transgender and cisgender groups, although the small number of studies included in this analysis meant that our confidence in the reliability of this result was poor.…”

Section: Discussioncontrasting

confidence: 52%

“…The most unexpected result of this present study was that there were no differences in the probability of presenting alcohol use or alcohol use disorder between cisgender and transgender people. In contrast, previous studies have postulated that one of the toxic substances with the greatest presence among the transgender population is alcohol [46,51,56]. Indeed, 60.4% of this population reported consuming alcohol regularly, and 24.3% reported having drunk excessively in the last 30 d [70].…”

Section: Discussionmentioning

confidence: 72%

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Substance Use in the Transgender Population: A Meta-Analysis

et al. 2022

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(1) Background: This meta-analysis aimed to assess the relationship between identifying as transgender and substance use. (2) Methods: We searched for relevant studies in PubMed, Scopus, the Web of Science, and PsycINFO on 21 July 2021. (3) Results: Twenty studies comparing transgender and cisgender people were included in this work, accounting for a total of 2,376,951 participants (18,329 of whom were transgender). These articles included data on current tobacco use, current tobacco use disorder, current alcohol use, current alcohol use disorder, lifetime substance (all) use, current substance use (excluding tobacco and alcohol), current use of specific substances (excluding tobacco and alcohol and including cocaine, amphetamines, methamphetamines, ecstasy, stimulants, heroin, opiates, cannabis, marijuana, LSD, hallucinogens, steroids, inhalants, sedatives, Ritalin or Adderall, diet pills, cold medicine, prescription medications, polysubstance, other club drugs, and other illegal drugs), and current substance use disorder (excluding tobacco and alcohol). We used the ORs and their 95% CIs to state the association between identifying as transgender and those variables. The control reference category used in all cases was cisgender. We employed a random-effects model. Transgender people were more likely to use tobacco (odds ratio (OR) = 1.65; 95% CI [1.37, 1.98]), have used substances throughout their lives (OR = 1.48; 95% CI [1.30, 1.68]), and present current use of specific substances (OR = 1.79; 95% CI [1.54, 2.07]). When current alcohol and substance use in general and tobacco, alcohol, and substance use disorders specifically were considered, the likelihood did not differ from that of cisgender people. (4) Conclusions: The presence of substance use disorders did not differ between transgender and cisgender people. Considering this population as consumers or as addicted may be a prejudice that perpetuates stigma. Nonetheless, transgender people were more likely to use tobacco and other substances, but not alcohol. Hypothetically, this might be an emotional regulation strategy, a maladaptive mechanism for coping with traumatic experiences, or could respond to minority stress, produced by stigma, prejudice, discrimination, and harassment. It is of particular importance to implement policies against discrimination and stigmatisation and to adapt prevention and treatment services so that they are inclusive of the 2SLGBTQIA+ community.

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Section: Discussioncontrasting

confidence: 52%

Section: Discussionmentioning

confidence: 72%

Substance Use in the Transgender Population: A Meta-Analysis

et al. 2022

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“…Additionally, we did not examine study objectives by gender as gender identity was not assessed in the parent study. Gender influences risks for SUD ( 7 ) and poor sleep ( 33 ), and gender minority individuals are a high-risk population for SUD ( 39 ). Next, recruitment for the parent study was aimed at composing a “real world” SUD sample.…”

