Since the onset of AIDS, increased concerns about maintaining one's health has contributed to many gay men beginning to reevaluate their use of "recreational" chemicals. The direct link between use of large quantities of alcohol and/or illicit chemicals and immune impairment has been undeniably proven. Thus for all people, but especially any person living with HIV or AIDS, use of recreational chemicals should be a serious concern. Although statistics on the prevalence of chemical dependency in the gay community are imprecise, studies since 1973 have consistently found that approximately one third of the lesbians and gay men surveyed by different studies at various locations all around the United States reported being chemically dependent. One study conducted in San Francisco in 1988 by Stall and Wiley found that the frequency and variety of drugs used by gay men is greater than that of heterosexual men.
While alcohol and drug use has always been fashionable for many gay people the recent increase in "circuit parties" is one venue where wide spread drug use is accepted as a norm. Last summer the druggy nature of circuit parties was publicized by the public controversy generated in both the gay and mainstream press when the appropriateness of GMHC sponsoring a fund raising event where drugs were widely used was questioned. The fact remains that the taking of drugs is widespread and socially sanctioned within certain parts of the national gay community.
As a psychotherapist I work with many gay men who are dependent upon some type of drug. In general, substance abuse has not been the reason these men have given for seeking therapy. Only after careful questioning does it usually become apparent that the individual's life style use of alcohol and/or other drugs is interfering with his life. For the purposes of this article, the term "chemical" refers to both alcohol and drugs.
Webster's defines a drug as "a chemical substance administered to prevent or cure disease or enhance physical or mental welfare...a substance affecting the structure or function of the body or mind." Attitudes towards the word "drug" can vary, depending on whether the drug under discussion is penicillin, prescribed to cure an infection, protease inhibitors to curb HIV replication, or whether it's alcohol, Valium, Ecstacy, Special K, Cocaine or Heroin.
Recreational and 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. Who determines how much is infrequent or modest usage? There is certainly a world of difference between wine with dinner and alcoholism.
Another aspect of the question is polydrug use. A 1988 study found that gay men not only used drugs more often but used a greater variety of drugs than did heterosexual men. Many gay men who regularly party describe dropping some kind of illicit stimulant drug (Ecstacy and Special K are the current favorites) before they go dancing. If they are not sufficiently off in a couple of hours, they do another dose, snort cocaine or amphetamine, smoke marijuana and perhaps have a few beers or hard liquor drinks in order to keep dancing until the party is over or the club closes. Some sort of sedative or tranquilizer is taken before departing the club in order to come down and perhaps catch a few hours of sleep prior to returning to work.
Some effects of these 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 the man feels dragged out, hung over, a bit muddled and unable to function at his normal level of performance. Other more insidious effects are far from clear. Regular polydrug use is a serious problem for many gay men. Aside from individuals already in recovery themselves from drug abuse, AIDS prevention, mental health and substance abuse professionals, few people within the gay community care to discuss this issue.
Drug abuse fits into one of two categories. An individual either disregards the specific instructions that a physician has written for a prescription, or has increased his use of recreational drugs to the extent that normal functioning becomes impaired. This interference can emerge in any one of a variety of areas: work, family, social, emotional, physical or sexual. One certain indication that drugs or drinking has entered the abuse phase is if the individual experiences "blackouts." A blackout means that the person is unable to remember any details of what was said or done during the time they were under the influence of the substance in question.
Drug dependence occurs when someone has come to rely upon a substance in order to function normally. 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.
An individual is addicted when the body has built up a tolerance for a specific drug, and withdrawl symptoms are experienced if the individual suddenly stops 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.
Crack cocaine is one example of how an individual's curiosity about trying a powerful intoxicant can lead to a serious drug problem quickly. The high produced when crack is smoked is described as being one of the most seductive and intense drug experiences, though it only lasts less than twenty minutes. I have worked with individuals who report that within a couple of weeks of first trying crack, they were so taken with it that they became addicted before they realized what had happened.
