David Fawcett and Mark King : Men and Meth

guymHIV Endgame 3

David Fawcett PhD, LCSW, CEO, Healing Path

Mark S. King, Blogger, Author, and HIV/AIDS Advocate

Men and Meth

A growing number of gay men are using crystal meth for sex. What’s the impact on their health and lives? What are the challenges of dealing with a meth addiction? What about treatments?

Descriptive Transcript

So thank you very much. I’m David Fossett. I’m a therapist and sex therapist in Fort Lauderdale Florida, and wrote a book called “Lust, Men and Meth” that came out a couple years ago. And based on about 20 years of clinical work, as a sex therapist trying to help guys move past some of the entanglement of sex and meth that that happens with chronic use of that drug, which interferes with with recovery. And my very good friend Mark King is going to be joining me, and we’re gonna kind of be going back and forth, from clinician to first-person kinds of activities.

So let’s start our journey. Those are the two books that we bring to the table. Mark has a book himself, called “A Place Like This”, exactly. So, the introduction. We’re seeing this really chronic epidemic of crystal meth I think. Over the years drugs have kind of come and gone in waves. In the states at least, because of some well intended federal legislation in 2005 to limit the amount of pseudoephedrine which is the kind of the precursor element that one needs to create methamphetamine, supply dropped but demand did not. And so in slipped the Mexican drug cartels. And today we’re seeing much stronger, more purer meth flooding the market that’s cheaper, and that’s really driving a lot of the addictive nature we’re seeing and a lot of the psychosis we’re seeing ,and a lot of the issues were seeing. I’ll also say too, because I’ll probably forget in the course of my talk today, that what we’re also seeing in the States, and just kind of a word of warning in terms of driving the epidemic, is that the epidemic…

Traditionally we think of a meth user, as at least in the LGBT community as a gay, bi, trans person who’s white and urban, and what we’re seeing in the States is this tremendous rise of meth use. Crystal meth use in the Black and Latin Mex community. And I think we really need to be aware of that, and in the States that has merged with the HIV epidemic. So that the very high rates of new HIV that we’re seeing in the South, particularly where I live, in fact I live in Broward County which is the number one place for new infections for the last 20 years. It’s a real factor, in that. Okay so I’m gonna use the term Chem Sex. Are people familiar with that term? I think generally they are now, and in my mind Chem Sex is really the kind of ritualized use of certain kinds of drugs, usually including a stimulant, with sexual behavior. And the two go together, and the title of our talk today is Meth and Men, but we know that people really use Meth in isolation. Right, there’s other drugs that are often used in conjunction with it, probably the most common is GHB or GBL, gamma hydroxybutyrate, which is probably the more lethal of the two, although Meth can cause a lot of strokes and pulmonary hypertension and cardiac issues. GBL can cause an overdose that is pretty quick.

We’re also seeing cocaine and crack cocaine sometimes. Back in Miami, in South Florida, where I live, cocaine is king again. And so we’re seeing in fact for the first time a really dangerous trend in that cocaine, methamphetamine, and prescription amphetamines are all at peak levels at the same time. And so that really spells out a pretty dangerous epidemic. We also see ketamine, K, which we’re not seeing as much because of interdiction, although that’s starting to have some therapeutic applications which are very exciting actually. Ecstasy, amyl nitrate poppers for the uninitiated. Mephedrone is in the UK. We don’t see that so much in North America, but I always like to include it just because I like to say that the slang name is meow-meow, and I just enjoy saying that. And then we’re also having a bunch of other synthetics coming in, with kind of chemically names that are produced in labs around, coming in from Southeast Asia, coming in from all over the place, that are quite dangerous and often laced with Fentanyl or Carfentanyl.

So pretty dangerous territories. In terms the effects of Meth, most people know this, but it was described to me as putting your foot on the gas pedal of a car and just holding it down. Right, it just drives everything. Drives the body into fight-or-flight mode. So you have a lot of increased energy, decreased appetite, sleep, reaction time. In the acute or short-term phase. I mentioned the other night we did a great community meeting, but the reaction time, the clients I have they’re using meth and really think they’re on top of their game when they’re using meth, and if we actually do testing they’re not quite as reactive, quickly and test switching, as they thought they are. Chronically we have a lot of tremors, a lot of cardiac issues. Some destruction to the dopamine pathways, that’s a big part of the story, which we’re gonna get to a little bit. Psychologically in the acute term we have increases mood confidence, talkativeness, sex drive, and I just want to plant a little seed here because we’re going to talk about this as well, but if you think about long-term survivors with HIV who are aging now we know about 20 – 27 percent of people living with HIV are gonna be over the age of 50.

