As the author of Lust, Men and Meth: A Gay Man’s Guide to Sex and Recovery, David Fawcett, Ph.D., L.C.S.W., has been speaking in cities across the United States, meeting many people affected by their own or other’s meth use. He is also a person with HIV, therapist and clinical hypnotherapist in private practice in Ft. Lauderdale, Florida, who serves as the mental health and HIV expert for TheBody.com’s “Ask the Experts” forum.
In Part 2 of our interview with Fawcett, we discussed how family members, hookup app users and other community members can counter the stigma that can exacerbate meth use, as well as possible next steps to harness the growing awareness of both meth use and stigma.(You can find part 1 of the interview here.)
Many friends, loved ones, care providers and community members are involved with people seeking to make changes in their meth use. What are common pitfalls that people may not even know they’re doing, in terms of using stigmatizing language or a stigmatizing framework? How can family members and allies be supportive and also take care of themselves – do what they need to do without compounding the stigma?
It’s a great question. It’s complicated.
One of the ways that people cope with addiction is to use a morbid humor about it and their behavior and some of the things they’ve done – almost joking about it – and having kind of a group identity based on those behaviors. One of the appeals of meth particularly is the taboo quality of it. It’s actually taking that stigmatized aspect and embracing it in an unhealthy way.
That can sustain a level of stigma, just because they’ve incorporated that into their identity somehow in ways that they’re not even conscious of; people can do it automatically. So pointing that out to them, pointing out the language, pointing out how to be conscious of words and correcting them and [encouraging them to be] in environments that are corrective is really important.
Often people continue to employ the defense of stigmatizing others as they’re coming through their healing process. So we’ll see a lot of stigma within the addiction community. As I mentioned [in Part 1 of the interview], alcohol users stigmatize meth. But even within the meth community, people who’ve smoked it look down on people that snorted, and people who’ve snorted look down on people who’ve injected: [There are] hierarchies of stigma that can persist if they’re not challenged or at least corrected. So just raising awareness of this is important.
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“Why I’ve Given Up on Hooking Up”

Sex has never been a particularly pleasant experience for me. It’s a fundamental part of being a gay man, of being a human being, but the “fun” part has always eluded me. Don’t get me wrong, I always enjoyed the bumping of proverbial uglies (I am a romantic at heart, after all) but the lead-up before and the fallout thereafter eclipsed that enjoyment. The hunt is exhausting. The encounter is fleeting. The loneliness seeps in. And then it begins anew. The cycle continues. Like all addictions, there’s a cycle.

For me, the process of hooking up has become an addiction. An addiction fueled by insecurity. The insecurity that comes with being a gay man. The insecurity that you’re not masculine enough when masculinity is demanded of you – absolutely demanded – as a matter of course from other gay men. “Masc musc” whimpers many a profile. Masculine. Muscular. Abs prominently on display. Face obscured or head completely decapitated. This is the faceless face of hooking up in the 21st century.

This emphasis on anonymity and masculinity further engenders internal homophobia in the gay male community. Never mind what sex between two (or more) men actually entails, we’re taught from a young age to embrace that which is manly and shun that which could be perceived as its antithesis. Femininity is weakness, is undesirable, is a boner-killer if there ever was one. From the ludicrously inflated pecs of Tom of Finland to the sculpted torsos on Grindr, gay men have always prized the hyper masculine, but this exaltation of all things manly forces those of us who don’t necessarily fit within those rigid gender constructs to make one of two choices: rebel or conform. I’ve tried both and I can say from experience – it takes a real man to be a queen.

I had my first flirtation with hookup culture back in high school – pre-Grindr, pre-Manhunt, maybe even pre-Craigslist – when XY (the now-defunct magazine for twinks and their admirers) had an online personals section. Then I was just coming into my own as a gay and I bought my occasional copy of XY with more than a little shame. I’d sneak onto my friend’s computer, excited to find others like me. It was all so new, but even then I remembered being confronted with the reality of the internet’s sway on people’s attitudes and mores: “no blacks, no Asians, no fats, no fems.”

The inherent racism of gay male hookup culture masquerading as a “preference” akin to height or hair color is an issue I’ve struggled with since then – and have grown weary discussing – but it’s incidental to my argument here. Being online and having a world of men at your fingertips with a wall of anonymity between you and them makes us all awful people. It reinforces unreal body expectations, encourages the enumeration of ideal qualities/deal breakers, and contributes to the further disconnectedness of my already disconnected generation. I’ve spent countless hours, whether alone or in the company of friends I rudely ignored, staring intently at my phone, slavishly yet listlessly flipping through the same profiles, wasting my time and poking holes in my self-esteem for what? Sex? Maybe. Love? Hardly. Validation? Probably.

