Substance Abuse/ Misuse

San Francisco has a complex relationship with substance use. While the city is known for its progressive harm reduction policies, access to treatment programs, and strong recovery community, there is also a broad spectrum of perspectives on what constitutes substance use, misuse, and abuse.

For some, substance use is a harmful cycle they want to break. For others, it is a tool for personal exploration, therapy, or spiritual healing—particularly with substances like ketamine, psilocybin (mushrooms), or cannabis. The distinction between use, misuse, and addiction is not always clear-cut, and many people seek therapy to better understand their own relationship with substances.

If you are exploring substance use in your life—whether through harm reduction, abstinence, or therapeutic use—working with a therapist can help you navigate these questions in a judgment-free space. Our therapists in San Francisco recognize that substance use exists on a spectrum, and recovery looks different for everyone.

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Quick Navigation

• What Is Substance Abuse/Misuse?
• Substance Use in San Francisco
• Substance Abuse/Misuse vs. Addiction
• Substance Abuse/Misuse and Other Mental Health Conditions
• Reasons to Seek Therapy for Substance Abuse/Misuse
• Types of Therapy for Substance Abuse/Misuse
• Substance Use Through a Multicultural & Systems-Based Lens
• Next Steps

 

What Is Substance Abuse/ Misuse?

Substance abuse, also referred to as substance misuse, involves the harmful or hazardous use of psychoactive substances, including alcohol and illicit drugs. It encompasses a wide range of behaviors, from using substances in excessive amounts to using them in situations where they pose risks to physical or mental health.

Substance abuse is characterized by the inability to control or moderate substance use, leading to negative consequences in various aspects of life, such as relationships, work, and overall well-being. It can manifest as addiction, dependence, or harmful patterns of use that jeopardize an individual’s health and quality of life.

Common Signs of Substance Abuse/ Misuse

Common signs of substance abuse or misuse can vary depending on the type of substance involved and individual differences, but there are several general indicators to watch for. It’s important to note that the presence of one or more of these signs doesn’t necessarily mean someone has a substance use problem, but they may warrant closer attention and, if necessary, professional evaluation.

Here are common signs of substance abuse/misuse:

• Increased Tolerance: Needing more of the substance over time to achieve the desired effect or experiencing reduced effects when using the same amount.
• Withdrawal Symptoms: Experiencing physical or psychological withdrawal symptoms when not using the substance, leading to the need to use it to alleviate these symptoms.
• Failed Attempts to Quit: Repeatedly trying to cut down or quit using the substance but being unable to do so.
• Loss of Control: Using the substance in larger amounts or for longer periods than intended, or being unable to control or stop its use.
• Spending Significant Time: Spending a significant amount of time obtaining, using, or recovering from the effects of the substance.
• Neglecting Responsibilities: Neglecting or reducing participation in work, school, or social and recreational activities due to substance use.
• Continued Use Despite Problems: Using the substance despite it causing or exacerbating physical or psychological problems or causing social or interpersonal conflicts.
• Craving: Experiencing strong and persistent cravings or urges to use the substance.
• Social Isolation: Withdrawing from social activities, friends, and family to use the substance alone or with a specific group of users.
• Risk-Taking Behaviors: Engaging in risky behaviors while under the influence of the substance, such as driving under the influence or unprotected sex.
• Legal and Financial Issues: Experiencing legal problems (e.g., arrests for substance-related offenses) or financial difficulties related to substance use.
• Physical and Mental Health Problems: Developing physical health issues (e.g., liver problems, respiratory issues) or experiencing deteriorating mental health (e.g., anxiety, depression) linked to substance use.
• Changes in Appearance: Neglecting personal hygiene and experiencing physical changes such as weight loss or deterioration in overall appearance.
• Secretive Behavior: Engaging in secretive or deceptive behavior related to substance use, such as hiding or lying about use.
• Loss of Interest: Losing interest in previously enjoyed activities or hobbies.

