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Therapy with Black Gay Men addicted to meth

Posted: 8-18-21 | Jerry St. Louis, LGSW

Shadow of a person making a heart with a rainbow flag background and Black fists wearing rainbow bracelets. This represents how affirmative therapy with Black Gay Clients addicted to crystal meth can be empowering and liberating.

To be a Black Gay Man with an addiction to crystal meth, is to be stuck between to worlds. This article will explore ways that psychotherapists can provide affirmative therapy with Black Gay men addicted to methamphetamines. The first two articles of this series, Affirmative Therapy: Crystal Meth in the Black Gay Community and Black Gay Men: My Story, illustrated how both treatment and support group options can be white washed. Because meth was not considered a threat to the Black LGBT community, campaigns and interventions reflected this. Subsequently, this created a gap in ways to support these individuals by providing culturally sensitive and affirming treatment. 

How mental health providers can help Black Gay Men

Mental health providers can help Black gay and bisexual men dealing with addiction in many ways. Certainly, helping to dismantle the systems that dehumanize Black people in America is a big task that will require consistent work. All parts of the ecosystem (macro, meso, micro)  must integrate into current practices in Black life and build upon current traditions and norms in Black communities. Most importantly, therapists must understand how community factors play a role in healing. 

Understanding the community factors for Black Gay Men

In December 2018, The Harm Reduction Coalition, BEAM (Black Emotional & Mental Health) Collective and the Counter Narrative Projects released a report titled Blueprint: A Community Response to Crystal Meth. This report details the risks faced by this particular community. The Blueprint Project includes assessments and voices from both community providers (medical doctors, social workers, etc.) and the Black and Latino gay and bisexual men addicted to crystal meth that the providers serve.  The report explores how the impact of homelessness and survival sex may relate to why people use crystal meth. It takes a deep-dive into the specific risks for Black and Latino MSM, and considers how power dynamics at the intersection of race and class plays a role in addiction.

In addition, the report includes harm reduction strategies and tools for addressing addiction. Resources address how community providers can address crystal meth addiction in these communities. The Blueprint serves an important part of the foundation needed to build essential culturally specific supports. Healing looks different for everyone! This report not only covers the gaps in service, but also illustrates the needs of a stigmatized community. With this knowledge, affirmative therapists are able to fill the gaps in service and provide for the needs of diverse communities.

"All the parts of the ecosystem must integrate into current practices in Black life and build upon current traditions and norms in Black communities" -Jerry St. Louis, LGSW on light blue background with hand of a Black person waving a rainbow flag

Understanding cultural influences on sexuality

Understanding how culture can influence Black Gay men’s views of intimacy and sex is essential. Crystal Meth can provide sexual freedom.  Users report that when high on Crystal Meth, they tend to explore sexual experiences that they would ordinarily not engage in (Pebody, 2014). It allows them to explore the freedom of sex without the negative thoughts or judgements of others. Living in a homophobic and racist world can cause many negative feelings and thoughts to become part of the psyche.  Crystal meth can create temporary relief.

Learning more about chemsex

Chemsex involves using certain substances immediately before or during sexual activities to facilitate, prolong and/or intensify sexual experience, mainly by some communities of men who have sex with men (Bourne, 2014). People who engage in chemsex report better sex. These drugs reduce inhibitions and increase pleasure (McCall, 2015). They shame associated with kinks like watersports (sex play that involves urine), make it less likely that an individual will share in the forms of play that bring them pleasure.. Organizations like The Rainbow Project have created a guide on how to safely engage in this experience. This helps to normalize intimacy and break down the barriers in communication. The Rainbow Project provides resources that work to improve the physical, mental & emotional health and well-being of lesbian, gay, bisexual and/or transgender people.

Chemsex is defined as using certain substances immediately before or during sexual activities to facilitate, prolong and/or intensify sexual experience, mainly by some communities of men who have sex with men (Bourne, 2014). on blue background with two round pills and an oblong pill to make the shape of a penis to represent how drugs and sex can be combined often in Black Gay male communities.

Affirmative therapists need to be mindful about what the client’s goals are. Abstinence may not be everyone’s goal. Abstinence may seem unrealistic because of their life circumstances, social circles,  neighborhoods, or the need to survive. Awareness of programs that offer options for Harm Reduction and full sobriety, can assist providers with meeting clients where they are. 

Be a sex-positive therapist

People, especially those who enjoy non-traditional forms of intimacy, fear being “slut shamed.” This may play a role in gaps in services for Black gay and bisexual men. Consequently, understanding how shame, religion, culture and socioeconomic factors can impact the growth of their own sexual identity and sexual expression is important to affirmative care. In short, providing a space for understanding can create a feeling of relatability that most addicts won’t find elsewhere. Working through any sex-negative or kink-negative biases is essential. 

Attending Affinity Spaces

Affinity spaces are “locations where groups of people are drawn together because of a shared, strong interest or engagement in a common activity” (Gee, 2004; Gee, 2005; Gee & Hayes, 2009). These spaces for honest dialogue aimed to directly address these gaps in support. 

For example, affirmative therapists can start an affinity group in the workplace or community where they work. All that’s needed is an interested group of people, a clear goal and enthusiastic support. It is vital that psychotherapists understand the role that racism plays in impacting and informing the unique experiences of Black people and the nuances of culture.

With a culture deeply scarred by racism, affinity rooms are often separated by race. For example, organizations like Foundation-sponsored Courageous Conversation About Race series, implementing Black Affinity and White Affinity breakout discussion groups. 

Creating a Safe Space in Therapy for Black Gay Men

Creating a safe space is imperative in therapy spaces. A safe space offers a space intended to be free of bias, conflict, criticism, or potentially threatening actions, ideas, or conversations. Consequently, creating a safe space for can clients can strengthen the therapeutic relationship by allowing people to feel supported and respected. In addition, therapists can use these ideas both private practices and while working in the community. 

Ongoing training

From here, community mental health providers must address the concerns of Black gay and bisexual men facing crystal meth addiction. This includes:

  1. Effectively implementing affirmative psychotherapy 
  2. Practicing from a trauma-informed lens  
  3. Creating creating safer spaces by engaging in anti-bias and anti-racist practices.  

For instance, The Affirmative Couch provides targeted teaching and training opportunities for psychotherapists.  Culture specific training is instrumental when working in this population. As a result, affirmative therapists should always be continuing to expand their knowledge and skills in order to serve effectively. 


These are only a few steps that practitioners can take to fully meet their clients where they are. Ongoing training is essential. Above all, learning about the impacts of racism and homophobia on Black gay men is key. As a result, continued antiracism work is a central component of affirmative psychotherapists. Learning and listening to community members rather than just service providers will help psychotherapists become more empathic and understanding.

Learn More!

I will be conducting a 2-hour continuing education course, The Black Gay Community and Crystal Meth, with The Affirmative Couch on September 15.  I will detail how to implement strategies and helpful hints to help address these gaps in services during the training. Hope to see you there! 

The Black Gay Community and Crystal Meth Presented by Jerry St. Louis, LGSW 2 CE Course

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