Some people believe that if a drug is prescribed by their physician, it is safe. Most of the time this is true providing the patient takes the drug exactly as it has been prescribed. Even then, some people become unwittingly addicted to prescription pain killers, tranquilizers or sedatives following medical treatment. During the 1960s and early 1970s, before controls on certain prescription drugs were tightened, it was not uncommon to find physicians who routinely prescribed such recreational drugs as amyl nitrate (poppers), and quaaludes.
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.
In the 1970s, in the hey day of the large discos the drugs of choice were marijuana, MDA, MDM, Cocaine, various halucinogenic drugs like Mescaline or LSD, any variety of amphetamine, Ethyl Chloride and Amyl Nitrate (poppers). Today the drugs are often different with Ecstacy and Special K being the current favorites, along with marijuana, Cocaine and crack cocaine. The issue is not which drugs are consumed, but the fact that chemicals are regularly and seemingly casually taken without any awareness of the possible negative ramifications of using them. While today's younger set of party boys do not use poppers and Ethyl Chloride as frequently as did the dancing men of the 1970s and early 1980s, if you look around the dance floors of today's clubs, you will see men who are now noticeably older than the majority of revelers on the dance floor still doing poppers and Ethyl.
The current trend for many gay men to have a well developed, gym toned body has produced an additional arena where drugs are used and abused. For many years professional body builders would routinely use anabolic steroids to increase their muscle mass. When steroids are taken in combination with regular gym work outs the results can produce rippled, well-muscled bodies like the ones routinely seen in muscle and body building magazines. These drugs have serious side effects in addition to the increase in muscle tissue. In order for them to be taken legally, they must be prescribed by a physician, and carefully monitored. Some gay men wanting to become "muscle queens" purchase and take nonprescribed steroids illegally. There are even some gyms where these drugs are sold on the black market by employees, trainers or other men who work out at that particular gym. Taking steroids without the supervision of a physician can be dangerous, especially for immune compromised individuals. Steroids are capable of suppressing the immune system, and may cause extreme mood swings and possible determatological problems.
The guidelines I offer here are only suggestions to help you decide if your drug use has become a problem.
If you answered any of the above questions "yes," then you may in fact have a problem with alcohol and/or drugs. The more of these questions that you answered affirmatively the greater the likelihood is that your use of chemicals is negatively effecting you.. What about people 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? No one but the individual himself can honestly answer that question. After all, people take party drugs or drink because the effects usually feel good.
When should you be concerned about the frequency and variety of your drug intake? The answer is always. But at what point can you be considered chemically dependent? If you are drug dependent, what if you don't see the problem because your drug or alcohol consumption does not appear to be out of control to you? How can you determine whether you're denying that you have a drug problem? Here is a chemical use self-assessment tool for you to evaluate the impact that drugs is having on your life. Try answering these questions.
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 are most likely chemically dependent to some extent. When questions about nicotine and caffeine consumption are added to this list, most Americans would have to be classified as chemically dependent individuals.
A question that needs to be addressed by all members of the gay community is why so many people need drugs to be able to relax and have a good time. The high incidence of alcoholism and drug abuse within the lesbian and gay community is probably related to the repressiveness of the highly homophobic society we live in. Until the past two decades bars were practically the only safe places for gay people to meet and socialize. Pervasive homophobia and the resulting internalized bad feelings is another reason why so many of us choose to anesthesize ourselves so often with such a variety of chemicals. The results can be tragic, including accidental death from an overdose.
Societal homophobia is impossible to ignore or escape, and the degree to which an individual can withstand his experience of the pervasive homophobia is directly related to that individual's sense of self worth. I often hear men discussing their fear of approaching someone in a bar, club or gym in order to ask them out, or even to make eye contact or smile at another man. My assessment is that so much of the obnoxious, but ever present "Attitude" that abounds within our community is really a self defensive posture meant to protect a truly insecure man. The multiple ways we intimidate each other needs to be looked at and ameliorated. It is important to remember too, that these fears and anxieties are often experienced by some of the most attractive, successful and well built of men. It is not uncommon to hear men say: "Only after I have a drink or two, or if I am high, am I able to go over and begin to chat up someone I find hot."
