Washington Blade - October 3, 2003
Joe Crea

She has discovered an empty bag with flecks of a white substance and a pipe in his possession. She describes her nephew as a 49-year-old gay man experiencing a "mid-life crisis." He is HIV-positive and Jackie said she knew he was abusing drugs long before his diagnosis and remains convinced that his abuse of crystal meth - also called tina, "T" and speed - contributed to his contracting HIV.

"I know what he's doing, and he's exhibiting all the classic symptoms," said Jackie, who spoke on condition of anonymity. "He'll just stare out the door for over an hour. He's admitted to me that he has tried [crystal] but won't admit to it now. He's twitching all the time, sloppy in his appearance and manner, talks about sores up his nose, wears sunglasses all the time, has a high-and-mighty attitude. I'm just so angry. Angry, angry, angry and I just want to cuss and I'm not one to cuss."

Jackie said that she has tried to talk to her nephew about the problem but he refuses. She said that he's been using drugs for three and half years and that it's getting worse. She also works with him and admits that she enables his habit in a professional setting.

"I feel like I'm being played for a fool," Jackie said.

Frustrated friends and family members of crystal abusers say they frequently feel sidelined during the destructive stages of the addiction, mere observers as their loved ones' lives spiral out of control. They are brought into the vicious cycle on the addict's terms, typically when the addict needs money for drugs, and then cast aside. Helpless, they don't know where to turn and often turn their backs on the addict in the interest of self-preservation.

"The smartest, funniest guy I know has spiraled out of control on this drug," said Rob, who asked that his real name not be used. "This guy was the most talented lawyer I've ever come into contact with - respected by colleagues and those he came up against. But, bit by bit, his life has fallen apart. And even though the reason is crystal clear - no pun intended - he won't even admit to using drugs, much less Tina.

"Now he's lost his job, he is HIV positive and not treating the disease properly, and this brilliant guy will go on at length instead about non-existent medical problems that even he realizes sound insane," Rob said. "And yet he is focused on curing those problems, and not the drugs that have caused his hallucinations."

Randy Pumphrey, executive director of the Lambda Center in D.C., said that the treatment facility receives calls from family members who suspect that their loved ones are abusing crystal and want to know what to do.

The "what to do" is a very difficult question for many family members and friends to answer. Pumphrey said that when he receives calls from an addict's loved ones, he asks if the abuser has identified that he or she has a problem.

"Then it is easier," Pumphrey said. "I say, 'Can you have them call me?'"

The Lambda Center, which provides in-patient and out-patient treatment for crystal abusers, doesn't offer any official programs for friends and family members of crystal addicts but for those clients in treatment, the center will conduct "family treatments" for that patient's loved ones.

Joseph LaFleur, a licensed independent clinical social worker in the D.C. area, stresses to family and friends the importance of dialogue and of not being judgmental. He added that a loved one can do little to help the addict and it is often the case that an individual must hit their "bottom" before they recognize they have a problem.

"For one person, it might be losing their job or a suicide attempt," LaFleur said. "One of the most common bottoms is usually an HIV-positive diagnosis. Then they start looking into treatment."

But LaFleur said that families and friends can try to "raise the bottoms" of the crystal meth user through an intervention or therapeutic mechanism such as the help they could receive from entering a treatment program, like the Harm Reduction Groups where users go to minimize their dependency on drugs. The purpose is to get the user to start thinking about his or her problem and what it is doing to their lives, LaFleur said.

He said it is critical to evaluate the relationships between the family member and the addict.

"How open is he? Is there good communication," LaFleur said. "Then you can work your observation [of suspected drug abuse] into the conversation. Start asking the person about the drug. Have you ever used it? Do you have any friends who use it? That kind of dialogue is good."

Recognizing the signs of drug abuse

Families and friends often recognize that their loved one has a problem following drastic changes in their character over a short period of time - usually within six months - said Beth Wheeler, a social worker at the Lambda Center. Symptoms of meth abuse can include dilated pupils, sweats, twitching, paranoia and depression. (See related sidebar on Page 22)

"The change in behavior is especially acute if the addict [prior to taking drugs] was under psychiatric care and taking medicine for say, bi-polar disorder," Wheeler said. "Often, the addict will stop taking his meds because they interfere with the crystal. Family members will often recognize the change in behavior and say, 'Hey, I think he's stopped taking he meds.' This makes the recovery time that much greater."

"It's a downward spiral," said Sara Mindel, another social worker at Lambda. "People see them in a very short period of time going from being high-functioning to distancing themselves from friends and family members. These loved ones often witness the change in such a short period of time, it's like a tornado they feel that they've been swept up in, so the feelings are fresh and raw for everyone involved."

Rob said he noticed those sorts of changes in his friend, who he has known for 15 years. "First he was late for dinner or drinks, then he was really late. Then he stopped showing at all, making up some outrageous medical excuse."

Feeling hopeless, family and friends of Rob's pal have tried interventions but so far with only limited success. "How can you help someone who won't even admit what his problem is?" Rob asked.

