{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T06:52:14Z","timestamp":1793256734725,"version":"4.5.0"},"reference-count":80,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2022,3,10]],"date-time":"2022-03-10T00:00:00Z","timestamp":1646870400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Fundaci\u00f3n Hospital Provincial de Castell\u00f3n","award":["CAF-21-034 and CAF-21-035"],"award-info":[{"award-number":["CAF-21-034 and CAF-21-035"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>(1) Background: This meta-analysis aimed to assess the relationship between identifying as transgender and substance use. (2) Methods: We searched for relevant studies in PubMed, Scopus, the Web of Science, and PsycINFO on 21 July 2021. (3) Results: Twenty studies comparing transgender and cisgender people were included in this work, accounting for a total of 2,376,951 participants (18,329 of whom were transgender). These articles included data on current tobacco use, current tobacco use disorder, current alcohol use, current alcohol use disorder, lifetime substance (all) use, current substance use (excluding tobacco and alcohol), current use of specific substances (excluding tobacco and alcohol and including cocaine, amphetamines, methamphetamines, ecstasy, stimulants, heroin, opiates, cannabis, marijuana, LSD, hallucinogens, steroids, inhalants, sedatives, Ritalin or Adderall, diet pills, cold medicine, prescription medications, polysubstance, other club drugs, and other illegal drugs), and current substance use disorder (excluding tobacco and alcohol). We used the ORs and their 95% CIs to state the association between identifying as transgender and those variables. The control reference category used in all cases was cisgender. We employed a random-effects model. Transgender people were more likely to use tobacco (odds ratio (OR) = 1.65; 95% CI [1.37, 1.98]), have used substances throughout their lives (OR = 1.48; 95% CI [1.30, 1.68]), and present current use of specific substances (OR = 1.79; 95% CI [1.54, 2.07]). When current alcohol and substance use in general and tobacco, alcohol, and substance use disorders specifically were considered, the likelihood did not differ from that of cisgender people. (4) Conclusions: The presence of substance use disorders did not differ between transgender and cisgender people. Considering this population as consumers or as addicted may be a prejudice that perpetuates stigma. Nonetheless, transgender people were more likely to use tobacco and other substances, but not alcohol. Hypothetically, this might be an emotional regulation strategy, a maladaptive mechanism for coping with traumatic experiences, or could respond to minority stress, produced by stigma, prejudice, discrimination, and harassment. It is of particular importance to implement policies against discrimination and stigmatisation and to adapt prevention and treatment services so that they are inclusive of the 2SLGBTQIA+ community.<\/jats:p>","DOI":"10.3390\/brainsci12030366","type":"journal-article","created":{"date-parts":[[2022,3,10]],"date-time":"2022-03-10T11:46:47Z","timestamp":1646912807000},"page":"366","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":90,"title":["Substance Use in the Transgender Population: A Meta-Analysis"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6013-9237","authenticated-orcid":false,"given":"Miriam","family":"Cotaina","sequence":"first","affiliation":[{"name":"TXP Research Group, Universidad Cardenal Herrera-CEU, CEU Universities, 12006 Castellon de la plana, Spain"},{"name":"Department of Mental Health, Consorcio Hospitalario Provincial de Castell\u00f3n, 12002 Castellon de la plana, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7860-765X","authenticated-orcid":false,"given":"Marc","family":"Peraire","sequence":"additional","affiliation":[{"name":"TXP Research Group, Universidad Cardenal Herrera-CEU, CEU Universities, 12006 Castellon de la plana, Spain"},{"name":"Department of Mental Health, Consorcio Hospitalario Provincial de Castell\u00f3n, 12002 Castellon de la plana, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mireia","family":"Bosc\u00e1","sequence":"additional","affiliation":[{"name":"Department of Mental Health, Consorcio Hospitalario Provincial de Castell\u00f3n, 12002 Castellon de la plana, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2155-9543","authenticated-orcid":false,"given":"Iv\u00e1n","family":"Echeverria","sequence":"additional","affiliation":[{"name":"TXP Research Group, Universidad Cardenal Herrera-CEU, CEU Universities, 12006 Castellon de la plana, Spain"},{"name":"Department of Mental Health, Consorcio Hospitalario Provincial de Castell\u00f3n, 12002 Castellon de la