Addressing Bisexual Substance Use: A Conversation Long Overdue

By: Karla Kovacek

Infographic by Karla Kovacek, template from CANVA is
licensed under a CC BY-NC-ND 2.0.

Bisexuality is a common sexuality, where over half of LGB individuals identify as bisexual1. In its simplest form, bisexuality is the romantic and/or sexual attraction to more than one sex or gender. This typically includes one’s own gender, and one or more other genders.

While bisexuality has been acknowledged increasingly over the past decade, and more people have started openly identifying as bisexual, bisexual-specific issues are still underdiscussed1. In extension, the issues have not been appropriately addressed.

Particularly, bisexual individuals tend to commonly present with various substance use issues2. For instance, it is estimated that 55% of bisexual individuals are likely to report binge drinking in the past year. Additionally, it is estimated that 46% of them are likely to report non-medical cannabis use, and roughly 14% to report the use of illicit drugs all within the past year. Even more, it is estimated that 31% of bisexual individuals report these uses of substances as a coping response to abuse and violence2. It is deeply troubling that these startling numbers are not more commonly discussed. More particularly, the root causes of this problem must be acknowledged. 

Are bisexual individuals at a higher risk when it comes to substance use?

In comparison to straight individuals, those who identify as bisexual appear to have much higher rates of substance use and related problems. A study using the U.S National Survey on Drug Use and Health, surveying nearly 150,000 adults, found that compared to straight individuals, bisexual identity was related to significantly higher use of substances such as alcohol, cigarettes, cigars, cannabis, illicit drugs and opioids3. Bisexual individuals were also more likely to be presented with a clinical substance related problem, such as alcohol use disorder, nicotine dependence, and substance use disorder. However, the findings suggest some gender differences in bisexual men and bisexual women’s substance use patterns in comparison to straight men and straight women:

  1. Compared to straight women, bisexual women have higher rates of alcohol use, cannabis use, and illicit drug use (including misuse of opioids).
  2. Compared to straight women, bisexual women are more likely to have a substance use diagnosis, and a nicotine dependence.
  3. Compared to straight men, bisexual men have higher rates of cannabis and illicit drug use.

Interestingly, this pattern is found within the LGBTQ+ community as well. The same study suggests that those who identify as bisexual appear to have increased substance use and substance related problems in comparison to those who identify as gay or lesbian3. Gender differences between bisexual men and women regarding substance use and related problems are suggested:

  1. Compared to lesbian women, bisexual women have higher rates of binge drinking, cannabis use, illicit drug use (including misuse of opioids).
  2. Compared to lesbian women, bisexual women were more likely to be diagnosed with alcohol use disorder.
  3. Compared to gay men, bisexual men have higher rates of cigar use.

A study using the U.S National Epidemiological Survey on Alcohol and Related Conditions, consisting of roughly 36,000 participants, particularly focused on cannabis use differences between gay/lesbian, straight, and bisexual individuals4. The results suggest that those who identify as bisexual are more likely to report severe cannabis use disorder compared to straight individuals. Meanwhile, gay and lesbian individuals were only more likely to report mild cannabis use disorder. While both groups display more disordered cannabis use compared to straight individuals, the severity is increased for bisexual individuals.

However, explicit identification with bisexual sexuality may not be necessary for increased substance use problems. In another study, using the same U.S national data, the researchers found that those who engaged in both same sex and opposite sex romantic/sexual behaviour in the past year had higher chances of reporting severe alcohol use disorder and tobacco use disorder in that same year, compared to individuals engaging only in same sex romantic/sexual behaviour. Additionally, in comparison to straight individuals, those who are not sure of their sexual identity label had higher chances of reporting severe alcohol use disorder, tobacco use disorder and drug use disorder5.

It is important to note that there are limitations to these findings, as individuals who are “not sure” of their sexuality are often left out of research. This is a limitation because bisexuality is frequently invalidated as a real sexual identity. As such, bisexual individuals report difficulty with accepting their sexuality, and are told by straight and gay/lesbian individuals that there is no such thing as bisexuality – they must be gay/lesbian in denial, or straight, but curious5. As a result, this may force bisexual individuals into the “not sure” category more frequently.

