Crystal Meth, Men Who Have Sex with Men, and Harm Reduction

“Harm Reduction therapy can include a strategy of abstinence but that is not the main focus of this work including with users of Crystal.  Really the focus of Harm Reduction is to first accept that crystal meth users can and do manage their drug use through a variety of methods.  Looking together at the reasons, both negative and positive, that a person uses we then create a strategy and use a variety of techniques to help manage their use and overall health.”

In my 13 year experience as a Harm Reduction Therapist, I have worked with many people with varying degrees of use of methamphetamine.  In the U.S., Meth use has been  deemed an epidemic for the last 30 years.  Meth has no discrimination – men, women, straight, gay and people of all races use the drug.  In my practice in San Francisco most of my methamphetamine work is with Gay and bisexual men. For many of the men I work with, there is an inextricable link between meth use and sexual behavior.

Crystal, a form of meth,started making it’s way into the gay community in the 1980s.  There are a variety of reasons that it landed there.  One is that while using crystal, one can feel superhuman and full of confidence.  As you can imagine, this is appealing to a population of people who have been marginalized, made to feel ashamed of who they love or who they want to have sex with. Another reason for the drug’s appeal, in later years, was that it was used as a way of helping people to feel energetic as many gay men were, and still are, suffering the effects of HIV and the HIV medications.

The men I work with who are having sex with men have used crystal for several years in both individual and group settings.  They seek me out because they want to change their use to minimize meth’s negative results.  Examples of negative results that I have seen first hand include psychosis (being out of touch with reality, for example, hearing voices), paranoia and significant weight loss.  Brain function can be affected. To give you a first hand account of what this might look like: I worked with a client who while high functioning in a variety of ways and with no history of psychosis, believed that objects in his apartment were talking to him.  Another was convinced that his neighbors were following his sexual activity online. Other common concerns clients share with me are the ways in which crystal causes weight loss and gauntness.  Across the board, all my clients speak of the depression that occurs at the end of a crystal ‘run’.

While crystal is very addictive and can be a very damaging substance, it can be used in a way that employs various harm reduction strategies. Therapists who are strategizing with Gay and bisexual male clients to change their use of meth should include a thoughtful discussion of the sexual practices that often coincide with meth use.  Many who use speed with sexual experiences are often afraid of missing the meth-fueled sexual encounters they are used to and enjoy. Addressing this loss and strategizing about alternative ways to increase sexual pleasure should be discussed as part of the treatment plan.

In my last post I shared that Harm Reduction therapy can include a strategy of abstinence but that is not the main focus of this work including with users of Crystal.  Really the focus of Harm Reduction is to first accept that crystal meth users can and do manage their drug use through a variety of methods.  Looking together at the reasons, both negative and positive, that a person uses we then create a strategy and use a variety of techniques to help manage their use and overall health. Some of the harm reduction techniques that are used for methamphetamine are similar to those that I spoke about when discussing alcohol and harm reduction.

They can include:

• Drinking water and eating before and during use to prevent dehydration.  I had a client who measured out a glass of water for every hour he intended to use so that it’s right there to drink and so that he knew how many hours of use he had left.
• This was his way of setting a time limit for his meth use.  Part of the reason that negative side effects occur is because of the lack of sleep..
• In addition to informing yourself about Crystal Meth (sites like Tweaker.org have great information), be sure you also know all you can about other drugs that are commonly used with Crystal, for example GHB.
• Use clean needles if injecting, your own straws and pipes if snorting or smoking.
• Include sustained periods of abstinence as a way to ‘reset’ tolerance.
• Use Harm Reduction therapy to address the reasons for use which might include: dealing with loneliness, how to have good sex without using meth, depression etc.
• Anticipate and factor in ‘crash’ time so that you can get to work or other obligations on time
• Know the interactions of crystal and any HIV or other medications.
• See a Harm Reduction psychiatrist to see if there are meds like Wellbutrin or Ritalin, that can help minimize use.

Again, this list is not exhaustive.  Individual and Group Harm Reduction therapy is available to help.  The techniques a person uses should be tailored to what works for them and also should be what is attainable so that some success can occur. This usually sets in motion further success.

Harm Reduction therapy is about just that – reducing harm.  This is accomplished by increasing awareness, identifying feelings, educating about the effects of the drink or drug being used and learning about some of the underlying issues like depression, anxiety or traumatic experiences, that may lead to an increase in harmful use. Treatment is individualized and decided on as part of a collaboration between therapist and client. It’s respectful, realistic and it helps to make lasting change.

Cynthia Hoffman, MFT, is a psychotherapist in private practice with over 13 years of extensive experience in working from harm reduction, psychodynamic and cognitive behavioral perspectives. She can help you to identify what you want and what you don’t want from your drug and alcohol use.She is an effective, compassionate and directive couple therapist. She sees individuals, couples and adolescents. www.cynthiahoffmanmft.com

Cynthia Hoffman

Cynthia Hoffman, MFT, is a psychotherapist in private practice with over 15 years of extensive experience in working from harm reduction, psychodynamic, mindfulness and cognitive behavioral perspectives. She can help you to identify what you want and what you don't want from your drug and alcohol use. She is an effective, compassionate and directive couple therapist. She sees individuals, couples and adolescents. She runs small, discreet, Harm Reduction Groups in her private practice office.

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