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S1E6_Gay-men-meth-Part-1_04-01-2019

Positive Effect21min

James Watson

00:05

Welcome to pozcast, the show that puts the positive in podcasting. Our program is created by and for people living with HIV. And we're here to explore HIV research in ways that matter. We're accurate, but not clinical. We want to hear and tell stories about what new research means for us, for our health, our love lives, and our relationships. We're based in Toronto, but global in outlook and we're produced at the MAP Center for Urban Health Solutions of St. Michael's Hospital, like universities without walls. We're pozcast, and we're bringing HIV research to life. Today, you'll hear the views and ideas of our pozcast guests and while we respect their expertise, they do not reflect the views of St. Michael's Hospital, or University Without Walls. I'm your host, James Watson, a person living with HIV and a community based research coordinator. I'll be your guide for today's journey into HIV research. It's not often you get to speak from the heart and say what's really on your mind at work. But here at pozcast, I get to do just that. I'm allowed to reflect on important issues and learn along with everyone else from some extraordinary people. And all the pozcasts mean a lot to me but some strike a more personal chord, and this is one of those topics. The harmful use of crystal meth is taking a heck of a toll on our gay brothers, folks, especially our gay HIV positive brothers. Anyone who knows me knows I'm drug positive, I've had my own experiences with substances. I'm close enough to this issue to be forever impacted. Meth can be like a rocketship to gay sex paradise, at least at first, I get that. But it's often a one way trip. And the landing is rough and the long term consequences can be devastating. But that's not everyone's experience, right? Some people seem to manage their meth use in ways that works for them. And that's okay. The meth is a tricky one to insidious and it creeps up on you. Meth distorts our sexual desire and plays off so many of our vulnerabilities as gay men. When a friend of mine heard I was doing research for the show, he asked me for some advice on how to approach a loved one he was concerned about. He wasn't sure what to do or say and, and I think there are lots of people who have been or are in similar situations, including myself. I've struggled not knowing how to reach out, or even if I should reach out. While most gay men don't use meth, there's an incredible amount of stigma cast on those that do, and from our own community- it's, well, it's shameful. That makes it so much harder for those seeking recovery to come forward. We don't want people to isolate further. We want people to know that they're loved and supported, that there's a way out. If out is what they want. Addiction is a disease friends. It's not a moral failing. It became clear to me quickly that I couldn't do this topic justice in a single twenty minute episode. There's just too much to talk about. So we decided to do a three part series to get a bigger picture and focus on solutions. In part one, we discuss the book Lust, Men and Meth: A Gay Man's Guide to Sex and Recovery by David Fawcett. And in part two, we get up close and personal with Crystal Meth Anonymous: the 12 step recovery program. And in part three, we explore how methamphetamine fits within a harm reduction model.

James Watson

03:58

This episode is anchored around a remarkable book by David Fawcett. It's called Lust, Men and Meth: A Gay Man's Guide to Sex and Recovery and explores the intersection of gay men drug use, and high risk sex. It's a fascinating read, and raises all sorts of questions. It's a great place to start the conversation. I had the privilege of interviewing both David Fawcett and the activist and writer, Mark S. King, tag-team style for this episode. David Fawcett is not only the author of this book, but a psychotherapist and a sex therapist who specializes in gay men's health. Mark S. King is a writer and activist who's been speaking out about living with HIV since testing positive in 1985, only weeks after the HIV test was publicly released. His blog My Fabulous Disease has been nominated for three consecutive GLAAD Media Awards and he is also a recovering meth addict and appeared in the 2008 documentary film Meth. So let's get to it.

James Watson

05:01

So welcome to pozcast, guys. I appreciate you guys being here. Why are gay men so attracted to this drug?

David Fawcett

05:06

Well, I think there's a number of issues. One is that, gay men really often feel that there's some issues that they've been compartmentalizing in their life in terms of sometimes starting with their sexual orientation, but other times some in shame and internalized homophobia. And just the difficulties, I think, at least in United States, and I suspect internationally, loneliness. There's a really chronic loneliness, and meth, as one client of mine described it, he has eight hours of bulletproof happiness, that he can just check out and go numb, from all those feelings.