Substance Use in San Francisco: Unique Challenges & Recovery Resources

San Francisco has a diverse and evolving landscape of substance use and recovery, offering both progressive treatment options and systemic challenges that impact individuals seeking help. The city’s approach to substance use is not one-size-fits-all—many people here have different perspectives on what constitutes use, misuse, and addiction.

Some individuals struggle with substance dependency and seek complete sobriety, while others use certain substances in therapeutic or intentional ways, such as ketamine, psilocybin (mushrooms), or cannabis. Navigating these choices in a way that aligns with your personal values, goals, and mental health can be complex, and therapy can help.

Access to Harm Reduction & Treatment Services

• San Francisco is a leader in harm reduction approaches, offering safe consumption sites, needle exchange programs, and medication-assisted treatment (MAT) for opioid use.
• Many people seeking help don’t resonate with traditional abstinence-only models and instead explore non-12-step recovery approaches and other alternatives.
• Therapy can help individuals understand their options, set personal goals, and create a recovery or harm-reduction plan that works for them.

The Intersection of Substance Use & Economic Pressure

• San Francisco has one of the highest costs of living in the country, and financial stress, job instability, and career pressure can contribute to substance use as a coping mechanism.
• In high-pressure industries like tech, finance, and healthcare, substance use is sometimes normalized as a way to manage burnout or social expectations.
• Therapy can help people in recovery develop stress-management skills, navigate workplace culture, and set boundaries around substance use in professional and social settings.

Intentional Use, Safe Use & Therapeutic Substances

• Some individuals in San Francisco use substances not for escapism, but as tools for healing, self-exploration, or therapy.
• Ketamine-assisted therapy, cannabis, and psychedelic experiences with psilocybin or MDMA are increasingly discussed in mental health treatment, trauma work, and personal growth.
• While some find these approaches helpful, others find them destabilizing—therapy can provide a space to process these experiences, integrate insights, and explore whether they align with long-term well-being.
• If you are considering therapeutic substance use, harm reduction strategies, or exploring your relationship with substances, a therapist can help you navigate these choices in an informed and intentional way.

Substance Abuse/ Misuse vs. Addiction

There is a difference between substance abuse and addiction, although the two terms are often used interchangeably. Here’s a distinction between the two:

Substance Abuse

Substance abuse refers to the harmful or hazardous use of psychoactive substances, including alcohol and drugs. It involves behaviors such as using substances excessively, in situations where it’s physically or mentally risky, or in a way that leads to negative consequences.

Substance abuse may or may not progress to addiction, and not everyone who abuses substances becomes addicted. For example, someone who occasionally binge-drinks and experiences adverse consequences like blackouts or trouble at work due to alcohol use would be considered as engaging in substance abuse.

Addiction (Substance Use Disorder)

Addiction, on the other hand, is a more severe and complex condition. It is a chronic brain disease characterized by compulsive drug seeking and use despite harmful consequences. Addiction involves changes in the brain’s reward, motivation, and memory systems, which can lead to intense cravings and a loss of control over drug use.

It often results in physical and psychological dependence, tolerance (needing more of the substance to achieve the same effect), and withdrawal symptoms when drug use is reduced or stopped. Addiction can have a profound impact on an individual’s life and typically requires specialized treatment for recovery.

Substance Abuse/ Misuse and Other Mental Health Conditions

The relationship between substance abuse/misuse and other mental health conditions is complex and bidirectional, meaning that each can contribute to or exacerbate the other. Several key relationships exist:

Comorbidity

Substance abuse/misuse often co-occurs with other mental health conditions. This is known as comorbidity or dual diagnosis. Common co-occurring mental health disorders include depression, anxiety disorders, post-traumatic stress disorder (PTSD), bipolar disorder, and personality disorders.

Self-Medication

Some individuals with underlying mental health issues may turn to substances as a way to self-medicate and alleviate symptoms such as anxiety, depression, or trauma-related distress. Substance use can provide temporary relief, but it often worsens the underlying mental health condition in the long run.