A huge wave, and in my experience those guys, and I’m one of them, and living with HIV for many years. People start to feel kind of less attractive, less connected, less visible in the community. So you get all the ageist issues and HIV stigma, and it all kind of compounds. And meth really provides this incredible escape for a couple hours, eight to ten hours. A client I mentioned the other night, described it as 8 hours of bulletproof happiness. He can jump out of his life and escape, and numb a lot of those feelings. So psychologically that occurs, and chronically we get a lot of depression. Again due to some of the dopamine destruction, and a lot of psychosis, and a lot of paranoia. So I’m looking at the air-conditioning vents, looking for cameras and microphones, and that’s kind of what happens in a clinical setting as well. So turn over to my friend Mark. Hi everybody. I’m Mark. I’m an addict. And I am so thrilled to be here, you know. This has been so much fun for us. I’ve never been to Toronto before. And David and I of course are both from the United States. I don’t know if you can put yourself in our mindset of what it’s like to leave the United States, and then have to answer for everything.

To the good people of Canada. And I just want to issue a blanket apology and we’ll move on. Okay, so you know I am part of the generation of the AIDS generation. Those of us living with HIV, who were studied and watched from the very beginning. The test came out in Markh of 1985. I took it and I was positive. And so I became part of that infamous generation, where we were watched the whole time. What will become of us? You know. There’s no meds how long will they live? Oh now there’s a med, there’s a CT? How long will they live? What will happen to them? Oh now there’s a whole bunch of meds and they’re living longer, but what are the side effects of those? Oh well, let’s wait and see. Let’s just keep an eye on them. You know. Oh, now that these new meds have happened they have new whole new lives. I wonder how they’ll deal with that? Well, I can answer that. For me I became a drug addict. That is how I dealt with the profound gift of a promise of a normal lifespan. It was an emotional whiplash for me. And… I’m getting ahead of myself.

Because if I look at the slide, I’m supposed to be talking before the addiction. So I will say this those are a couple of pictures of me. I did get involved in the fight as soon as I tested positive in 85, and it gave my my life meaning. It turned me from your typical vapid young gay thing to a less vapid young gay thing with a mission, and that was to help people living with HIV and to prevent the epidemic from getting worse. And so I went to work for agencies. I got arrested a few times just to earn my bona fides. And that was what life was like before. Now I’m no angel. I drank in the 70s. I did coke in the 80s. I did the dancefloor drugs in the 90s. I’m a joiner. And then in the 2000s crystal meth was introduced. And so I did not have a perfect record. Many people who turned to meth did, but for me all of those other things were you might say typical of life in the big city for a guy. It was something that I did for a while. I stopped doing it when it seemed stupid. And life went on. So that was the young man at the beginning. And there’s people like that, that had perfectly meaningful lives before this happened to them out of the blue, meth addiction. ( with no history of addiction )

First of all just say I’ve been gently making inquiries about asylum, but that’s another point. There are many people that had no history of addiction who’ve gotten caught up in the meth problem. This year I had a 70 year-old meth client. For some of those aging issues that we’re talking about. So what are some of the drivers of chem sex among MSM? Really a lot of it is just dissociation, to numb those uncomfortable feelings of shame, of stigma, we know from research that the more stigmatized identities you have the greater the risk you are for mental health disorders and addiction. Many of the clients I work, many of the guys I know, many of my friends, are not only a sexual minority but they may be an ethnic or racial minority. They may be on disability, they may be a sex worker, they may have a little health disorder, they may have addiction. Boom-boom-boom. All these layers of of stigma, that really contribute to this urge to kind of jump out of your skin. And there’s a phrase that I hear universally, and it was kind of echoed in the wording of a plenary before lunch, but basically it’s “I feel like damaged goods”.