plana, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0785-3570","authenticated-orcid":false,"given":"Ana","family":"Benito","sequence":"additional","affiliation":[{"name":"TXP Research Group, Universidad Cardenal Herrera-CEU, CEU Universities, 12006 Castellon de la plana, Spain"},{"name":"Torrente Mental Health Unit, Hospital General de Valencia, 46900 Torrente, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1299-9611","authenticated-orcid":false,"given":"Gonzalo","family":"Haro","sequence":"additional","affiliation":[{"name":"TXP Research Group, Universidad Cardenal Herrera-CEU, CEU Universities, 12006 Castellon de la plana, Spain"},{"name":"Department of Mental Health, Consorcio Hospitalario Provincial de Castell\u00f3n, 12002 Castellon de la plana, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,3,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1080\/15532739.2011.700873","article-title":"The World Professional Association for Transgender Health. Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People. 7th ed, Version 7","volume":"13","author":"Coleman","year":"2012","journal-title":"Int. J. Transgenderism"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1192\/bjp.119.549.195","article-title":"Incidence and Sex Ratio of Transsexualism in Sweden","volume":"119","year":"1971","journal-title":"Br. J. Psychiatry."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1111\/j.1600-0447.1988.tb06373.x","article-title":"The prevalence of transsexualism in Singapore","volume":"78","author":"Tsoi","year":"1988","journal-title":"Acta Psychiatr. Scand."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"455","DOI":"10.4321\/S1137-66272012000300011","article-title":"Estudio descriptivo de la transexualidad en Navarra","volume":"35","author":"Basterra","year":"2012","journal-title":"An. Sist. Sanit. Navar."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1007\/s10508-015-0557-6","article-title":"Sociodemographic Characteristics and Psychological Adjustment among Transsexuals in Spain","volume":"45","year":"2016","journal-title":"Arch. Sex Behav."},{"key":"ref_6","first-page":"295","article-title":"Estimaci\u00f3n de la prevalencia, incidencia y raz\u00f3n de sexos del transexualismo en Catalu\u00f1a seg\u00fan la demanda asistencial","volume":"34","year":"2006","journal-title":"Actas Esp. Psiquiatr."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"E1","DOI":"10.2105\/AJPH.2020.305774","article-title":"Intimate Partner Violence in Transgender Populations: Systematic Review and Meta-analysis of Prevalence and Correlates","volume":"110","author":"Peitzmeier","year":"2020","journal-title":"Am. J. Public Health"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"107802","DOI":"10.1016\/j.drugalcdep.2019.107802","article-title":"Social marginalization, gender-based violence, and binge drinking among transgender women in Cambodia","volume":"207","author":"Yi","year":"2020","journal-title":"Drug Alcohol Depend."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1080\/15538605.2012.725649","article-title":"Addiction in LGBTQ Communities: Influences, Treatment, and Prevention","volume":"6","author":"Chaney","year":"2012","journal-title":"J. LGBT Issues Couns."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/15574090802226626","article-title":"Effects of perceived discrimination on mental health and mental health services utilization among gay, lesbian, bisexual and transgender persons","volume":"3","author":"Burgess","year":"2007","journal-title":"J. LGBT Health Res."},{"key":"ref_11","unstructured":"Rodman, K. (2015). Transgender People\u2019s Experiences in Substance Abuse Treatment. [Ph.D Thesis, California Institute of Integral Studies]."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1016\/j.jadohealth.2017.06.024","article-title":"Transgender Youth Substance Use Disparities: Results from a Population-Based Sample","volume":"61","author":"Day","year":"2017","journal-title":"J. Adolesc. Health."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1016\/j.jadohealth.2017.10.004","article-title":"The Effects of Gender- and Sexuality-Based Harassment on Lesbian, Gay, Bisexual, and Transgender Substance Use Disparities","volume":"62","author":"Coulter","year":"2018","journal-title":"J. Adolesc. Health."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1080\/01488376.2011.637858","article-title":"Gender identity and social services: Barriers to care","volume":"39","author":"Stotzer","year":"2013","journal-title":"J. Soc. Serv. Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1089\/trgh.2020.0042","article-title":"Using a Comprehensive Proximal Stress Model to Predict Alcohol Use","volume":"6","author":"Lindley","year":"2021","journal-title":"Transgend. Health"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"990","DOI":"10.1037\/0022-3514.69.5.990","article-title":"Drinking to regulate positive and negative emotions: A motivational model of alcohol use","volume":"69","author":"Cooper","year":"1995","journal-title":"J. Pers. Soc. Psychol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1111\/socf.12193","article-title":"The Social Costs of Gender Nonconformity for Transgender Adults: Implications for Discrimination and Health","volume":"30","author":"Miller","year":"2015","journal-title":"Sociol. Forum"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1089\/lgbt.2015.0001","article-title":"Substance Use to Cope with Stigma in Healthcare among, U.S. Female-to-Male Trans Masculine Adults","volume":"2","author":"Reisner","year":"2015","journal-title":"LGBT Health"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1012","DOI":"10.1111\/acer.13358","article-title":"Alcohol-Related Blackouts, Negative Alcohol-Related Consequences, and Motivations for Drinking Reported by Newly Matriculating Transgender College Students","volume":"41","author":"Tupler","year":"2017","journal-title":"Alcohol Clin. Exp. Res."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1016\/j.addbeh.2017.08.017","article-title":"A descriptive analysis of alcohol behaviors across gender subgroups within a sample of transgender adults","volume":"76","author":"Staples","year":"2018","journal-title":"Addict. Behav."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1300\/J463v03n02_07","article-title":"Differentiating LGBT individuals in substance abuse treatment: Analyses based on sexuality and drug preference","volume":"3","author":"Cochran","year":"2007","journal-title":"J. LGBT Health Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1007\/s11524-014-9930-3","article-title":"Binge Drinking among Men Who Have Sex with Men and Transgender Women in San Salvador: Correlates and Sexual Health Implications","volume":"92","author":"Peacock","year":"2015","journal-title":"J. Urban. Health."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"106544","DOI":"10.1016\/j.addbeh.2020.106544","article-title":"Prevalence and correlates of substance use among transgender adults: A systematic review","volume":"111","author":"Connolly","year":"2020","journal-title":"Addict. Behav."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1080\/1533256X.2011.592795","article-title":"The Substance Abuse Treatment Experiences of a Small Sample of Transgender Clients. The Substance Abuse Treatment Experiences of a Small Sample of Transgender Clients","volume":"11","author":"Senreich","year":"2011","journal-title":"J. Soc. Work Pract. Addict."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1080\/15538605.2012.727743","article-title":"Understanding risk factors contributing to substance use among MTF transgender persons","volume":"6","author":"Wolf","year":"2012","journal-title":"J. LGBT Issues Couns."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1016\/j.ijsu.2010.02.007","article-title":"Preferred reporting items for systematic reviews and metaanalyses: The PRISMA statement","volume":"8","author":"Moher","year":"2010","journal-title":"Int. J. Surg."},{"key":"ref_27","unstructured":"Wells, G., Shea, B., O\u2019Connell, D., Peterson, J., Welch, V., Losos, M., and Tugwell, P. (2021, December 28). The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Metaanalyses. Available online: http:\/\/www.ohri.ca\/programs\/clinical_epidemiology\/oxford.asp."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Aparicio-Garc\u00eda, M.E., D\u00edaz-Ramiro Em Rubio-Valdehita, S., L\u00f3pez-N\u00fa\u00f1ez, M.I., and Garc\u00eda-Nieto, I. (2018). Health and Well-Being of Cisgender, Transgender and Non-Binary Young People. Int. J. Environ. Res. Public Health, 15.","DOI":"10.20944\/preprints201809.0120.v1"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/j.drugpo.2019.07.024","article-title":"Cigarette, smokeless tobacco, and alcohol use among transgender adults in the United States","volume":"73","author":"Azagba","year":"2019","journal-title":"Int. J. Drug Policy"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1089\/lgbt.2020.0293","article-title":"Mental Health and Substance Use Diagnoses and Treatment Disparities by Sexual Orientation and Gender in a Community Health Center Sample","volume":"8","author":"Batchelder","year":"2021","journal-title":"LGBT Health."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1016\/j.amepre.2016.11.022","article-title":"Transgender Use of Cigarettes, Cigars, and E-Cigarettes in a National Study","volume":"53","author":"Buchting","year":"2017","journal-title":"Am. J. Prev. