Bay Area Reporter - September 13, 2007
Bob Roehr

While there is no solid national data on the interplay of those factors, a range of urban studies suggests that gay men are twice as likely to use crystal meth as the population at large, said Perry N. Halkitis, Ph.D., a researcher at New York University.

He conducted detailed interviews with 311 Chelsea men who worked out at least three times a week at a gym and found that nearly 25 percent of these health-seeking men had used meth within the last six months. And that wasn't the only thing they were putting into their bodies; most reported use of cocaine, ecstasy, party drugs, and a lot of alcohol, either alone or in combination.

A study of black men in New York who have sex with men found a greater geographic diversity of residence than whites, which Halkitis believes contributes to the spread of meth use among women. They were spending $159 a month on crystal methamphetamine and a total of $775 on all substances of abuse each month, suggesting the complex patterns of addiction.

He said that HIV-positive men are more likely to use meth. "They tell us over the years that methamphetamine provides them with a way to deal with their stigma for being gay and HIV-positive. It gives them energy. It is completely understandable why they would turn to this drug," Halkitis said.

Project MASC û Meth and Social Cognition û found patterns of recreational use of methamphetamine on weekends. "But the neurological, emotional, psychological, and physical repercussions last longer than that," Halkitis noted. "By the time you get some homeostasis [no influence of the meth], it is time to start using the drug again."

Halkitis said that these gay men "don't believe they have a problem, they don't want to go to an addiction facility, they are much more willing to come into a gay agency where they can work at a more holistic approach on their methamphetamine use." That is part of the reason why gay health organizations, not simply addiction programs, need to be involved, advocates said.

Addiction is treatable

Another meth myth is that the addiction is not treatable, said Elizabeth Disney, Ph.D., who works with Chase Brexton Health Services in Baltimore. That is not true, recovery rates are about the same as with cocaine and similar substances.

Good clinical trial data shows that bupropion (Wellbutrin) reduces both the "high" of use and the craving of withdrawal associated with meth, while other pharmaceutical interventions are showing similar promise. "But none of them are silver bullet, stand alone interventions; they all have to be given in the context of behavioral treatment, learning how to change your life," said Disney.

Disney pointed to information and treatment programs developed by the UCLA Integrated Substance Abuse Programs that are available at http://www.uclaisap.org.

The Gay Men's Health Crisis in New York developed an intervention called "Hurricane Tina" in 2006. Bill Stackhouse, Ph.D., who heads up the Institute for Gay Men's Health, said the community level intervention aimed to reduce crystal meth use among young men who have sex with men. It was funded in part by the city health department.

They began with in-depth interviews with the target groups. They found that low self-esteem, curiosity about the drug, homophobia, isolation, the need for escapism, and coping with life were all driving use of crystal meth. Earlier campaigns in the city had stigmatized the use of meth and made it more difficult to initiate honest conversations about use of the drug.

Stackhouse said, "Primary prevention is most effective when multiple messages and approaches are utilized." They created a program that blanketed targeted neighborhoods. It even included video public service announcements on DVDs to be shown in bars and clubs, and announcements on Web sites like Manhunt. Evaluation of the program is under way.

Halkitis said use of and succumbing to meth is part of a lifelong trajectory. "We need to better understand what is happening to kids in childhood and adolescence that is predisposing them to use drugs" during the crucial age of 18-25 when most people transition into adulthood, he said. "We have to help them get to the next stage of their lives without depending on drugs."

Solutions

One congressional staffer asked what the panel thought of the "scared straight" type public service announcements on meth use that have run in Montana. They are slickly produced, garnered a lot of attention, and have been funded by a local entrepreneur.

Barbara Warren, PsycD, with the LGBT Community Center in New York, was very familiar with the series. She acknowledged that the ads certainly caught people's attention, but testing found that young people "were attracted to the imagery but they didn't take in the message ... it was sort of like a video game to them."

She said that what worked better in New York were videos of diverse young people talking about "their own experience, the reasons why they really needed to get educated about meth, and to think about the risks before picking it up ... we had a much, much more powerful response."

"What we need from Congress is support for adequate resources to continue the programs that we now have, and to implement more," Warren said. "Meth knows no bounds." Much of the work in prevention and treatment "is as relevant to straight communities as it is in communities of men who have sex with men."

The National Coalition for LGBT Health also believes the nation needs a better baseline understanding of who is LGBT and where they live. It is pushing for the addition of $2 million for inclusion of a question on sexual orientation on the next National Health Interview Survey.

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