There’s this kind of internalized shame that goes with that, and even in people who will tell you these gay guys I work with who have no sense of shame, they go to their partners place for Christmas. And they’re out at work, but if you dig a little deeper there’s there’s a lot of apprehension there. Boredom. I think these people are used to a lot of hyperarousal. They need a lot of stimulus, and boredom is a huge trigger for people. Just empty space, so I think that clinically that’s really something to be aware of. I kind of was late to the party understanding that, but that’s a huge thing. And probably the most important thing is that third one, I’ve come to believe, and that’s this search for connection. You know we have this epidemic of loneliness not only in society in general, but I think particularly in the gay community. There’s so many young gay men I see that kind of come out of really tough circumstances, jump into the community thinking they’re gonna be kind of safe. And we hear that word again this morning a lot too. About trauma and safety.

And the gay community is not a very friendly place for a lot of people, at least in the states. It’s very stratified. It’s very tribal. It’s very hierarchical. And I think a lot of people just never quite feel comfortable there. So that search for connection is something that’s really critically important, and I think a lot of guys, as a sex therapist we talk about sexual connection, emotional connection, and they say well meth gives me a connection. And I always kind of put connection in air quotes, because it’s really a chemical connection. And really not an authentic emotional connection from my point of view. And then the final thing that’s a component I think, is really embracing sex without shame. I think I have had a lot of guys use meth to celebrate their gayness. We kind of touched on this a little bit before, but I just want to underscore the point of HIV and aging, and chem sex. And the point of timing in the 90s with a convergence of certain things. I think Mark is going to talk about.

HIV status is important. That idea that I mentioned before mentioned before. Reduced sexual stamina, energy levels, the social isolation, and so on. I think is a really critical factor. Oh okay. This one. This slide. So I decided in 1996-1997 I was kind of a nerd you know. I was a pretty nerd, but I was a nerd nevertheless. You know and I never went to a gym or did any of those jockey things but what the new medications promised me was you have a life ahead of you, and why don’t you rejoin it. And the circuit party scene, was popular at that time and kind of birthed during that time, and some other things happened at that time as well. Crystal meth became a slightly more acceptable drug to be seen in your pocket in a dance club. And viagra was approved by the FDA in the United States. So we had all sorts of tools in our toolbox, as it were. And I joined a gym. I got a trainer. I took tons of steroids so that I could dance shirtless on boxes, because that was the life I thought I deserved, that was what I was entitled to.

And there’s trauma there. There’s trauma there for someone who believes that that is the answer to what he has just endured since 1985. But that’s what you should do. That’s the smart thing, and part of that of course would be my own. I bought into sex, to gay culture, lock stock and barrel. All the stuff, including the stuff that’s rather surface. I bought into it and that’s what I went for. Well what happened is then I started doing crystal meth at some of these circuit party events and then pretty soon I just skipped the circuit party events altogether because I could buy more drugs if I didn’t pay for the ticket to that place, and the drinks are expensive anyway, and who wants to drink when you’re on crystal meth, and so I stayed home or I just went directly to a sex club. Now mind you at this time I was executive director of an AIDS agency in Atlanta Georgia. That’s where my career had taken me and I was very proud of that. But within a few years I was the executive director of the AIDS agency, that was shooting up crystal meth in public sex environments, and having unprotected sex in 1997. Way before U equals U, way before it was cool. You know, and that’s that’s where it took me.

And I know that this is very specific, it seems very specific to me but because of this audience, and that so many of you are working in community-based organizations. In case you don’t know it, a lot of us were lost not just to the virus, and to AIDS, and in hospital. A lot of us were lost to addiction, because of the sheer weight of what it is we’re dealing with. We lost doctors. Prominent doctors throughout the United States, and activists to drug addiction. And I don’t think that that’s any coincidence , so I think actually my story might be a little more common than you might think. It is also true that there are young men who are 25 years old and dealing with their own minority stress, who are experimenting with meth for the first time. Their stories might be different than mine, but I think a lot of the solutions will be the same. Thanks. So I think that really just summarizes a lot of what Mark just talks about in terms of just coming into comfort zones, kind of taking ownership of one’s sexuality in one’s body and feeling hot. And some of the issues that that we see. In the interest of time I want to jump a few slides here. I want to talk a little bit about why meth is different, and why meth is particularly dangerous I believe.