All addictions have their respective highs. Guys telling me how sexy I was, or how cute I was, or what a great body I had made me feel good about myself. I worked out to be attractive to other men. Working out also made me feel good about myself, but that esteem was tied to the approval of others. I could stare in the mirror for hours on end – artfully posing to achieve that perfect profile pic – but if no one told me I was attractive, why would I have reason to believe it? My ego as inflated as the pecs of the bikers and sailors in Tom of Finland’s iconic drawings, I drowned in my own reflection. And I perpetuated the cycle of unreal expectations and ideals. Homosexuality is acknowledged narcissism and guys tend to seek out others like themselves. So I tried to be like the guys I wanted to attract. I can work out obsessively; I can take shirtless, faceless selfies of myself and plaster them across the internet; I can pretend to be masculine, but I can’t be something I’m not. I can’t be white, I can’t be the masculine ideal others want me to be, I can’t live my life by rigid standards to which I never subscribed.

It’s all a game and I tried to play by the rules. Not so at first. I tried to be myself, or rather, to represent myself as truthfully as I could. Even the truth requires the proper lighting and the omission of certain facts. My profiles – with the proliferation of hookup apps and websites like Adam4Adam and Manhunt, I had about six profiles running concurrently – featured my face along with the obligatory shirtless pics and a playful description of me. I got some attention, but not from the caliber of guys I felt I deserved. My looks, as validated by the very men I was rejecting, gave me license to be more selective. As I grew more selective, my profiles grew less playful. I erased my face. I added more shirtless pics and naked pics; I worked out harder; I left my descriptions blank so I would have nothing to blame for a guy not messaging me back, other than his own “preference.”

But it was never enough. Some guys can put aside their personal feelings with a studied yet cool sense of detachment; they can allegedly just have fun and not take this silly thing too seriously. But I’m not one of them. I take everything too seriously. I would wait with bated breath for a response from a guy and if it didn’t come I would wonder what was wrong with me. Was it something I said or didn’t say? Am I not muscular enough? Am I not masculine enough? Am I too black? Not black enough? Guys that I would strike up a casual conversation with immediately became potential boyfriends. We would either meet and have sex and I’d never see him again or we’d casually text until one or both of us lost interest. Some times, we’d meet and I’d face my rejection in-person. Were we to meet in another, less sexually-charged way, things would probably be different. Giving all the goods off the bat, however, takes the surprise and spontaneity out of meeting each other.

But these apps and sites have rendered me completely unable to interact with guys in any other way because they cater to my insecurity. My insecurity about talking to guys. My insecurity with coming off too effeminate or too needy. My insecurity of attracting someone without using my body. It’s one thing to be rejected based on a picture and a headline, but to be rejected based on something more substantial like personality is a soul-crusher. I broke myself down and I beat myself up and I compromised my values and what I believed in in order to satisfy my all-consuming sexual desire. I recognized that this desire was just a desire to be less lonely, which explains why I would often get attached to someone so quickly and so easily.

For instance, I chatted on the phone for an hour with one guy I met on Adam4Adam. After the fact, I sent him a few texts to which he didn’t respond right away. That prompted me to send him a long message on Adam, apologizing if I had scared him away. I’m not a phone person in general and an hour long conversation is otherwise unheard of with me, except on very rare occasions with very dear friends I probably haven’t seen or spoken to in a while. Meanwhile, the object of my misguided affection had no idea what I was talking about. He was busy and had meant to respond to my texts, but for me, a steady stream of second-guesses immediately came flooding into my head.

I hung out twice with another guy I met off the app Jack’d. The second time he slept over and we cuddled all night. The following morning was perfect. He was in my arms, the sun filtered in through my apartment windows, illuminating our naked, intertwined bodies. I recorded the moment in my head because I knew it would never last and that I would likely not experience it again any time soon. I didn’t hear from him for a while after that most perfect morning. I sent him a text to the end that I assumed he had lost interest. He replied that he was simply busy so I added – perhaps with the intent of pushing him away before I was inevitably hurt – that I was “kinda crazy” and that I “kinda liked” him. I never heard from him again.