Traditional interventions helpful

Pumphrey said that in some cases traditional intervention techniques are helpful in getting the addict to admit to a problem. The Lambda Center offers advice to families and friends about the intervention process, but does not facilitate such meetings.

LaFleur, who has assisted in a number of interventions, said they are effective but that a professional should facilitate them.

In the workshops, the friends and family members discuss the intervention and how to stay focused when they eventually confront the addict. When everyone is comfortable, someone will invite the addict to a safe place, usually a home, where the professional and other friends and family members are waiting. The key players in a person's life then discuss the impact of the addict's behavior on their lives, LaFleur said.

"The facilitator will usually say, in a non-confrontational way, 'Look, your friends and family are concerned with what's going on in your life, and I'd like you to listen to them,'" LaFleur said. "And each person in the room starts off and says, 'Over the last several months you've done this to me and this is how it felt. If this continues to happen then this will happen to our relationship.' The addict usually wants to jump in and interject but the facilitator urges them to simply listen."

LaFleur said that the addict usually breaks down and agrees to get help.

"The fear [for families and friends] can come back in an instant," LaFleur said. "There really is no fixed amount of time before the fear abates. It really depends on how extensive the damage caused by the addict is."

When the addict breaks down, admits his problem and acknowledges that needing treatment, Pumphrey said that it is critical to get the addict immediately into treatment and minimize the "question time" for the abuser.

Crystal meth is a unique type of addiction with a stigma attached to it that makes it difficult for the addict to confess the abuse to a loved one. LaFleur said that in many cases the addict suffers a relapse.

"The families need to understand that [relapse] is likely and they need to support the addict," LaFleur said. "The families generally live in fear."

Pumphrey added that loved ones falsely assume that if they can get the addict into treatment, then their job is finished. But Pumphrey noted that a hospital can only provide a 48-hour physical de-tox treatment. The patient, friends and family members are left to deal with the many emotional side effects of the drug that include depression and paranoia.

LaFleur urged families and friends to seek professional help for the addict in their lives, whether from an addiction counselor, social worker or experienced clergy.

Coping with manipulation

Another problem that friends and family members face are the emotional manipulations the addict frequently practices with loved ones.

"[Addicts] will be crying one day asking for help and it feels genuine, but the next day they will want to use again," Wheeler said. "Friends can feel manipulated by that. You want to help but today they want to go use again."

La Fleur said that the addict's manipulation tactics can be one of the hardest things for friends and families to deal with.

"You must be stern and not feel guilty about it. 'No, I will not give you money.' The addict has a great way of making them feel guilty about it."

Once the recovery process is underway, it's important for loved ones to understand that there are no quick fixes to addiction.

"I usually tell the family that the addict must put a lot of time and energy into recovery, like the time they put into drug use," LaFleur said. "For the first one to five years, the addict is really into recovery mode. I also encourage the family members to go to Alanon-type meetings so they can understand what the recovery process is all about - highs and lows, just like any normal relationship."

To rebuild trust between the addict and his loved ones, Wheeler suggests that sometimes a "written contract" helps those eager to repair the damage that has been wrought.

"The addict usually agrees to a number of meetings they will attend and other things that help re-establish trust between, say, their partner," Wheeler said.

Gay complications

There are certain complications involved in recovery that are unique to gay addicts. Often, the gay addict will censor the details of his or her addiction for family members. While a parent might know that their son or daughter is gay, they might not know that they regularly attend circuit parties, Pumphrey said.

"Most families are very accepting of their son's sexuality but don't know if they use drugs," Pumphrey said. "They often say, 'Why would he? He's a professional.'"

And frequently it is difficult for the gay addict to tell parents of the crystal abuse. Some addicts have said that it was difficult for them to come out to parents and that acknowledging a drug addiction is to admit to another "character defect."

"There's a certain amount of homo-negativity going on that impacts the addict," Pumphrey said. "Many will say, 'Well, if I'm going to be gay, I have to be the best gay person in the world.' Saying that they have an addiction means that they are not good. It's all a part of the vicious cycle of abuse."

Fearing rock bottom

Jackie remains frustrated with her nephew's drug abuse. She worries what his rock bottom will be and wonders if he will ever discuss his addiction with her.

"I don't care if he is HIV-positive," Jackie said. "I care about the drugs he's abusing. HIV is not a death sentence anymore and I wish he would see that and stop using the crystal. In my heart, I know I've done the best for him but to come to the conclusion that you can't talk about this, its very hard. I don't want him to take me down with him."

Rob said the problem is spreading. "First it was my friend, the lawyer. Now I see the beginning signs in another friend, and I see guys out on the scene who are all over the map. And when you talk to these guys, they will say it's under control; they don't see the problem. But when you talk to their non-using friends and boyfriends, you get the rest of the story."

Next week: The series concludes with a look at treatment options and recovery from crystal meth addiction.

031003
WB031003

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 2003. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .