By Jason Parsley
Besides struggling to accept themselves, which is hard enough, transgender individuals face higher rates of suicide, homelessness, addiction and discrimination. And when it comes to getting help for substance abuse issues, trans people face a unique set of challenges.
While many treatment centers and sober houses claim to be gay- and trans-friendly, that's not always the case, because being "friendly" depends more on the knowledge and compassion of the staff than on the policies of the facility.
Take, for instance, Raphael Esangbedo, 29, of Dania Beach, Florida. Esangbedo has struggled with addiction issues for years and had no idea he was transgender when he went into treatment.
"I thought I was just weird," Esangbedo said. "I didn't know what it meant to be trans I thought maybe I was bisexual. I thought I was the only one feeling like that back then. I didn't know anybody else like me."
And the staff at the facility he was in at the time didn't help his situation.
"The nurse said I needed therapy, I needed help, I needed God and Jesus and all that shit," he said.
Esangbedo had always felt more comfortable dressing in men's clothing. But when he entered treatment, one nurse in particular tried to force him to wear more feminine clothes, at one point even throwing away a pair of his blue corduroy pants.
"I was very upset and angry," he recalled. "I was crying. She gave me problems for dressing in boy clothes. She'd even bring in girl clothes and make me wear them. She said it wasn't normal for girls to think like that. If I had my male clothes on, she'd make me take them off and put on the girl clothes."
The nurse was correct on one point: Esangbedo did, in fact, need help, just not the kind the facility was offering.
Esangbedo ended up leaving that treatment center -- and then leaving the next one. The third time was the charm.
"I had given up talking about it," he said. "I was thinking of killing myself. I was planning an endgame. But I decided to give my new therapist a chance. She was the one who told me I may be transgender."
And that's when it all clicked.
Soon after that, Esangbedo made his way to a transgender support group at a local LGBT center, where all his feelings and thoughts were confirmed and validated.
Today Esangbedo's life is on the right track. He is almost three years clean.
"You feel so out of place in your body, so uncomfortable in your skin you can't think," he said. "I had to take care of this issue first before I could focus on [recovery]. It was a lot easier once I accepted myself for who I was."
Not all trans folks are as lucky as Esangbedo.
Arianna Lint, Director of Transgender Services at SunServe in South Florida, says she's used to having to educate facilities on trans issues.
"Some programs accept my invitation and make changes immediately for transgender clients, and some don't," Lint said. "I still offer the training regardless, because I believe in advocating for transgender rights and equality."
Brandi Selden understands all too well what trans people with substance abuse problems face. As the director of the Morris House in Philadelphia, she oversees an eight-bed treatment facility for trans people. Morris House is the only all-trans and gender-variant facility in the nation. It opened in 2012.
"It was a forward-thinking program," Selden said. "It's the first of its kind in the nation."
While at one time they were looking to expand their services, due to financial issues, that no longer appears to be an option. A more feasible option would be for the facility to transition into a step-down program, another name for a halfway house-type facility.
"There is absolutely a need for step-down programs in the trans community," she said. "Halfway homes that exist in Philadelphia haven't caught up to the times that we live in, and they're not trans-friendly."
Selden said there's a trans woman in her facility right now who wants to go to a woman's program but isn't far enough along in her transition.
"Some places might have a floor dedicated to trans people," she said. But even that isn't ideal. "Having a floor is ostracizing them. I understand why they did it, but it's counterproductive. They're being isolated to a certain section of the building. We need to allow them to integrate into society."
So far, 44 people have gone through the Morris House. Like Lint, Selden also goes to other facilities to help educate their staffs.
"Many places aren't as trans-friendly as they think," she said. "If the staff is insensitive to the population, it's going to trickle down to the clients. So the education has to start on the staff level."
But opening up all-trans facilities across the nation for transgender addicts just isn't a viable option. Elliot Kennedy, Special Expert for the Office of Policy, Planning and Innovation at the Substance Abuse and Mental Health Services Administration (SAMHSA), believes education is the key for this very reason.
"There will never be enough resources, because the [trans community] will never be a large enough part of the population," Kennedy said. "So we have to make sure mainstream providers of care are culturally competent. The knee-jerk reaction shouldn't be to send them to an LGBT center."
Clair Farley, Associate Director of Economic Development for the San Francisco LGBT Community Center, is trying to provide trans housing in San Francisco by launching a housing program. While it wouldn't be specifically for trans people with substance abuse issues, it would inevitably serve that community, since addiction, employment issues and homelessness are common in the trans community.
"San Fran is a very expensive place to live," she explained. "Oftentimes they're forced to live on the streets, and to cope, they turn to drugs. If your life is only based on survival, it makes it really difficult to cope. Safe housing is a preventative measure to substance abuse. We have to build a community, a foundation, so they can pursue their goals, build that stability, so that they don't get back into drugs or alcohol."
Farley said they're still in the process of raising funds, but they hope to have a residence in place by next spring. When it comes to addiction, she sees this future program serving as an additional stepping stone once trans individuals leave a treatment center or a halfway house.
"People are given two to three months to find a job, and then they're kicked out of a treatment program," she said. "It takes time for people to build stability and afford a place of their own. Without that, people are forced to go back to environments or relationships that are more survival-based, which can lead them back into addiction."
The Oxford House is a group of mainstream halfway houses across the nation with more than 1,700 locations. But a few aspects make them unique.
"Each house is autonomous, and it takes an 80-percent vote of the residents to be accepted into the house," said founder Paul Molloy. "The key question is whether they are serious about recovery from addiction."
But more importantly, by having the residents of the house interview the addicts and vote on them, it is much more likely that if a trans person is accepted, the residents would be comfortable, or at least open-minded enough, to learn about trans issues.
Jason Parsley lives in Boynton Beach, Florida, and is the associate publisher of the South Florida Gay News. He last interviewed the acting U.S. drug czar.