Addiction (substance abuse) treatment and community recovery centers provide essential services to trans and queer folks. These spaces provide treatment or resources (such as sober activities, safe injection sites, or job training) that encourage folks to limit substance use or to use substances in a safer way. Narcan training, fentanyl test strips, needle safety, sex education, mental health services, resource sharing… the boundaries start to blur when it comes to community-engaged work. Trans and queer folks are a stronghold of the recovery community, often the most ardent distributors of resources and aid.
Recovery spaces, on the other hand, are not exactly what I would describe as “safe spaces” for trans people. Even with SAMHSA (Substance Abuse and Mental Health Services Administration)’s DEI guidelines in place, attitudes are slow to change among staff and clients alike. I get the impression that my coworkers just don’t understand, and don’t really feel like asking. This is hard for me to parse because we are all here to help people. How can we even begin to help LGBTQ+ folks if we aren’t trying to understand and be in community with them? Although initiatives were being put into place to acknowledge the range of gender expression, the proper conversations are not being had with staff— how could they be?
Although there was some federal support for inclusivity, those have since been rolled back. Since February 2025, the SAMHSA workforce has been reduced by 10%, and the organization will be absorbed entirely into a new department: the Administration for a Healthy America (AHA). Despite pushback (including Cory Booker’s marathon speech), it appears that restructuring and budget cuts will only continue. In accordance with Trump’s policies, language surrounding diversity and support for LGBTQ+ people has also been scrubbed from grant documents and policy.
Another part of the problem is that this industry is tired. Months feel like years in this industry. Burnout and staff turnover are common, caseworkers are pretty much always overwhelmed, funding was scarce even when SAMHSA existed, and now… well, we must adapt to changes as they occur. It starts to feel like a Sisyphean task just to hold our programs together. Still, we must do the impossible, that is, we must try to hold onto all of our marbles. We must continue holding space and making it safe for trans people.
With Trump walking back federal recognition of trans personhood, there is less support than ever for trans people in recovery spaces. But come to think of it, the government has never thrown enough support behind recovery. The Opioid Crisis wasn’t real until rich, white kids started getting sick. Even then, substance use disorders are still heavily stigmatized. It isn’t fair. It isn’t fair that to get and provide life-saving services, we must endure dehumanizing and unsafe experiences. But the problem is, there is no one else to help.
I don’t think it has all gone to shit, yet. After all, the primary reason people enter Recovery Services is because they care. Our clients understand stigmatization– there is common ground here. Still, the only way forward for trans people is to continue to assert our personhood; we are all companions in suffering. And it is scary, dangerous sometimes, to do so. But I don’t really think I have another choice.