Thursday, June 26, 2008
Everyday A Challenge
By: CHRISTOPHER MURRAY
So what happened with gay men and meth? A couple of years ago everyone was in a panic. Eighth Avenue was crowded with bus stop posters decrying the scourge that was crystal methamphetamine, it seemed like everyone knew someone who had just lost their job or soul to Tina, brunch pals were dropping like flies. Health officials and community activists made the direst possible predictions about the perfect storm of meth and HIV, not to mention flesh-eating, drug-resistant bacterial infections. Yikes!
Well, the truth is that meth, like crack cocaine, is still around and still wreaking havoc in the lives of gay men and others; it's just gone underground. The public panic has waned, as it always does - a point this newspaper's Duncan Osborne has taken pains to point out - and all the hoopla has subsided into the daily grind of users using and former users struggling to stay clean.
The effort to silence the seductive siren's call of crystal meth has proven in many cases to be a tremendously difficult battle that still takes enormous effort even years after a user has admitted he has a problem and taken substantial steps to address it.
Just ask anyone in the still crowded rooms of the 12-step group Crystal Meth Anonymous (http://www.nycma.org), which has more than 30 meetings a week in Manhattan. Those guys know the different cycles of relapse, because they hear about it every day.
There are people like Davis (all the names in this article have been changed) in early recovery but still struggling to go for even a week without binging. "It's like I'm trying to climb up the slope of a mountain and just can't get traction. I keep sliding back. If I have money, I'll buy drugs. If I feel down, I'll go online to try to hook up with someone who's using. I just can't get over the hump."
Achieving abstinence can be particularly difficult with meth because the way it operates on the brain may actually interfere with a person's ability to withstand triggers to use. Cocaine is known to flush the brain with more than 500 percent the normal level of the feel-good neurotransmitter dopamine, whereas meth can stimulate the release of more than 1,500 percent. But when the party's finally over, a user is running only on fumes to support his emotional stability as the brain slowly attempts to recover.
For many people, getting sober requires an all-out effort, not infrequently an inpatient detox program with specific experience in treating meth addicts like the ones at Manhattan's Addiction Institute (http://www.addictioninstituteny.org), at the Pride Institute (http://www.pride-institute.com), a long-time presence in Minnesota that now operates in New Jersey as well. But go-away rehab programs are costly and often not covered by stingy managed care companies. Luckily, there are other options, like the LGBT Community Center's new outpatient recovery program (http://gaycenter.org/health/recovery) that operates on a sliding scale based on people's ability to pay and accepts Medicaid.
But all too often, even when someone has been able to cobble together a few months of clean time, and has a whole host of new perspectives on what made them vulnerable to getting hooked on meth, and has even re-crafted their world from a shady network of users into a supportive sober community, relapse is more often the norm than an exception.
"I was six months off meth," said Charlie, "I was going to CMA meetings every day. But I was lonely I hadn't learned how to have sex and be intimate with another guy without meth. Slowly I started back sniffing around online, then jerking off thinking about crystal sex. An old fuck buddy from like more than a year ago texted me one day I called in sick to work and was back in the saddle with meth."
For Charlie, his relapse was luckily just a slip and within a couple days, he was back at CMA and slowly counting each clean day again. But for some guys, getting back to sobriety can take months. "I was so ashamed of myself," said Gordon who relapsed last year after being two-and-a-half years off meth. "I was supposed to be a pillar of sobriety, advising people who just got clean. I was supposed to have it figured out. When I broke up with my boyfriend, I got so depressed, and then when I relapsed, I just couldn't face telling people it had happened. And so it kept happening. It was really a nightmare."
While Gordon has stopped again, the sense of fragility - that the specter of meth addition might raise its head at any time - plagues him daily. "It's never over with crystal," he said. "As long as it's out there somewhere, I need to be constantly vigilant."
While the intensity of the drug and its effect on the brain explains some of the frequency of relapse, it's likely that there are other contributory factors. Internalized homophobia may find expression in the power of the drug to silence all the self-lacerating chatter that goes on in the minds of gay men as they attempt to find love and connection in a world still freaked out by HIV and where standards for physical beauty and success can often seem unattainably high.
Crystal's sneaky specialty is that it puts gay men in a precious mental zone where they can be with themselves, with their own bodies and with other men and their bodies, without the often covert self-sabotaging thoughts that tell them they are too fat, too stupid, too something to be loved. The problem, of course, is the awful price that meth exacts for the few hours of unalloyed pleasure.
If relapse is regularly a part of the recovery process with meth, the challenge is learning how to quit through slips - not let them deter you but rather teach you, helping you to get back up on the horse. Relapse is dangerous, certainly, but the hope is that the skills that someone learns in getting clean once can be applied when they are needed again - skills like reaching out to others, making sure there are plenty of resources to help and not the bare minimum, and uncovering the shadowy influence of internalized homophobia.
Gay men are nothing if not resilient. In the ongoing battle against addiction to crystal meth, meeting the challenge of relapse means being fully who we are and not allowing a drug to turn us into mere shells of ourselves.
Christopher Murray, LCSW, is a therapist in private practice in Chelsea who can be reached at http://www.christophermurray.org.