San Francisco Chronicle - November 9, 2008
John Diaz, jdiaz@sfchronicle.com

The counselor turned to the friends and family members of the dozen or so clients who were there for a two-hour session. He asked: "Who wants to start?" No one volunteered. He then gazed at a woman of about 20, who had placed her left hand on the knee of her younger sister.

"I'm angry, and I really don't want to be here," she began, without a trace of emotion in her voice. "But I am here, because I love my father."

She proceeded to catalog the devastation her father's addiction to crystal meth had wreaked on the family: the wild mood swings, the abrupt absences for days at a time, the financial ruin, his physical and mental deterioration. She spoke of the anxiety inflicted on her mother, who was getting tested monthly after learning recently that her husband had become HIV-positive.

The father fidgeted in his seat as his daughters, rigid and resolute, talked about how the lies and suspicions that pervaded the household were finally explained when their mother found his stash of meth. They remained calm as their fidgeting father, under unrelenting questioning from the counselor, filled in the details of his plunge into methamphetamine addiction and sexual recklessness.

What was striking about the meth addicts was the commonality of their stories and the magnitude of their collapse, despite their variation in age and socioeconomic circumstances. Each talked of the drug's seductive effects - endowing them with almost superhuman focus and the ability to stay up for up to 72 hours, enhancing their performance on the job and in the bedroom - and their ultimately futile attempts to continue at a "maintenance level" of use. They described how their lives contracted into a world of meth users that revolved around their dealers, providing them with "a family" to support an addiction that was destroying their real ones. And they all spiraled into an existence of depravity, despair - and a level of denial that rehab had yet to exorcise.

As I heard these searing accounts of methamphetamine's toll, I reflected on an October 2005 panel on "Crystal Meth and HIV: One Pandemic or Two?" that I moderated at the Commonwealth Club. At the time, media attention was focused on the pervasiveness of crystal meth use in the gay community, particularly in the San Francisco club scene, and its connection with high-risk sex. I recall being struck by the sensitivity, among both the panelists and the audience members, about the effect of media coverage in "stigmatizing" gay men who use meth. I worried that such sensitivity - or political correctness - would make it difficult to confront what was, indisputably, a serious public-health problem.

Besides, I wondered, what was the problem with stigmatizing behavior that was so obviously destructive to self and society? After all, the stigmatization of drunk driving and cigarette smoking helped reduce its occurrence and thus save lives.

So what has happened since 2005?

Health officials and community leaders suggest that attitudes toward crystal meth are changing.

"There was a a norm that it was accepted in certain parts of the community," said Supervisor Bevan Dufty, who said he encountered "nasty messages and ridicule" from "some of my brothers in the community" when he helped spearhead a task force on crystal meth. "I think we've brought it out of the closet."

The city and state have poured more resources into prevention and treatment. The price of meth has risen, partly a result of pharmacies exerting tighter control over precursor substances. Public health officials in San Francisco said they have gained a better understanding of meth-use patterns, which has allowed them to develop more effective treatment strategies. For example, about 90 percent of meth users are also abusing alcohol or another drug.

"There is a little evidence that the peak of the crystal meth epidemic has subsided," said Grant Colfax, director of prevention for the city Department of Public Health. "But I think it's too early to declare victory."

One encouraging sign, he said, is a slight reduction in meth-related admissions to San Francisco General Hospital. Colfax was heartened that crystal meth was no longer "quote-unquote cool in some quarters," though it remained "a major problem."

As the personal stories at the rehab session show, there are many routes to ruination. Alcohol had at least a supporting role in every single one. But there was something distinctly insidious about meth, in the force of its grip and its power to steal a user's need to eat, sleep and care about others.

"It's like a wrecking ball," Dufty said.

As I left the rehab center that Saturday afternoon, a driving rain forced visiting family members to pull their coats over their heads as they sprinted to their cars. Many had promised the counselor they would return for the next week's session; some had seen their loved one go through the 28-day drill before. For them, addiction is the cloud that never lifts.

John Diaz is The Chronicle's editorial page editor.

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