In Craig Sloane's session on gay men and crystal meth, one message was clear: Gay sex isn't the problem. The problem is the context in which gay men have sex while using crystal meth.
Sloane, LCSW, is a clinical social worker in a private practice in New York City. He is also a member of NALGAP, the Association of Lesbian, Gay, Bisexual, Transgender Addiction Professionals and Their Allies, and was a speaker at this year's National Conference on Addiction Disorders in Anaheim, Calif.
To understand why gay men use crystal meth, we have to understand gay men, Sloane said. Many start using to combat the stigma associated with being gay. Some use it to increase confidence. The way some straight people view gay sex as sinful and that it should be done in dark secret places is shameful to gays, Sloane said.
Heavy usage of meth among gays started back in the 1970s and rocketed into what experts were calling an epidemic by the 1990s.
"In the 90s and early 2000s, meth became the most used illicit drug among urban gay and bisexual men," Sloane said. "Crystal meth is harder to control than other abused drugs because of its pharmacology."
When used, crystal meth causes the user's brain to produce abnormally high levels of dopamine. Users experience increased energy, prolonged sexual performance and supressed appetite. It also causes intense sexual desire which can lead to sexually risky behaviors.
"The neurological effects of meth are a sense of power, inflated confidence, hypersexuality and it neutralizes negative feelings," Sloane said. "So once they use, those feelings of shame and guilt go away. But they also use unsafe sex practices which could lead to HIV."
Sloane added that the Internet is the single most influencing factor into how gay men have sex and do drugs. It also plays a prominent role in relapse.
Gay men use the internet to put personal ads on Craigslist asking to "PNP," party and play. If men place ads using words like "parTy," the capital T symbolizes that they want to also use crystal meth.
Gay men also use websites to find random hook-ups in their areas.
"The problem with treating gay men who want to stop using meth or who want to use it less is that they're afraid sex will never be as good as when they're on the drug," Sloane said. "And that's true. It's never going to be as intense as when they used."
So how do you treat someone who wants to quit?
"By using gay affirmative treatment," Sloane said. "Promote self acceptance, create safe and non-judgemental environments. We have to set up treatments that don't pathologize gay sex."
In treatment centers, group sessions have a profound effect on users because they aren't used to being in a room with other men who all have their clothes on, Sloane added.
"Not all crystal meth users are sex addicts, some may have mental disorders," Sloane said. "Psychoeducation is so important with this drug because of disempowerment of gay men taking place within our culture."