As the author of Lust, Men and Meth: A Gay Man's Guide to Sex and Recovery, David Fawcett, Ph.D., L.C.S.W., has been speaking in cities across the United States, meeting many people affected by their own or other's meth use. He is also a person with HIV, therapist and clinical hypnotherapist in private practice in Ft. Lauderdale, Florida, who serves as the mental health and HIV expert for TheBody.com's "Ask the Experts" forum.
In Part 2 of our interview with Fawcett, we discussed how family members, hookup app users and other community members can counter the stigma that can exacerbate meth use, as well as possible next steps to harness the growing awareness of both meth use and stigma.(You can find part 1 of the interview here.)
Many friends, loved ones, care providers and community members are involved with people seeking to make changes in their meth use. What are common pitfalls that people may not even know they're doing, in terms of using stigmatizing language or a stigmatizing framework? How can family members and allies be supportive and also take care of themselves -- do what they need to do without compounding the stigma?
It's a great question. It's complicated.
One of the ways that people cope with addiction is to use a morbid humor about it and their behavior and some of the things they've done -- almost joking about it -- and having kind of a group identity based on those behaviors. One of the appeals of meth particularly is the taboo quality of it. It's actually taking that stigmatized aspect and embracing it in an unhealthy way.
That can sustain a level of stigma, just because they've incorporated that into their identity somehow in ways that they're not even conscious of; people can do it automatically. So pointing that out to them, pointing out the language, pointing out how to be conscious of words and correcting them and [encouraging them to be] in environments that are corrective is really important.
Often people continue to employ the defense of stigmatizing others as they're coming through their healing process. So we'll see a lot of stigma within the addiction community. As I mentioned [in Part 1 of the interview], alcohol users stigmatize meth. But even within the meth community, people who've smoked it look down on people that snorted, and people who've snorted look down on people who've injected: [There are] hierarchies of stigma that can persist if they're not challenged or at least corrected. So just raising awareness of this is important.
Another thing, on an individual level, is to understand how stigma operates within the individual. There's something called felt stigma or internalized stigma. It's just like internalized homophobia. It's where there are so many stigmatizing messages that come at the individual that, after a while, they internalize them. They don't need anybody else to tell them that anymore. They perpetuate it themselves.
With meth addiction, because of the damage it does to the brain and how long it takes (up to 18 months) to kind of rewire those neural pathways, it continues to be a challenge for a quite a while into recovery. People have that persistent, negative, automatic voice that continues to stigmatize them: "Who are you to think you could do that? You're nothing but an addict. Look at all the damage you've done."
It's an inside job -- it continues to stigmatize, in a way, until they can practice challenging those automatic thoughts with corrective thoughts.
These [corrective thoughts] would be something we would call affirmations, you know? "I am deserving of a loving relationship. I am going to get better. I am worthy of a life free of shame," and those kinds of things.
But that takes work. Because those automatic thoughts are so persistent. They're really deeply engrained. And they come from long before anybody ever picked up methamphetamine. As gay men, we got those messages early on. We've learned, as a consequence of that, to go deep within ourselves and bury that part of ourselves under this shield of defenses -- whether it's the perfect body, or a certain car we drive, or an income or whatever it is. To really drill down to our authentic selves is the recovery process. That's where a therapist is helpful -- to help people get past all the barriers, to get to their real selves and to own that and to start to express that to the world.
What about the issues of meth use and stigma when it comes to online dating and hook up apps?
We do see sometimes the whole "UB2" kind of thing in profiles. So many men using meth hook up on those apps. If someone puts "PNP" (which means "party and play") in a profile, it means the person wants to have sex and use drugs. It's become another divide in our world. I would love to have more dialogue. There's lot of judgment about PNP as well as "no PNP." It's polarizing the community instead of [helping us] engage each other.
In terms of individual practices, or community practices, what would that dialogue consist of?
There's been some modeling I've seen in workshops where -- if people see others want to party and play or see the other codes for drug use -- like the capital "T," or "Tina," or "get to the point" (meaning injection) -- instead of just walking away or saying something nasty, they seek to really engage, in terms of raising awareness, in terms of just starting a conversation about alternatives.