Risk Factors

Substance abuse can be both a cause and a consequence of mental health problems. Individuals with a predisposition to mental health conditions may be more vulnerable to the effects of substance use, and engaging in substance abuse can increase the risk of developing mental health disorders.

Neurochemical Changes

Substance abuse can lead to neurochemical changes in the brain that affect mood, cognition, and behavior. These changes can contribute to or exacerbate mental health symptoms.

Impulsivity and Risky Behavior

Substance use can impair judgment and increase impulsivity, leading individuals to engage in risky behaviors that may negatively impact mental health.

Withdrawal and Cravings

The withdrawal symptoms and cravings associated with substance use can contribute to anxiety and depression, making it challenging for individuals to quit using substances.

Social and Interpersonal Effects

Substance misuse can strain relationships and lead to social isolation, which can exacerbate feelings of loneliness, depression, and anxiety.

Treatment Challenges

Co-occurring substance use and mental health disorders can complicate treatment. Addressing both issues simultaneously, often referred to as integrated treatment, is typically the most effective approach to achieve lasting recovery and mental health stability.

Reasons to Seek Therapy for Substance Abuse/Misuse

People may seek therapy for substance abuse or misuse, as well as for addiction, for various reasons related to their substance use patterns, mental health, and overall well-being. Some of the most common reasons people seek therapy for substance abuse/misuse include:

Prevention and Harm Reduction

Some individuals may seek therapy to address early signs of problematic substance use or to prevent substance misuse from escalating into addiction. Therapy in this context often focuses on harm reduction strategies, helping individuals develop healthier coping mechanisms and behaviors to minimize the risks associated with substance use.

Education and Awareness

Therapy for substance abuse/misuse may involve psychoeducation about the effects of substances and their impact on physical and mental health. It aims to increase awareness and empower individuals to make informed decisions about their substance use.

Behavioral Change

Individuals seeking help for substance abuse may want to modify their usage patterns or quit using substances altogether. Therapy provides strategies and support to help clients achieve their goals, such as setting limits, improving self-control, and reducing risky behaviors.

Stress and Coping

Therapy for substance misuse often addresses underlying stressors, emotional triggers, and coping mechanisms. Clients learn healthier ways to manage stress and emotional challenges, reducing the reliance on substances for relief.

Benefits of Therapy for Substance Abuse/ Misuse

• Professional Guidance: Access to trained therapists who specialize in addiction treatment and recovery.
• Understanding Triggers: Identification of underlying triggers and causes of substance abuse.
• Relapse Prevention: Development of strategies to prevent relapse and maintain sobriety.
• Improved Coping Skills: Learning healthy coping mechanisms to deal with stress, cravings, and triggers.
• Emotional Support: Receiving emotional support during challenging times in the recovery process.
• Accountability: Setting goals and being held accountable for progress toward recovery.
• Safe Environment: A confidential and non-judgmental space to share thoughts and feelings.
• Dual Diagnosis Treatment: Addressing co-occurring mental health issues alongside substance abuse.
• Healthy Relationships: Rebuilding and improving relationships damaged by substance use.
• Education: Learning about the effects of substances and their impact on physical and mental health.
• Community Resources: Access to resources and support groups for ongoing recovery.
• Self-Empowerment: Empowerment to take control of one’s life and make positive changes.
• Personal Growth: Opportunities for personal growth, self-discovery, and a more fulfilling life.
• Improved Mental Health: Addressing mental health symptoms and improving overall psychological well-being.
• Reduced Risk: Lowering the risk of legal issues, accidents, and health complications related to substance use.
• Increased Quality of Life: Working towards a healthier, happier, and more fulfilling life in recovery.

Types of Therapy for Substance Abuse/ Misuse

There are several effective types of therapy for substance abuse/misuse, and the choice of therapy often depends on the individual’s needs and preferences. Here are some of the best types of therapy for addressing substance abuse/misuse and why they can be effective:

Cognitive-Behavioral Therapy (CBT)

CBT helps individuals identify and change negative thought patterns and behaviors associated with substance use. It teaches coping skills, problem-solving, and relapse prevention techniques, making it one of the most widely used and researched therapies for addiction.