This “not sure” label has been found to increase one’s risk of developing not only alcohol and tobacco use disorders, but also drug use disorder6. However, this is understudied, as not many studies on sexual minorities and substance use consider individuals who are unsure of their sexuality, although this factor may be directly related to increased substance use as a coping strategy6. These limitations also may lead us to underestimate substance use in the bisexual community – meaning that their substance use may be even greater than anticipated.

Why are bisexual individuals at such a heightened risk?

There are several explanations for why bisexual individuals report higher substance use and development of substance use disorders compared to straight and gay/lesbian individuals.


Infographic by Karla Kovacek, template from CANVA is
licensed under a CC BY-NC-ND 2.0.

Bisexual individuals are faced with a unique set of prejudicial attitudes and discriminatory actions, specifically targeting the aspect of their sexuality that is attracted to more than one gender/sex. Broadly, bi-negativity (also referred to as biphobia) refers to attitudes that are commonly underpinned by beliefs that bisexuality is not real, that bisexual individuals are promiscuous, and that they cannot be trustworthy partners6.

For gay and lesbian individuals, LGBTQ+ community spaces are a safety resource that protects them from stigma and harmful stereotyping that occurs in the general population. However, for bisexual individuals, the stigma does not stop, even within the LGBTQ+ community. The notions that bisexual individuals are less gay, straight passing, or at risk of leaving their same sex partner for somebody of opposite sex are widely held in the LGBTQ+ community, which can isolate bisexual individuals from what was intended to be their safe space3.

However, there are suggested differences in bi-negativity across genders. In a study of 253 straight men and women, researchers administered a Gender-Specific Binegativity Scale, and two open ended questions regarding bisexuality in men and women7. The results suggest that straight women are equally accepting of bisexual women and men. Meanwhile, straight men are less accepting of bisexual men compared to bisexual women.

The study also suggests notable differences in beliefs about bisexuality based on the gender of the bisexual individual. That is, bisexual men are perceived extremely negatively, and are perceived as gender non-conforming and “actually gay.” Higher acceptance rates of bisexual women, however, may be related to oversexualization of bisexual women by straight men. This is evident in straight male participants describing bisexuality as “sexy” in women. To directly assess the relationship between bi-negativity and substance use in bisexual women, 224 women identifying as bisexual completed a survey to report on their experiences with bi-negativity, substance use, and motivations to use alcohol as a coping strategy. The results suggest that increased bi-negativity experiences are related to more frequent alcohol use as a coping strategy, which in turn generally increased alcohol use in bisexual women8. Considering this link between bi-negativity and alcohol use, it is particularly concerning that bisexual individuals cannot escape stigma and discrimination, not even within the LGBTQ+ community spaces.

Sexual violence and oversexualization

Compared to straight and lesbian women, bisexual women are at an increased risk of sexual violence1. These findings may be applicable to bisexual men, but sexual violence towards bisexual women oftentimes stems from oversexualization of bisexuality in women by straight men. As previously mentioned, straight men report holding beliefs that bisexual women are “sexy”. Consequently, bisexual women are targets of sexual violence.

In a study examining perceived attitudes towards bisexuality by bisexual individuals, both bisexual men and women commonly reported being sexually objectified, sexually harassed, sexually assaulted, and raped. They reported believing that they were specifically targeted because of their bisexuality6.

Furthermore, bisexual teenage girls report sexual dating violence and forced sexual intercourse at a higher rate than lesbian girls. Similarly, bisexual adult women report sexual assault more commonly than lesbian women3.

These high rates of sexual violence and oversexualization relate to increased substance use in bisexual women, as they often report using substances to cope with sexual victimization3. Further, bisexual women also report using alcohol to cope with pressure to engage in sexual behaviour, including being pressured to engage in sexual activity with multiple sexual partners at once3. This pressure stems from widely held beliefs that bisexual women are promiscuous and non-monogamous.

Collectively, bisexual individuals are extremely prone to experiences that may increase their substance use and increase the risk of developing substance use disorders. Unlike those identifying as gay/lesbian, bisexual individuals are uniquely targeted both inside and outside of the LGBTQ+ community, isolating a group that is particularly in need of strong social support.

How can substance use issues in bisexual individuals be addressed?

Infographic by Karla Kovacek, template from CANVA is
licensed under a CC BY-NC-ND 2.0.

Given that some of the motivation for substance use in bisexual individuals stems from bi-negativity and consequences of stereotyping, those issues must be addressed. Individual-level interventions aimed at bisexual individuals are necessary, but cannot fix issues that are rooted in societal misconceptions and attitudes. As such, a group of authors propose micro, mezzo, and macro solutions for improving mental health and problematic substance use in the bisexual community9.

Micro solutions refer to resources that are targeted at an individual bisexual person. This may include developing a specific therapy to help teach bisexual individuals to cope with bi-negativity in more positive ways9. The authors suggest that there must be a focus on delivering interventions that are bisexual-affirmative, meaning that the bisexual client is validated and advocated for. This is particularly important, as bisexual clients report being stigmatized by some health care professionals6.

Mezzo solutions refer to resources that are targeted at improving environments bisexual individuals may be a part of. This may include educating school counsellors on bisexual issues and creation of bisexual-safe spaces. The authors propose ensuring bisexual-affirmative care before the client even identifies themselves as bisexual. This may take a form of a sign that states that a clinician’s office is a safe space for people identifying as bisexual, and/or including a bisexual pride symbol9.

Infographic by Karla Kovacek, template from CANVA is
licensed under a CC BY-NC-ND 2.0.

Another proposed mezzo solution is offering multiculturalism training to clinicians, as this could assess their attitudes about bisexuality and provide knowledge and skills that may be required for positive interaction with bisexual clients9. This would ultimately ensure that clinicians are competent at providing a service that recognizes the complexity of bisexual experience, and are aware of potential risks that bisexual individuals may face, such as problematic substance use.

In addition, it may be particularly useful to introduce early interventions, as research suggests that sexual minorities tend to be motivated to begin using substances as a coping strategy as early as in adolescence10. A study found that supportive community resources in gay, lesbian, bisexual, and questioning high school students are related to lower substance use compared to those who did not have access to such resources11. As such, introducing resources to bisexual adolescents may be particularly effective at promoting community inclusion, and decreasing risky coping behaviours, such as substance use.

Macro solutions refer to targeting an entire population in ways that would indirectly improve bisexual issues. This may include campaigns to reduce stigma towards bisexuality. The authors propose that non-discrimination policies must be enacted to protect bisexual individuals. In particular, clinicians are encouraged to advocate for these changes, as advocacy is a large part of bisexual-affirmative care9.

In addition, there is a call for research regarding how to reduce bi-negativity in the general population. Although more research is needed, a potential bi-negativity reduction strategy is as simple as exposing the population to bisexual individuals, as there is some evidence that it might decrease negative attitudes towards bisexuality9. On that note, another solution at the macro level might involve encouraging contact between bisexual individuals and the rest of the population, either directly or vicariously (through displaying straight-bisexual interaction in the media)9.

Bisexual individuals are facing substance use issues at alarming rates compared to gay, lesbian, and straight individuals, and this can be changed. It is important to understand that the proposed solutions do not have to stay limited to clinicians and bisexual individuals themselves. Sharing an informative article, conversationally spreading knowledge about bisexuality, and correcting misconceptions are some of the easiest, yet meaningful, ways in which everybody can tackle some of the root causes of the issues that bisexual individuals face far too often.

Substance use does not have to be the unwritten legacy of bisexual individuals, and meaningful change can start with you.