James Watson

05:44

What drew you, Mark, to do meth?

Mark S. King

05:47

I agree with David, there's a lot of that. For me, it was about escape and it was about connection. Escape, because I'm, fifty-seven years old, I came of age during AIDS, and there was so much death and mortality that by the time 1996 and 1997 rolled around, and new drug therapies told us that maybe we weren't all going to die.. I wanted to hit the dance floor. I felt entitled to the celebration. And indeed, there was a lot to celebrate. And so people like me, who thought we were gonners- took to the clubs and the dance floors and the gyms and the steroids and the trainers. And pretty soon I was dancing on boxes having the time of my life. And it was that sense of celebration and escape from what had happened to us as a community, that previous generation, and that sense of entitlement. And then the sense of connection, because I had lost a lot of my peers, and I found this new tribal community on the dance floor, and then slowly through my interactions with other drug users. Then pretty soon, what I was escaping was my own drug addiction by doing more drugs and isolating more. And so those people I was surrounding myself with, were more and more were we devoting our interaction, that community that I thought I was looking for became a community of just a few other people who were using daily the way that I was.

James Watson

07:17

Are (HIV) positive, people more vulnerable to this drug?

David Fawcett

07:21

I think, yes. What I've seen is that if we think of maybe a meth user starting his career, it might be a younger person in their late 20s. It's not the first drug they experiment with, but it comes along quite early. But I think for persons living with HIV, I've seen 50, 60, 70 year olds who are long term survivors who are not feeling as attractive, not feeling as energized, as sexual, they're not feeling visible. Sometimes the community, and meth really gives them as we said, an opportunity to kind of avoid those feelings. But also it gives them a chance to kind of have a sense of belonging—a connection again.

Mark S. King

08:01

It gave me a sexual currency that I had not had as a person living with HIV. I entered this culture in which "oh, you're positive, you're not", we don't even bring it up anyway. And there's not a condom inside. It doesn't matter what this is all about. Letting go of your inhibitions and going for it as it were. And so yes, as a positive person, I craved that sort of complete abandon, and was accepted as much. Now the inverse is also true. And that is, a lot of people who are doing crystal meth, if they're not positive now, they're they're much more likely to become positive as a result of their meth use because of those very inhibitions. And so the culture of who's doing meth hardcore and who's HIV positive is pretty intertwined.

Mark S. King

08:01

And do you think U=U is going to have any impact on meth use or transmission or people's approach to crystal meth? Because it's, you know, you're undetectable? You're untransmittable?

Mark S. King

08:58

Well, you bring up an interesting point. And that is, how adherent is someone on crystal meth being with their drugs? In other words, you could say that crystal meth addiction could be the very thing that undoes U=U, because you're more likely to skip doses of your medications. I know I was. That was my experience. When I'm up for 48 hours, three days, four days at a time, No, I'm not thinking about doing my drugs, nor am I eating properly or getting enough rest. So the chances of my having been detectable and transmitted, transmittable during that time are pretty high.

David Fawcett

09:35

I think the impact of U=U on destigmatizing HIV will have a beneficial effect, but I'm not sure it'll outweigh the issues that Mark just referred to and then some of the other issues.

Mark S. King

09:47

And the reason for that is there is a culture among those of us who are doing drugs in which those sort of social norms. Oh, are you taking your meds? Oh, did you know if you're undetectable? You're on transmittable? That is that is a fairyland far away from the fantasy world we're living in as active drug users. We don't want to talk about that we don't we don't want to talk about U=U or condoms, or HIV, or our mothers. We want to have sex and do drugs. When I say "we", I'm talking about my experience, experiences results may vary.

James Watson

10:18

Right. So when we're talking about the effects of math and recovery, is it necessary to distinguish between somebody who's hit rock bottom, who's, who blew up their lives compared to somebody who is able to, who manages to do it once a month, or once every couple of months?

