Transgender people disproportionately at risk of alcohol harms

Dr. Dean Connolly is a Specialty Registrar and NIHR Academic Clinical Fellow in Public Health Medicine. Their research focuses on LGBT+ health, including drug and alcohol use.

“Since 2018, I have had the opportunity to work with the Global Drug Survey,” they say. “What we found, using the AUDIT score as a measure of likelihood of alcohol dependence, was that nonbinary people had three-and-a-half-fold greater odds of self-reported alcohol dependence than cisgender women, and trans men and women also reported greater odds, despite lower odds of reporting using alcohol, so they were less likely to use alcohol than cis people but were more likely to experience harm.

“We also found that in that work that trans and nonbinary people reported a greater unmet need for care related to their desire to reduce alcohol and other drug use, and trans and nonbinary people, particularly transmasculine people, reported that they were more likely to experience sexual violence after having used alcohol.”

A quarter of trans and nonbinary respondents to a UK-wide survey reported AUDIT scores of 16 or above, indicative of “higher risk” drinking or probable dependence, compared to 4% of the general population. Although these figures are likely not entirely inaccurate due to flaws with self-reporting, this signifies a considerably increased risk.

Despite these significant findings, Connolly and their colleagues struggle to access funding to improve knowledge and services. “Acquiring funding for trans health research is challenging. Most large funders in the UK have a poor track record supporting research with this community. When funding has been allocated, there has been quite significant backlash from gender critical groups, which may deter funders from supporting similar projects in the future,” Connolly says.

This dearth of specialised support goes some way to explaining why, of the people Connolly surveyed who are now sober but have a history of alcohol use, almost all “become abstinent without any external supports.”

Due to experiences of discrimination within drug and alcohol services, research in Scotland found that many “trans and non-binary people prefer digital means, as it allows them to retain control over their privacy and safety.”

The relationship between discrimination and alcohol harms is symbiotic. “Transphobic discrimination is associated with higher risk of alcohol dependence and other harms, as was gender dysphoria, which, given the difficulties in accessing gender-affirming care and how widespread and pervasive and transphobic sentiment is in the UK, is significant. I see it as one part of a public health crisis,” Connolly says.

They call for more specialist services, particularly in metropolitan areas with significant LGBTQ+ populations, such as London, Brighton and Manchester. But, they add, “people working in services for the general population must ensure that their practice is trans-inclusive” across all sectors, and “service providers need to have more training.”

Connolly emphasises that reducing alcohol harms necessitates a serious commitment to tackling discrimination. “Until anti-trans hostility in the UK meaningfully declines, alcohol-related harms are unlikely to decrease,” they say. “We can’t undersell the significance that transphobia has in terms of alcohol use and alcohol-related harm.”

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