Milo Scanlon’s previous work for The Toast can be found here.

“[Against Me’s “Paralytic States”] is about a transgender person dealing with addiction and dysphoria and killing themselves in a hotel bathtub. Obviously I’m not dead in a hotel bathtub, but all the experiences of existing that way, being in that hotel room, are very much real to me, that’s a life that I’ve lived.”–Laura Jane Grace

“My momma said, ‘baby stay clean, there’s no in-between.’ But all you ladies and you gentlemen, between’s all you’ve ever seen or been.“–Elliott Smith

Transgender people are painfully familiar with feeling “in-between,” specifically feeling in between the extremes of masculine and feminine. Harassment, discrimination, and violence are realities for us, and even well-intentioned folks often say things like, “biologically male” or “trapped in a woman’s body” to describe our experience. Some surveys offer “Male/Female/Transgender” as options, as if being assigned one gender and realizing that assignment was wrong, warrants binary trans people our own category.

It doesn’t. I am a trans man, a man of trans experience. Most simply, I’m a man, no qualifiers or disclaimers needed. However, to briefly explain, a doctor labeled me female at birth, and after years of confusion, self-loathing, and drug addiction, I live as male; I am male. I’m not biologically female or trapped in a woman’s body. Both my body and its biology are mine, so they are male.

Not everybody agrees with me on this.

Repeatedly defending one’s identity, to parents, friends, acquaintances, coworkers, bosses, government employees, healthcare professionals, etc, can be enough to make anyone feel like they need a drink or a smoke. Or something more.

The trans community has a problem with substance use. The problem is the fact that very few resources help transgender substance users, despite disproportionately high rates of use.

In 2010, a survey found that over 25% of trans respondents misused drugs, including alcohol, specifically to cope with the discrimination they faced due to their gender identity or expression. Up to 30% of trans people are estimated to abuse substances, compared to about 9% of straight and cis people, though underreporting and other statistical considerations suggest the 30% figure is a low estimate. And despite substance abuse disproportionately impacting the trans community, many treatment programs fail to recognize trans folk, instead practicing the discrimination and harassment that prompted many of us to use drugs in the first place.

I certainly started using drugs to escape reality, which at the time consisted of daily harassment and violence at my conservative middle school. In addition to bullying, I dreaded the impending effects of estrogen-fueled puberty. What I know now to be body dysphoria, completely dominated my consciousness.

In high school, I caved in to my cis friends’ misguided advice, and started wearing clothes and hairstyles marketed towards women. I distracted myself with drugs. As they do, my addiction intensified. At college, I began psychotherapy, then tried antidepressants, which triggered an adverse reaction and subsequent forcible hospitalization. Upon release, I cut my hair and wore comfortable clothes again. Finally, I met a non-binary person who explained the idea of trans identities to me, and I came out as male. My parents kicked me out after we argued over pronouns, and I soon got into hard drugs. A year later, after losing friends, money, jobs, self-respect, and nearly half my body weight, I got clean.

Easing my way into recovery, I considered inpatient drug rehabs. However, spaces segregated by gender, such as restrooms, locker rooms, and inpatient drug rehabs, are often unsafe for trans people. Though a rehab employee said they would place me with residents of my gender identity, I knew I would feel just as unsafe living pre-T with cis men, as I would feel dysphoric, dishonest, and resentful living with women.

Many trans people simply won’t consider inpatient treatment, and it’s hard to blame them. As May Wilkerson writes:

Those who do seek treatment are often directed towards inadequate or ineffective services. Medical professionals are often uneducated in trans people’s specific needs, and most in-patient drug rehab centers are segregated by gender—making them an unsafe, alienating space for this population. Even rehabs that market themselves as “trans-friendly” often refuse to provide crucial hormone therapy, misguidedly considering it an “elective drug.”

While combing through search engines for transgender drug rehabs, I discovered the Morris Home in Philadelphia. It is the first and only facility that exclusively serves the trans population. Unfortunately, it is also exclusive to Philadelphia residents, and has only eight beds.

I didn’t attend inpatient treatment and I still got clean. It’s definitely possible and may be a more practical choice for many people, given the financial and geographic limitations of inpatient rehabs. Though I felt apprehensive, mostly about religion, I recover with a 12 step program. It’s free, accessible in many locations, and religion is not involved. It’s not the only way to stop using substances, but many people find it effective.

However, the reality remains that options for trans people are severely limited. The recovery industry, including inpatient facilities, outpatient and community programs, and substance abuse counseling, does not effectively serve the trans population. Like many of us, I’m still waiting on the paychecks I earned for teaching various practitioners what transgender means. A Google search for transgender addiction recovery yields various directories, which arbitrarily lump trans folk into the term, LGBT. Explanations of why trans people use drugs cite the data I mentioned, and some authors acknowledge providers’ lack of competency in this area, but few suggest solutions or alternatives.

In November, a trans woman named Greta Martela founded the Trans Lifeline, a crisis phone line solely operated by and specifically serving trans people. This resource is tremendously necessary, considering 41% of trans people attempt suicide (though suicidality is not a requirement to call).

We need more trans-awareness in the recovery industry. The Morris Home is an excellent start, and the Trans Lifeline provides crucial support for trans people experiencing emotional distress, including substance use. But we need so much more. Though some education initiatives prompt healthcare professionals to learn the specific needs of what they call “special populations”, we still have a long way to go before trans people with drug problems can find safe and effective help.

While trans drug users face a number of serious obstacles, I want to emphasize that recovery is a reality for many of us, and it’s possible for everybody. There are 12 step meetings specifically for transgender people, and literature which uses trans-inclusive language and includes a personal story about a trans woman in recovery. Many transgender celebrities, such as Laura Jane Grace and Chaz Bono, discuss their own struggles with addiction and recovery. And as the mainstream representation and legal protections for trans people improve, inpatient rehabs, outpatient programs, and other paths to recovery will follow suit.

And in the meantime, I will continue to stay clean, spread awareness of this issue, and save money so eventually I can invest in some resources for the trans community. We need them.