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Substance Abuse/Dependence and Transgender People

Transgender people experience a high burden of substance abuse or dependence, including high prevalence of alcohol, tobacco, marijuana, nonmarijuana illicit drugs, and nonmedical prescription drug misuse. This entry addresses the etiology of substance abuse or dependence; reviews a public health “syndemic” approach to understanding substance abuse or dependence; and examines the need for culturally competent, gender-affirming health care.

Etiology of Substance Abuse or Dependence

The etiology of substance abuse or dependence is complex, and multiple causal factors contribute to substance abuse or dependence in transgender people. Some risk factors that fuel substance abuse or dependence for transgender people are shared with the general population—for example, genetic predisposition or biological risks (e.g., dopaminergic pathways) and/or psychological risks (e.g., avoidant coping). However, transgender people also experience unique risk factors ...

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