Motivational Interviewing (MI)

MI is a client-centered approach that focuses on enhancing an individual’s motivation to change. Therapists use empathetic listening and guiding questions to help clients explore their ambivalence about substance use and find intrinsic motivation for recovery.

Contingency Management (CM)

CM is a behavior-based therapy that reinforces positive behaviors related to abstinence. It often includes rewards or incentives for meeting treatment goals and abstaining from substance use.

Dialectical Behavior Therapy (DBT)

DBT combines cognitive-behavioral techniques with mindfulness practices. It helps individuals regulate their emotions, tolerate distress, and improve interpersonal skills, which can be particularly beneficial for those with co-occurring mental health issues.

12-Step Facilitation

Based on the principles of 12-step programs like Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), this therapy helps individuals understand and engage with the 12 steps, which emphasize surrender, self-examination, and support from a community of peers.

Trauma-Informed Therapy

For individuals with a history of trauma, trauma-informed therapy helps address the underlying trauma that may contribute to substance use. It focuses on safety, trust, and empowerment.

Holistic Therapy

Holistic approaches consider the mind, body, and spirit. Therapies such as mindfulness meditation, yoga, and acupuncture can complement traditional therapies, promoting overall well-being.

Family Therapy

Substance abuse often affects not only the individual but also their family. Family therapy involves working with the entire family unit to improve communication, address enabling behaviors, and promote recovery as a collective effort.

Medication-Assisted Treatment (MAT)

MAT combines counseling and therapy with medications (e.g., methadone, buprenorphine) to reduce cravings and withdrawal symptoms. It is particularly effective for opioid use disorders.

Substance Use Through a Multicultural & Systems-Based Lens

Substance use is not just a personal experience—it is shaped by cultural beliefs, generational trauma, systemic inequalities, and social expectations. Understanding substance use through a multicultural and systems-based lensallows us to see how different communities navigate substance use, addiction, and recovery in ways that reflect their histories and lived experiences.

Cultural Views on Substance Use, Recovery & Healing

• Some cultures deeply stigmatize substance use, viewing it as a moral failing or personal weakness rather than a mental health issue.
• In some families, substance use is normalized or dismissed—whether through social drinking, cannabis use, or avoidance of discussions about addiction.
• Certain communities have long-standing traditions of plant medicine, psychedelic use, and ritualistic healing, making the distinction between misuse and therapeutic use more complex.
• Therapy can help individuals explore these narratives and decide what aligns with their personal values and well-being.

The Intersection of Substance Use, Systemic Inequality & Legal Consequences

• Not all substance use is treated equally. BIPOC and lower-income individuals are often criminalized or pathologized for substance use, while wealthier individuals have greater access to harm reduction and medicalized psychedelic therapies.
• Historical and legal policies—such as the War on Drugs—have shaped which communities experience incarceration, medical intervention, or access to alternative treatments.
• Therapy can provide a space to unpack these systemic factors and explore personal recovery in a way that acknowledges these disparities.

The Role of Psychedelic & Alternative Therapies in Mental Health & Recovery

• With the rise of ketamine-assisted therapy, psilocybin research, and cannabis legalization, some individuals are exploring non-traditional paths to healing.
• While some find substances like MDMA, ketamine, and psilocybin beneficial for trauma work, anxiety, or addiction recovery, others may find them destabilizing.
• Certain cultures have long used psychoactive substances in sacred, community, or healing contexts, but Western medical frameworks often separate these substances from their original cultural significance.
• Therapy can help individuals process, integrate, or make informed decisions about whether alternative approaches align with their mental and emotional well-being.

Substance use and recovery look different for everyone. Therapy can provide a judgment-free space to explore personal, cultural, and systemic influences on substance use and develop an approach that honors your background, values, and goals.

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