Then yesterday, I had enough. A guy that went to my gym messaged me on Scruff, yet another app in my casual sex arsenal. We had seen each other in the gym before and had obviously checked each other out, but as is often the case, it was easier to talk through our mutual online profiles. No one likes being rejected and that additional buffer makes the rejection less painful. Or so it would seem. When I saw him in the gym again he completely ignored me. And that’s when I nearly burned my gym down to the goddamn ground. I got so mad. So enraged. But why? Why was I letting this get to me again? It wasn’t the first time this had happened. I had been on both sides of that equation. The ignored and the ignorer. But that was the last straw.

I had finally grown tired of putting myself through all these waves of doubt and insecurity over what some guy with a few pictures and a handful of sentences (if not just a headless torso with nothing else) may or may not think of me – if he thought of me at all. I want to have more respect for myself. To stop sending naked pics of myself to strangers in hopes that they’ll like me based not on who I am but what I look like and what I could potentially do to their eagerly awaiting assholes. To stop attributing my value to my body and its ability to attract. I want to have relationships away from my screen. So I quit.

I deleted all of my sex profiles.

Some addictions you have to quit cold turkey. That’s not to say I won’t be back. I’ve deleted my profiles before, only to come crawling back, promising myself that things would be different. But I fall into the same trap every time. The cycle of self-loathing and self-compromise. So I’m quitting, for now, indefinitely. I need to work on myself and my insecurities rather than hiding them or magnifying them in digital form, or trying to banish them all together through sex with the hottest men I could find. If they liked me, I could like myself. Oh, gurl. I’m not even into S&M but playing the casual NSA hookup game is the most masochistic thing I could have possibly done to myself.

Now it’s up to me to attempt to make real connections in the real world. Because through this process I realized the most important thing – that all those apps and sites aren’t real. I always attempted to see the headless torsos as real people, but they’re just the versions of the people they want to be. That’s why the connection online and in-person is often lost in translation: you can’t carry on a relationship – strings attached or not – with someone who doesn’t exist.

By David Fawcett, Ph.D., L.C.S.W.

She’s back. Tina, that is. Crystal, crank, meth, ice, amp – all slang for the same drug: methamphetamine. In the early part of the millennium, meth was pervasive both in rural America and in urban gay communities. Its use peaked around 2005 when, following a federal law limiting access to its primary precursor, pseudoephedrine, usage seemed to drop. In gay communities, men became aware of its hazards as they watched friends lose lovers, jobs, health, freedom and even their lives. Pursued by law enforcement, hardcore users went underground but never really went away. Now, because of the cycles of recreational drugs, a new generation, short memories, and the seductive power of this dopamine-releasing supermolecule, the drug appears to be making a comeback, at least in the gay community.

This trend hasn’t really emerged yet in epidemiological data, but I have recently begun to receive more and more calls from men struggling with meth. I hear the same from my colleagues with private practices here in south Florida, and from those treating gay men in Washington, New York and Los Angeles. Clinics serving the LGBT community report similar phenomena, and there is standing room only in Crystal Meth Anonymous meetings.

Methamphetamine has an unfortunate natural affiliation with HIV. It targets the pleasure center of the brain, releasing torrents of dopamine while at the same time fusing that pleasurable rush with sexual feelings. It “turns off” the ability of the frontal cortex to predict negative consequences and promote good judgment. It stokes erotic thoughts to the point that many users report an inability to satiate their sexual desire. Multiple partners, high-risk sex practices, medication non-adherence and a nearly universal disregard for precautions make meth and HIV a perfect storm. Add to this injection drug use (“slamming”) and a bad situation gets even worse.

Why are gay men particularly vulnerable? One aspect of methamphetamine’s high is the ability to neutralize longstanding negative feelings that express themselves as self-doubt, poor self-image, social anxiety, and a feeling of being disconnected from and bypassed by the larger community. Methamphetamine allows users to suddenly feel powerful and confident. They feel sexually attractive and fearless. For these reasons, I find that younger men who are finding their way into sexual self-acceptance are sometimes drawn to the drug.

But another group that seems to have higher risk, surprisingly, is gay men in middle age. In my experience, among those at highest risk are long-term survivors of HIV who, after years of living with the virus, often feel discouraged, powerless, marginalized, isolated and unattractive. Despite the obvious consequences, meth seems like an erotic balm that can overcome these feelings and allow them to suddenly experience a connection with others.

Of course, a weekend run with meth (usually in combination with other drugs) is ruinous in terms of medication adherence. I have had clients bravely set timers or, with all the best intentions, call on friends to remind them to take their antiretrovirals. These efforts are inevitably futile in the face of meth’s power to derail rational thinking.

