Resist Being Judgmental in Working with Chemsex Patient

In treating the patient enmeshed in methamphetamine use and compulsive sexual behavior, clinicians must leave any feelings of shock, disgust or disapproval at the door, interventionist Brad Lamm said at the Cocaine, Meth & Stimulant Summit.

“You should go in with the spirit of not being judgmental,” said Lamm, founder of Breathe Life Healing Centers. Among his approaches in working with the “chemsex” patient, Lamm will give the individual space to tell his/her story privately, if family members are involved in an intervention scenario.

Lamm, who talked in his plenary session about his own struggle of nearly 20 years with methamphetamine addiction, said the two populations he now enjoys working with most are those with meth addiction and those with an eating disorder (despite the challenges in assessment and referral for both). He said individuals with a meth problem often will be amenable to intervention if they perceive the alternative to be others talking about them when they're not there, given their tendency to exhibit paranoia.

What he's less enthusiastic about in working with these patients are the limited viable options for detox services for persons with meth addiction. “Insurance doesn't cover a recognized detox protocol,” Lamm said.

Legislative language that would have moved California toward mandated insurance coverage for methamphetamine detox was scrapped from successful state legislation on patient brokering, he said.

Clinical hurdle

Lamm described as arguably the greatest challenge in working with the chemsex patient (often but not always a gay male) the establishment of a healthy “sexual recovery plan.” The dominant thinking for patients becomes, “How can they possibly self-regulate without the drug and the sex in their life?”, he said.

That is particularly challenging because both meth and sex are so readily available, at any time and any place. “It is present for all of us,” Lamm said—potentially minutes away.

A sexual recovery plan will involve components such as avoiding fantasy life and refraining from viewing the prevalent chemsex videos available over the Internet, Lamm said.

Recovery also can be complicated by the observations of others about the seriousness of the individual's problem. “Sometimes I hear, 'He does his best work on meth,'” Lamm said. The user may look haggard and have engaged in odd behaviors, but otherwise is seen to have met all of his goals at work. That essentially was part of Lamm's profile until he collapsed on live TV in the early 2000s when working as a broadcaster, he said.