Download LGBTQ Methamphetamine Use

REASONING BEHIND
LGBTQ
METHAMPHETAMINE USE
JENNIFER CALVERT
JOHN KORKOW, PH.D., LAC, SAP
UNIVERSITY OF SOUTH DAKOTA
CAADE CONFERENCE, 2016, SACRAMENTO
METHAMPHETAMINE
• Powerful stimulant that is extremely addicting
• Form of a powder or cooked into a crystal, called crystal meth
• Production significantly different than that of the other classic
illicit drugs such as cocaine, heroin, or marijuana
• Most other substances are derived from nature and altered to
make a psychotropic substance
• Meth can be made by anyone with a few simple ingredients that
can be purchased at a supermarket and a container
A variety of different combinations of
ingredients, but a few popular ones include1:
• red phosphorus (strips of match boxes)
• sulfuric acid (drain cleaner)
• Lithium (battery acid)
• Toluene (brake fluid)
• Acetone (paint thinner)
• The base of pseudoephedrine (decongestant)
METHAMPHETAMINE
WHAT SEPARATES METH FROM OTHER DRUGS
• Methamphetamine holds a reputation separate from
street drugs
• It is not sold and used within the same street networks and
is not well distributed in the street economy2
• According to one methamphetamine user, cocaine is
“Crystal’s [methamphetamine] younger, weaker, disabled
sister”3
• “It [meth] felt like coke but twenty times stronger. It just
wakes you up. I don’t know. It’s so much stronger. And the
high lasts way longer than coke. Like you can do a line of
Tina and it’ll last like I don’t know, four hours and it’ll still
be pretty intense”3
METHAMPHETAMINE
EFFECTS ON THE BODY
• Right after use, the user experiences a rush that can last
up to thirty minutes
• Heartrate increases and blood pressure and pulse
skyrocket.
• After this comes the high—can last up to 16 hours
• The user experiences increased attention, energy, or
even aggression.
• Significantly longer than the high of other drugs, such
as cocaine, which only has a high duration of around 30
minutes.
• Metabolizes in the body differently
• Gives the user a high peak for an extended period of
time
• Methamphetamine is a Schedule II drug
• Has a high potential for abuse and can only be
obtained through a non-refillable prescription
LESBIAN, GAY, BISEXUAL, TRANSGENDER,
QUESTIONING
LGBT YOUTH
• In 1992, only 1.8 percent of adults identified as
lesbian, gay, or bisexual4
• 20 years later, that doubled to 3.5 percent4
• As stigma decreases, more women, racial and
ethnic minorities, younger individuals, and older
individuals are more willing to identify as LGBT
• Widens and diversifies the demographic of those
that fall under the LGBT identity
LGBTQ
DISCRIMINATION & STIGMAS
• Social stigma toward LGBT people and their relationships is
declining
• In 1998, analyses of the General Social Survey showed that
nearly two-thirds of adults (63.1 percent) in the United States
thought that same-sex sexual relationships were almost always
or always wrong5
• By 2010, that figure had dropped to less than half (49.4 percent)
5
• 2014 General Social Survey rate of 4 in 10 Americans still said
that relationships between those of the same sex are always
wrong5
LGBTQ
LEGAL RIGHTS
• In the United States, it is still legal in some states or areas
to discriminate against someone due to their sexuality
• Prior to 1973, homosexuality was considered a mental
illness in the Diagnostic and Statistical Manual (DSM) III
• Still to this day, some people believe that homosexuality
can be cured by simple methods like “Pray the gay away”
• In 1997, it was estimated that a child will hear 25 antigay
remarks every day at public school and 97 percent of the
teachers made no effort to stop the remarks6
• When appropriate coping strategies are not utilized,
unconventional methods may be used, such as the use of
addictive substances
• Legalization of same sex marriage in June, 2015
• Stigmatization should lower next survey
• The United States military had in place the Don’t Ask,
Don’t Tell policy until September 20, 2011 when it was
repealed
• Growing up in an environment that condones separate and
unfair treatment of individuals based on sexual orientation
could lead to shame of one’s self
• Coping strategies and resilience are needed to make it
through discrimination and stigmatization
LGBTQ
RATES OF DRUG USE
• LGBTQ individuals have higher drug usage rates than the
general population7
• Gay and transgender people smoke tobacco up to double
the rate of their heterosexual and non-transgender peers7
• 5 to 10 percent of the general population abuses alcohol,
25 percent of gay and transgender people do7
• Men who have sex with men are 9.5 times more likely to
use heroin and 3.5 times more likely to use marijuana than
men who do not have sex with men7
• The CDC states, “Studies have shown that, when compared
with the general population, gay and bisexual men,
lesbian, and transgender individuals are more likely to: use
alcohol and drugs, have higher rates of substance abuse,
not withhold from alcohol and drug use, and continue
heavy drinking into later life”8
LGBTQ
MENTAL HEALTH
• Methamphetamine symptoms can mimic many different
psychiatric or mental disorders
• The comedown from meth can appear as depression if a
physician was unaware that a patient uses meth
• Patients come down off of meth, experience feelings of
depression, get prescribed antidepressants or
tranquilizers, but they would have been fine after a few
days later without the medication
• Patients that are depressed, but also recreationally use
methamphetamine on weekends also affect their therapy
for their depression9
• It is important to keep methamphetamine use in mind
when someone is being screened for a mental health
problem and is also a meth user.
