gay men substance use San Francisco 94102

As a gay man, how can I change my substance use?

If you’re a gay man wanting to change your relationship with substances, there are many different resources available for you in San Francisco. There are programs based on moderation and others based on abstinence. It can be useful to first clarify what your unique goal is for changing your substance use.

What substances am I talking about?

While this post is about changing your substance use, you can use some of the same information for addressing out-of-control sexual behavior, over eating, compulsive shopping and a number of other behaviors that you’re having trouble keeping in check.  

What are your goals?

It’s important to be clear about what your goals are before you begin trying to change your behavior.  As with many things, it can be more useful to think about substance use on a spectrum. If we think about substance use on a spectrum from problematic substance use to abstinence, where are you now and where would you like to be?

Spectrum of Substance use for gay men.  Therapy for gay men in San Francisco

Which approach is best for me?  


Abstinence refers to eliminating the unwanted behavior completely.  With alcohol use, an abstinent approach would be cutting out all alcohol use completely.  This can be an important and life-saving approach for those heavy in addiction or dependent on certain substances. But maybe less ideal for people who would like to moderate their drinking.

12 step programs

12 step programs like Alcoholics Anonymous are abstinent based approaches to removing unwanted substances or behaviors from your life.  Typically, you find a sponsor, work the step and remove the substance from your life. These programs provide a great community atmosphere and you will not be alone in changing your relationship to substances.

12 step resources

Castro Country Club is a fantastic place to learn more about recovery in the queer community in San Francisco.  On their website you can find more information about meetings and other resources.

There are specific 12 step programs for different substances, like alcohol or methamphetamine.  There are also programs for overeating and sex addiction. You can find out more about those programs here.


Moderation is an approach that doesn’t require you to completely cut out a problematic substance or behavior.  If you were a problematic drinker and you wanted to reduce your alcohol intake without completely eliminating it from your life, this could be a good approach for you.  

Harm reduction

According to the Harm Reduction Coalition, Harm Reduction “is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug(and alcohol) use. Harm Reduction is also a movement for social justice built on a belief in, and respect for, the rights of people who use drugs(and alcohol).”

Harm Reduction focuses on mitigating harm that the use of drugs or alcohol can cause on a person’s life. Here’s an example using the Harm Reduction framework. If your goal was to avoid drinking and driving, you could take an Uber to a party where there will be alcohol served. That way you make it less likely that you will drink and drive.

Harm Reduction is a person-centered approach that can be catered to your individual needs and goals. There is not a requirement to abstain from using, although some people who practice Harm Reduction are abstinent. In the Harm Reduction movement there is a real push to examine the psychological causes of a person’s substance use and help them address those areas in the treatment.

Harm reduction resources

While you can work on Harm Reduction in individual therapy, there are also a number of other resources in San Francisco where you can find support.

The Center for Harm Reduction Therapy in San Francisco offers individual and group support as well as medication-assisted treatment.

The Stonewall Project located in the Castro District of San Francisco offers many different groups and options for individual therapy. Simply attend one of their walk-in individual or group sessions or call 415-487-3100 for more information.

For additional reading on Harm Reduction, I recommend the book Over the Influence: the Harm Reduction Guide to Managing Drug and Alcohol Use. This is guide written by some of the pioneers responsible for starting the Harm Reduction movement, including Patt Denning.

Not sure where to start

Perhaps all this talk about addiction doesn’t sit well with you.  The label addict doesn’t feel right, but you wonder if you’re drinking or partying too much. On one hand your life is pretty together. But you’re worried things may be going a bit too far.  Or maybe someone you respect has called you out on your substance use.

But gay culture centers around drinking and partying

It’s true. Much of gay culture is centered around drinking or partying.  Gay bars are the places many of us have found acceptance and community.  In a gay space you can let your hair down and find people to connect with. It can be hard to make new friends or find connections in other places.

What do you like about it?

Think about what you enjoy about your relationship with drugs or alcohol. Does it provide some relief? Connection? Excitement? Even if there are some negative parts about your relationship, there are probably some really good things, too.

How does it get in the way?

However, if you’re thinking about making a change in your behavior, there are probably some negative consequences that are causing you concern.  Have you blacked out recently? Are you worried that you have done something you regret?


Luckily, there is no one size fits all approach to exploring and possibly changing your relationship with drugs or alcohol. Some people decide they need to stop all together, but the vast majority can make choices that limit the harm or consequences while maintaining some of the fun.

It’s important to honestly look at what’s working and what isn’t. Become curious about the role that substances are playing in your life. You do have choices and you can find something that works better for you.

Tom Bruett

Tom Bruett

Tom Bruett, LMFT is a licensed psychotherapist with an office in San Francisco, CA. Tom feels passionately about helping people have better relationships. The purpose of this blog is not to provide advice or to take the place of working with a mental health professional. For more information please visit the homepage.