What It Means To Be An Addict + Trans

Stories, Mind + Spirit, Home + Community, Social, Intervention Support, CommunityMJ Eckhouse
Image by Rebecca Lieberman

Image by Rebecca Lieberman

By MJ Eckhouse

My interest in drugs began at age 11. My classmates had begun tormenting me for my masculine appearance, and I was terrified of impending puberty. So when an older kid offered me weed, I jumped at the chance for some escape.

Over the next ten years, I watched myself do literally whatever it took for another hit of meth or crack cocaine. By then, I had already come out as trans, but that wasn’t enough to motivate me to stop using. It wasn’t enough being hospitalized, or threatened with jail time. Finally, after an experience getting high with the only other trans person I knew, I finally became ready to quit. There I was, still feeling paranoid and alone, despite the company of someone who actually understood me. It was time.   

While considering treatment, I ran into a problem: Inpatient rehabs are segregated by gender—restrooms, locker rooms, and even activities. I knew these programs probably wouldn’t be the safest places to be trans. Though I found “LGBT-friendly” rehabs over the course of my research, I felt skeptical that the “T” was anything more than an afterthought.

Ultimately, I didn’t go to rehab. Fortunately, I haven’t used drugs or alcohol since 2013. Instead of inpatient treatment, I decided to try 12-step meetings. As a queer agnostic, the “God” language concerned me at the get-go, but now that it’s been more than three years, I can say confidently that it hasn’t been a problem. Belief in a monotheistic religion hasn’t been a requirement for support from the 12-step groups, and I’m still as queer and agnostic as ever.

A First Step: Do I Have A Problem?

Studies show that trans people are more likely to use substances. And in a way, substance use seems built into queer culture. Most cities have several gay bars, but rarely have LGBT homeless shelters. Queer sex and drug use have intertwined for decades. Many trans folks end up doing sex work as a response to discrimination, and that might include drug use. With substance use so prevalently positioned in the community, it can be hard to determine if you have a problem with substances, or if it’s just habit. If you think you might have a problem, or if the question seems worth exploring, here are some questions you can consider as a starting point:

  • Do you frequently think about drugs/alcohol?
  • Does your use of drugs/alcohol interfere with work, school or relationships?
  • Do you use/drink alone?
  • Have you ever stolen or had sex to obtain drugs/alcohol?
  • Do you use/drink to change how you feel or escape reality?
  • Has your using/drinking gotten progressively harder to control?
  • Do you still use/drink despite legal, financial or other consequences?  

Before I quit, I would have answered “yes” to all those questions—that is, if I answered honestly. For years, my friends, family and therapists told me I had a drug problem, but I denied it, always finding a way to rationalize my way out of coming to terms with it. “I’ll stop eventually,” “I still have a job,” “l’ll just get another job,” “I don’t shoot up, so it’s not a big deal”—the list goes on and on. Fact is, I put drug use first. I didn’t need to live under a bridge and share needles to have a problem.

What Might Be Next: An Overview of Treatment Options

Inpatient Rehab

Residential treatment centers are a well-known method of addiction recovery. However, they pose some drawbacks for trans people. Plus, the costs of private facilities can be prohibitive. But if you’re still deciding, it may help to consider the “pros” and “cons.”

There is one trans-exclusive rehab in Philadelphia. Unfortunately, it has only eight beds and only welcomes Philadelphia residents.

Advantages of Inpatient Treatment:

  • Takes you away from your environment, dealers and drinking/using buddies.
  • Provides structure and routine to your daily activities.
  • Constant access to support.     
  • May include medically-supervised detox.

Outpatient Treatment

Outpatient treatment also provides structure and guidance for staying sober but on a part-time basis. Instead of living in a facility, people attend individual and group counseling. This allows time for work or school and might relieve some of the problems trans people face in gender-segregated rehabs.

Many areas have state-funded inpatient and outpatient programs, which can help with the cost.


Due to medical gatekeeping, trans people are often familiar with therapy. Over the years, I’ve seen several therapists. Unfortunately, most of them didn’t know how to help me with transition or addiction. However, some are knowledgeable, and often, finding the right therapist comes down to just finding the right fit. Therapy is worth considering—it may just take patience, and a willingness on your part to ask around for references for therapist who have experience working with trans people and/or substance users.

If there is an LGBT clinic or community near you, it’s worthwhile to ask other trans people for suggestions. “Find A Therapist” sites list therapists who describe themselves as “LGBT-friendly,” which may be better than not.

12-Step Meetings

I maintain my recovery with a 12-step program. The “God stuff” in the 12 steps worried me, but the people are far more accepting and open-minded than I expected. At meetings, I speak openly about being trans and I’ve never encountered hostility.

12-step meetings are:

  • Free.
  • Widely accessible.
  • Sometimes designated as LGBT-friendly or for agnostics/atheists.
  • Based on suggesting abstinence from all substances.

Other Peer Support

12-step meetings aren’t the only non-professional recovery option. Other programs include Smart Recovery, Moderation Management, LifeRing Secular Recovery and Secular Organizations for Sobriety.

These nonprofit programs,

  • Don’t use religious language like “God” or “Higher Power.”
  • May or may not emphasize complete abstinence from all substances.
  • Have fewer in-person meetings.       

Recovery coaching is a professional form of supportive mentorship, usually with a coach who has personal experience with addiction recovery. Through early recovery, I spoke with a California-based recovery coach over the phone. A new practice, recovery coaching is growing in coastal states. This may benefit trans people, since many of these states are strong champions of trans rights.

Along the Way: Consider Harm Reduction

Two years ago, a close friend of mine died of a heroin overdose. Naloxone is a medicine for harm reduction, which immediately reverses the effects of opiate overdose. Other harm reduction strategies include,

  • Safe injection sites
  • Hiding your keys or giving them to someone if you might drink and drive
  • Needle exchanges
  • Opioid replacement treatments (Suboxone, Methadone)

Bottom Line: Know You’re Not Alone

Society misunderstands trans people as well as people with addictions. So, as a trans addict, it’s easy to feel isolated. I can’t say it’s easy to find community, because it’s not, but it’s also not hopeless. In early recovery, I told people I was trans, expecting them to reject me.

To my surprise, people welcomed me, respected my gender and even told me about other trans people in recovery. We’re out there and if I can do it, so can you.



MJ Eckhouse is an activist, writer and student of political science. Though he's still in Ohio, MJ dreams of someday being able to afford San Francisco's cost of living. Contrary to popular belief, MJ regularly uses public restrooms without attacking anyone or provoking societal downfall. He's also the editor-in-chief of Kent State's LGBTQ magazine, Fusion.