LGBTQ
CIRCUIT PARTIES AND “DRUG CULTURE”
• Circuit parties in the early 80s became fundraisers for
HIV/AIDS foundations
• Eventually they turned into a place for those living with
HIV/AIDS to socialize and connect with others with similar
status
• Various drugs worked their way into these parties, and
since they were mainly held in urban areas, it brought a lot
of different people together.
• New people with new party favors helped spread the
initiation and use of different drugs, including crystal
methamphetamine
• Crystal meth use in Miami became more popular at the
same time that the dance scene rapidly declined10
• Feelings of isolation and attempt to bond with others,
connect, find intimacy with others that was not allowed
among gay men
• Report using methamphetamine to party or get high
• may be a cover up for a need for social connection or
coping with loneliness
METH AND LGBTQ
• Significantly more gay and bisexual men report
lifetime methamphetamine than other groups
• Lesbian and bisexual women also report higher
lifetime methamphetamine use than heterosexual
men and women
METH AND LGBTQ
INITIATION
• Some reasons for methamphetamine use are not
exclusive to the LGBTQ community
• Common reasons for use are:
• Social
• Finding friends
• To party
• To connect
• Sexual
• Increased sexual desire
• Decreased sexual inhibition
• Increased sexual opportunities or partners
METH AND LGBTQ
INITIATION
• Some reasons for methamphetamine use are not
exclusive to the LGBTQ community
• Common reasons for use are:
• Emotional
• Coping with stress
• Coping with trauma
• Coping with mental health
• Sense of belonging
• Physical
• Increased energy
• Weight loss
THERE ARE VARIOUS FACTORS WHICH COMPRISE
THE ENVIRONMENT OF FIRST USE2,3
• Physical place
• Residential home , Apartment, Studio, etc
• bar or club
• Public place such as a park, adult bookstore, or a bathhouse.
• Social surrounding
• Sexual partner
• Family members
• Friends
• Drug dealers
• Strangers
• Isolation
METH AND LGBTQ
INITIATION
• Emotions
• Depression
• Loneliness
• Excitement
• Hopelessness
• Desperation
• Intentional or Accidental Initiation
• Many people think methamphetamine is cocaine when
they initiated through nasal administration of the drug
METH AND LGBTQ
PHYSICAL LOCATIONS
• Typically, one initiates methamphetamine in a social
setting, such as a club, bar, house, or an apartment
among a group of friends or acquaintances2
• Within club subcultures, gay and bisexual men were
more likely to have used methamphetamine than any
others3
• Heterosexual men and lesbian/bisexual women were
more likely to use than heterosexual women2
METH AND LGBTQ
INTENTIONAL VS. ACCIDENTAL OR UNAWARE INITIATION
• Most participants in an initiation study hadn’t actually
planned to use methamphetamine at the time of their
first use3
• Many of the participant quotes taken in the study
narrate mistaking methamphetamine for cocaine
• Others reported that they had been using cocaine
earlier in the evening, and it just wasn’t doing the
trick anymore, so they upgraded to
methamphetamine
CONTINUED USE: SOCIALIZATION
• Some in another study reported using meth for the social
aspects of the drug11
• within the context of parties, dance clubs, bars, and social
gatherings among friends
• For the party atmosphere respondents explained meth as their
“social drug”
• In environments where friends or sexual partners were already
using
• One participant took the drug “just to be at the same place sort of
where the person [that I’m] going to be having sex with. Like if
they’re going to do it, I’ll probably do it with them”
• Various types of socialization may be increased due to using
methamphetamine, including sexual relationships.
