#24: Crystal Meth (Part 1)
COMMUNITY VOICE: Ben Anonymous | HEALTHCARE EXPERTS: Jona Tanguay PA-C, MMSc, AAHIVS; Luis Illades (he/him) LMSW, CASAC | COMMUNITY REVIEWER: Anonymous | GUEST PRODUCER: Eric Kutscher, MD
SHOW NOTES
Is Meth Use an LGBTQ Health Topic?
Yes, notably in the Gay, Bi, and Queer cis male community as well as the trans community. A 2013 study found that up to a quarter of men who have sex with men in New York and LA had used meth at least once in their life. Another study found that in San Francisco that one in five trans women had used meth in the past year.
Internalized stigma, or the shame someone feels due to one or more of their identities, is something that is deeply wrapped up with meth use in the GBQ and trans community. In short, meth use can serve as a bridge to intimacy for someone’s whose identity-based shame limits emotional and/or sexual connections.
Some Acronyms, some labels, some thoughts on therapy!
Acronyms:
CMA: Crystal Meth Anonymous; a type of 12 step program
IOP: intensive outpatient program, often a three month, therapy-intensive program
AA: Alcoholics Anonymous; a type of 12 step program
Our guests self-labels as an addict, in the episode (transcript below) he explains why. But not everyone dose this and not everyone may find it empowering. Our community voice explained how the power of the label lay in its self-understanding and framework for his challenges with addiction.
While 12 step programs can be therapeutic, our guest therapist points out that they are not necessarily Therapy. This is because they have different frameworks for approaching someone’s goals. Everyone pointed out how they are all tools in someone’s arsenal to fight problematic substance use.
What is stimulant use disorder?
Its a DSM, or formal mental health diagnosis
In short, someone’s substance use has to cause them problems for it to be, well, problematic. One of our expert’s summarized this as loss of control, with physical dependence on the substance and also psychosocial (work, job, relationship) consequences.
The American Academy of Addiction Medicine has more information on the criteria for a formal diagnosis at this link
Chemsex. Chemex. Chemsex an internalized stigma, again
To quote our guest: “crystal meth can act as a shortcut to liberation or self-acceptance”.
All our guests noted how working through that is a huge party of therapy, whether that's in a 12 step program or one-on-one therapy.
What is Chemsex? It is the phenomenon of sexual encounters and a sexual subculture that forms around meth and sex. You may also hear this called “party with Tina” or “parTy” (with a capital T).
Problems at the Disco
Meth functions in our brain's reward pathways. It makes something rewarding SUPER rewarding. In part, that explains the intense cravings and physical dependence for meth use folks can get.
Meth allows for longer and often rougher sexual encounters. Meth can also dry out the rectal mucosa (the inner lining of inside someone’s butt). Based on both of those things, the risk of getting HIV during chemsex with meth is significantly elevated. (Sharing needles is also a way of getting HIV through blood.)
Crystal meth psychosis is when someone loses touch with reality, characterized by hallucinations or mania – which is intense energy.
Cognitive Distortions
Cognitive distortions are unproductive ways that our thinking patterns frame our experiences. These include making assumptions about how others think or feel, perceiving events in black-or-white ways, seeing small events as catastrophes
Why care? Identifying cognitive distortions and challenging them is the basis of cognitive behavioral therapy, one of the most evidence-supported types of psychotherapy.
Our expert guests walked us through a few:
Misperceiving one’s relationship to meth use as non-problematic after a period of it having been obviously problematic.
Recovery is not a long term process.
“I know better this time” and this mistaken understanding of control over meth use.
Stay tuned for part 2 and more show notes to come with that episode!
TRANSCRIPT
Ben Anonymous: I wish I would have been more able to ask for help. I wish I would have known earlier on what 12 step programs really are, I thought it was. For people who didn't want to think for themselves, who were like sheep, who weren't very smart. You know, You have to surrender to a higher power. What the hell is that? And that's not what it is. so, yeah, I wish I would have had a more open mind about what a 12 step program was. I wish I would have been more able to ask for help.
[QHP THEME MUSIC STARTS]
Gaby: Welcome to Queer Health Pod!
Sam: I'm Sam, I use he/him pronouns, and I am a primary care doctor in New York, and 2025 will be the year I remember to buy a Wigstock ticket and get it off my bucket list.
Gaby: I'm Gaby. I use she/her pronouns. I am also a primary care doctor in New York. My gay bucket list item, not for this year, I don't have time, is I want to go to one of those lesbian vacation trips where specifically Brandi Carlile performs and brings all of her cool lesbian friends.
Richard: That sounds amazing. And I'm Richard. I use he/him pronouns. And I'm the director of LGBTQ clinical services at Bellevue Hospital in New York City. And this will be the year that I hold a headstand in yoga.
