Discrimination, gender dysphoria, drinking to cope and alcohol harms in the UK trans and non-binary community

Background Trans and non-binary people may be at increased risk of alcohol harms, but little is known about motives for drinking in the United Kingdom trans and non-binary community. Aims This study explored the relationship between risk of alcohol dependence, experience of alcohol harms, drinking motives, gender dysphoria and discrimination within a United Kingdom sample of trans and non-binary people with a lifetime history of alcohol use.Methods A cross-sectional survey was co-produced with community stakeholders and administered to a purposive sample of trans and non-binary people from 1st February until 31st March 2022. A total of 462 respondents were included - 159 identified as non-binary and/or genderqueer, 135 solely as women, 63 solely as men, 15 as another gender identity and 90 people selected multiple identities.Results Higher levels of reported discrimination were associated with higher risk of dependence measured by AUDIT scores and more reported specific harms from drinking. Coping motives, enhancement motives, and drinking to manage gender dysphoria predicted AUDIT scores. The relationship between discrimination and risk of dependence was mediated by coping motives and drinking to manage gender dysphoria. Conclusions There is an urgent need to understand how to reduce discrimination against trans- and non-binary communities in order to reduce drinking to cope and alcohol harm. Interventions are needed which promote healthier strategies to cope with the myriad stressors unique to this population. Social and enhancement functions of alcohol could be replaced by alcohol free supportive social spaces.