SEX AND RELATIONSHIPS
• Sexual reasons seem more prevalent among LGBTQ individuals
than heterosexual individuals
• May be connected to other underlying issues
• Sense of belonging and new sexual opportunities
• HIV
• Emotional and sexual reasoning may go hand-in-hand for
some LGBTQ individuals
• In one study, a majority of participants (68.8 percent)
described the sexual effects of meth as one of the most
important, if not the most important, reason for using meth11
• Those that did not use for sexual reasons still acknowledged
that others use for that reason
CONTINUED USE
SEX AND RELATIONSHIPS
• 45.8 percent said they used meth to change their sexual
encounters whether that be prolonged performance,
heightened sexual feelings, or changing attitudes about
sex11
• 29.9 percent used to change beliefs or attitudes about sex
• lowering anxiety and increasing openness about
activities or partners
• One participant reported using for sex because it allowed
him to go for 11 to 15 hour sessions11
• Impotence
• HIV and STI Transmissions
CONTINUED USE
HIV STATUS
• “It is impossible to discuss the impact of methamphetamine
use in the MSM community without talking about sexually
risky behavior and HIV/AIDS”12
• Reasons and influences to use methamphetamine among gay
and bisexual men can be related to the user’s serostatus
• Older and/or HIV positive men were significantly more likely to
report using meth for sexual reasons than younger and/or HIV
negative men
• HIV negative men were significantly more likely to use meth
for social reasons than HIV positive men13
• Younger men were more likely to report social reasoning, but it
is unclear if social reasons are separated by serostatus or age
• There is a greater likelihood of lifetime methamphetamine use
among Black individuals compared to White individuals14
• Black individuals also have a higher likelihood of being HIV
positive
• Those that are HIV positive report more lifetime use as well
• higher likelihood of being HIV positive could be a correlation
to likelihood of also reporting lifetime methamphetamine
use
CONTINUED USE
BEHAVIORAL REASONING
• Pretty large and diverse category
• Two subcategories
• behavior changes to enhance potential socialization and/or
productivity
• be more outgoing and less inhibited
• more productive in the user’s life.
• Physical changes
• weight loss, changes in appearance, increased energy, and increased
sensory capabilities
• different than socialization because users are using meth to
change intrapersonal skills related to behavior
• This may lead to an increase in socialization, but that is not the
main goal for use under this reasoning
CONTINUED USE
BEHAVIORAL REASONING
• The behavioral reasoning category is much more diverse than
the other reasonings discussed
• Increased productivity
• Increased energy
• Used either for cleaning and work or for energy to dance for
a night out to party
• Some users use meth daily for energy in a way that many
people use coffee in the morning
• Save meth for big weekends so they can fully take
advantage of meth’s energy boost
• Use meth to accomplish tasks in other parts of life to have
time for partying
CONTINUED USE
EMOTIONAL REASONING
• Methamphetamine use’s characteristics may fill a void of
coping strategies
• Changing the user’s mood to happier, more carefree, and an
increase in self-esteem
• To feel detached from their actual lives, so it could make
them feel less lonely
• The emotional effects are only temporary with meth use, but
users still used knowing this
• One user used meth for dissociation, not emotional
reasoning in one study11
CONTINUED USE
ADDICTION
• One study found 78 percent of participants that
reported methamphetamine use within the previous
year were classified as dependent on
methamphetamine13
• Of that 78 percent, 65 percent were also classified as
dependent on ecstasy and 78 percent were also
dependent on cocaine
• Pattern of not only poly-drug use, but poly-substance
addiction among gay, bisexual, and MSM
METHODS
INTERNET
• “The Internet is becoming an increasingly useful setting to
engage in sex and drug use with others. Internet access,
although not directly causal of either methamphetamine use or
unsafe sex practices, it is an important facilitator of both and
needs to be considered in the practical application of
interventions with MSM”12
• The Internet increased the ability to find potential partners
• There are many specific sites that offer services to men seeking
men, differing from dating sites to hook-up sites to party scene
sites
• Increase the potential for anonymous sex practices.
