What's Important to Consider in Talking About Meth

Why it can be difficult for gay men to talk about their meth use.

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KEY POINTS

• Crystal meth use among gay and bisexual men is above the general population, yet remains a silent epidemic.

• The word "meth" itself can be stigmatizing, preventing clients from talking about their use.

• We're allowed to question our relationship with substances long before it ever becomes a problem.

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When a client of mine brought up his meth use, what I started to notice was that he seemed to avoid saying the word “meth.”

It was confusing at first, because he'd talk about “acting out,” but I'd have a hard time deciphering whether he meant sexual behavior or meth use.

Whenever I would use the word to help clarify what he was saying, his affect would subtly change.

I reflected it to him and he said that if I've noticed he's uncomfortable using the word, I'm right. He is.

He started to tell me how common it is in his industry and in many industries. He's successful and high functioning, but uses meth about once per month.

He's only bringing it up now in therapy because it's starting to become ego-dystonic. He's recognizing that while his use is only once per month and he doesn't view it as compulsive or an addiction, meth keeps him from experiencing vulnerability and intimacy in his connections with other gay men.

Meth use among gay and bisexual men is documented as rising and is a silent epidemic among the gay community today.

Crystal meth prevalence among men who have sex with men has been estimated between 15% and 23% across studies in Europe, Canada, and the US, far above the general population.

When it comes to substance use, of any kind, there are many ways to change our relationship to it, and clients’ goals may vary, but there are common factors that contribute to why we drink and use.

Whenever I hear someone recognize that their substance use is starting to cause negative consequences, yet they have difficulty making any change, what I hear is that the pain they have outweighs the negative consequences.

Shame on top of shame is just more shame and so for many gay men, we might drink or use drugs to numb the shame, conscious or unconscious, and then we feel even more shame because we don’t like where the drinking or drug use leads—blacking out, avoiding intimacy, risky sexual behavior, feeling shame about sex, the list goes on.

I meet many gay men who feel unsure about their relationship with drugs and alcohol, but think they have to wait until something dramatic happens before changing anything. That isn’t true. We’re allowed to question our relationship with drinking or using drugs long before it becomes a problem. We’re also allowed to want a different relationship with ourselves without substances.

I want to invite clinicians, or anyone reading this post, to take a client-centered approach in meeting someone where they’re at. For instance, my client helped me understand that sometimes, the very word for the substance can evoke feelings of shame. My client told me the word carries so much stigma, even among other gay men, that for him to say it out loud sometimes causes him to shut down.

I was grateful for what our work together taught me. So that my client could feel safe enough to even explore his meth use, we took the words meth, addiction, and abstinence off the table for now.

If you're sober-curious yourself, or thinking about cutting back—or quitting altogether—here are three things that helped me:

• Understand what the substance is doing for you. There’s a reason you drink or use, so what is it giving you?

• Explore your relationship with it the way you would with a person. Does it support you, or does it lead you into choices you wouldn’t otherwise make and later regret?

• Ask what story you're telling yourself about why you drink or use—like, do you tell yourself you’re more confident with it?

These questions helped me understand that, just like anything in our life, we have a relationship with substances. Unless we stop to question our relationships, though, we’ll sometimes stay in one longer than we want to.

My own journey of sobriety and learning that I don’t ever have to feel hungover again set me on the path to where I am today—a therapist and advocate for gay men’s mental and spiritual health.

I’ve lived both sides of the story and I know how unfamiliar it can feel to turn inward when we’ve spent so long looking outward. I also know how liberating it can be to tell the truth.

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Chris Tompkins is a gay male therapist in West Hollywood (Los Angeles) who specializes in working with adult gay men, individuals and couples. He supports clients navigating identity, relationships, religious trauma, addiction, and self-esteem. To learn more, explore therapeutic services or schedule a free consultation.