Superscript References

  1. Gates, G. (2011, April). How many people are lesbian, gay, bisexual, and Transgender? Retrieved April 20, 2021, from
  2. Government of Canada, S. (2020, September 09). Health risk behaviours, by sexual orientation and gender. Retrieved April 20, 2021, from
  3. Schuler, M. S., & Collins, R. L. (2020). Sexual minority substance use disparities: Bisexual women at elevated risk relative to other sexual minority groups. Drug and Alcohol Dependence, 206, 7. doi:
  4. Boyd, C. J., Veliz, P. T., & McCabe, S. E. (2019). Severity of DSM-5 cannabis use disorders in a nationally representative sample of sexual minorities. Substance abuse, 41(2), 191–195.
  5. Boyd, C. J., Veliz, P. T., Stephenson, R., Hughes, T. L., & McCabe, S. E. (2019). Severity of Alcohol, Tobacco, and Drug Use Disorders Among Sexual Minority Individuals and Their “Not Sure” Counterparts. LGBT health, 6(1), 15–22.
  6. Doan Van, E. E., Doan Van, E. E., Mereish, E. H., Mereish, E. H., Woulfe, J. M., Woulfe, J. M., Katz-Wise, S. L., & Katz-Wise, S. L. (2019). Perceived discrimination, coping mechanisms, and effects on health in bisexual and other non-monosexual adults. Archives of Sexual Behavior, 48(1), 159-174.
  7. Yost, M. R., Yost, M. R., Thomas, G. D., & Thomas, G. D. (2012). Gender and binegativity: Men’s and Women’s attitudes toward male and female bisexuals. Archives of Sexual Behavior, 41(3), 691-702.
  8. Livingston, N. A. (2017). Ecological momentary assessment of daily microaggressions and stigma-based substance use among lesbian, gay, and bisexual individuals
  9. Feinstein, B. A., Dyar, C., & Pachankis, J. E. (2019). A multilevel approach for reducing mental health and substance use disparities affecting bisexual individuals. Cognitive and Behavioral Practice, 26(2), 243-253. doi:
  10. Ramos, J. (2020). Coping motives as a moderator of the association between minority stress and alcohol use among emerging adults of marginalized sexualities and genders (Order No. 27738508). Available from ProQuest Dissertations & Theses A&I: Health & Medicine; ProQuest Dissertations & Theses A&I: Social Sciences; ProQuest Dissertations & Theses Global: Health & Medicine; ProQuest Dissertations & Theses Global: Social Sciences. (2428584534). Retrieved from
  11. Eisenberg, M. E., Erickson, D. J., Gower, A. L., Kne, L., Watson, R. J., Corliss, H. L., & Saewyc, E. M. (2020). Supportive community resources are associated with lower risk of substance use among lesbian, gay, bisexual, and questioning adolescents in minnesota. Journal of Youth and Adolescence, 49(4), 836-848.

Hyperlink References

APA Dictionary (n.d.). Affirmative therapy. In dictionary. Retrieved April 1, 2021, from

APA Dictionary (n.d.). Coping strategy. In dictionary. Retrieved April 1, 2021, from

APA Dictionary (n.d.). Multicultural education. In dictionary. Retrieved April 1, 2021, from

Juergens, J., & Parisi, T. (2019, January 2). Illicit drug abuse and addiction. Addiction Center. Retrieved April 01, 2021, from

Mayo Clinic. (2017, October 26). Drug addiction (substance use disorder). Retrieved April 01, 2021, from

Mayo Clinic. (2018, July 11). Alcohol use disorder. Retrieved April 01, 2021, from

Mayo Clinic. (2020, March 14). Nicotine dependence. Retrieved April 01, 2021, from

Merriam-Webster. (n.d.). Microaggression. In dictionary. Retrieved April 1, 2021, from

Merriam-Webster. (n.d.). Monogamy. In dictionary. Retrieved April 1, 2021, from

Merriam-Webster. (n.d.). Prejudice. In dictionary. Retrieved April 1, 2021, from

The Center. (n.d.). Defining LGBTQ. Retrieved April 01, 2021, from

The Binary Gender Of Addiction Screening Tools: Can Transgender People Benefit From Them?

by Krisoula Kotassidis 

A recent national US study found that transgender people 18-35 years old are more likely than cisgender people to be diagnosed with a substance use disorder10.Research shows that transgender people face additional stressors due to stigma, compared to the general population14 which explains their high rates of substance use. As a result, young transgender adults do not feel comfortable accessing medical and mental health care services, including substance use treatment7. This is why widespread awareness about transgender stress, and prevention of substance use disorders in these populations is crucial. However, existing prevention tools for substance use screening and treatment may cause more harm than benefit to transgender individuals, as they were designed with exclusively cisgender heterosexual people in mind10.