Gaby: And upside down or not, you're listening to Queer Health Pod Season three, episode five: Methamphetamine use in Gay and Bisexual Men.
[QHP THEME MUSIC ENDS]
Sam: Because I'm not on social media, I do have to ask, is crystal meth taken as a drag name?
Richard: Oh gosh.
Gaby: So a quick, very quick, took me all of two seconds, Google search reveals that fans of RuPaul Season 12 already know this. Crystal Method is a drag name and it is taken.
Richard: Thank you, lesbian who techs.
Sam: Meth use is a topic that, like RuPaul's Drag Race, can last for many seasons in many forms. Which is to say that this is part one of a two part series on methamphetamine use in gay and bi cisgender men.
Richard: I feel like talking about meth is so important, though, because I feel like in some ways it's one of the last taboos to be discussed in the gay community.
Gaby: What else is on that list of taboos?
Sam: Steroid use, and more importantly: Taylor Swift is bisexual theories, my sixth grade haircut, and Shawn Mendes.
Richard: That –
Gaby: Wait a second, Taylor, Taylor is bi, it's GAYLOR. Okay, we can come back to this.
Sam: Oh, sorry, I'm not a lesbian who techs, famously, so…
Richard: Well, steroid use we've already done an episode on, and those other three not sorry to say, may not warrant an episode.
Gaby: Mm. Uh, you are so wrong. Season 8, I see us doing an episode on Shawn Mendes. You should look out for that.
Sam: But before the two part episode on our sweet, sweet Sean Mendes, let's focus on this one.
Richard: Today's meth episode is going to focus on the basics of methamphetamine use and the way that internalized stigma and queer identity play a role in driving meth use at times.
Sam: We'll also talk about when meth use rises to the level of medical substance use disorder and the various shades of use and consequences that folks can experience.
Gaby: And we'll finish this episode talking about what we call cognitive distortions, or these ways of thinking that may prevent people who want to change their relationship with meth from doing that.
Richard: Though this is Queer Health Pod, this episode could definitely have a broader audience, because meth use is definitely not limited to queer communities. However, studies that have looked at rates of use in queer communities note way higher rates of use than our straight or cisgender peers.
Sam: If you had polled me before I read this statistic, I probably would have said maybe three, maybe up to 5 percent of folks in their life had used meth in the gay and bi community. But a 2013 study found that up to a quarter of men who have sex with men in New York and LA had used meth at least once in their life. And another study found that in San Francisco, which is famously not New York, one in five trans women had used meth in the past year. These numbers highlight that in queer communities, meth often centers in Urban spaces. Meth also impacts communities of color at higher rates, which we won't highlight in this episode, but we did want to mention.
Gaby: For more about drug use – doesn't that sound fun?– and why it's more common among stigmatized communities and those with internalized stigma, you should check out our episode in season two. It's called Club Drugs. And if you don't hear something about meth that you wanted to hear discussed in this episode. Please remember this is part one of a two part episode series, and it's likely that what you are thinking about will probably get covered in that second episode.
Richard: Absolutely. Episode two will be more focused on things like harm reduction, prescribed drugs that support recovery, and then my favorite, therapy, therapy, therapy.
Sam: Is it like Beetlejuice where a therapist will just show up and help?
Gaby: Nope. But with the power of editing software, I can summon back our community voice, Ben, for this episode.
Ben Anonymous: So my name is Ben. My pronouns are he, him. And I am a member of the Fellowship of Crystal Meth Anonymous. I'm also a member of Alcoholics Anonymous and Narcotics Anonymous and lots of other anonymous is, the only requirement for membership in those programs is a desire to stop drinking or desire to stop using. And that's me.
Sam: FYI, Ben is a pseudonym that our guests chose to remain anonymous. We asked him about why he chose not to use his real name so folks could have some context.
Ben Anonymous: I think people have a lot of misconceptions about that. The sort of obvious reason is that you want the rooms of recovery to be a safe place. And if I go in there and I see my neighbor, they're not going to go tell my boyfriend if my boyfriend doesn't know. So that's the obvious element of it. But it's something deeper too. It's something about being humble. And it's something about that we're all the same. We're just one addict helping another. We don't have status. And so I'm not here as a spokesperson for Crystal Meth Anonymous. I'm not the face of Crystal Meth Anonymous. I'm not going to be the face of CMA here. I'm just here as an individual person who's a member of the fellowship. So I don't know if that makes sense. Sometimes people say it's about shame. It's not about shame. It's about ego deflation. It's not about shame. I'm not ashamed to be a member of this fellowship. I'm not ashamed to be an addict. That's who I am. And it's – it's gotten me to where I'm at, which is a pretty good place.
