A trans character is occasionally referred to as someone's son or brother. Most of the misgendering is removed by current patches, but there are still a few moments.
The trans character also deadnames herself by saying "[Dead Name] is dead."
There are no alcoholic or drunk characters. However, the player can choose to drink as much as they want, leading to them stumbling around. One side quest forces you to do so if you want to complete the quest.
Zach uses medicinal marijuana in 2019. The 2005 plot revolves around the manufacture of a fictional drug. The red seeds are implied to have drug-like properties.
Sort of. The enemy monsters appear "real" while in the combat sections. However, if you stay outside past midnight, ghostly "red shadow" versions of these same monsters attack you. They don't resemble traditional ghosts, though.