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1037\/fam0000776","article-title":"Demographics and health outcomes in a U.S. probability sample of transgender parents","volume":"35","author":"Carone","year":"2021","journal-title":"J. Fam. Psychol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1136\/sti.2006.020628","article-title":"Sex worker health: San Francisco style","volume":"82","author":"Cohan","year":"2006","journal-title":"Sex. Transm. Infect."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1016\/j.drugalcdep.2015.07.006","article-title":"Differences in alcohol use and alcohol-related problems between transgender- and nontransgender-identified young adults","volume":"154","author":"Coulter","year":"2015","journal-title":"Drug Alcohol Depend."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1111\/josh.12499","article-title":"Substance Use Among Transgender Students in California Public Middle and High Schools","volume":"87","author":"Gilreath","year":"2017","journal-title":"J. Sch. Health"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1080\/19325037.2020.1822242","article-title":"Gender Identity and Health-related Outcomes in a National Sample of College Students","volume":"51","author":"Dinger","year":"2020","journal-title":"Am. J. Health Educ."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"969","DOI":"10.1016\/j.addbeh.2014.01.011","article-title":"Characteristics of transgender individuals entering substance abuse treatment","volume":"39","author":"Flentje","year":"2014","journal-title":"Addict. Behav."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1007\/s12529-019-09846-8","article-title":"Family Rejection and Cigarette Smoking Among Sexual and Gender Minority Adolescents in the USA","volume":"27","author":"Gamarel","year":"2020","journal-title":"Int. J. Behav. Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1037\/sgd0000467","article-title":"Mental health among transgender and gender diverse youth: An exploration of effects during the COVID-19 pandemic","volume":"8","author":"Hawke","year":"2021","journal-title":"Psychol. Sex. Orientat. Gend. Divers."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1016\/j.ypmed.2018.05.014","article-title":"Sexual and gender minority cigarette smoking disparities: An analysis of 2016 Behavioral Risk Factor Surveillance System data","volume":"113","author":"Hoffman","year":"2018","journal-title":"Prev. Med."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"107619","DOI":"10.1016\/j.drugalcdep.2019.107619","article-title":"Sexual orientation and gender identity disparities in substance use disorders during young adulthood in a United States longitudinal cohort","volume":"205","author":"Jun","year":"2019","journal-title":"Drug Alcohol Depend."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1111\/dar.12158","article-title":"Substance use by same sex attracted young people: Prevalence, perceptions and homophobia","volume":"34","author":"Kelly","year":"2015","journal-title":"Drug Alcohol Rev."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Kiekens, W.J., Baams, L., Fish, J.N., and Watson, R.J. (2021). Associations of Relationship Experiences, Dating Violence, Sexual Harassment, and Assault With Alcohol Use Among Sexual and Gender Minority Adolescents. J. Interpers. Violence, 1\u201329.","DOI":"10.1177\/08862605211001469"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Stanton, A.M., Batchelder, A.W., Kirakosian, N., Scholl, J., King, D., Grasso, C., Potter, J., Mayer, K.H., and O\u2019Cleirigh, C. (2021). Differences in mental health symptom severity and care engagement among transgender and gender diverse individuals: Findings from a large community health center. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0245872"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1111\/ajad.12244","article-title":"A pilot study to assess tobacco use among sexual minorities in Houston, Texas","volume":"24","author":"Lin","year":"2015","journal-title":"Am. J. Addict."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1820","DOI":"10.2105\/AJPH.2012.300796","article-title":"Experiences of Transgender-Related Discrimination and Implications for Health: Results from the Virginia Transgender Health Initiative Study","volume":"103","author":"Bradford","year":"2013","journal-title":"Am. J. Public Health"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1502","DOI":"10.1093\/ntr\/ntv221","article-title":"Structural Discrimination is Associated with Smoking Status among a National Sample of Transgender Individuals","volume":"18","year":"2016","journal-title":"Nicotine Tob. Res."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1007\/s10508-007-9307-8","article-title":"Sociodemographic, Clinical, and Psychiatric Characteristics of Transsexuals from Spain","volume":"38","author":"Trilla","year":"2009","journal-title":"Arch. Sex. Behav."