Gaby: We're going to hear more from Ben about his experience in CMA and the role it played in his recovery. But before that, we wanted to introduce our first guest who talked about the difference between CMA, which is a 12 step based program and capital T therapy, as we'll call it.
Richard: Ooh, therapist, therapist, therapist.
Sam: Good try, Richard.
Luis Illades: My name is Luis Illades. My pronouns are he/him and his. I am a social worker, psychotherapist, and a CASAC, which is a substance use counselor. I've worked in various capacities with substance using populations. Including 12 Step work as an interventionist, working with families to get a loved one who's struggling with substance use into care definitely as a social worker and as a clinician. So for several years specifically, I worked with people struggling with methamphetamine use in the LGBTQIA community as part of an IOP, an outpatient at the LGBT center in the West Village.
Sam: Luis described how a 12 Step program is not necessarily capital T therapy. Although he was clear, it certainly can be therapeutic.
Luis Illades: 12 Step has a very specific modality, right? You are here because you're seeking to stop using and therefore we're going to do these 12 steps and we're going to build community around you and support you. And there is a social and spiritual component to the work. An IOP or a rehab is going to bring someone into groups, into individual sessions, and talk about history, outcomes, build objectives, and collaborate those as you go for a finite period of time, building an arsenal, so to speak
Gaby: So CMA is a 12 step program, like Alcoholics Anonymous or AA, that is designed for folks who want to get and stay sober with methamphetamines.
Richard: We also want to unpack another big term that Ben used earlier when he labeled himself an addict. We talked to him about claiming that dicey label and the role that labels play in his recovery.
Ben Anonymous: Being an addict is not a bad thing, it's not a shameful thing. How can you solve a problem if you don't admit you have one? Being an addict is, it's a part of who I am, just like being gay is a part of who I am, being HIV positive is a part of who I am. It is not a bad thing, if you don't want to say it, don't say it, you're not required to say it. But just for me, it's not a – it's not a bad thing! It's who I am. And if you're an addict. If you don't want to say it, that's okay. But if you're an addict, don't feel bad about it. It's keeping you from being who you are, your addiction, so deal with it and you can thrive. This program has made me strong enough that I can say I have problems and I want to fix them.
Richard: And I'm not talking about Sam's 6th grade hair when I say that this is a loaded topic.
Sam: Wow, you couldn't have made a Sean Mendes joke? Is this what I get for all the season one bald jokes?
Richard: Season one? They happen every episode, girl.
Sam: Sorry, I couldn't hear you over the glare on Zoom from your head. But, to be fair, we could get a lot more joke mileage from my middle school hair and musical theater career, but I digress and I do feel shame.
Gaby: All right, boys, the loaded topic is not read receipts from earlier this season, it's labels. First up, we wanted to let y'all know that the word addict is obviously very charged and we will not be using that language. Instead, we're gonna use terms like: person with a substance use disorder. But we also wanted to give Ben the space to define his own experience.
Richard: Yes, for Ben, the label of addict was critical to his recovery and the insight he gained in CMA, but obviously that may not be everyone's experience.
Gaby: You might be wondering, why doesn't everybody claim that term “addict”? Or, you may not, which is fair, but we'll explain anyway. So, one reason that Ben's claiming of the term “addict” may feel really divisive to people is because of how stigmatized substance use is.
Sam: And not just the stigma of drug use itself, but the claiming of an identity centered around drug use. An identity that can feel really based in psychiatric diagnoses and come with a lot of stigma, but at the same time some folks find power or control in claiming that identity.
Richard: Before getting back to Ben, we wanted to introduce one last big label, and that is the medical or psychiatric labeling of “substance use disorder”. We're going to introduce our other clinical expert and have them define substance use disorder or SUD as you'll hear them call it.
Jona Tanguay: So my name is Jona Tanguay. I use they/ them pronouns. I'm a clinical instructor at Yale School of Medicine but my main role is the leader of medical substance use disorder programs at Whitman Walker Health, which is a federally qualified health center in Washington, DC that specializes in working with the LGBTQ community,
Richard: Jona is the president elect of GLMA
Sam: Our season three media partner...
Richard: And is a medical advisor at Amida Care, an insurance company.
Gaby: Jona talked about the "textbook" diagnostic criteria for substance use disorder as per this thing called the DSM 5. The DSM is the Diagnostic and Statistical Manual, which is basically a psychiatrist's list of mental health diagnosis and their criteria for things like, yeah, substance use, but also like bipolar disorder. It's basically how we gather our diagnoses and sort of codify them. So, you can imagine that the DSM has a lot of criteria for each diagnosis in it, and we'll link to the formal criteria in the show notes, but Jona does a really good job of distilling these in terms of their broad strokes
Jona Tanguay: So, like: if you're boiling down the DSM 5 criteria, I would say it's like:
Loss of control
Tolerance and physical dependence on the substance, and then
Psychosocial consequences. People losing their job or housing, et cetera.
