Addiction treatment for transgender people

(left) and Zerandrian Morris in a lounge at the eight-bed Morris Home, in the Southwest section of the city. Putting together a staff that clients could trust took 10 months. CHARLES FOX / Staff Photographer
(left) and Zerandrian Morris in a lounge at the eight-bed Morris Home, in the Southwest section of the city. Putting together a staff that clients could trust took 10 months. CHARLES FOX / Staff Photographer (Employees Deborah Lytle)

A one-of-a-kind treatment center where transgender people can free themselves of addictions is about to open in Philadelphia.

Posted: March 26, 2012

Determined to overcome a cocaine addiction that had propelled him into a downward spiral of unemployment, sex work, and life one step off the street, Erik Leiff contacted dozens of treatment programs.

In person, when he explained who he was - a trans man, having medically transitioned from his birth gender to the only one he could live with - office workers giggled and pointed: "It's like, 'Look at the freak.' "

On the phone, all said he would be housed with women. "If you saw me, that would have been ridiculous. I look nothing like a woman," he said. "The women in a program would have been just as uncomfortable as I would have been."

He eventually succeeded largely on his own. It was excruciating.

"I would have gotten clean a lot sooner if there had been a place where I could go and be understood and treated like a human being," he said.

Just that kind of place is expected to open in the coming weeks in Southwest Philadelphia. Morris Home, an eight-bed residential drug and alcohol treatment center specifically for transgender people, is believed to be the first of its kind in the nation. Leiff, 40 and clean since Jan. 15, 2005, is a peer specialist on staff.

Reaching out to a largely invisible trans population badly in need of services is one more way the city is making a mark with its innovative system of behavioral health care. Several years ago it began shifting to a grassroots recovery model that seeks to sustain progress by treating the whole person, not just the addiction, and recruiting entire communities for support.

About 100,000 people a year, most of them poor, receive addiction treatment and mental health services from the city, a small fraction of the number estimated to need them. In bits and pieces - like the push to establish Morris Home - the city is trying to fill some of the gaps.

Those eight adult beds at Morris Home will probably fill quickly. Trans people have high rates of depression, suicide, and catastrophic health problems, so it's no surprise they also have high rates of substance abuse.

People who identify themselves in ways that make no sense to most Americans - a girl who knows she is a girl despite her penis - describe lives of ridicule, rejection, and beatings, often from the moment they ask a question, typically during the wide-eyed innocence of childhood.

Babysitters abused Leiff so badly that he later needed jaw surgery.

"Transgender people are at much more risk for physical, emotional and sexual abuse for violating social norms," said Jeanna Eichenbaum, a trans woman and psychotherapist in San Francisco.

Transgender people are diagnosed with HIV at quadruple the national rate, according to a survey last year by the National Center for Transgender Equality and the National Gay and Lesbian Task Force. One in four black trans people had HIV, almost 40 times the national rate. More than 40 percent of trans people said they had attempted suicide.

Experts point to underlying reasons, found in the same survey: 50 percent had been harassed at work, and 26 percent had lost a job. Unemployment, homelessness, and lack of health insurance all run far above national rates.

"A lot of the folks we see who are unable to access care are living in an underground economy," said Sadé Ali, a deputy Philadelphia commissioner of behavioral health.

It was Ali who championed the new center, forming an advisory board with people from the trans community. She made several key decisions early on:

"One, it had to be named Morris Home," she said - a memorial to Nizah Morris, a transsexual entertainer whose 2002 murder, still unsolved, provoked outrage over the police response before she died. The name sends a message of acceptance to the community.

Second, Ali said, it had to include staff whom clients would trust. Finding them - 70 percent of the hires identify as trans - took 10 months.

A safe environment is critical to recovery. "I've had patients, because of the responses of other residents, who have left the programs that they've been in and relapsed," said Dan Karasic, a clinical professor of psychiatry at the University of California, San Francisco.

Ali's third requirement was that the center be "holistic," treating not just substance abuse but also "anxiety, trauma, PTSD, and other behavioral challenges that come from having to live in a community where you are marginalized on a daily basis."

It would include medical care - possibly hormone therapy to help with gender transitions - through an affiliated health center.

When Ali's staff researched models for an all-trans program, they found none. Indeed, when it comes to trans people, there is a dearth of reliable data of all kinds.

Estimates of Philadelphia's trans population run from 3,000 to 10,000. At the national level, a 2011 Institute of Medicine report was unable to even make a rough guess. Health and Human Services Secretary Kathleen Sebelius told a White House Conference on LGBT Health last month in Philadelphia that her agency expected to add questions relating to lesbian, gay, bisexual, and transgender people to surveys whose data are used in thousands of research studies.

Even most researchers don't understand the differences among transgender (gender identity that is opposite the biological sex), trans variant (does not identify as one gender or the other, or whose gender identity is fluid), and transsexual (has medical treatment to match gender and body).

Trans people can be gay, straight, or bisexual. Yet they are not always welcome in the LGB community, which defines itself by sexual orientation but where women remain women and men are men.

The city's original plan - to renovate an abandoned apartment building in the Ogontz section for an 18-bed treatment center and a separate facility for elderly people with mental health issues - sparked intense local opposition. So Resources for Human Development, a Philadelphia-based national nonprofit that will run Morris Home, switched to a smaller building it had long owned and once housed former state psychiatric patients.

The nondescript rowhouse on Woodland Avenue has eight private rooms, newly furnished, and comfortable common rooms. It will be staffed 24 hours a day.

The clientele may be unique - the handful of LGBT substance abuse programs around the country house trans people with others of their gender - but admission criteria, training, and methods of treatment must meet state regulations. Still, the treatment approaches will be unusually flexible and wide-ranging. And the gender identity of the staff is expected to change literally everything.

"We validate their trans experience," said Susan Collins, 60, a male-to-female transsexual and counselor who returned here from Portland, Ore., for the job. "We say, 'OK, this is who you are. Now, let's get to work.' "

Most patients are expected to come from shelters or the street, many without health insurance. Medicaid reimbursement will make up much of Morris Home's budget of nearly $800,000 a year. Start-up money had been set aside, sparing the center from severe cuts in Gov. Corbett's proposed Department of Public Welfare budget, at least for the first year.

Morris Home's staff of about 10 has been working for a few months, training and sprucing up the place, while the state Department of Health completes final reviews necessary to issue a license. They already call it their "dream job," in a place that means hope, both symbolic and real.

Said David Dan, a social worker who helped design the program: "It is an affirmation of the original vision of Philadelphia, which was welcoming people who aren't welcome in other places."

Contact Don Sapatkin at 215-854-2617 or

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