Everybody’s probably familiar with how cocaine and stimulus in general block dopamine receptors. Dopamine is the big neurotransmitter that we’re talking about today. So cocaine to start, will come along a natural molecule from the coca plant, right, goes along blocks that receptor, a lot of dopamine flows into the the synapse, there’s a burst of good feelings and then it rolls off the receptor. And after about 10 or 15 minutes, things return to normal. That’s the process with coke. With methamphetamine a synthetic molecule much larger comes along and kind of rolls along like a baby Huey and plops down on that dopamine receptor and stays there for eight or nine or ten hours. Which is why the high is that much longer, but the brain is not meant to be able to process this molecule and doesn’t do a very good job with it, because meth does a couple other things, it flushes out the dopamine from the other half of that receptor, so it it’s very quickly creating a toal loss of dopamine, and when we don’t have dopamine we can’t regulate our moods.

We’re having severe depression, we’re impulsive, a lot of the factors that go into relapse and anhydrous sex for that matter. But the other thing and more profound perhaps in the long run, is that when it sits on that receptor its neurotoxic. Which means it’s actually destroying that dopamine receptor. So with chronic meth use people are really kind of destroying their their dopamine transport system. And I heard it equated just last week by a researcher, to basically a traumatic football head injury. That you’re kind of really destroying the ability of the brain to distribute dopamine in an effective way. Now the good news is that those can regenerate, the bad news is that it takes up to two years for those things to regenerate, and in that time people are really experiencing a lot of problems because that dopamine dysregulation. In terms of emotional issues and impulsivity, and so on. And so Mark was saying, kind of how can this head of an AIDS agency sort of get hooked on drugs, especially this particular drug so much.

And I think this tells the story. And to just talk about our reward system in our brain which really keeps us surviving as a species. Where we have natural rewards. Things like eating, collective work, being loved, being touched, to being hugged, belonging. Those all give us little shots of dopamine that make us feel good. Those are called natural rewards. Drugs come along and kind of hijack that system and start really resetting the system to require a much level higher of stimulation to get any kind of enjoyment or pleasure. So if you look at just the right relative dopamine release here of a baseline is 100 food is energy or pasta or ice cream or warm bread or whatever your this is. Particular is going to give you about 150 units, the highest natural reward we can get as human beings is an orgasm. Right, that gives us the highest level of dopamine. Let’s hear it for orgasms. There you go. And then we get into the realm of unnatural reward. So we have nicotine which is not on this graph, is about 220, much more of a little burst of reward than even an orgasm. Cocaine 350, but look at methamphetamine. That tells the story of the kind of addictive potential of the drug, in terms of this massive amount of dopamine that’s released.

I mentioned that those pathways take a while to recover. If you look at the top that’s normal control, and the dopamine levels are orange and red. That’s how it should look. If you look at the second slide there it’s meth abuser after one month of abstinence. Now this tells the tale. I think if we were to do this at 3 months it would probably look quite the same. The six months maybe some improvement. And as I said if you don’t have adequate dopamine levels you’re really dealing with a lot of, what we call anhedonia, the inability to experience pleasure. A lot of impulsivity, a lot of depression, a lot of hopelessness a lot of suicidality. People know the expression suicide Tuesdays. Okay. So in the States at least your typical weekend warrior starts using meth maybe Thursday night. Misses work Friday, by Saturday’s having a great time, Sunday putting on the brakes. You know Monday, trying to crawl back to work. And Tuesday or suicide Tuesdays. And that is reflective of the dopamine is gone and people are hopelessly depressed at that time. And they kind of stagger back. You should totally get horny again, and then the cycle starts again.

So I did want to talk about the intersection of HIV and meth, particularly briefly we course we know that meth use creates a high risk for acquiring the virus, but I think it’s also important to note there is some potential drug interaction between methamphetamine and and protease inhibitors or boosters, like Norvir or Cobicistat, that we see in a lot of the multiple drugs now. And that simply is that the role of those boosters is to slow down the metabolism through through certain liver enzyme, and keep the other levels of the HIV drugs at a higher level in the bloodstream. Unfortunately methamphetamine is processed by that same enzyme. And so if you’re on a protease inhibitor it can actually increase the amount of meth in your blood level to sort of dangerous proportions there are more dangerous than you would think based on your intake. Okay, I couldn’t help but notice David that you flew past the slide of me when I looked hot. I don’t know if you noticed it, but if you blink you missed it. But I was… Oh thank you. Okay thank you very much. Okay, and there’s no legitimate reason for that slide probably anyway. Other than those were my circuit party years, it felt relevant, and if you looked closely at the eyes of the young man in that picture, they were shipwrecked. They were not a man who was having a good time. At any rate, so the the wreckage continues.

