I have been seeking recovery from alcohol, heroin and pharmaceutical opioid use disorders since late 2013. The treatment system is fraught with barriers, especially so if you’re transgender. It could leave you in worse shape than you were in to begin with, especially if you aren’t prepared. I’m hoping that my experiences can be of use to people entering that world—trans and cisgender alike—and to anyone working to reshape the recovery industry into something more equitable.
Between 2012 and 2020 I went through 17 psychiatric and substance use disorder inpatient programs, and at none of them was I ever safe.
In 2013, I had to define “transgender” and “gender dysphoria” to providers at one of Philadelphia’s mental health crisis response centers. I even learned later that they’d classified me as at higher risk for suicide not because I was trans, but because I was “male.”
She said I’d be housed with women, but upon arrival I learned that I would be housed with men.
After that, I was sent to a hospital that was purportedly LGBTQ+ friendly. The Human Rights Campaign had given it a high score on its Healthcare Equality Index. During intake they asked to see my genitalia. I was immediately isolated into a room by myself, with no roommate. Other patients were allowed to walk around the halls, to mingle and make friends, but I wasn’t allowed to leave my room or interact with anyone else for more than a few moments at a time. When I asked why these rules were in place for me and no one else, they wouldn’t give a straight answer.
They brought in Alcoholics Anonymous members to talk to us about recovery. Which is not inherently a problem of course, but it was the same people every time, at every meeting for the two weeks I was there. They wanted to address me separately from the group. They would talk at length about how God could solve my “problem”—not my alcohol or opioid use, but my gender identity. They asked me to stop my hormone-replacement therapy. They asked me to pray to God to “restore me to manhood.” They said that’s what would help with my other problems.
After I was released, I went to their AA intergroup and told them about my experience, but they ignored me. I didn’t go to any 12-step meetings for a while after that.
Behavioral health patients have the right to receive treatment in the least restrictive setting necessary, as well as to not be subjected to harsh or unusual treatment. Trans patients should have access to private rooms if they’re concerned about their safety, but they shouldn’t be forced into them or cut off from social settings without reason.
When I expressed that I needed to be in women’s housing in order to stay, they said I would need to arrange my own transportation to get home.
A few months later I was trying to get into recovery housing. A caseworker who worked with LGBTQ+ populations referred me to an organization that owns several recovery houses in the Philadelphia area. They asked about whether I’d had surgery. They asked whether I masturbated, and how often, and by which method. I decided not to stay there.
In 2017, an outpatient program counselor recommended I try a luxury rehab that’s since closed. She said I’d be housed with women, but upon arrival I learned that I would be housed with men. Despite all the legal paperwork clearly documenting my gender identity, and medical paperwork clearly documenting my gender dysphoria and treatment history, the facility staff never mentioned anything about housing me with men until I got there. When I expressed that I needed to be in women’s housing in order to stay, they said I would need to arrange my own transportation to get home. I saw a patient who was discharged for bringing drugs into the facility still get offered their car service to get home.
So I had to stay. I was there for the full 28 days. Male patients made lewd comments and asked me for sexual favors. One tried to enter my room; another tried to enter the bathroom where I was showering. Fortunately both were locked. After I aired this out during a group meeting, the women unanimously asked for me to be housed with them, a request they made several times. Nothing was ever done.
I’ve had some positive experiences, but trans people are basically left to try to recover on our own.
As we neared the end of our stays and our counselors prepared to transfer us to recovery housing, the facilities they contacted would only house trans residents according to gender assigned at birth. My counselor made it clear she wasn’t going to help, so I refused to go and said I just wanted to go directly home. She berated me in public.
Monikers like “LGBT-affirming facilities” don’t really mean anything. In 2025, there are still very few trans-supportive facilities and even fewer dedicated to trans patients specifically. I’ve had some positive experiences, like the clinic where my buprenorphine provider made sure no one harassed me, but those have been few and far between. We’re basically left to try to recover on our own. I’ve been working on compiling a list of clinics, rehabs and recovery housing groups that are supportive, but it’s slow going to confirm things.
Like prisons and jails, recovery spaces house trans people according to their gender assigned at birth, with no regard for their safety. Trans women frequently receive the worst treatment, at the hands of people who view us as men. Any behavioral health facility that denies someone’s gender identity is incapable of providing them the equitable treatment they need to recover.
I’ve been fortunate to know many cis allies who’ve stepped up when I needed them. Whether or not they were actually able to help me, when they called out transphobia during meetings, or to their providers, they were still being agents of change. Recovery facilities serve so many people who already face medical stigma—queer people, disabled people, people of color—which is compounded by the stigma of being associated with drugs. If trans people are liberated in this field, if we can safely and freely access drug treatment and recovery housing, it will free all people who need these services.
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