Discrimination, gender dysphoria, drinking to cope, and alcohol harms in the UK trans and non-binary community.

Transgender (trans) and non-binary people may be at increased risk of alcohol harms, but little is known about motives for drinking in this community. This study explored the relationship between risk of alcohol dependence, experience of alcohol harms, drinking motives, dysphoria, and discrimination within a United Kingdom sample of trans and non-binary people with a lifetime history of alcohol use. A cross-sectional survey was co-produced with community stakeholders and administered to a purposive sample of trans and non-binary people from 1 February until 31 March 2022. A total of 462 respondents were included-159 identified as non-binary and/or genderqueer (identities outside the man/woman binary), 135 solely as women, 63 solely as men, 15 as another gender identity, 90 selected multiple identities. Higher levels of reported discrimination were associated with higher risk of dependence and more reported harms from drinking. Coping motives, enhancement motives, and drinking to manage dysphoria were associated with higher Alcohol Use Disorders Identification Test scores. Social, coping, and enhancement motives alongside discrimination and drinking to have sex were associated with harms. The relationship between discrimination and risk of dependence was mediated by coping motives and drinking to manage dysphoria. Further to these associations, we suggest that reducing discrimination against trans and non-binary communities might reduce alcohol harms in this population. Interventions should target enhancement motives, coping motives and gender dysphoria. Social and enhancement functions of alcohol could be replaced by alcohol free supportive social spaces.

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

INTRODUCTION: Transgender (trans) and non-binary people experience disproportionate harm from alcohol use, have a greater likelihood of developing dependence, and experience exclusion from both clinical and peer-based support systems. This study aimed to understand experiences with and preferences for alcohol reduction support among UK-based transgender and non-binary people. METHODS: The study team and community stakeholders co-produced a cross-sectional survey and administered it to a purposive sample of trans and non-binary people from 1st February to 31st March 2022. The study recruited participants through social media, mailing lists, blog posts, and news articles. Participants (n = 565) had a lifetime history of alcohol use, were in one of five gender categories, and were classified as people who drink or formerly drank alcohol. Open- and closed-ended questions measured motivations for alcohol reduction and views surrounding various support modalities. RESULTS: More than 15 % of the sample no longer drink alcohol and reported long-term abstinence, achieved without support, and were motivated by a loss of control over drinking behaviour and a desire to improve both physical and mental health. Mental illness, gender dysphoria, and a culture of alcohol excess were common antecedents of alcohol use. Thirty percent of participants who drink alcohol wanted to reduce their consumption. They suggested that this could be achieved with self-help tools, specialist trans and non-binary or LGBT+ services, access to both gender-affirming medical services, and sober queer social spaces. CONCLUSIONS: UK-based trans and non-binary people face unique gender minority-related stressors which contribute to patterns of alcohol use that are perceived to be out of control and harmful to health. While many wanted access to self-help tools, there was interest in the availability of specialist alcohol reduction services and more inclusive general services. Conducting needs assessments to inform Needs assessments should inform the development of such services and trans-affirmative training should be mandated for all who provide support with alcohol reduction.