I stopped going to those circuits parties. I stopped going to clubs, except the sex clubs. I go to the sex clubs right away and don’t bother going to the dance beforehand. Then I couldn’t really go to the sex clubs anymore, because it was hard to do drugs is intensely as I did in a fixed club. And so I just stayed home. And it was me and the computer and the apps and porn. And that was life. And then there was no more job at that point either. That first picture I’m showing you because a lot of people thought that I had AIDS wasting, and that’s what I said it was. Oh yeah, as a matter of fact, before I left the job, when things were bad, my excuse was I’m sick, it’s the HIV. Here’s a person that devoted their their adult life to helping people with HIV, who takes the very thing that means the most to him and he twists it around, so that he can protect the addiction. That’s what we do. I make it sound really dramatic, but the fact is this that’s what we do. I apologize if I’m using language that is not politically correct for you. I refer to myself as an addict because that’s what I believe I am, and I’m fine with that. Because I pay attention after that. But you may have other language and I respect that as well.

So yeah, that was the result of a few years of using. And then of course there’s my mugshot from February 27th of 2008, that was picked up for a possession charge. Stupid guy, high on meth drives right into a police barricade, where they’re stopping people that might be drunk drivers, you know they’re checking licenses and stuff. I thought oh it’s an accident. All those lights. It’s an accident, and so I drive around him into a barricade and they’re like “you”. So that did not stop me. It got my attention, but I didn’t have the tools. I didn’t have the tools to understand what was really going on with my addiction. And by the way you know I’ve written about living with HIV for 30 years. This is pretty new for me to talk about my addiction. Only now after 6 years, 8 months and 17 days of recovery do I feel more comfortable talking about what happened to me, because it just seemed more precious, and more delicate, and fragile. And so I treat it with great respect, but now it feels more important for us to have this conversation. So that was the low.

It gets better. So on the on the way to get better I just want to sort of slow down a bit and talk about this phenomena, this meth sex fusion, that happens largely I think, as a product of dopamine, which is a kind of a bonding agent. There’s an expression in neurology that what fires together wires together. And then we have this phenomenon of people engaging in sex acts in the intoxicated state, and over time the brain starts to undifferentiate those things, and this has implications for recovery, because someone wants to give up the drug because. Oftentimes if they stop using crystal meth their sexual desire totally goes away. They’ve reset their desire levels so high that it really interferes with that. And so a hot guy will trigger a drug thought, and a drug thought will trigger a sex thought, and it kind of goes back and forth. That really is a big difficult thing to untangle. One of the things we know about dopamine, I say it has kind of a short shelf life, which means that if something is attractive, something gets me off today. If I keep doing that pretty soon it’s not gonna do it anymore. I need to escalate. I need to up the ante get more stimulation. That occurs sometimes with more drugs. People do some stacking of drugs.

Like you’re taking multiple combinations of drugs. Oftentimes with meth it increases the sexual activity so people get into more taboo stuff. Into rougher stuff, and to whatever that means, kinkier stuff. Just to get that level of stimulation. And that is one of the destructive aspects. That often I think results in really just PTSD for a lot of the clients. They can’t believe some of the things they’ve done in that state and it’s really reinforced through fantasy and porn, and other things. So that becomes a problem for people. So hitting bottom, ironically. Stimulants decrease the ability to have an erection. So that’s God’s little joke that people have to deal with. Everything becomes secondary to that chem sex piece, and ironically, and I think Mark kind of illustrated this too, you start to feel more and more isolated despite all your attempts to do that. There is an issue with increased partner objectification, which is a mouthful but what that simply means I think is that we start to see our partners as objects. And I think meth is such a head trip, at least with the clients I’ve worked with, talking about that connection they’re having, really that they’re having sex with a body who is kind of a prop in the fantasy that’s playing out in their head. Right.