Those are the three main categories of what you're looking for if you don't have those 11 criteria right in front of you.
Richard: Just for context, the criteria are very similar across multiple substance use disorders, whether that's stimulants or methamphetamines, cocaine, opioids, alcohol, and so on.
Gaby: So let's drive this point home with an example. If you use cocaine on a Saturday and had a miserable hangover on Sunday, and now it's Monday and everything is back to normal…
Richard: No diagnosis.
Gaby: But: if you use cocaine, say, four days in a row, sold your wedding ring at a pawn shop to buy more drugs, lost your job because you showed up late because you overslept after an all night cocaine bender…
Sam: Like my sixth grade haircut, problematic.
Richard: There are definitely folks who fall in between these two examples, and so even someone whose drug use doesn't necessarily meet criteria for a “diagnosis,” per se, may have elements of their drug use that cause them severe problems. An element of meth use that has come up frequently in my clinical practice, though, is that it's really easy to think that your use is, like, casual, and not to notice when it goes from being, like, once a month, or every other month, to being, like, every other week and starts to be a thing that you look forward to and spend a lot of mental energy planning for and then escalates to weekly. My experience is that frequent use really sneaks up on people and they justify it until…
Sam: …until they get my sixth grade haircut.
Richard: Exactly.
Gaby: So, in short, when someone's relationship with a drug becomes problematic in a few of the 11 ways listed in the DSM, it will likely get a label of substance use disorder in a medical setting.
Richard: So like many things in the first 10 minutes of a QHP episode, the way things get labeled is nuanced, controversial, and often very specific to someone's unique experience.
[TRANSITION MUSIC]
Sam: At the top of the episode, we mentioned how this episode is about gay and bi cisgender men who use methamphetamines. We've heard from Ben about how he labels his meth use the way he does, but here he is talking about his identity as a gay man impacted his meth use.
Richard: Ben's story, as with anyone's, isn't like one definitive version. Some things to listen for are how the stress of his gay identity and experience was something that fed into his alcohol use and later his meth use.
Ben Anonymous: Sometimes people say, Oh, why are you an addict? Why are you an addict? And sometimes we say, I'm an addict because I'm an addict. I'm going to tell you stuff about my life and my pain and my discomfort and things like that. And, most people who have tragedy and discomfort in their lives don't use crystal meth. So I'm an addict but there is background that's important about who I am. You know, it’s like I grew up as a gay kid in a time when there weren't a lot of good role models. I'm so happy and grateful that. That exists now. They're beautiful stories about young people who come of age and get to have boyfriends and get to tell their parents and go to the prom and things like that and I didn't have that. And, so I was very isolated and very uncomfortable and very repressed. I really was shut down and scared. And when I was 15, I discovered alcohol. I went to – I was in a play at the local community college. I was, no joke, peasant number two. And I went to the cast party with adults so I drank this screwdriver and got drunk and was like – just felt so much relief. So I felt really comfortable in my own skin for the first time.
Gaby: That comfort in his skin for the first time is not a feeling to underestimate. The background buzz of stress, a feeling constantly vigilant because of being gay, was something that Ben felt really rid of with the release that alcohol provided.
Ben Anonymous: Here's Ben talking more about how the elements of his gay identity influenced his early alcohol use. Getting drunk was a way for me – you know, I was very, very introverted. I felt very I didn't feel like I was attractive, and the only time I felt when I, that I was attractive was when I was having sex with somebody. So I thought, “Oh this is the equation. If I have sex with enough good looking guys, I'll feel like I'm good looking.: And no…it like worked the opposite. I didn't ever feel good about myself. The only time I felt good about myself was when I was having sex with somebody who I thought was good looking. And I thought gee, I hope they don't realize it's me. So I think a lot of those insecurities either came from or certainly were heightened or exacerbated about being gay.
Sam: The idea that a stressful experience is specific to someone's gay identity, or extremely wrapped up in it, has a name, internalized stigma.
Gaby: And internalized stigma is something that Luis spends a lot of time unpacking with folks in therapy. Capital T Therapy.