High-risk sexual practices, multiple partners and a disregard for precautions are only part of the story of this drug. Meth is neurotoxic. Cocaine, another amphetamine, is derived from the coca plant and is therefore a natural molecule that blocks dopamine receptors but then washes away after a few minutes. The dopamine must be replenished but the receptors remain intact. Methamphetamine, on the other hand, is a man-made molecule – one the human brain was never meant to process – that sits on the receptor for hours. This accounts for meth’s much longer duration of action, but also results in the destruction of the receptor. The extensive time needed to rebuild the dopamine transporter system has grave implications for recovery.

When a user has made the decision to quit meth, he begins a long journey of recovery characterized by strong cravings and extreme depression. Dopamine is so depleted and the dopamine transporter system is so damaged that the brain must form new neural connections, that is, it must literally rewire. FMRI scans of meth users’ brains show no signs of dopamine after one month, little after five months, and only after 15-18 months do levels begin to return to something resembling normal. During that time, the recovering user will struggle with depression, unable to experience much pleasure or reward despite an intense daily struggle to resist the drug. To make matters worse, meth effectively hijacks sexual desire so that when the meth goes, erotic desire often disappears as well. I have clients who describe themselves as “sexual cripples” as they struggle to regain normal sexual functioning. Because of the resulting depression, anhedonia and sexual dysfunction, meth recovery is characterized with a tendency to relapse.

At first glance, meth use isn’t very obvious. Among gay men it’s largely distributed through social networks or connections made on sexual network sites. The experience here in south Florida, an international gay tourist destination, is typical. A newly arriving visitor can turn on his laptop or smartphone, sign in to a sexual networking site, and scan the profiles for “chem-friendly” or “PNP” (party and play). In minutes, both a hook-up and a drug connection can be arranged. Such easy connections can be made in every major city around the world where there are gay men and computers.

Involvement with meth results in a quick, downhill progression. I have met men who claim they can use it and walk away, but I know many more who would like to be able to do this but clearly cannot. Typically their use begins as a weekend of partying, but soon progresses to long weekends. Many begin to experience “suicide Tuesdays,” a recovery day when severe depression is experienced because of the disruption in dopamine and other neurotransmitters. Quickly, many begin to crave the drug, lose interest in other activities, and increase their use dramatically. Medication non-adherence, high-risk sexual activities, co-occurring sexually transmitted infections, letting go of responsibilities in life, sinus infections, dental concerns and weight loss are some symptoms that can indicate a problem.

As noted earlier, recovery is a long and difficult process. Dopamine is the neurotransmitter that effectively bonds various stimuli in the brain. The intoxicating feelings caused by meth become fused with sex and other activities, making relapse cues pervasive. Certain music, a ringtone, an instant message alert, the smell of poppers or even an attractive man walking down the street can set off intense cravings for the drug. Each of these must be “unlearned,” a process that is difficult and time-consuming.

Best practices for the treatment of methamphetamine addiction take into account the functional brain injury that has occurred with extensive meth use. In early recovery, people are not thinking clearly and are unable to focus to any great extent on verbal tasks (visual memory seems less impaired). Because of this short attention span, the ideal treatment model involves an abbreviated daily group, something that is difficult to replicate in most settings. Some practitioners describe using “CBT-lite,” a modified form of cognitive behavioral therapy that takes into account the limited ability of the meth user for focus and concentration.

Groups are important in the recovery process. A 12-step group, Crystal Meth Anonymous (CMA), has emerged because of the explicit connection between meth and sex, discussion of which would not typically be tolerated in other 12-step meetings. Because of the power of this sexual connection and its ability to induce strong cravings, it is my belief that other supports should be utilized in addition to CMA. I recommend attendance at additional 12-step groups such as Narcotics Anonymous or Alcoholics Anonymous, where more recovery is likely found. It is also my experience that a facilitated peer group that addresses some of the underlying issues of shame, unworthiness and disconnection from the community is helpful for recovery.

Meth hitting the streets today has a much higher purity than ever before, an unintended consequence of the pseudoephedrine control laws that effectively wiped out “mom-and-pop” labs, creating a supply opportunity for Mexican superlabs. Its high purity and resulting high-risk sex creates a potent danger for both new HIV infections and treatment failures among those living with the virus. With funding cutbacks, increased social stress and a common lack of highly effective treatment for methamphetamine dependence, the risks are great. Being alert and informed is our best defense.