I think it’s not really an interaction, an emotional connection that I would think would be healthy and authentic, and there’s a lot of decreased empathy. And I won’t talk about that too much in the interest of time, but we’ve had some studies in the States where a lot of child abuse, especially in the Midwest where meth is chronic in the heterosexual population, is related to meth use. So the road to recovery, by the way, see it goes can up and down, and again my clinical experience has been basically people who have have really bottomed out, and are seeking treatment and recovery in abstinence based modality. I totally recognize and value harm reduction as well. And for me, many times I have a client who will come in who doesn’t want to hear about abstinence. Right there on that. I know David’s gonna talk a little bit more about stages of change, but we really have to tailor our intervention to the proper level that the client is at. And if that means harm reduction for awhile, that’s perfectly fine with me. We know that the biggest factor in healing is retention. Keep them coming back.

As we hear in the 12-step program. I think unlike some addictions where you’ll say the addiction has to be treated first, before anything else, before any other behavioral issues, or mental health issues. I use the term sex addiction here, and I don’t know to wade in the political weeds of terminology, but but hyper sexual activity, I think that co-occurs with meth addiction in a way that we have to address those two things simultaneously. One as I mentioned triggers the other. They’re totally fused and bonded, and if we don’t do that, we’re missing out. …Ditto, I did all that stuff. Okay. So some of the implications for this. One, take a break from sex. Right. I think oftentimes, if people give up stimulants after problematic use, they’re not feeling sexual anyway. And, so I think it’s not a bad idea to use that window of opportunity to put sex on the shelf and deal with your triggers, with your thoughts, your feelings. Learn how to feel again, and wait to get in touch with your emotions, and so really get to take a break from sex. I think really to believe that time will heal, there’s a kind of predominant myth out there in the community that recovery from meth is kind of impossible, and that’s certainly not the case.

One of the most moving events I do, and I do roundups or different conventions of people who are not using meth anymore is just standing up in 10 years, 15 years, 20 years free. 6 years, 7 months, and 17 days. That’s an amazing thing. And that brain as I mentioned needs a chance to recover. I’m going to do this slide, and then I’m gonna to bring you back. So one of the other mistakes when people have this an ongoing problem recovering their sexuality or even staying clean if that’s their clinical goal, is to really avoid habits that will keep meth mode alive. Right. In addictions we have bargaining. I think a lot of guys at first want to sort of have that wonderful “meth sex” without the meth. You know have all the stimulation and issues without the meth. First of all, I think we’ll really examine their sexual behavior, it wasn’t so great. And I think Mark can give a few examples of that. Often times people are isolated and they’re just not in that space. I recommend people giving up alcohol. And I know I’ve had a lot of clients who resist that, who will basically say you know stimulants are my problem I can’t have a beer with my buddies? And in my experience often times having a beer with your buddies leads to a lowering of your resistance to meth use, and suddenly they’re out partying with their buddies. Get rid of all sexual apps and online hookup accounts, and I know there’s younger guys in the audience.

I don’t see any jaws dropping yet, but life is possible without apps on your phone. We did it for many years. In treatment I’ve actually thought about trying to do a some kind of course on good old-fashioned cruising. You know when we used to kind of make eye contact, and do the old look, those are the good old days, but but I think those apps are really part and parcel with this whole meth phenomenon. The party and play. You can get online and hook up with drugs and sex incredibly easily, and those are just triggering. I don’t have a slide, and I don’t know where I was at the time, but with methamphetamine visual memory goes up. So people become highly sensitized to visual stimulation. Right. So if they see pictures, if they see videos. Porn. If they see a hot guy all that can sort of trigger that meth use. And by the way we know that if this is true for addictions, but particularly true with methamphetamine. If people start to think about using, their brain starts to act as if they’ve already ingested the drug. Right.

A little kind of drooling phenomenon, and we and that’s a problem with apps because they pick it up and their brain starts to go there. And the longer they kind of linger in that space, the more inevitable it is that they’re gonna actually pick up and use the drug. Change phone number contact info in comments and stuff. Right. Avoid impulsive behaviors. I suggest people avoid hookup behaviors, even if there’s no drugs involved. And make a date. Which is probably the most terrifying thing I asked my clients to do. And that can be a coffee date. You know, and my friend Rob Weiss talks about arriving in two cars. Feet on the floor thirty minutes of conversation and leave in two cars. That’s it. And that could be pretty terrifying for people who haven’t been used to being vulnerable in that space. So things were really bad. I ended up in rehab, and I had to figure things out. And take responsibility for that which I had done.