• In 2005, 40 to 50 percent of the users on these sites use
them for this reason12
METHODS
SURVEY QUESTIONS
• Online Social Study Survey Creation Site
• 45 questions
•
Multiple choice
•
Sliding scale
•
Write your own
•
“Other” option for many questions
• Goal was to find the reasoning each participant provided for why they use
methamphetamine
• One of the last questions: “Please describe why you use meth”
• Common underlying connections that lead to methamphetamine use
• Relationships
• If common reasons were found among participants, then treatment providers,
prevention specialists, and health care providers would better be able to
screen for methamphetamine use or risks of use among this population.
DISTRIBUTION
• Without any success from the online dating sites, different
resources were contacted
• Treatment centers
• Professional organizations
• Websites related to resources for meth users, LGBTQ, or
both were contacted via
• Facebook messages, email, or “Contact Us” forms on
the websites
SIMILAR TO THE DATING SITES, MIXED RESPONSES
OCCURRED FROM THE FOLLOWING SITES
• The National Institute of Drug Abuse (NIDA)
• Inactive organizations that were once very active
• Irrelevance to one Facebook group
• Gay Men Health Clinic (GMHC) in New York City
• Those that gave an affirmative response to my research
inquiries are: onegoodlove.com, GKiss and LDate (Online
Buddies Inc companies), Gaydar, National Institute of Drug
Abuse, and Gay Men’s Health Clinic.
RESULTS
• Due to low website involvement, this survey only had two
participants
• When asked why the participants used methamphetamine
• “It makes me happier” and “I’m addicted”
• When asked about feelings before the use of
methamphetamine
• “life was happy” and “I thought it would be cool to
try”
• When discussing what life was like when they were in a
period of life when they were using the most:
• “I was more depressed. I refused to go to therapy”
• Both reported having gone to treatment before though
• When asked if there was any additional information they
would like to add
• One of the participants responded that he or she
needed help
• Barrier to this participant to receive proper treatment?
DISTRIBUTION
• Largest difficulty
• Online dating sites catering to LGBTQ individuals
• Few sites agreed to advertise or distribute the survey link
• Marketing fees or advertising fees
• Contact Us forms
• Lack of space on website pages
• $1,250 one time fee for one region within the United
States
• $1,000 monthly fee for one “hook up” site
• Inactive Social Media presence
DISCUSSION
INTERVENTIONS
• MSM who use methamphetamine are more likely to have
a higher educational level and health insurance coverage14
• Possible to use clinical care settings for interventions
• Training health care providers in screening is beneficial
to try and get those addicted patients to appropriate
assessments and treatment
• With health care coverage, it may also be easier to
convince patients to go through with treatment, since
it could be covered by insurance.
TREATMENTS: THE MATRIX MODEL
TREATMENT CONTINUED
• One study discovered that CBT combined with Contingency
management had greater success than three other models
15
• Gay CBT had more negative UAs and better performance
over Gay Social Supportive Therapy 16
INTERVENTIONS
• There are different categories or levels of LGBT sensitivity in treatment
centers
• LGBT tolerant
• treatment center is aware of LGBT issues and may even have a
staff member that identifies LGBT
• LGBT-sensitive
• programs acknowledge the existence of LGBT individuals and treat
them with dignity and respect
• LGBT-affirmative
• actively promote self-acceptance of a LGBT identity as part of
recovery
• affirm sexual orientation, gender identity, and choices, validate
values and beliefs, and recognize sexual orientation develops at
an early age
• Hostile or anti-LGBT
INTERVENTIONS
• The hope is that LGBT individuals never end up at a center
that is openly hostile towards them
• Overall LGBT-affirmative treatment is specifically designed
for LGBT individuals.
• Treatment centers that are not already should strive to
become more LGBT sensitive, so those members can be
better treated, understood, and can reach recovery
successfully.
CASE: MARK AND GINA
• Mark is 24 years of age, bisexual, in a relationship with a
female currently, is HIV negative, positive for Hepatitis C,
states crystal meth is the drug of choice “as a couple,” and
is in contemplation concerning cessation of meth use.
• Mark and Gina are very interested in couple’s therapy, but
Gina is pre-contemplative concerning cessation of
methamphetamine use (and is also bisexual). The
relationship is non-monagamous.
• This is not an atypical relationship, is your agency prepared
to work this this couple where they are at (i.e. relationship
status, diagnoses, stage of change)?