Photo credit: Juan Moyano, 2019
[Photo description: Person standing in the middle of a beach, shown from the chest and up. The transgender flag including the colours of blue, pink and white covers their head. At the background the sky is clear with only a few clouds].

Let’s talk labels first

Gender is pretty simple, right? You are born with male genitalia; therefore, you are a boy and your caregiver dresses you in blue. You are born with female genitalia; therefore, you are a girl and your caregiver dresses you in pink. This is a binary cisgender identity which assumes that your sex assigned at birth defaults to only one of two gender options. Individuals who feel happy and comfortable with such an identity and expression usually do not have to think about their gender; they just enjoy being accepted for who they are. Gender identity is your individual experience of being man, woman, both, something in between or something else. Gender expression is the way you communicate your gender identity to others through your clothing, behaviour, preferred pronouns etc.1

People who do not identify as neither a man nor a woman are non-binary. But, what about transgender people? Transgender is an umbrella term describing individuals whose gender identity or gender expression does not conform to the gender norms associated with the sex (female vs. male) they were assigned at birth6. In reality, there are many more ways in which people identify with or express their gender.

From minority stress to substance use to substance use disorders

Although research on transgender populations is extremely limited, the evidence about their poor physical and psychological well being is alarming. Transgender people face more discrimination, receive more threats about their safety, and are more likely to be victims of sexual and physical violence compared to non-transgender people 6. In the workplace, transgender people are more likely to get fired and be denied a job because of their gender identity and expression compared to non-trans folks. As a result, trans people are more likely to be homeless.14

Image by: NCTE
[Photo description: Activists on the street protesting for transgender rights. They are standing in front of a historical building and only their heads are depicted in the picture. One person, closest to the camera, holds a sign reading “We want to live free”. The rest of people are holding primarily transgender flags, and one person is holding the US flag].
This image has an empty alt attribute; its file name is K_Image3.jpg
Infographic made on Canvas by: Krisoula Kotassidis

Transgender people learn to expect such stressful events to happen, which makes them hide their gender identity to protect themselves from emotional and physical harm6. However, this often exacerbates their distress13. At the same time, transgender folks often agree with stigmatising beliefs about the way they identify with and present their gender (aka internalised transphobia) which hinders their ability to cope and accept themselves for who they are13.  To make things worse, transgender individuals are less likely to access available health care and report gender-based violence to the police 6. This is because transgender prejudice and discrimination is deeply rooted in social institutions, such as our education, healthcare, and law enforcement.12

All these experiences are traumatising to the transgender person who lives each day with fear because of the stigma they experience due to their minority status. As a result, trans populations are found with high rates of psychological disorders, substance use disorders, and suicide attempts.46

Screening & timely intervention: An example 

The Screening, Brief Intervention, and Referral to Treatment (SBIRT) model is a public health screening process used to identify individuals who use substances6. The goal of this process is to:

  • identify users who are at risk of developing a substance use disorder
  • intervene when the individual is engaged in high-risk substance use, and
  • refer individuals with severe use to a specialist. 
Image by: SAMHSA
[Image description: Four smaller pictures places next to each other creating a square and showing images of family, friends, and a hospital setting with a doctor standing in front of the camera having their hands crossed. On the right side the background of the image is in blue reading “SBIRT: Screening, Brief Intervention and Referral to Treatment”].

The model is usually used in clinical settings by doctors, nurses, social workers and other healthcare professionals6; however, there is evidence that the model is also beneficial in non-professional settings used by individuals with little or no clinical training6.   Plenty of research supports the effectiveness of this screening tool particularly with vulnerable populations such as racial minorities6, prenatal and parenting women, adolescents, and the elderly.6

Is SBIRT trans inclusive?

The answer is: no. In fact, this model uses screening tools supported by binary research using gender binary biological standards and language, without taking into account transgender-specific stressors and stigma 6. For example, the pre-screening questionnaire only refers to binary risk limits  for alcoholic drinks per day, by expecting individuals to choose only between the risk limits for men (5 or more/day) or women (4 or more/day) when answering the questions.7 However, these drinking thresholds are based on biological sex and only refer to biological females or males who also identify as women or men, respectively, in terms of gender. This may be harmful for trans folks because we do not even know how many drinks for them are too much, and also because of the non-affirming language being used.

