The perspective of transgender and non-binary people on their substance use trajectories and resilience processes

Background:

Transgender and non-binary (TNB) people struggling with risky and problematic substance use SU face difficulties accessing addiction treatment services. Risk of discrimination and perceptions that services are not tailored to their needs and concerns contribute to their disengagement from and even avoidance of services. Nonetheless, TNB people mobilize various resources and capacities to overcome the challenges they face. A better understanding of these processes of resilience, from the perspective of lived experience, is needed to shed light on how people manage minority stress and the efforts they make to improve their well-being and mental health. This study aims to understand the meanings that TNB individuals with risky and problematic substance use attribute to processes of resilience in the context of SU trajectories, as well as gender affirmation and transition pathways.

Methods:

Semi-structured interviews of approximately 90 minutes were conducted in Quebec (Canada) with 20 TNB individuals who reported risky or problematic SU Interviews addressed substance use trajectories, as well as gender affirmation and transition pathways, paying particular attention to significant life events and challenges that were overcome in the context of these trajectories. Analysis was guided by an intersectional approach and a multidimensional theoretical framework of the resilience process (Luthar et al., 2000; Walsh, 2016). A collaborative committee composed of TNB individuals contributed to each stage of the research, including interpretation of results and formulation of recommendations.

Results:

Analysis of the experience of SU trajectories and gender affirmation pathways highlights several dimensions associated with processes of resilience. Participants reported that mobilizing resources to negotiate and overcome obstacles in a range of environments is to be at the core of their resilience process. Family, peer groups and community resources also appear to encourage and reinforce this process. Identity affirmation (coming out), the decision to go through the gender affirmation and transition process, and the establishment or strengthening of emotional and support bonds within the TNB community contribute to well-being. At the institutional level, some TNB individuals who utilize health and harm reduction services, despite anticipating stigma and discrimination within these services, report benefiting from them. For others, using these services exacerbates distress and reinforces distrust of healthcare providers.

Conclusion:

Understanding the lived experience of processes of resilience among TNB individuals helps identify concrete solutions to better adapt harm reduction and treatment services. Collaborative approach to addressing the specific concerns and needs of TNB individuals can point to solutions to service delivery challenges while supporting realistic, effective, equitable, and sustainable change in how addiction services are provided.