Luis Illades: I think internalized stigma is a big thing to talk about, right? Because I think one of the things that crystal meth does is it has acted as a shortcut, right? It has acted as a shortcut to liberation or to self acceptance or to, as you say, disinhibitory experiences and sex, right? And so – if this has become automatic if our pathway to sexual liberation or self acceptance or even like body dysmorphia – has been tied up in our crystal meth use, it's going to be very difficult to do that work later on like why would I not pick up this crutch right or a muscle memory or like a coping skill or whatever we may refer to it as. And so part of the revelations that we see in recovery are allowing oneself to be vulnerable. And so when we're coming into recovery, right, a lot of these things are things that we're learning on our own outside of family systems, right, on our own. And that this – this thing that delivered us so easily, whether it be true or a false sense of self acceptance and liberation sexually and the ease of transactional relationships within the crystal meth world, right, all of a sudden, it's like stopping all of that. And sometimes for the first time in your 30s or 40s, right? And having to learn for the first time how to be vulnerable in an inertia that never dropped from a homophobic world that we grew up in, right? And so that still continued and fortified itself.
Richard: The internalized homophobia, feeling confident in yourself, and how that all gets wrapped up in drugs and lets down those barriers is something that Ben talks about with his experience with meth.
Sam: And for many gay and bi men, one of those big barriers is around sex, because sex can be such a huge source of shame.
Richard: We've touched on this a little bit, but Ben emphasizes how, for many folks, meth use is closely tied in with sex, and how often sexual situations are their introduction to the drug.
Ben Anonymous: The first time I used crystal meth was in a sex situation, like a group sex thing I walked into – it was actually on a houseboat of the 79th Street Boat Basin and in the dead of winter. And there's these three guys there. It's warm and they're hot. I think they probably said, “Do you want some Tina?”
Richard: Ben here is referring to meth as its common street name, Tina.
Ben Anonymous: I didn't know what it was, what they were offering me. And I thought, “Oh, gee, thank you. So nice of you.” And so I did crystal meth for the first time. And I met somebody there who I started using crystal meth with kind of regularly.
Richard: So here's a drug that lasts a long time, makes pleasure and reward hundreds of times more pleasurable and rewarding, and then combine that with intense and long held insecurities around your gay identity and shame around sex.
Sam: Therapy. Therapy. Therapy.
Richard: Not yet, Sam, not yet.
Sam: Fair enough. With this understanding of how certain drugs can bridge the divide between pleasurable affirming sex and shame and insecurity, we wanted to name this idea more clearly, chemsex.
Richard: Chemsex is the name commonly given to the phenomenon of sexual encounters and a sexual subculture that forms around meth and sex. These are also sometimes known as party and play, party with Tina, or if you're on the apps, party with a capital T.
Gaby: This is just stuck in my head. Tina is a seminal character in The L Word. Like, I need to understand the etymology. I keep thinking about Tina and Bette. Tina's very wholesome. This is something that I need to reconcile between the two corners of the LGBT community. Anyway.
Richard: Tina was the one that got cheated on. Bette cheated on her, right?
Gaby: Don't ruin The L Word for everybody. Richard, what are you doing? There could be baby gays listening to this. Or unedified cis gay men.
Richard: Yeah, but I'm a – I'm a 50 year old gay man who watched it when it was on live. So
Sam:He's earned a lesbian spoiler.
Gaby: that's what it's called,
Sam: Guys, Tina – Tina is a horcrux. You heard it here first.
Gaby: Oh my god. Don't invoke that franchise.
Sam: Different spoiler. Sorry. Fair. Fair, fair, fair. Okay, what we were saying about chemsex.
Gaby: Jona defined chemsex using Dean Street's definition, that's an LGBTQ focused London based clinic, and defined it as the use of a substance to enhance or enable the experience of sex.
Jona Tanguay: But meth is a way to do that. Where you can have marathon sex sessions, and so you're not just getting the pleasure of the drug, but you're also getting the pleasure of the obviously sexual stimulation, and of course the sex is much more intense and this is also, it gets wound up in other things too. People, especially with suffering from body dysmorphia, or perhaps who don't fit into what oftentimes, certainly there's racism within the LGBT community. Certainly there's like fat shaming and other kind of bodyphobias and a real obsession in some ways with a certain perfect form. And if you don't fit into that category, It can be where people finally feel powerful, finally feel affirmed. I always like to say feel like they're the main character in a rom com. That's a really important feeling for people. So it's not just the sex. Yes, it's making their sex better, and they're having marathon sex sessions. But again, it's also, like, how they're feeling community and connection and main character energy, as I like to call it. And so for some people, it's a way to feel like they finally have again, community and facilitate social interaction where maybe they aren't getting any social interaction that's affirming outside of that.
Ben Anonymous: There was this sex and drug configuration, the sort of subculture I was a part of, people who knew each other. And there's these sex parties where people are using drugs and having sex and sometimes, kinky subculture things that I was a part of. And that was meth. It was more of an event, certainly alcohol was not an event, that's socially acceptable and you just do it. Ecstasy if you're going to go out dancing, but, meth was part of a – a big thing. It wasn't just the substance.
