Gay men, meth, and sex: what addiction professionals need to know

Meth use among gay men has returned with dramatic ferocity. The National HIV Behavioral Surveillance Study found its use in the New York gay community has more than doubled in three years, and similar findings are reported for Los Angeles and San Francisco. Across the country, gay men are seeking help for meth, and many Crystal Meth Anonymous meetings in urban areas are standing-room only.

Meth is utilized for sexual enhancement among gay men, many of whom underestimate its danger. In my book, Lust, Men, and Meth: A Gay Man’s Guide to Sex and Recovery, I combine 20 years of therapy sessions with meth-using clients with personal research to document this drug’s impact, providing professionals and users a pathway to both physical recovery and healthy sex with intimacy.

The meth epidemic is a perfect storm, combining an extremely potent drug with heightened sexual desire and high-risk sex, occurring in communities with high rates of HIV, hepatitis C, and other STIs.  Treating meth requires not only a substantial level of competence working with gay men, but also knowledge of specific characteristics of the drug that impact both the addictive and recovery processes.

The neurotoxicity of methamphetamine is a primary concern. Unlike cocaine, meth remains in place on the dopamine receptor for eight or nine hours, protracting intoxication and ultimately destroying the receptor itself. The brain can only slowly regenerate the dopamine transport system, a process that can take up to 18 months. During that time a client, although abstinent, may experience persistent anhedonia, depressed mood, hopelessness, and increased relapse risk. Well-known symptoms of Post-Acute Withdrawal Syndrome may be more prolonged and pronounced.

In addition to impacting emotions, triggers, and relapse risk, this slow cognitive repair has implications for other interventions, especially cognitive-behavioral Therapy (CBT). For a matter of months, many clients experience impaired cognition, reducing their ability to benefit from traditional CBT. Short attention span, poor concentration, and distractibility require therapeutic adaptation reflecting such diminished concentration.  This is also reflected in the Matrix Model, approved for amphetamines, which promotes shorter and more frequent groups.

Empathy and personal relatability among meth abusers also becomes impaired.  Many are unable to differentiate emotions related to various facial expressions. Most default to a perception of hostility, heightening the importance of a strong therapeutic alliance that is both non-judgmental and empowering. Many meth abusers have destroyed their social networks, and their counselor may be the only person in their life offering hope and support.

Just as it impairs cognitive functioning, methamphetamine also increases sensitivity to visual imagery. Consequently, triggers can be activated by a variety of visual images, including pornography, heightening relapse risk. At its extreme, this visual appeal manifests in online chatrooms where users simply watch others inject themselves. Because of such triggers, many users conclude that recovery will always remain elusive, so hopeful messages that recovery is attainable despite the difficult physical and emotional work are necessary.

Meth commandeers sexual desire and heightens the experience to a level that, once the drug is withdrawn, sexual desire disappears. Although welcome early in recovery, the eventual integration of healthy sex and intimacy requires consistent support and understanding from the counselor. For example, I encourage men not to attempt to recreate meth-sex without the meth, and to delete any online profiles and sexual hookup apps. Most gay men have not experienced sex and intimacy without the insulating effect of addictive substances, and some describe the intense emotions elicited by sober sex as a “second coming out.” In my book I fully describe this pathway to recovery as well as effective strategies for both the user and the healthcare professional.

Gay men are recovering from meth and reclaiming healthy sex and intimacy, but it is a complicated process that requires both skill and support from their counselor and a greater level of discussion in the community to reduce stigma and increase awareness.  

Dr. David Fawcett, a nationally recognized psychotherapist in mental health and drug treatment, is author of the book Lust, Men and Meth: A Gay Man’s Guide to Sex and Recovery (Healing Path Press). Learn more at www.david-fawcett.com