},{"key":"ref_49","first-page":"189","article-title":"Patrones de consumo de alcohol, tabaco y drogas ilegales en personas transexuales","volume":"31","author":"Simulionyte","year":"2018","journal-title":"Adicciones"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1089\/lgbt.2019.0005","article-title":"Cigarette Smoking Among Youth at the Intersection of Sexual Orientation and Gender Identity","volume":"6","author":"Wheldon","year":"2019","journal-title":"LGBT Heal."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"e2036512","DOI":"10.1001\/jamanetworkopen.2020.36512","article-title":"Prevalence and Co-occurrence of Alcohol, Nicotine, and Other Substance Use Disorder Diagnoses Among US Transgender and Cisgender Adults","volume":"4","author":"Hughto","year":"2021","journal-title":"JAMA Netw. Open"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/j.addbeh.2017.03.022","article-title":"Drug use among transgender people in Ontario, Canada: Disparities and associations with social exclusion","volume":"72","author":"Scheim","year":"2017","journal-title":"Addict. Behav."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1177\/0956462415595319","article-title":"Non-medical use of prescription drugs and HIV risk behaviour in transgender women in the Mid-Atlantic region of the United States","volume":"27","author":"Benotsch","year":"2016","journal-title":"Int. J. STD AIDS"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"108474","DOI":"10.1016\/j.drugalcdep.2020.108474","article-title":"Prevalence and minority-stress correlates of past 12-month prescription drug misuse in a national sample of transgender and gender nonbinary adults: Results from the U.S. Transgender Survey","volume":"219","author":"Kidd","year":"2021","journal-title":"Drug Alcohol Depend."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"67","DOI":"10.15585\/mmwr.mm6803a3","article-title":"Transgender Identity and Experiences of Violence Victimization, Substance Use, Suicide Risk, and Sexual Risk Behaviors Among High School Students\u201419 States and Large Urban School Districts, 2017","volume":"68","author":"Johns","year":"2019","journal-title":"MMWR Morb. Mortal Wkly. Rep."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1111\/dar.12116","article-title":"Alcohol and substance use among transgender women in San Francisco: Prevalence and association with human immunodeficiency virus infection","volume":"33","author":"Santos","year":"2014","journal-title":"Drug Alcohol Rev."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1097\/ADM.0000000000000769","article-title":"Disparities in Documented Drug Use Disorders Between Transgender and Cisgender, U.S. Veterans Health Administration Patients","volume":"15","author":"Frost","year":"2021","journal-title":"J. Addict. Med."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1080\/15574090802093562","article-title":"Gender nonconformity as a target of prejudice, discrimination, and violence against LGB individuals","volume":"3","author":"Gordon","year":"2007","journal-title":"J. LGBT Health Res."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1089\/lgbt.2014.0009","article-title":"Transgender Health Disparities: Comparing Full Cohort and Nested Matched-Pair Study Designs in a Community Health Center","volume":"1","author":"Reisner","year":"2014","journal-title":"LGBT Health"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1080\/00224499.2014.886321","article-title":"Gender Minority Social Stress in Adolescence: Disparities in Adolescent Bullying and Substance Use by Gender Identity","volume":"52","author":"Reisner","year":"2015","journal-title":"J. Sex. Res."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1097\/MLR.0b013e31829fa90d","article-title":"Transgender patient perceptions of stigma in health care contexts","volume":"51","author":"Kosenko","year":"2013","journal-title":"Med. Care."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1037\/a0029597","article-title":"A conceptual framework for clinical work with transgender and gender nonconforming clients: An adaptation of the minority stress model","volume":"43","author":"Hendricks","year":"2012","journal-title":"Prof. Psychol Res. Pract."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1007\/s10935-018-0508-9","article-title":"Protective Factors Among Transgender and Gender Variant Youth: A Systematic Review by Socioecological Level","volume":"39","author":"Johns","year":"2018","journal-title":"J. Prim. Prev."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1176\/appi.ps.201900029","article-title":"Stress, Coping, and Context: Examining Substance Use Among LGBTQ Young Adults with Probable Substance Use Disorders","volume":"71","author":"Felner","year":"2020","journal-title":"Psychiatr Serv."