Sam: Ben went on to make the point that outside of chemsex as an event in and of itself, more casual meth use is readily accessible in gay hookup culture. Look no farther than most hookup apps, where many users are quick to invite or exclude hookups based on specific drug use.
Gaby: We do love to take questions in our Instagram, but I'm gonna be honest, you all can DM Sam or Richard if you have questions about who's signaling what on the hookup apps, because if you ask me about Tina, I will refer you to The L word.
Richard: I promise this isn't the last you've heard of chem sex and meth from us, but we want to pause and recap here.
Sam: As Ben's story makes clear, using meth can help people jump the hurdles of internalized homophobia or shame around gay identity and shame around sex. Hurdles that are often so high, folks cannot navigate them or just don't have the support or community to navigate those hurdles on their own.
Gaby: This is why Luis points out how in recovery part of what's so difficult about giving up meth is how it's giving you a pathway to self acceptance and sex that bypasses those hurdles.
Richard: And to say it again, the labels of addict substance use disorder and quote problematic use are terms that are likely to come into play in different ways for different experiences
Sam: And with that, here's some music Sean Mendes didn't write for us.
[TRANSITION MUSIC]
Sam:With the core part of Ben's narrative under our belt, we wanted to dive more into his experience with the consequences of meth use. Ben told us about how when he first started with meth use, it wasn't something that felt like a quote, heavy drug to him.
Ben Anonymous: I was pretty naive about it. When I first started using crystal meth, it actually seemed mild in a way, like compared to smoking weed that, things would get all trippy or acid or something like that. Cause I'd done, a fair amount of drugs along the way. That it just seemed like just wake me up and made me feel kind of happy and horny. So for a while it seemed oddly mild to me.
Sam: That happy horny feeling is a byproduct of - biology.
Gaby: Meth works in two ways at the same time. It tells neurons or brain cells to dump dopamine or happy neurohormones into the pathways where it signals pleasure and reward. Meth also prevents the dopamine that is signaling from getting cleared so it keeps signaling, keeps the thing around that's making that good signal.
Sam: To spare you the neuron diagram, it opens the floodgates for cell signaling and reward and pleasure pathways. And for that reason, it's very easy to quickly and intensely rewire those pathways to start to crave meth. Here is Ben, who's referencing a friend he used meth with whose name is Mike, on how he felt this reward pathway craving another dopamine flood.
Ben Anonymous: The time that I felt just most at peace and most happy and most excited was when Mike called me and said, you want to come over and hang out. And I didn't think I was an addict. I didn't know I was an addict, but I had some sense that wasn't right. That was the time when I was happiest? I'd be with my family, I'd be with my friends, and I'd think this is nice. But really what I wanted to do is do drugs and have sex.
Richard: Ben went on to talk about how these cravings, his mood, and his sex life all started to mix together to result in his problematic meth use.
Ben Anonymous: I wasn't gonna do drugs, I was just gonna have sex with him. And we went – go to his dealers, I'm waiting outside, he's up talking to the dealer, getting the drugs, and I'm standing there thinking, “Am I gonna use or am I not gonna use? Am I gonna use or am I not gonna use?” And, if I use, ugh, I'm gonna feel so awful on Tuesday. it's going to be that horrible, bleak, hopeless pit of depression and just bleakness and no hope. But: I might have fun tonight! Might be fun! Might be fun! I'll feel bette! And if I don't use, I'm just going to feel like shitty for the whole rest of my life. So I got high. So yeah I tried a lot, do it by myself and I couldn't do it by myself. I needed help. Some people can. Some people are like, “Oh, I don't want to do this anymore. This is bad for me.” And they stopped doing it. But some of us can't do that.
Sam: The tension between maybe not wanting to use and the emotions that ultimately won out in that charged moment is something that we'll come back to later.
Gaby: We will definitely also come back to having sex without meth, which is such a hurdle for folks who are pursuing sobriety.
Sam: Which leads us to another common consequence of meth use that connects meth and sex, which is HIV.
Ben Anonymous: I did seroconvert to HIV. I'd been HIV negative for a long time and started using crystal meth and was HIV positive. So that was a pretty serious consequence.
Richard: The relationship between meth and HIV is very well studied and has two main drivers. The first is injection use and shared needles - a very efficient, for lack of a better word, way to pass the HIV virus from one person's body to the other.
Sam: Meth, because it is a stimulant, also allows for people to have very long periods of often rougher sex. Meth can also dry out the rectal lining, because of the drug's biological properties. So that dryness, with the potential for rougher and longer sessions of sex, can increase the risk of small rectal tissue tears, which in turn make the risk of blood transmission, and therefore HIV transmission, go up.
