Out On The Couch
Crystal Meth & the Gay Community
Crystal meth has had a devastating effect on the gay community. Over the last 20 years, the drug–also known by its street name, Tina–has grown into a catastrophic force, contributing to about 15% of all drug death overdoses (NIDA, 2019). Because gay and bisexual men use methamphetamines at a higher rate than heterosexual men (Lea et al., 2017), it is safe to assume that a high percentage of crystal meth overdoses come from within the LGBTQIA+ community.
Further, crystal meth has played an instrumental role in the increase of HIV infection rates. According to a joint report by The National Alliance of State and Territorial AIDS Directors (NASTAD) and the National Coalition of STD Directors (NCSD), “crystal methamphetamine use is a large contributing factor to a substantial increase in risky sex behaviors and higher rates of HIV infection among MSM” (Molitor et al., 1998 p. 3).
Considered a club or party drug, crystal meth is often used by young adults and teenagers to stay awake (Dowshen, 2018). During use, the neurotransmitter dopamine floods parts of the mesolimbic dopaminergic pathway in the brain, which regulates feelings of pleasure (CSAT, 1999). A common effect shared by gay and bisexual men during crystal meth use is an insatiable sexual appetite, and drug use can result in feeling sexually adventurous and experiencing a heightened sense of pleasure, stamina, and endurance that can last for days even without the user taking proper rest. On a psychological level, crystal meth can produce feelings of confidence, power, and invulnerability. The aforementioned increased sexual desire can overpower necessary activities of daily living like bathing and going to work.
While in this state, men who have sex with men (MSM) may engage in chemsex–taking any combination of drugs including crystal meth, mephedrone, and/or GHB/GBL while engaging in sex. The use of crystal meth lowers one’s inhibitions and is often associated with multiple partners, who may contact each other via hookup apps.
Crystal meth users may also engage in what is called “tinkle tweaking,” in which they store their own urine and try to recover un-metabolised methamphetamine from it to fuel another high (Wakefield et al., 2019). Another version of this is called a “booty bump.” One way to receive a booty bump is to dissolve a shard of crystal in water and put it into a syringe without the needle, then “bump” this solution of crystal into one’s anus. A version of this may be practiced during chemsex as well, but what users may not realize is that booty bumps can result in hepatitis, parasites, and other diseases (Frankis et al., 2018).
Crystal Meth & Black Men
In the gay world, crystal meth has been known as a rural white men’s drug; however, per most recent reports, Black men’s use of crystal meth has increased significantly. A study conducted by MSM in New York demonstrated that Black men reported use of methamphetamines at a higher rate than white men (Halkitis et al., in press). Filter, a New York City magazine, shared that Black men experienced more hospitalizations for amphetamine poisoning, dependence, and “nondependent abuse” in the city’s public hospitals than did all white people (Blanchard, 2019). Although Black men reported a higher rate of usage of methamphetamines than white men, they reported less enrollment in treatment (Saloner & Le Cook, 2013).
Research shows that those who enroll in treatment programs for substance misuse demonstrate a higher success rate in their journey of sobriety; obviously, treatment provides access to necessary behavioral supports such as counseling, and is linked to improvement in social and psychological functioning (NIDA, 2020). Statistically, if Black men are not seeking or receiving treatment, then they are at higher risk of long-term use or succumbing to addiction. Positive responses to treatment outcomes are, of course, dependent upon the appropriateness of the intervention, as both affirmative care and client involvement are essential.
Affirmative Treatment Facilities for Gay Black Men
Of the eight crystal meth treatment facilities in New York designed for gay and bisexual male patients, seven of them are located in Manhattan, imposing severe geographical demographic limitations. It bears noting that substance abuse is significantly more prevalent among those living in poverty, as are most of the risk factors for drug abuse (Nakashian, 2019). Residents of Black neighborhoods are 7.3 times more likely to live in high poverty with limited to no access to mental health services, according to the CDC (Denton & Anderson, 2005). This forces those who are seeking help to search outside of their neighborhoods for treatment and services. Traveling outside of one’s neighborhood can be intimidating and present a culture shock. Culture can play a dynamic role in patient and provider engagement.
There is a great need for knowledgeable and accessible mental health care and substance abuse service providers who can treat Black gay and bi men using crystal meth. Culturally cognizant psychotherapists can help to increase awareness of use of illicit drugs amongst African American communities, and can also provide culturally appropriate services targeted to consumers’ needs (Harawa, 2008). Providers who understand the cultural intricacies and experiences of Black men who use crystal meth can be instrumental in their recovery.
