Substance Abuse Issues

Alcohol, Drugs, and Your Health

If you are living with HIV, drug and alcohol use can significantly affect your health and well-being, and complicate your HIV care and treatment. It can also put you at risk of transmitting the virus to others. Some people develop substance use disorders—the use of alcohol or drugs that is compulsive or dangerous (or both). Luckily, if you have a substance use disorder, treatment is available that can help you to recover and live a full and active life. Getting treatment for substance use disorders is an important part of staying healthy with HIV.

HIV and Substance Use: What’s the Connection?

HIV and substance use have been closely connected since the very beginning of the HIV epidemic. Injection drug use is one of the ways that HIV is spread and is responsible for approximately 10% of new HIV infections each year.


If you have HIV and you inject drugs and share drug preparation or equipment (“works”), you can transmit HIV to others who don’t have it.

Risky Behaviors

In addition, the use of alcohol and the non-medical use of drugs can significantly increase the likelihood that you will engage in risky behaviors, including having sex without a condom, or trading sex for drugs, money, food, or shelter. This can increase your risk of transmitting HIV to others, or for getting a sexually transmitted infection, which can be more extensive and harder to treat in people living with HIV.

Poor Health Outcomes

Substance use disorders are associated with poor health outcomes for people living with HIV and can speed up the progression of HIV disease. For example, the drug methamphetamine (meth) decreases your CD4 levels, allowing more of the virus to get into your cells.

Interfering with HIV Care and Treatment

Drugs and alcohol can also impede your memory and affect your ability to plan, make good decisions, and stick to a routine. That makes it harder for you to adhere to your antiretroviral therapy (ART). “Adherence” means taking the correct dose of your HIV medication on time, exactly as prescribed. Strict adherence to ART is essential for people living with HIV. Skipping a dose even occasionally gives HIV the opportunity to multiply. When you miss doses, it increases the likelihood that HIV will mutate and become resistant to ART.

People who experience substance use disorders also sometimes experience other issues, including unstable housing or homelessness, a loss of relationships and social support systems, a loss of employment, and involvement with the criminal justice system. If you are living with HIV, all of these things can affect your physical health by:

  • Making it harder for you to take all your HIV medicines on time;
  • Making it harder for you to keep your health appointments or take advantage of your support network;
  • Interfering with your healthy behaviors, such as getting enough sleep and exercise; and
  • Impairing your ability to cope with the stresses of daily life.

Substance Use and Other Health Conditions

People who misuse drugs and alcohol often have other health conditions.

Mental Health Issues

For example, some people experiencing a substance use disorder may also experience a mental health issue. This combination is often referred as a “co-occurring disorder.” This usually happens because:

  • Certain illegal drugs can cause people to experience one or more symptoms of a mental health disorder.
  • Mental disorders can sometimes lead to alcohol or drug use, as some people with a mental health condition may misuse these substances as a form of self-medication.
  • Mental and substance use disorders share some underlying causes, including changes in brain composition, genetic vulnerabilities, and early exposure to stress or trauma.

More than one in four adults living with serious mental health problems also has a substance use problem. Substance use problems occur more frequently with certain mental health problems, including depression, anxiety disorders, schizophrenia, and personality disorders.

Mental health issues are a concern for anyone, but they present special challenges for people living with HIV. Like substance use disorders, mental health issues affect your ability to cope and carry out typical functions in your life, making it hard for you to adhere to ART. They also interfere with your healthy behaviors, such as getting enough sleep and exercise and avoiding risk behaviors such as having unprotected sex. (Learn more about Mental Health and HIV.)

Hepatitis C

The majority of injection drug users who are living with HIV are co-infected with the hepatitis C virus (HCV), a leading cause of liver disease and cancer. Viral hepatitis progresses faster among people living with HIV, and HCV infection is a leading cause of non-AIDS-related death among individuals who are HIV-positive. (Learn more about hepatitis and HIV.)


In addition, tuberculosis (TB) exposure is common among people who use injection drugs. TB infection and HIV infection can work together to make you very sick. Worldwide, TB is the leading cause of death among people living with HIV.  Because of the serious health risks for co-infection with TB and HIV, the CDC recommends that all HIV-positive people should be tested for TB. Those who test positive for TB should begin treatment immediately. (Learn more about tuberculosis and HIV.)

How Do I Know if Something is Wrong and How Can I Find Help?

Millions of Americans experience substance use disorders. They are serious and complex health conditions that can affect anyone. Yet, substance use disorders are preventable and treatable diseases, which people recover from to live healthy and productive lives in their communities.

If you are concerned that you or someone you love might have a substance use disorder, there are several symptoms that you can look for.  These include changes in behavior, changes in physical appearance, and changes in social relationships. For a complete list of symptoms, see Mental Health and Substance Use Disorders: What To Look For.

Get Help

If you or someone you love shows these symptoms or you otherwise feel that something might be different or “wrong,” it’s important to tell your doctor or other healthcare provider—such as your nurse, case manager, or social worker—so that he or she can help you and, if indicated, connect you to other services or resources.

There are many other resources to help you. To find a substance abuse treatment facility that offers special programs or groups for people living with HIV/AIDS, use the HIV/AIDS Testing and Care Services Locator or enter your location here:

Find HIV Testing Sites & Care Services


You also can call 1-800-662-HELP (4357). This is a confidential, free, 24-hour-a-day, 365-day-a-year, information service, in English and Spanish, for individuals and family members facing drug and alcohol and mental health issues. This service provides referrals to local treatment facilities, support groups, and community-based organizations. Callers can also order free publications and other information in print on drug and alcohol and mental health issues.

The Importance of Treatment for Drug and Alcohol Use

Treatment for substance use disorders is effective and readily available. The main goal for substance use treatment is for individuals to stop using and start their journey toward recovery. People can recover and can lead full and active lives in their communities and workplaces, and with their families and friends. One continual challenge, however, is helping people to stay in treatment long enough for them to achieve this goal. 

If you are living with HIV, getting treatment for a substance use disorder can help you improve your adherence to ART, stick to other parts of your care plan, and support you in making healthy choices that will reduce your risk of transmitting HIV to others.

In order to be successful, drug and alcohol treatment must be tailored to your individual needs. Outcomes will depend on the severity of your drug or alcohol problem, if you have previous experience with treatment and what that experience was, the type of treatment you receive, and other factors.

If the treatment you receive for a substance use disorder includes medication, and you are also taking medication to treat your HIV, it’s very important to tell your health care providers and treatment providers. This is because there may be a risk of drug interactions that can decrease the effectiveness of either or both treatments. You will need to work very closely with your providers to find a plan that works for you. There are many professionals in both fields who have experience working with people receiving treatment for both conditions.

The main thing to remember is that treatment for substance use disorders is available and you can begin recovery to lead an active life in your family, community, and workplace.

Frequently Asked Questions

What if I only use drugs on the weekend? Is it really that bad?

Recreational or occasional drug use can be just as dangerous as an addictive pattern of behavior. The use of stimulants such as cocaine or depressants such as alcohol can be associated with immune system damage, reduced HIV treatment adherence, infection, organ damage, and overdose. Some of these effects can be seen even if a person only uses them on the weekends or when out “partying.” Sometimes this behavior is more dangerous because it leads to a greater loss of control, more risky behavior, increased vulnerability, and poor judgment. For more information, see the Department of Veterans Affairs’ HIV/AIDS: Drugs and Alcohol.

Last revised: 12/30/2016