Harm Reduction and Trans Liberation

Written By Aerin Riegelsberger

During grad school I was a clinical intern for The Stonewall Project, a SFAF substance use counseling program for queer men and trans folks. I began my master’s program at CSU East Bay thinking I would solely become a gender specialist. But as I got deeper into the substance use counseling field, I discovered the deep connection between harm reduction and trans liberation.

I saw people transform when they were finally treated with dignity instead of suspicion. When drug use stopped being the thing that disqualified someone from care, deeper conversations about safety, pleasure, trauma, and identity became possible.

What Is Harm Reduction?

Harm reduction is an approach that aims to decrease the unwanted consequences of drug use without necessarily reducing or ceasing the consumption of drugs. In practice, this can look like many things: helping someone plan safer ways to use substances at a party, building strategies to reduce overdose risk, exploring how substances are meeting emotional needs, or supporting someone who wants to change their relationship to drugs without demanding immediate abstinence.

Some principles of harm reduction include:

  • Drug use is not inherently problematic. It is not a moral failing. Drugs have been part of human civilization for millennia. Not everyone who uses drugs has a substance use disorder (SUD) or faces severe consequences from their use.

  • All individuals deserve dignity and respect, regardless of their substance use. Harm reduction upholds the right of individuals to make choices about their own bodies, and aims to empower them with information and resources.

  • People should be met where they’re at. Rather than requiring abstinence, harm reduction prioritizes the reduction of adverse effects (HIV transmission, overdose, etc) through achievable, practical steps that honor a person’s readiness and goals.

Why Harm Reduction Matters for Trans and Gender-Expansive Communities

Transgender, non-binary, and other gender-expansive folks face higher risks of problematic substance use due to systemic discrimination, limited access to healthcare, and resulting mental health distress. When people are denied affirming care, housing, safety, or belonging, substances can become tools for survival, connection, pleasure, or relief from pain.

Similar to how providing naloxone and safe injection sites reduce overdoses and HIV transmission, providing access to gender-affirming medical care dramatically reduces suicide risk and improves mental health outcomes. It’s all connected.

My Approach to Therapy

In my therapy practice, harm reduction means honoring the complexity of people’s relationships with substances, bodies, pleasure, and survival. Rather than focusing solely on stopping behaviors, we explore what those behaviors are doing for you—and how to build more safety, choice, and self-trust in your life. This is often part of a larger process of reclaiming autonomy, embodiment, and joy.

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Aerin Riegelsberger