Transgender and non-binary people's experiences with alcohol reduction in the UK: A cross-sectional study

Background: Transgender (trans) and non-binary people are at greater risk of alcohol-related harm, including dependence, and are excluded from both clinical and peer-based support systems. This study aimed to understand barriers to alcohol reduction, and experiences of and preferences for external alcohol reduction support among UK-based transgender and non-binary people . 
Methods: A cross-sectional survey was co-produced by the study team and community stakeholders and administered to a purposive sample of trans and non-binary people from 1 February to 31 March 2022. Participants were recruited through social media, mailing lists, blog posts, and news articles. Participants (n = 565) had a lifetime history of alcohol use, were assigned to one of five gender categories, and were classified as people who drink or formerly drank alcohol. Motivations for alcohol reduction and views surrounding various support modalities were assessed using both open- and closed-ended questions. 
Results: Motivated by a loss of control over drinking and a desire to improve both physical and mental health, more than 15% of the sample stopped drinking alcohol without support and reported long-term abstinence. A culture of alcohol excess, mental illness, and gender dysphoria were common antecedents of alcohol use. Of participants who drink alcohol, 30% wanted to reduce their consumption. They suggested that this could be achieved with self-help tools, specialist trans and non-binary or LGBT+ clinical services, and access to both gender-affirming medical services, and sober queer social spaces. 
Conclusions: Trans and non-binary people in the UK face unique stressors related to their gender minority status which contribute to patterns of alcohol use they perceived to be out of control and particularly harmful to health. While many expressed interest in self-help tools, others wanted increased availability of specialist alcohol reduction services and more inclusive general services. Needs assessments are required to inform the development of such services and all those providing alcohol reduction support to trans and non-binary people  should be required to undertake trans-affirmative training.