David Fawcett

10:36

I've come a long way in terms of I guess, I was pretty formerly pretty black and white and my thinking on this. And I do think that meth is very easy to become addicted to and it's very, such a powerful drug that once you cross the line into, I guess I call problematic use now. I believe abstinence is really the only way to go back. Perhaps there are people that can do it in ritualized ways once or twice a year and in a context like a circuit party or something, and keep it manageable. But I do know that no matter where someone is on the spectrum, if we, if the first contact they have with any kind of health care provider is to demand abstinence, chances are that we're going to lose them. I think a harm reduction approach absolutely has a place because of giving people education and seeing where they're at helping them decide what they need to do. And they think it's a critical piece.

James Watson

11:25

As we all know, crystal meth is about fusing of meth and sex. It's a powerful effect of the struggle. And you describe it in your book as sort of what fires together, wires together, which I think is a very apt way of saying it or hijacking sexual desire. So can you explain a bit how this connection is actually forged?

David Fawcett

11:47

Yes. So basically, it's in terms of neuroplasticity, or the ability of the brain to kind of rewire itself in an ongoing Yes, when two behaviors occur at the same time, the brain simply kind of collapses those two things into an undifferentiated firing of nerve cells and neurons. And so the two can really quickly happen. And the binding agent, there's dopamine- example I use often is when we teach a dog a trick. He associates the behavior and the treat, that dopamine is the binding agent, those two things become associated, and the same phenomenon is happening with sex and drug use. People get accustomed to being sexually aroused in the intoxicated state. And those two become very much one in the same. The other thing that goes with meth is that it's such a powerful release of dopamine, it's far beyond any natural so called rewards we have. So some mere sex without the drug becomes uninteresting. People can't even function unless they have that much higher level of stimulation, they become dependent on.

Mark S. King

12:48

That was absolutely my story, what David just described because it was completely fused for me. And in the recovery process, I had the hardest time with how do I have healthy sex again? I was single at the time, no big surprise, because I was a drug addict, and I had a hard time trying to reintroduce sex into my life. And I had a therapist tell me, "you need to cleanse the pallete Mark, cleanse the pallete. No porn. No, you know, let's not worry about that right now about a sex life right now". And I feared that, and many relapses that I had on my way to long term recovery were based on "Oh, I'm just horny, though. I just want to get out". What I didn't realize, is that actually, that was that was my addict self saying, "Yeah, your just horny, that's all you are". You just go out and get some sex. Right. And of course, you know, I immediately was was using again. The good news for me has been the fact that I am in a loving relationship, I am in a committed relationship. And the sex is great. And I don't think about drugs anymore when I have that sex, but I think I needed enough time to get well again, and understand what it means to be, to care for the person that you're having sex with, and to have that connection, because so much of the sex before had been so transactional and anonymous. And, and I mean, and and, hey, that's great for some people when they can do it, and they're healthy. For me, it was not healthy.

David Fawcett

14:15

But I think Mark's experience is really critical just to underscore and that I think there's such a belief out there that someone in giving up meth once they've once it's become problematic is that they're they're doomed to a life of kind of vanilla boring sex or no sex at all. I think that's a total myth and recovery is totally possible. Healthy sexuality is possible. It takes time and patience, and it's not easy, but it's certainly possible.

Mark S. King

14:36

I'm still no Pollyanna, let me just say that we're rocking it. Okay. And we're both sober and we're having a great time. And it's better sex than I could have thought I would be having at this age. So I'm very happy.

James Watson

14:49

In your forward, because you write the forward to David's book, you talk about how reassuring it was to read that there were physiological reasons for your addictive behaviors. And your opinion, how does knowing the science of addiction help in recovery?