Section: Discussionmentioning

confidence: 99%

Sex Specific Sleep Parameters Among People With Substance Use Disorder

et al. 2022

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IntroductionSleep can have substantial impacts in substance use disorder (SUD) pathogenesis, treatment, and recovery. Sex differences exist in both sleep and SUD, but how sleep is uniquely associated with SUD by sex is not known. The study objective was to compare, within sex, sleep parameters between individuals with SUD and non-substance misusing controls.MethodsSecondary analyses of a parent cross-sectional study examining the feasibility and acceptability of a novel neurocognitive phenotyping assessment battery were completed. SUD and control subjects were recruited through local advertising and an established research registry. Subjects with SUD were also recruited through a university-based outpatient SUD treatment clinic. Self-reported sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Sex-stratified t-tests compared sleep between SUD and control subjects while Crosstab analyses explored group differences in the proportion of individuals reporting poor sleep (defined as PSQI ≥ 5).ResultsData from 162 males (44 controls, 118 SUD) and 146 females (64 controls, 82 SUD) were included in the present study. For females only, a significantly lower proportion of controls reported PSQI-defined poor sleep than individuals with any SUD or specifically with opioid use disorder. Male, but not female, controls reported shorter sleep latency, longer sleep duration, and less sleep disturbance than males with each SUD type.Discussion/ImplicationsSleep holds promise as an avenue to address SUD within a biopsychosocial model. Future work at the intersection of SUD and sleep should prioritize investigations of their interplay with sex to identify targets for tailored SUD interventions.

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“…TGD populations regularly report increased violence and discrimination, particularly among trans people of color [17], including fears and experiences with discrimination in healthcare settings [18]. In the face of stigma and violence, substance use remains a health concern facing TGD populations [19,20]. These complex factors contribute to health disparities leading to negative outcomes among individuals in this high-risk group.…”

Section: Introductionmentioning

confidence: 99%

Integrated Comprehensive Care for Transcare and Gender Diverse Clinic Patients: An Assessment of Physical, Mental, and Social Needs

Carlson¹,

Irwin²,

Dowdall³

et al. 2021

Cureus

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IntroductionThere is a large body of research reporting the healthcare needs of groups identifying as lesbian, gay, bisexual, transgender, and/or queer (LGBTQ); however, a gap exists in the research literature because many epidemiological studies focus on sexual orientation rather than gender identify/incongruence. To address the lack of specific data from transgender and gender diverse (TGD) individuals, our organization designed and deployed a survey to assess the gender-affirming physical, mental, and social care needs of current patients. MethodsA group of subspecialty physicians currently working with TGD patients created a list of questions and requested feedback from medical professionals familiar with the healthcare needs of this population. In addition, patients reviewed the survey for content and clarity. The final 68-item survey was distributed in April 2020 to patients or patients' representatives with an email address on file at the Nebraska Medicine Transgender Care Clinic (NMTCC). Participants were asked to respond to questions regarding their gender identity, their transition-related medical decisions, and their interest in services. ResultsInvitations were sent to 690 patients and 168 surveys were completed (response rate: 24.3%). Over 90% (n = 153) of the participants were patients and 9% (n = 15) answered survey questions on the patient's behalf. A majority (77.2%) had started the medical transition (hormones or puberty blockers) in the past four years. Nearly half (46.4%) identified as trans women, 43.4% identified as trans men, and 10.2% indicated they were nonbinary or gender expansive. Participants' sex assigned at birth was 50.9% female and 46.1% male. Most patients (n = 149; 92%) reported currently receiving hormone treatment within the Nebraska Medicine healthcare system. Results indicated the highest level of clinical services interest was primary care (38.4%), gender-affirming surgery (73.5%), voice therapy (49.0%), and hair removal (37.5%). In addition, participants were very likely to participate in support groups with "people of similar gender identity" (32.9%), with "others around my age" (28.6%), and "including a mix of ages and identities" (26.9%). DiscussionThis study suggests that our TGD patients would utilize integrated services to access a variety of clinical and non-clinical services. Ongoing community engagement and direct feedback from patients are critical to the success and growth of our gender-affirming care clinic. The results of this study will inform the planning and further evolution of a program designed to build trust and address health inequities for TGD individuals throughout the region.

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Prevalence and Co-occurrence of Alcohol, Nicotine, and Other Substance Use Disorder Diagnoses Among US Transgender and Cisgender Adults

Cited by 110 publications

References 50 publications

Substance Use in the Transgender Population: A Meta-Analysis

Substance Use in the Transgender Population: A Meta-Analysis

Sex Specific Sleep Parameters Among People With Substance Use Disorder

Integrated Comprehensive Care for Transcare and Gender Diverse Clinic Patients: An Assessment of Physical, Mental, and Social Needs

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