The call was not a surprise since for several months he and I had been exploring his use of "recreational" drugs and alcohol. I had often told him that his descriptions made clear that the way he used and had come to rely on chemicals was causing problems.
"I would suggest that you get on the train, come back into the city and go the beginner's AA meeting that is at the Episcopal Church on 9th Avenue and 28th Street at 6:30 tonight. When you get there, walk up to whoever is running the meeting, tell him or her that this is your first meeting and could they get you an interim sponsor who will guide you through your entry into the program? Call me later and tomorrow so we can touch base." This was not some flaky individual. He was a very well educated and sophisticated computer professional. That phone call began his long hard journey to learn how live and enjoy himself free of chemicals.
Unfortunately, this man's story is all too familiar, and similar to that of scores of other men who have consulted me for psychotherapy over the years. Most studies, including a highly regarded 1988 survey in San Francisco by Ron Stall and John Wiley have found that the frequency and variety of drugs used by gay men is greater than that of heterosexual men. But, gay men are not so different than the rest of society in using either alcohol or some other drug to help them have a good time and to let off steam. For many people recreational use does not pose a major difficulty. This article is intended to help you decide for yourself whether your use of drugs has caused you to lose part of your life.
How drug use can be problematic takes a variety of forms. Take Orlando, for example. He is a thirty year old successful buyer in the woman's clothing industry. He is HIV positive though asymptomatic and in excellent health, except for chronic active Hepatitis B. Initially he told me that his drinking was moderate and happened only on weekends. But his weekend social life was based around heavy drinking. He admitted that while on a recent visit to the Westside club he had engaged in unsafe sex. It was obvious that his drinking, combined with his antiretroviral drugs, was directly contributing to his elevated liver functions, a recent relapse of Hepatitis and ultimately could result in his developing liver cancer and killing him. I told him he had a serious drinking problem. He sat stunned, disbelieving and meekly asked, "a seriousproblem with alcohol?" Orlando is a clear example of how powerful people's denial about their drug use can be.
While alcohol and drug use has always been fashionable in gay circles, the recent increase in "circuit parties" is one venue where wide spread drug use is accepted as a norm. In his recently published book Life Outside, Michelangelo Signorile explores the relationship among the circuit, drug use, and the wider gay male culture. Signorile provides numerous examples of men who describe using drugs for a variety of reasons including: increasing their energy and stamina in order to dance all night; reduce feelings of insecurity about their body not measuring up to the current standard of gay male perfection; to become more uninhibited; and to get out of their minds and escape their ordinary lives. While you may not frequent the circuit that Signorile describes, or even identify as a "party person," it is always a good idea to honestly examine how often and how much you drink or use drugs.
Let's look at the spectrum of ways people can use drugs. Recreational, nonproblematic use of drugs and alcohol is intended to enhance enjoyment of an event or occasion. The term implies infrequent and moderate usage. Can any drug be used safely without abuse, in a recreational way? No one, not even experts, seem to agree. There is certainly a world of difference between wine with dinner and alcoholism, and occasional use of pot, coke or ecstacy to party and using it all weekend every weekend.
Do you have a problem with drugs if you occasionally get very drunk or stoned? One certain indication that drugs or drinking has become problematic for you is if you experience blackouts, periods of time about which you cannot remember any details of what was said or done. The man +vacationing in the Pines called me only after he had awoken from a blackout. A very simple way of determining whether you have a problem with drugs is if your use of chemicals causes you problems in any area of your life: work, family, social, emotional, physical or sexual.
Another indication that you may have a problem with drugs is if you have become dependent upon them to function in any way. For example, a reliance upon alcohol, tranquilizers or pot can develop as a necessary part of unwinding after a hard day. It can also take the form of needing to be high in order to have fun and not become bored. It is normal and understandable that many men feel that they need a drink or joint in order to loosen up when in a bar, cruising or on a date. But if the only way you can talk with another man, or have sex, is to be high, then you are dependent upon one or more drugs, and that can lead to trouble.
An individual is addicted when the body has built up a tolerance for a specific drug, and withdrawl symptoms are experienced if you suddenly stop taking it. Tolerance for a particular drug means that increasing quantities are required to achieve the same effect. Alcohol is one of the drugs for which people quickly acquire a tolerance and eventually a possible addiction. For instance if you begin to shake if you don't have a drink for a certain amount of time, you are probably addicted to alcohol.