In order to keep treatment for crystal meth and other substance use client-focused, drawing on Rogers’ approach to treatment, therapists must allow clients to use the therapeutic relationship in their own way (Client-centered therapy, 2006). This means taking into consideration the client’s cultural background and personal experiences in creating an effective treatment plan for them. Crystal meth addiction clearly transcends racial and ethnic lines, making evident the need for further outreach and support to Black gay and bisexual men who are using. Further, specific assessment and risk reduction measures to address crystal meth use and sexual behaviors and roles among these community members are warranted. Crystal meth addiction is a disease that shows no cultural biases; as mental health providers, we must ensure that our services reflect that.
Blanchard, S. K. (2019, August 8). Black New Yorkers Hospitalized for Amphetamines at Alarming Rates. Filter. https://filtermag.org/black-new-york-amphetamines-hospital/
Center for Substance Abuse Treatment (CSAT). Substance Abuse Treatment: Addressing the Specific Needs of Women. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2009. (Treatment Improvement Protocol (TIP) Series, No. 51.) Available from: https://www.ncbi.nlm.nih.gov/books/NBK83252/
Center for Substance Abuse Treatment (CSAT). Treatment for Stimulant Use Disorders. Rockville (MD) Substance Abuse and Mental Health Services Administration (US); 1999. (Treatment Improvement Protocol (TIP) Series, No. 33.) Chapter 2—How Stimulants Affect the Brain and Behavior. Available from: https://www.ncbi.nlm.nih.gov/books/NBK64328/
Client-centered therapy. (January 2006). Harvard Health Publishing. Retrieved December 28, 2020, from https://www.health.harvard.edu/newsletter_article/Client-centered_therapy
Denton, N. A., & Anderson, B. J. (2005). Poverty and Race Research Action Council analysis of U.S. Census Bureau data. The Opportunity Agenda. Retrieved from http://www.opportunityagenda.org.
Dowshen, S. (Ed.). (2018, May). Methamphetamine (Meth) (for Teens) – Nemours KidsHealth. https://kidshealth.org/en/teens/meth.html.
Frankis, J., Flowers, P., McDaid, L., & Bourne, A. (2018). Low levels of chemsex among men who have sex with men, but high levels of risk among men who engage in chemsex: analysis of a cross-sectional online survey across four countries. Sexual health, 15(2), 144–150. https://doi.org/10.1071/SH17159
Halkitis, P. N., & Jerome, R. C. (2008). A comparative analysis of methamphetamine use: black gay and bisexual men in relation to men of other races. Addictive behaviors, 33(1), 83–93. https://doi.org/10.1016/j.addbeh.2007.07.015
Harawa, N. T., Williams, J. K., Ramamurthi, H. C., Manago, C., Avina, S., & Jones, M. (2008, October). Sexual behavior, sexual identity, and substance abuse among low-income bisexual and non-gay-identifying African American men who have sex with men. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2574823/.
Lea, T., Kolstee, J., Lambert, S., Ness, R., Hannan, S., & Holt, M. (2017). Methamphetamine treatment outcomes among gay men attending a LGBTI-specific treatment service in Sydney, Australia. PloS one, 12(2), e0172560. https://doi.org/10.1371/journal.pone.0172560
Molitor, F., Truax, S. R., Ruiz, J. D., & Sun, R. K. (1998). Association of methamphetamine use during sex with risky sexual behaviors and HIV infection among non-injection drug users. The Western journal of medicine, 168(2), 93–97.
Nakashian, M. (2019, July 26). Substance Abuse Policy Research Program. Robert Wood Johnson Foundation. https://www.rwjf.org/en/library/research/2012/01/substance-abuse-policy-research-program.html
NIDA. 2019, May 16. Methamphetamine DrugFacts. Retrieved from https://www.drugabuse.gov/publications/drugfacts/methamphetamine on 2020, December 28
NIDA. 2020, September 18. Principles of Effective Treatment. Retrieved from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/principles-effective-treatment on 2020, December 31
Saloner, B., & Lê Cook, B. (2013). Blacks and Hispanics are less likely than whites to complete addiction treatment, largely due to socioeconomic factors. Health affairs (Project Hope), 32(1), 135–145. https://doi.org/10.1377/hlthaff.2011.0983
Wakefield, L., Maurice, E. P., Parsons, V., & Smith, R. (2019, June 26). This is why people drink their own urine after taking drugs. PinkNews. https://www.pinknews.co.uk/2018/04/30/urine-drugs/.