Gender binary language also includes the use of only she/her and he/him pronouns without considering whether the individual feels comfortable with these pronouns. If you consider the gender-based emotional trauma that transgender folks have to live with, you can understand why language and representation in screening measures are important for them to feel safe in substance use screening and intervention settings. If the person does not feel accepted for who they are, they will be reluctant to receive any advice or treatment no matter how well intended it is.

Image by: Shutterstock
[Image description: Six people standing next to each other, all of different ethnicities wearing a pink, orange, yellow, green, violet, and purple clothing. They each have their preferred pronouns written on their tops].

What if SBIRT (trans)itions?

Just because something doesn’t work the way it’s supposed to doesn’t mean that we should give up on it.  Transgender focused research is almost non-existent, while there are very few transgender-specific substance use disorders healthcare professionals. But, transgender people are still struggling with substance misuse. Transgender people, especially those who are racialized, homeless or involved in sex work are overdosing 12.Therefore, we need to act fast by changing our already existing tools. Here is how SBIRT and the medical and mental health care field can change:

  • By giving priority to transgender healthcare professionals in developing and administering transgender-specific substance use prevention and treatment programs6.
  • By changing the language of screening questionnaires used in the interviewing process to include gender neutral pronouns 6.
  • By training healthcare professionals to be sensitive to the lived experiences of trans folks6 and aware of their other social identities, such as race and socioeconomic status without making binary assumptions about the individual 
  • By making use of effective peer support

How does peer support work?

According to research, peers helping each other is effective for HIV prevention, as well as, depression and substance misuse treatment.11 Therefore, some researchers believe that training transgender individuals to use tools like  SBIRT in transgender spaces could be effective, especially for those at higher risk for substance use19. Peer support can help with gender-based stressors and build resilience to cope with stigma by creating a non-judgmental environment, while preventing substance use or preparing those with heavy use for treatment6.

How you can help 

Be a transgender ally! You do not have to be transgender nor a healthcare professional to support transgender folks at risk of substance use disorders. Although there are available courses for SBIRT training online, you do not have to undergo training in order to help. Instead: 

Photo credit: John Keon, 2018
[Photo description: Portrait of writer and performance artist, ALOK. They are wearing a pink, blue, and light brown hair extension. Their make-up is in pink, white, and purple tone. They are also wearing long purple and white earrings and a navy blue and white striped, long sleeved top with gold buttons].
  • Learn more about transgender individuals through social media spaces. My favourite Instagrammer is ALOK. They have helped me so much in understanding gender. The best way to learn about transgender people and be an ally is to listen to them. It is the first big step in removing any  stereotypical thinking you might have adopted.
  • Remember the suggestion about SBIRT (trans)itioning? Well, you can do it too! You can change your language by using gender neutral pronouns when you feel ambivalent about one’s gender. Or even better: you can just ask the person what their preferred pronouns are. Trust me, they will very much appreciate it.
  • Call out (in a civilised manner) on transphobic jokes or other acts of discrimination against transgender people. If you actively show your allyship, a transgender person will feel more comfortable around you and even trust you in talking to you about their substance use. Take the first step to become an ally here.
  • Donate, donate, donate here. Even if you cannot donate, you can volunteer! Don’t have the time to volunteer? No worries! You can make the continuous effort to use the proper pronouns and simply accept transgenders for who they truly are. This is an important first step to allyship.

Dealing with substance use disorders is challenging, especially for transgenders who live with additional stressors because of their gender identity and expression. Be there for them, listen, and give them voice. Provide them with valuable peer support to identify those at risk and point them to trans-affirming treatment environments. Try it! You might save a life.