Many people use drugs to mask feelings of anxiety and insecurity, not only about approaching people, but about how they are perceived by others on many levels. Over the past twenty five years, alternatives to meeting other gay people only in the highly charged sexual arenas have developed and blossomed. Gay professional, social, political, religious and athletic organizations all provide places for gay people to meet others with similar interests and to participate in activities that are not primarily sexual, and where alcohol or drug consumption are minimal.
A typical weekend for many gay men goes something like this. Early Friday evening, there is a dinner with friends or a date where alcohol and marijuana is consumed. The later part of the night is spent in the bars or at home "doing the deed,"continuing to drink, or take some other substance. Still later, if one has not met "Mr. Right" the evening continues at one of the after hours sex or dance clubs where even more chemicals are consumed. After waking up on Saturday there will be an obligatory visit to the gym for a work out. If time allows perhaps there will be a nap. If people are going to go to one of the late night dance clubs, they often gather at a friend's house for a pre-club cocktail party where communal drug taking is de rigeur. Once at the club, alcohol and more drugs may or may not be consumed. Early Sunday morning one returns home to either play with a new found friend or sleep. If due to the consumption of stimulant drugs, sleep does not come easily, then perhaps a sedative will be taken to knock the person out. Sunday afternoon may or may not be spent with friends at brunch where more cocktails are consumed, and the evening winds down in one of the bars or bath houses.
If this combination of events and drugs seems exaggerated to you than either you are not what is commonly referred to as "a circuit queen," or you don't use drugs heavily in order to party. For large numbers of gay men, the above is a fairly routine weekend. The combination of chemicals and socializing is regularly experienced by gay men in large urban centers.
If you're not sure whether or not you can enjoy the bar, club, dinner, baths, party or sex without some kind of artificial stimulant, perhaps it is time for you to try doing anything you would regularly do, but without the drugs. If you don't enjoy yourself as much, perhaps it would be in your best interest to ask yourself why that might be?
The first thing to do is to try dealing with the problem directly. This means cutting down or stopping your consumption of alcohol and recreational chemicals on your own. If you're concerned about your use of a specific drug, try stopping taking this substance entirely and without substituting anything else. Another way to assess whether you feel you have a drug or alcohol problem is to set a limit for yourself and see if you can stick to that predetermined amount. For instance, you decide that you will have only three drinks, whether they be wine, alcohol or something stronger in any given day. Having one or two the day before does not mean that you can now have four or five in order to consume your quota. If you are unable to stick to a self imposed limit, you probably have a problem. A patient of mine who is in recovery for alcoholism explained that after dinner with a friend he noticed that the friend was leaving a glass of wine, largely untouched. "If that had been me when I was drinking I would not have been able to have left that table without finishing off every drop of my own drink, and very possible everyone else's as well!"
If you are using drugs, before stopping any drug suddenly, it is important to consult with your doctor and ask him or her whether it is safe for you to stop any particular drug without medical supervision. For example, full blown addiction to alcohol, barbiturates, and a variety of tranquilizers should never be stopped "cold turkey." Usually detoxification occurs in a hospital. Heroin, Demarol and the other opiates can be stopped cold turkey and do not require in-hospital detoxification. Suddenly stopping these drugs can be quite an unnerving experience and usually results in the individual becoming quite ill, but not to a life threatening extent. Detoxification from opiates is therefore most comfortably and safely accomplished in a medical facility specifically geared to this procedure. If you are not certain about what you require in order to get help for your problem with either drugs or alcoholism try calling either the Smithers Alcoholism and Treatment Center at 212 523-6491 or the Greenwich House Counseling Center at 212 691-2900. Either of these agencies will be able to set up an appointment for you where a complete assessment of what is the best way to begin dealing with your problem will be formulated, and suggestions offered for how best to proceed in order to begin to obtain help.
Issues of substance abuse are routinely dealt with during the course of psychotherapy. Not all therapists are trained to or are experienced in working with the unique needs of alcoholics and other chemically dependent individuals. If you are thinking of beginning counseling or therapy to get help with a drug or alcohol problem be sure to inquire from the prospective therapist whether he or she has worked with large numbers of other people around this problem. A therapist skilled in the area of substance abuse can be very helpful in deciding which course of treatment seems most appropriate. In addition, ask him or her if they routinely refer chemically dependent people to one of the twelve step programs like AA, NA or CA. 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.
Joining gay AA (Alcoholics Anonymous), NA (Narcotics Anonymous), or CA (Cocaine Anonymous has been a life saving step for tens of thousands of gay alcoholics and drug addicts. These are organizations of people who are themselves recovering from addiction to one or more substances. They provide support for people who are at any stage of identifying the nature of their drug or drinking problem. There are now special interest meetings for people living with HIV/AIDS and 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, the Alcoholism Council Fellowship Center of New York Hotline (212 979-1010), or the 24 hour Alcohol Abuse Action Help Line (1-800-888-9383).
The only requirement for attending one of the twelve step programs mentioned above is a desire to stop drinking or using drugs. There are now drug treatment programs where a desire to stop using is not a requirement in order to get help with looking at the impact of drugs on your life. These counseling programs are the newest and for some individuals in recovery as well as drug treatment professionals, the most controversial approach to helping people with drug and alcohol problems. The approach is called the "harm reduction model" and it began in England in the mid 1980s as a response to the spread of HIV/AIDS among people who used drugs and shared needles. Harm reduction has gained popularity both in Europe and around North America. Though originally developed to work with people who shoot up, harm reduction has now been expanded to become a method of reaching and serving a wide variety of people who use all kinds of drugs with AIDS prevention and education messages without requiring that they stop using. Needle exchange programs are one example of a harm reduction approach to working with street addicts.
Prior to the development of Harm Reduction all alcohol and drug treatment programs had complete and life long abstinence from substances as the only acceptable goal of treatment. Proponents of harm reduction believe that abstinence from drugs should not be the only objective of services to drug users because it excludes a large proportion of the people who are committed to a lifestyle of long term drug use. The SUCE (substance use counseling and education) program at GMHC is one example of a harm reduction model that offers counseling to people who want to talk about their drug use without feeling a pressure to stop. While opponents of harm reduction feel that harm reduction condones drug use, advocates of the model view it as simply a realistic way of providing needed AIDS information to people who have no desire to stop their usage, increasing their access to abstinence models if they ever want to go that route.
When I showed a draft of this article to friends, they were disturbed that they "failed" the drug
dependency questionnaire. These are successful, professional men, most of whom I would not
classify as having a serious problem with drugs. Yet they admitted that they routinely relied upon
some kind of chemical as part of their recreational patterns. At least after reading this article they
are asking themselves certain difficult questions. If we want our community to continue to
develop and grow as a healthy and vibrant entity, then we must address all threats to our health
and well being including the misuse of alcohol and drugs. Drug addiction and alcoholism have
resulted in the needless deaths of tens of thousands of gay people. These are preventable
tragedies with the correct treatment.
Key Words: Drugs, Drugs, Drugs, Drugs, substance abuse, substance abuse, substance abuse,substance abuse, chemical dependency, chemical dependency, chemical dependency, chemical dependency, chemical dependency, alcoholism, alcoholism, alcoholism, alcoholism,
Michael Shernoff, MSW is a psychotherapist and author in private practice in Manhattan. He can be reached via e mail at mshernoff@aol.com or at his home page http://members.aol.com/therapysvc