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Navigating Substance Abuse

Pandemic stress has sparked a worrying increase in alcohol and drug use.

To say the last couple of years have been a lot is an understatement. During times of stress, health behaviors are often negatively impacted. Eating nutritious meals, getting regular exercise, and maintaining good sleep habits can be particularly challenging in moments such as these. Disrupted patterns of behavior can also extend to changes in one’s relationship to alcohol or drugs, creating new problems or worsening old ones.

As one might expect, the COVID pandemic has had a big impact on alcohol and substance use. In one preliminary study, while 13 percent of participants reported drinking less during the pandemic, 60 percent reported an increase in drinking. Perhaps just as concerning, roughly one-third of participants reported binge drinking, which is defined as having 4 (for females) or 5 (for males) or more drinks in one sitting at least once over the past 30 days. While consuming that amount of alcohol might seem innocuous, binge drinking has been associated with an increased risk of driving while intoxicated, or the development of alcohol-use disorder and other psychiatric conditions.

Just as alcohol use has increased, the negative consequences of drug use have also skyrocketed. Most alarming is the substantial increase in accidental drug-overdose deaths last year, which reached an all-time high of more than 93,000 in 2020. While opioid-related overdose deaths represent a majority of these unfortunate cases, the impact of other substances like alcohol—or psychostimulants such as cocaine and methamphetamine—cannot be understated.

There are many reasons why the COVID pandemic led to an increase in alcohol and drug use. The restricted access to group-activity spaces left many people without easy ways to entertain themselves. Boredom represents a risk for some, since alcohol and drugs can serve as an easy distraction. 

For some, increased isolation and loneliness likely contributed to negative moods that individuals try to “medicate” with substances. Others may have experienced significant stress related to job loss, personal or familial illness, or relationship challenges. These factors all contribute to the increased use of substances as a means of coping.

LGBTQ individuals are particularly vulnerable to developing substance-use disorders. According to the Substance Abuse and Mental Health Services Administration, LGBTQ folks have higher rates of tobacco, alcohol, and drug use in comparison to their cis-het counterparts. 

There are a number of factors that contribute to this elevated risk. Homophobic cultural attitudes are often internalized by LGBTQ individuals, resulting in lower self-esteem. Also, in an effort to cope with being shamed regarding identity or health status, alcohol and drug use may be increased. Further, the use of substances among LGBTQ individuals can increase comfort with sexual activities that society has deemed “unnatural” or “sinful.” These psychological underpinnings can complicate LGBTQ people’s relationship with alcohol and drugs.

Not all factors are rooted in emotional or psychological distress, however. Increased alcohol and drug use is observed in many cultural groups where stigma, discrimination, and oppression are part of the fabric of everyday existence.

When evaluating whether or not alcohol or drug use has become problematic, these three questions are helpful:   

In the past year, have you consumed more than 4 drinks (for women) or 5 drinks (for men)? (Unfortunately, this question does not acknowledge transgender or nonbinary identities, and is based on the National Institute on Drug Abuse (NIDA) Quick Screen.)

Have I made certain rules for myself about alcohol or drug use such as only drinking on weekends, but find that I have difficulty following them?

Has my alcohol or drug use resulted in relationship problems, impacted my ability to work, or contributed to health challenges?

If you answered yes to any of these questions, this may suggest issues to explore more fully with a healthcare provider.

If the holidays are particularly challenging, start by establishing reasonable goals. What changes do you want to make regarding your alcohol or drug use? Are there people or support strategies you can turn to that will increase your chances of success?

If you’re interested in becoming abstinent, consider attending a mutual-help group like Alcoholics Anonymous (AA). Not only are there LGBTQ-focused in-person AA meetings in Houston, but you can also attend virtual meetings from the comfort of your own home that offer LGBTQ people a safe space. In addition to providing guidance about how to stay sober, programs like AA offer communities of people who are all trying to establish or maintain sobriety. And during the holidays, there are also alcohol-free activities that serve as an alternative to bars and house parties that serve alcohol. 

If you’ve already tried a 12-Step recovery program and it wasn’t a good fit for you, there are other programs that can provide support. For example, Self-Management and Recovery Training, or SMART Recovery, takes the approach that you can change your relationship to alcohol or drugs by figuring out your specific triggers and managing the thoughts, feelings, and behaviors that contribute to substance use. Alternatively, Refuge Recovery operates from a Buddhist perspective and features meditation as a cornerstone practice to reduce use. Again, online and in-person meetings are offered.

Ultimately, because there is no one-size-fits-all approach to finding the right self-help program, it’s important to approach the challenge with curiosity and an open mind. Also, planning sober activities with friends—particularly those who do not drink or use substances—can help provide structure and promote healthy behaviors. If additional assistance is needed, consider scheduling an appointment with a physician or mental-health clinician to further explore the many treatment options. 

This article appears in the December 2021 edition of OutSmart magazine.

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Daryl Shorter, MD

Daryl Shorter, MD, is a Diplomate of the American Board of Psychiatry and Neurology and is board certified in both general and addiction psychiatry. His clinical practice focuses on the use of psychotherapy and medications to treat mental health and substance use disorders. Dr. Shorter serves as the psychiatrist of record at The Montrose Center and lectures widely on LGBTQ mental health and wellness. Dr. Shorter can be reached at
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