  1. American Psychological Association. (2014). Transgender people, gender identity and gender expression. Retrieved from:
  2. Bavinton, B., Gray, J., & Prestage, G. (2013). Assessing the effectiveness of HIV prevention peer education workshops for gay men in community settings. Australian and New Zealand Journal of Public Health, 37(4), 305–310. doi: 10.1111/1753-6405.12076
  3. Candian Centre for Addictions. (2019). Addiction in the LGBTQ community: LGBTQ individuals tell their stories. Retrieved from:
  4. Clements-Nolle, K., Marx, R., & Katz, M. (2006). Attempted suicide among transgender persons: The influence of gender-based discrimination and victimization. Journal of Homosexuality, 51, 53–69. doi: 10.1300/J082v51n03_04 
  5. Day, J. K., Fish, J. N., Perez-Brumer, A., Hatzenbluehler, M. L., Russel, S. T. (2017). Transgender youth substance use disparities: Results from a population-based sample, Journal of Adolescent Health, 61(6), 729-735. doi:
  6. Dentato, M. P., Ortiz, R., Orwat, J., Kelly, B. L., Gates, T. G. & Propper, E. (2019) Peer-based education and use of the SBIRT model in unique settings with transgender young adults, Journal of Social Work Practice in the Addictions, 19:1-2, 139-157, doi: 10.1080/1533256X.2019.1589884.
  7. Gilbert, P. A., Pass, L. E., Keuroghlian, A. S., Greenfield, T. K., & Reisner, S. L. (2018). Alcohol research with transgender populations: A systematic review and recommendations to strengthen future studies. Drug and alcohol dependence, 186, 138–146. 
  8. Glynn, T. R., & van Den Berg, J. J. (2017). A systematic review of interventions to reduce problematic substance use among transgender individuals: A call to action. Transgender Health, 2(1), 45–59. doi:10.1089/trgh.2016.0037  
  9. Gonzalez, C.A., Gallego, J.D., Bockting, W.O. (2017). Demographic characteristics, components of sexuality and gender, and minority stress and their associations to excessive alcohol, cannabis, and illicit (noncannabis) drug use among a large sample of transgender people in the united states. J. Prim, 38, 419–445. doi:
  10. Hughto, J. W., Quinn, E. K., Dunbar, M. S., Rose, A. J., Shireman, T. I. & Jasuja, G. K. (2021). Prevalence and co-occurrence of alcohol, nicotine, and other substance use disorder diagnoses among US transgender and cisgender adults. JAMA Network Open, 4(2), e2036512–. doi: 10.1001/jamanetworkopen.2020.36512
  11. Kelly, J. F., & Yeterian, J. D. (2015). Outcome research on twelve-step programs. In M. Galanter & H. D. Kleber (Eds.), Textbook of substance abuse treatment (5th ed., pp. 579–595). Washington, DC: American Psychiatric Press.
  12. Laye, B. (2019). The Overdose Crisis Isn’t Gender Neutral. West Coast Leaf. Retrieved from: 
  13. Martino, W., Kassen, K. & Omercajic, K. (2020) Supporting transgender students in schools: Beyond an individualist approach to trans inclusion in the education system, Educational Review, doi: 10.1080/00131911.2020.1829559
  14. Meyer, I. H. (1995). Minority stress and mental health in gay men. Journal of Health and Social Behavior, 36, 38–56. Doi:
  15. Meyer, I. H., Schwartz, S., & Frost, D. M. (2008). Social patterning of stress and coping: Does disadvantaged social statuses confer more stress and fewer coping resources? Social Science & Medicine, 67, 368–379. doi:10.1016/j.socscimed.2008.03.012
  16. SBIRT training. (2021). Retrieved from: 
  17. Trans Pulse. (N/A). Drug use among transgender people in Ontario. Retrieved from: 
  18. Trans Equality Canada. Retrieved from: 
  19. Hughes TL, Wilsnack SC, Kantor LW. The Influence of Gender and Sexual Orientation on Alcohol Use and Alcohol-Related Problems: Toward a Global Perspective. Alcohol Res. 2016;38(1):121-32. PMID: 27159819; PMCID: PMC4872607. doi: 

 Images & social media 

  1. CBC News. (2020). 4 Canadian transgender activists you should know. Retrieved from: 
  2. Moyano, J. (2019). Retrieved from: 
  3. Keon, J. (2018). Retrieved from: