Introduction

Minority stress theories suggest that high rates of discrimination experienced by transgender people are precipitants of substance use. This risk is likely exacerbated by an inadequate provision of trans-inclusive substance misuse services. However, the exclusion of transgender people from the general substance misuse literature makes it difficult to determine the extent to which transgender status influences substance use. A systematic review was undertaken to better understand the prevalence, patterns and correlates of substance use among this group.

Methods

In accordance with the PRISMA guidance, a literature search was conducted to 29th May 2019 on PubMed, PsycINFO, Embase and Global Health databases. Primary quantitative studies, published in English, that reported the prevalence, patterns or correlates of substance use by transgender people were included, with no restriction on methodological design.

Results

653 unique records were identified, and 41 studies were included. Half the studies reported on both transgender men and transgender women and half transgender women only. There was high and excess prevalence of substance use among transgender compared with cisgender people, but insufficient evidence to estimate prevalence or quantify the risk for substance use. Correlates of substance use included transphobic discrimination or violence, unemployment and sex work, gender dysphoria, high visual gender non-conformity and intersectional sexual minority status.

Conclusions

The sparse findings lend support to the minority stress model. However, the overreliance of the literature on disproportionate investigation of transgender women with multiple intersectional disadvantages, means there are significant gaps regarding the wider transgender community. To ensure substance use treatment services are inclusive, gender identity should be recorded and targeted interventions available. Clinicians should be aware of the multiple, complex drivers of substance use and be prepared to ask about substance use and offer support. Given the high prevalence of trauma experienced by transgender people, trauma-informed psychosocial interventions may be useful in the management of problematic substance use in transgender adults.

中文翻译：

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跨性别成年人中物质使用的普遍性和相关性：系统评价。

介绍

少数群体压力理论表明，跨性别者经历的高歧视是吸毒的诱因。这种风险可能是由一个供应不足的加剧反式-inclusive药物滥用服务。但是，将跨性别者排除在一般滥用毒品文献之外，这使得很难确定跨性别状况影响吸毒的程度。进行了系统的审查，以更好地了解该组中物质使用的流行程度，模式和相关性。

方法

根据PRISMA的指导，于2019年5月29日对PubMed，PsycINFO，Embase和Global Health数据库进行了文献检索。包括以英语发表的主要定量研究报告了跨性别者使用毒品的普遍性，模式或相关性，方法设计不受限制。

结果

确定了653个独特的记录，包括41个研究。一半的研究报告了变性者和变性者，一半只报道了变性者。与顺式性别人群相比，跨性别人群中药物滥用的患病率高且高，但是没有足够的证据来估计患病率或量化使用毒品的风险。物质使用的相关性包括仇视性歧视或暴力，失业和性工作，性别不安，视觉上的性别不合格率较高以及性交少数群体的状况。

结论

稀疏的发现为少数派压力模型提供了支持。但是，对跨性别不利多重性别的跨性别妇女的不成比例调查的文献过于依赖，这意味着在更广泛的跨性别社区中存在巨大差距。为确保药物使用治疗服务具有包容性，应记录性别身份并提供有针对性的干预措施。临床医生应该意识到物质使用的多种复杂驱动因素，并准备询问物质使用并提供支持。鉴于跨性别者遭受创伤的患病率很高，因此以创伤为依据的心理社会干预措施可能有助于管理跨性别成年人中有问题的物质使用。