And I try to reclaim a life for myself. A real one. And it was hard. And although I experienced all of those challenges that he talked about, including all the sexual stuff. I will not, you know, waste your time with my every erection. I will just say that there was a lot of “oh but I’m just horny”. Well no. I want the drug, and I just won’t admit it. I had a lot of relapse. And that was fairly common in my fellowship community. But sooner or later, if people stick with it, my experience has been that they figure it out. And they see that it’s an all-encompassing thing. Addiction is all-encompassing. It changes the way that I feel as a human being towards you. Everything is transactional. Everything is open for manipulation. Everything is about how can I lie to protect this thing, about which you don’t know. And so it affects everything. So fortunately, one day, after one day, things got better.

And that is a message that I want to say with David, that is actually possible. Yes there is a lot of relapse, especially among drug addiction. There certainly is. Those who stick with it tend to eventually figure it out. Though that is also true, and for me I figured it out when I had had a length of clean time and had resumed my career. This time doing “My Fabulous Disease”. Be sure to see me at MyFabulousDisease.com, bookmark it. And working on my contribution to our community in that way, and then met this guy at a International AIDS Conference in 2012, who was sort of cute. And it turns out that I was able to treat him as a human being. It’s like suddenly something clicked, and I was able to ask him what he was doing, and care about somebody else, which I had not demonstrated in a really long time in an intimate relationship. I was able to have sex with him without thinking of meth to get me off.

Which had been a real problem, because I was now dealing with a human being that I cared about. And that guy was so great and this whole situation was so fabulous that I married him, and we’ve been married for a few years. Yes, you may applaud. And I take that relationship because of the intimacy of it. And the fact that it takes work and truthfulness. And those were qualities I not had for a long time. Thanks. So we just have a few minutes left. This gets into more depth about negative self talk and empathy. There’s a really interesting study on empathy, and we haven’t done a lot of work with that in the field in general, but chronic meth users have a difficult time distinguishing facial expressions on other people. It really interrupts our mirror neurons and other kinds of effects. The default is paranoia or hostility, so I think that’s really important to consider. There was some life altering point that I thought of when Mark is speaking. Now it’s gone. I’m sorry. I will come back. We have by the way a conversation after this, so a lot more discussion is possible.

I just wanted to mention because there are a lot of providers in the room, in my experience, especially dealing with with gay men, with bi men, with trans men. And by the way the highest risk group is trans females. Who oftentimes engages sex work, a really high risk and unrecognized group, and untreated group. Owning your identity, as Mark illustrated really well, without the drug use, is really like a second coming out. And I think we have to kind of gently treat our clients to help them through that process. Right. They’re really dealing with stuff that probably would have been dealt with at 12, or 15, or 20 years old. But drugs interrupted that process. So I think we really have to honor that. And the other point I want to make, a little bit out of sequence, but and it’s important, is that we have to really honor our clients. If they’re going to be abstinent and want to be abstinent, to grieve that. To grieve that in that sex. To grieve the fantasy of what it was, not necessarily the reality and that’s really the therapeutic part, is to kind of help us connect what was it actually like, not what your kind of euphoric recall tells you it was like.

So with that we’ll go to the most important slide of the event. This is the second most important. That’s my book and that’s a video that Mark was in, and now… Wait for it. Tell me about this, for those of you who may not be familiar with that documentary it’s called “Meth”. You can see it on YouTube. It was made in 2008, the director is Todd Ahlberg. It is specifically about gay men, gay white men and crystal meth. It’s extremely triggering. There is explicit drug use throughout. I do not recommend it to anyone who is struggling in recovery. However, if you are a provider and want it for educational purposes, or you’re wondering if you have a meth problem, then it is an excellent film to see. Okay. I’ll just say I’m grateful Mark wrote a foreword to my book. Actually it was a nice gift. So and this is probably the most important thing. That engagement photo. I’m the one proposing. That’s me. Okay. And that’s our contact information. Thank you very much. [Applause]