},{"key":"ref_65","first-page":"108","article-title":"Minority stress and drug use among transgender and gender diverse adults: A daily diary study","volume":"220","author":"Flores","year":"2021","journal-title":"Drug Alcohol Depend."},{"key":"ref_66","doi-asserted-by":"crossref","unstructured":"Katz-Wise, S.L., Sarda, V., Bryn Austin, S., and Harris, S.K. (2021). Longitudinal effects of gender minority stressors on substance use and related risk and protective factors among gender minority adolescents. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0250500"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1016\/j.drugalcdep.2014.11.023","article-title":"Prevalence and correlates of substance use among trans female youth ages 16-24 years in the San Francisco Bay Area","volume":"147","author":"Rowe","year":"2015","journal-title":"Drug Alcohol Depend."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"2199","DOI":"10.2105\/AJPH.2014.302106","article-title":"Gender abuse, depressive symptoms, and substance use among transgender women: A 3-year prospective study","volume":"104","author":"Nuttbrock","year":"2014","journal-title":"Am. J. Public Health"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1089\/trgh.2017.0032","article-title":"Transgender Women\u2019s Drug Use in the Dominican Republic","volume":"2","author":"Budhwani","year":"2017","journal-title":"Transgender Heal."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"108223","DOI":"10.1016\/j.drugalcdep.2020.108223","article-title":"Association of transphobic discrimination and alcohol misuse among transgender adults: Results from the U.S. Transgender Survey","volume":"215","author":"Kcomt","year":"2020","journal-title":"Drug Alcohol Depend."},{"key":"ref_71","doi-asserted-by":"crossref","unstructured":"Mintz, S., Ingram, K.M., Milliken, A., Kuehl, T., and Espelage, D.L. (2020). Longitudinal Associations Between Sexual Victimization and Substance Misuse Among High School Youth in Colorado. J. Interpers. Violence, 1\u201324.","DOI":"10.1177\/0886260520959628"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1080\/15532739.2016.1258352","article-title":"Transgender and anxiety: A comparative study between transgender people and the general population","volume":"18","author":"Bouman","year":"2017","journal-title":"Int. J. Transgenderism"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1016\/j.jad.2018.02.051","article-title":"Levels of depression in transgender people and its predictors: Results of a large matched control study with transgender people accessing clinical services","volume":"235","author":"Witcomb","year":"2018","journal-title":"J. Affect. Disord"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1159\/000090429","article-title":"Severity profiles of substance-abusing patients in Italian community addiction facilities: Influence of psychiatric concurrent disorders","volume":"12","author":"Scioli","year":"2006","journal-title":"Eur. Addict. Res."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1016\/j.drugalcdep.2016.08.011","article-title":"Heavy episodic drinking among transgender persons: Disparities and predictors","volume":"167","author":"Scheim","year":"2016","journal-title":"Drug Alcohol Depend."},{"key":"ref_76","first-page":"35","article-title":"Social and Cultural Contexts of Alcohol Use: Influences in a Social-Ecological Framework","volume":"38","author":"Sudhinaraset","year":"2016","journal-title":"Alcohol Res."},{"key":"ref_77","unstructured":"Substance Abuse and Mental Health Services Administration (2020). Key Substance Use and Mental Health Indicators in the United States: Results from the 2019 National Survey on Drug Use and Health, Substance Abuse and Mental Health Services Administration. HHS Publication No. PEP20-07-01-001, NSDUH Series H-55."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1016\/j.jsat.2020.03.001","article-title":"Comparing intentions to reduce substance use and willingness to seek help among transgender and cisgender participants from the Global Drug Survey","volume":"112","author":"Connolly","year":"2020","journal-title":"J. Subst. Abuse Treat."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1080\/15332640.2016.1264338","article-title":"Transgressing gender norms in addiction treatment: Transgender rights to access within gender-segregated facilities","volume":"17","author":"Matsuzaka","year":"2018","journal-title":"J. Ethn. Subst. Abuse"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1300\/J463v03n02_05","article-title":"Substance use treatment experiences of transgender\/transsexual men and women","volume":"3","author":"Lombardi","year":"2007","journal-title":"J. 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