What I've found is that people using meth are kind of trapped in a way that they don't see many options. They're not received very kindly by people that don't use meth. Making the landscape friendlier would go a long way toward reducing that stigma.
Is there anything that you think that the apps themselves could do?
I would love to see banner [ads] -- in the same way that we occasionally see HIV messages, to see meth resource places, sites people can go to get help.
Even at TheBody.com, in the substance forum I must get about 20 questions a week like, "I missed [the vein while] injecting meth and what do I do? It's red and sore and tender for four days." But they don't want to go to the E.R. There are sites out there that have information.
Yeah. Are there sites that you send people to?
I do. Tweaker.org.
There's also stigma within the gay community about HIV. Is there additional stigma experienced by people who became HIV positive during the course of a meth addiction that can create further barriers to coming to terms with their diagnosis, or seeking out help, or finding support from others who are living with HIV?
Absolutely. I still hear people talking about the innocent victims of AIDS -- as opposed to, I guess, the not so innocent. But meth users see themselves as the not-so-innocent people that got HIV.
Actually, there are two groups. There tend to be the people that become HIV infected as a result of their meth behavior, and their high-risk sex, and reduced inhibitions, and even injecting drug use. Those people often feel a lot of shame and stigma about becoming HIV positive when they knew better.
And unfortunately I see a lot of rifts, with people that have been living with HIV for a long time judging those people. It's like, "In my day, we didn't know any better. But you should."
But there's another side, as well -- people who have been living with HIV for a long time, for multiple years, the so-called long-term survivors who have had HIV 25-30 years. Typically they're aging. They've lived with HIV a long time. They have less energy. They feel less sexual. They feel less attractive. They can feel more invisible, more isolated -- all the things that can set them up for the "curative" effects of methamphetamine, which basically gives them energy, makes them feel invincible, very sexual. They don't care if people judge them.
So for people who are living with HIV for a long time, there can be particular risk of getting involved with drug use because of all those factors that go hand-in-hand with long-term HIV status.
Where are we in our journey as an HIV community in dealing with meth use and stigma?
I think, with some effort, we're starting to have that conversation.
How has your book been received? What kinds of dialogue are you having? How is your book serving as a tool to combat stigma associated with gay men and meth use and HIV?
I've done groups, presentations, in New York, and Seattle, and Fort Lauderdale, and Miami, and a small presentation in Washington. In every case, it was standing room only. These were mostly the community members of men who were dealing with meth themselves or in recovery from meth. What's happened with them, in terms of their reception to the book, is that they finally have something that explains what's been going on with them.
I just did a thing Saturday for a group of men in recovery. Probably 50 people came up and said, "Thank you for explaining what's going on." Because I talked about some of the impact of meth on the brain, some of the neurology and the different elements that are predictable with meth. People have been having to find their way on their own. So the book has been wonderfully received and really resonates as a resource for those people.
We have been doing a lot of outreach in gay newspapers, or LGBTQ newspapers and communities across the country. It's been getting very well received in HIV magazines. They really understand and get the connection between HIV and methamphetamine.
In other community papers, it's raising awareness for people for whom meth is kind of invisible. People don't see it unless they're involved in the community. In that case, it just continues to hide until we bring it to the fore. I think that's what's going on right now.
So what should we be doing now to reduce the stigma around gay men and meth?
My vision for reducing stigma around methamphetamine would be to continue this dialogue. I'm pleased to see that ACT UP in New York has taken on methamphetamine as one of their primary objectives right now, in terms of raising awareness. They've had me speak. They've had Perry Halkitis from NYU and other scientists and clinicians talk to them. They're putting together a plan.
I've been kind of an instigator, some days, in different cities around the country. All these people are now working and doing wonderful work at a grassroots level. There would be great power in joining the message of these individuals into one strong voice, to raise awareness -- similar to what they're doing in the U.K. If we could have that same level of dialogue, we'd be a lot farther down the road.
This transcript has been slightly edited for grammar and clarity.
JD Davids is the managing editor for TheBody.com and TheBodyPRO.com.