Richard: But despite experiencing these many negative consequences of his meth use, Ben still lived with a fair amount of denial about how much it was really impacting his life.
Ben Anonymous: When I first came into the program, I thought: “Was I in denial about stuff?” People would say denial and it didn't feel quite right. And then I realized, “Oh, I wasn't in denial. I was delusional.” I didn't think I had a problem. And when I think about things that happened one of my favorite people to use with overdosed. And I thought “Wow, he just didn't know how to use that GHB, did he? That's sad.”And, when I was with him, he gave me the drugs that I would use. I would be places where people got arrested, there was this underground sex club where they raided it and took everybody off to wherever they take people off to in their underwear and stuff like that. And I thought, “Oh man, that must've been embarrassing for them.” And the next week I went there (laughs) Like I, I used drugs once with somebody who was a sort of notorious front page scandal story murderer. I avoided some consequences. And, I didn't die, but things were worse than I thought.
Sam: I wonder what that guy's sixth grade haircut was.
Gaby: What happened to you in sixth grade? Like I just, I need to know.
Sam: So much.
Gaby:Besides this haircut.
Richard: I need to know what the haircut looked like.
Sam: The ninth grade haircut was really where things changed, but I'm missing the point.
Gaby: Okay, so, Ben mentions arrests. These tend to be common among folks who use meth. but are particularly common among brown and Black individuals who are often arrested for drug related crimes at higher rates despite having comparable substance use rates because of systemic racism.
Sam: Dr. Eric Kutscher, an addiction medicine physician who guest produced this episode, did point out how overall, the criminalization of drugs and drug use has caused far too many people to be caught up in the criminal legal system instead of connected to evidence based addiction medicine care, with a disproportionate impact on minority communities who are subject to over policing.
Richard: One last consequence of meth we want to mention is crystal meth psychosis, which is when someone loses touch with reality. This can be characterized by hallucinations or something called mania, which is a period of intense energy.
Sam: So we're not talking about intense lesbian crystal energy, we're talking about florid, in your face, psychotic behavior that starts during meth use. Think less Goop crystal, candle moment, Brandi Carlile concerts, and more Hulk flipping cars, people jumping onto the train tracks, like really intense scary stuff. And, before Gaby or Richard gets a shot at the Goop jokes, let's return to the reality that Ben's meth use continued despite the many consequences he experienced.
Ben Anonymous: Eight years before I got sober, I found a journal that I'd written, and it said: “I've replaced my sex friends with sex and drug friends.” Clearly a step down. I wanted to stop for a long time that I tried different things. I thought the big problem I had was the crash that came after, which is awful, which is horrifying, horrible, bleak. And so I would try different things. It's “Oh, I don't drink alcohol with it.” “Oh, if I take a wellbutrin afterwards.” “Oh, if I just use during the day and not at night. I'll not use crystal meth.” One summer, I was at Fire Island. I didn't use crystal meth. I just drank and did ecstasy and I went back to crystal meth because that's the drug I like. So I knew I was miserable. I, I knew I became positive when I was using crystal meth, which was devastating, but I don't know. I just kept going.
[TRANSITION MUSIC]
Sam: Throughout Ben's story, he has pointed out a tension between knowing that there are bad things happening to him because of meth use, but continuing to use meth.
Richard: This tension, and at times obvious conflict between what someone is thinking and what someone is doing, is often underpinned by cognitive distortions.
Gaby: Cognitive distortions are unproductive ways that our thinking patterns frame our experiences. These include making assumptions about how others think or feel, perceiving events in black or white ways, seeing small events as catastrophes…
Sam: Identifying cognitive distortions and challenging them is the basis of cognitive behavioral therapy, one of the most evidence supported types of psychotherapy. It's commonly used for anxiety and depression, and even sometimes insomnia. Our community reviewer also pointed out that while 12 step programs are not capital T therapy, they do challenge people's cognitive distortions and help them work through them as well.
Gaby: We asked Luis to walk us through a few cognitive distortions that he often encounters in therapy that often warp how folks view their relationship with meth and prevent them from meeting their goals with meth use.
Luis Illades: For like top of the hierarchy of cognitive distortions, it's like once the smoke has settled, right? And once like someone's feeling stabilized, the belief that they can use without the repercussions that they had that brought them in.
Richard: Sound familiar?
Luis Illades: Once we've arrived at a certain state of using, when we try to prove that wrong: “I know better now. I know what my limits are,” right? “I know what this really means because I have a distance from it.” But, the nature of addiction usually puts us back in the same state of relating to that substance, right? So a cognitive distortion, the top on the hierarchy would be, “I can use normally or I can dabble” or “this time I know better,” right? But part of this is the idea and, it's hard to meld between the 12 Step world in the clinical world, right? But like the idea of the 1st step in 12 Step programs, right? Which is that we have to somehow arrive at the idea that we are powerless over the substance, right? that we've tried using on the weekends. We've tried throwing it out. We've tried, just taking one hit. We've tried whatever.