An example provided by Signorile illustrates the "polydrug" use of many men on "the circuit":
"In order to feel better, Walt hits the dance floor high on drugs. I'm on Ecstasy, but still maybe I take another hit. But it'll be awhile before it works, so I take a hit of poppers, and then everything is fine, wonderful, I feel like I belong. And then, in a bit my second hit of Ecstacy kicks in,, and I'm doing good for the night." But Walt's wonderful feelings are short lived. Usually he winds up home alone later and to cope with his loneliness he will spend hours on the phone sex lines, snorting amphetamines, (a stimulant drug) to stay awake. Walt told Signorile that he now uses amphetamines at work, to "get through the day."
Even if you do not use as many drugs as Walt, some effects of drugs, taken in combination with each other and with marijuana and alcohol do not become apparent until one or two days later when at work you may feel hung over, or just dragged out, a bit muddled and unable to function at your normal level of performance. I had one patient who accepted that his weekend use of chemicals was interfering with his life only after he got fired from a second job for repeatedly missing work on Mondays due to how "fucked up" he got over the weekend.
There is considerable difference of opinion about whether any nonprescribed drug can be taken safely in a recreational way. When does occasional use of marijuana, Special K, Ecstacy, acid, mescaline, ordinary cocaine or crack cocaine, a drink or one of those other numerous "vague white powders" that are sold as speed, cocaine, MDA, MDM or Heroin that so many people casually inhale, and others inject, cross the line from recreational use to abuse? There is no hard and fast answer to this question.
Most people answer questions one through seven "yes"--- of course they're able to hang out, have fun, cruise, dance and go home with someone without having to be high. The next question to ask yourself is when was the last time you chose to do any of these things without being under the influence of alcohol or some other kind of drug? If you have difficulty remembering, the last time you did any of these activities drug free, then you most likely are abusing drugs to some extent.
What about people, like Orlando, who are never high during the work week and are only rarely adversely affected by the previous night or weekend? These may also be people who take a hit of something to go out dancing. Is there anything wrong with blowing off some steam and using drugs to help shut off the mind's computer? The answer is dependent upon whether there are any ill effects to you related to your use of alcohol or drugs. But, no one but you can honestly answer whether you have a problem with drugs. After all, people take drugs or drink because the effects usually feel good, and help disinhibit people so they can do things they might be too uptight to do if they were sober. This can be good and bad..
Before stopping any drug suddenly, it is important to ask your doctor whether it is safe for you to stop without medical supervision. For example, full blown addiction to alcohol, barbiturates, and a variety of tranquilizers should never be stopped "cold turkey." It is possible to have a seizure as a result of suddenly stopping a drug that your body has grown dependent upon. Usually detoxification occurs in a hospital. Heroin, Demarol and the other opiates can be stopped cold turkey. They do not require in-hospital detoxification, though I have often heard people who "cold turkeyed" heroin say that during the process they wanted to die. A person detoxing from opiates therefore might also want to do so in a medical facility.
Issues of substance abuse are routinely dealt with during the course of psychotherapy. Not all therapists are trained or experienced in working with the unique needs of alcoholics and other chemically dependent individuals, so you should inquire about a prospective therapist's experience in helping people get off drugs. In addition, ask if the therapist routinely refers chemically dependent people to one of the twelve step programs like AA (Alcoholics Anonymous), NA (Narcotics Anonymous), or CA (Cocaine Anonymous). If this professional does not believe in the usefulness of AA or similar programs, do not begin treatment with this individual. After almost twenty years of practicing psychotherapy, I know that there is no way that I can effectively help a chemically dependent individual who refuses to go to one of these programs.
People who have been drinking or using drugs for many years very often can not even imagine stopping, or what their life would be like if they did no longer drink or drug. Very often the most difficult part of giving up alcohol or drugs is beginning the recovery process. The first step in addressing the problem is admitting to yourself that you do indeed have a problem and that you need help. The next step is finding the right kind of help.
Numerous patients of mine have told me that had I not given them the phone number of someone they could call to accompany them to their first AA meeting, they would never have gotten there. Asking for help is very hard, especially for men. But so many people in our community have gotten sober, that it is a rare gay or lesbian person in New York who does not know someone who is in "The Program,"and who would be happy to be of assistance during the difficult and trying period of beginning to face the reality of a drug or alcohol problem.
Joining gay AA, NA, or CA has been a life saving step for tens of thousands of gay alcoholics and drug addicts. These organizations are made up of people themselves recovering from addiction to one or more substances. They provide support for people at any stage of identifying the nature of their drug or drinking problem. There are now special interest meetings, ranging from people living with HIV/AIDS to men into the leather and s/m lifestyles. Information about how to locate the all gay meetings can be obtained anonymously by calling either the AA office at 212 870-3400, or the Alcoholism Council Fellowship Center of New York Hotline (212 979-1010). The only requirement for attending one of the twelve step programs mentioned above is a desire to stop drinking or using drugs.