Mark S. King

15:03

Well, clearly, I don't know the science but as well as someone like David does, and I don't think that you have to in order to get well. But to me, it was just reassuring to know, I'm not alone. I'm not crazy, I'm not a shameful pervert. Because there were a lot of things that I did that I said that I watched, much during my active use that are not my authentic sexuality, and about which I felt a lot of shame that I went into therapy once I got clean to get over that. And so it's very reassuring to know that these, that the pushing of the envelope and the sorts of things that David talks about in his book in terms of, you know, trying to have to get more bang for your buck. And so suddenly, the fantasies get darker, and the sex gets stranger and further away from who you really are. So coming back to who I was, again, was a lot of us year when I realized science is on my side. And therapists like David, understand that this was this is just part of the wreckage of my use.

David Fawcett

16:03

Because of the unique impact of meth on the brain physiologically and destroying the dopamine transport system. Meth has some unique characteristics, such as the recovery process, and I think one of the great satisfying reactions I've had to readers of the book is that they can understand, okay, there's a reason why I keep relapsing. Why, I can't feel pleasure for so long, why I'm confused, why I'm impulsive. It's the brain healing. It's a traumatic brain injury, really. And so I think it's very reassuring to know, gosh, this is the normal process.

James Watson

16:31

And now in that book, this sort of seven essential tools for a strong recovery, such as developing empathy, and embracing self compassion and forgiveness. So how can a person use these tools in a practical way? Or do they need to seek help? Can they use them themselves? Is that enough?

David Fawcett

16:51

Absolutely, I think I think it's beneficial to get professional help. Sometimes it's because there's a lot of issues that have come up, including deeper issues. And often times for a gay person using meth, discovering who they are without the drug, it's like a second coming out in a way. But of those seven tools that I think are really useful, I think mindfulness is probably the the first step of the critical one to just become self aware. And just watch and, and mindfulness isn't some complicated thing. It's just being simply being present. And by watching your feelings and reactions.

James Watson

17:26

So on that note, you know, and this is a question to both of you. If and when a meth user—I'm sure this has happened—reaches out to you for help, what is the first piece of advice you would give them?

David Fawcett

17:42

Well, the first thing I would do is check myself and make sure that I'm in a good spot in terms of not shaming, not stigmatizing, not doing anything that might drive that person away. And so I think oftentimes, I would say just connect. Connect with other people, with peers, with a therapist with an oftentimes one of the sad things is that many meth users, by the time don't have many people in their lives. I think maybe people who are in therapy who describe the support system, as Joe from Grindr, you know, that's the extent of it. And so I think, to really to reform those connections, is probably the bedrock of recovery.

Mark S. King

18:21

The first thoughts that I usually say to someone like that is, "you're not alone, it gets better, and recovery is possible." For a while, I didn't believe that, that my recovery was possible, or that I even deserved it, because of what I've been through. And so to be able to say to somebody, recovery is possible, and you deserve to get well just to be able to start building the building blocks of self esteem and somebody again.

James Watson

18:46

So how can the gay community help do you think? What do we need to do to create safe spaces for for recovery?

David Fawcett

18:55

I think we need to talk about this. I'm not as familiar with the situation in Canada, but certainly in the States, it's still kind of a something no one wants to talk about, no one wants to go there. We occasionally will have, with a lot of effort, a town hall meeting, and then just kind of, there's no follow up. It just kind of drops into the mist again. So to really drag this out in the daylight and talk about this as an issue, that we are gonna have to confront just like we did HIV. We have to take it into our own hands and really educate providers and an advocate for money. There's been some wonderful work in New York City where the community really advocated for money, and they got it, they got data, and they got programs to follow. So I think that it really starts from the ground up.

James Watson

19:41

Thank you so much.

David Fawcett

19:43

Thank you.

James Watson

19:48

A big pozcast thank you, to Dr. David Fawcett, and Mark S. King for sharing their fascinating insights into meth use and offering us some practical advice for healing and recovery. Hearing both perspectives to clinical and lived experience at the same time, was incredibly engaging. Truly enlightening. Thank you. I highly recommend both David's book Lust, Men and Meth: A Gay Man's Guide to Sex in Recovery, and Mark S. King's blog, My Fabulous disease. Thanks for listening.

James Watson

20:23

Production services are provided by the Ontario HIV Treatment Network.

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