Richard: Luis spoke about another cognitive distortion he commonly sees. He's going to use an acronym, IOP, to reference intensive outpatient programs.
Luis Illades: So another cognitive distortion is “I've got it from here,” right? “I did my 90 days at IOP and now I'm done.” Rather than like a life's work in addiction. They often say while you're engaging in recovery, your addiction is in like the corner doing pushups, just waiting for an opportunity to come back. And so the idea of these cognitive distortions are that like, if I can justify it enough, I can let the beast back in. And these things are sneaky and they're pervasive.
Gaby: And if someone is in that "i've got it from here stage and is abstaining from meth, this can also cause cognitive distortion around the use of other substances.
Luis Illades: Now, there are a lot of different beliefs on this in regard to like harm reduction too, right? That is it less harmful to eat a weed gummy than to go on a crystal meth binge? Of course, right? Of course it is. And that is a state of being, right? That is a state of recovery from crystal meth. But I think all the things that we're talking about are Again joining with community, overcoming vulnerability learning to inhabit one's body for the first time, and that far be it for me to name somebody else's goals for them, but I think that There is a reason why it seems important to abstain from substances, especially in the first six months or year of your recoveries, because we have to make contact with these things that we've been running away from, and it's going to be hard to when we're like half in the bag. But that's not for everyone, right? It is less harmful to eat weed gummies than to be shooting crystal meth.
Sam: Luis' point that making contact with community and overcoming vulnerability - two pillars of recovery - can be harder to do with any substance use is well taken. And so is the point that a weed gummy doesn't really set off the alarm bells the way that meth use does.
Gaby: We'll explore all of that more when we talk about harm reduction in our next episode.
Sam: Before we wrap up, we just wanted to walk through these cognitive distortions one more time.
The first one Luis mentioned was misperceiving one's relationship to meth use is not problematic, after a period of it having been obviously problematic.
Another distortion is that recovery is not a long term process.
And a final important cognitive distortion was the idea that "I know better this time.". And that this is a mistaken understanding of someone's control over meth use.
Richard: Oof, heavy stuff.
Gaby: Yes, we have heard a lot of Ben’s struggle. So let's end for right now on a positive note.
Ben Anonymous: You know, I, I by chance, really, by it was like a moment of grace, Got into the program. I was sitting at my desk at work. I was miserable at that time. I didn't think it was possible for me to be happy in life. I just didn't think it was possible. I didn't have hope. I didn't know what was wrong. Maybe you could be happy, but not me. A friend of mine called me up and said, you want to go to the gym this week? Do you want to work out? I said, yeah, sure. He said, what about tomorrow? And I said, I have therapy. Which was a very kind of sad place, because it wasn't really working at that point. Therapy's great, I'm an advocate of therapy, but it wasn't helping me with this problem at that point. And I said, what about tonight? And he said, I'm going to a Crystal Meth Anonymous meeting, and I said maybe I should come along. So I went, I saw hope there, I saw something new, and I stuck around, and I've been sober for over, over 20 years.
[QHP THEME MUSIC BEGINS]
Richard: QHP is a power sharing project that puts community stories in conversation with healthcare expertise to expand autonomy for sexual and gender minority folks.
Sam: As always, thank you to our community voice, Ben, for sharing his story. We would also like to thank our healthcare experts, Jona Tanguay and Luis Illades. We would also like to thank our community reviewer, who chose to remain anonymous, but whose insight is deeply appreciated. And lastly, we would like to thank Dr. Eric Kutscher, who helped us co produce this episode and gave us insight into the important topics we discussed.
Gaby: For more on this episode's topic, please check out our website www.queerhealthpod.com
Richard: And help others find this information by leaving a review and subscribing on Spotify or Apple.
Gaby: We are on social media, our handle everywhere is @QueerHealthPod, reach out to us.
Sam: Thank you to Lonnie Ginsberg, who composed our theme music, and to the Josiah Macy Jr. Foundation who supported some of the technology we used to produce these episodes.
Richard: Opinions in this podcast are our own and do not represent the opinions of any of our affiliated institutions. And even though we're doctors, don't use this podcast as medical advice. Instead, consult with your own healthcare provider.
[QHP THEME MUSIC ENDS]
Sam: I would say that my haircut, though, really did reach a crescendo in seventh grade, and then in eighth grade was more of a denial period, and then a camp counselor called my mom and got permission to just buzz cut my hair. And that was really, um, as you might say, a spring awakening, but at Jewish summer camp.