FUTURE DIRECTIONS
• Most research on this subject focuses on one
specific city or location and reports on those
participants’ responses to questions with limited
or general reasoning options
• Those not involved in club scenes
• One limit to this study
• Bias of those on dating sites, those with Internet
access, or those receiving treatment or care
• Future studies should find ways to alleviate, if not
eliminate that bias.
FUTURE DIRECTIONS
• Legalization of same-sex marriage in June, 2015 across the
United States is a game changer
• Due to most of the “battle” being won with marriage
equality, a lot of oppression, discrimination, homophobia,
and self-hatred may be diminished for future generations
of LGBTQ youth
• Many of the reasons found by previous studies were
fueled by effects of inequality or unacceptance into
society. This may lessen the rate of methamphetamine use
along with other substances, or it may shed light to other
reasons LGBTQ find to use methamphetamine
• Last study of this type?
• Only the future will tell what impact marriage equality will
have on the next generation of the LGBTQ community.
REFERENCES
What is Meth? | Ask the Meth Project. (n.d.). Retrieved July, 2015, from
http://www.methproject.org/answers/what-is-meth.html#Whats-in-Meth
1
Kelly, B. C., Leclair, A., & Parsons, J. T. (2013). Methamphetamine Use in Club Subcultures. Substance Use
& Misuse, 48(14), 1541-1552.
2
Parsons, J. T., Kelly, B. C., & Weiser, J. D. (2007). Initiation into methamphetamine use for young gay and bisexual
men. Drug and Alcohol Dependence, 90(2-3), 135-144.
3
4
Gates, G. J. (2013). Demographics and LGBT Health. Journal of Health and Social Behavior, 54(1), 72-74.
Swanson, E. (2015, March 5). Major survey shows most Americans support same-sex marriage.
Retrieved February 7, 2016, from http://www.apnorc.org/news-media/Pages/News Media/Majorsurvey-shows-most-Americans-support-same-sex-marriage.aspx
5
Stewart, C. (Ed.). (2010). The Greenwood encyclopedia of LGBT issues worldwide (Vol. 1). Santa Barbara, CA:
Greenwood Press.
6
Hunt, J. (2012, March 9). Why the Gay and Transgender Population Experiences Higher Rates of
Substance Use. Retrieved March 4, 2016, from
https://www.americanprogress.org/issues/lgbt/report/2012/03/09/11228/why-the-gay-andtransgender-population-experiences-higher-rates-of-substance-use/
7
Substance Use. (2016, February 29). Retrieved March 4, 2016, from
http://www.cdc.gov/msmhealth/substance-abuse.htm
8
9 Saltman,
D. C., Newman, C. E., Mao, L., Kippax, S. C., & Kidd, M. R. (2008).
Experiences in managing problematic crystal methamphetamine use and associated
depression in gay men and HIV positive men: In-depth interviews with general
practitioners in Sydney, Australia. BMC Family Practice, 9(45).
Kurtz, S. P. (2005). Post-Circuit Blues: Motivations and Consequences of Crystal
Meth Use Among Gay Men in Miami. AIDS and Behavior, 9(1), 63-72.
doi:10.1007/s10461-005-1682-3
10
11 Halkitis,
P. N., Fischgrund, B. N., & Parsons, J. T. (2005). Explanations for
Methamphetamine Use Among Gay and Bisexual Men in New York City. Substance Use
& Misuse, 40(9-10), 1331-1345.
12 Aguilar,
J. P., & Sen, S. (2013). The Culture of Methamphetamine: Reframing Gay
Men's Methamphetamine Use. Journal of Human Behavior in the Social Environment,
23(3), 370-382.
13 Solomon,
T. M., Halkitis, P. N., Moeller, R. W., & Pappas, M. K. (2012). Levels of
methamphetamine use and addiction among gay, bisexual, and other men who have
sex with men. Addiction Research & Theory, 20(1), 21-29.
14 Rhodes,
S. D., Hergenrather, K. C., Yee, L. J., Knipper, E., Wilkin, A. M., & Omli, M. R.
(2007). Characteristics of a Sample of Men Who Have Sex with Men, Recruited from
Gay Bars and Internet Chat Rooms, Who Report Methamphetamine Use. AIDS Patient
Care and STDs, 21(8), 575-583.
Shoptaw, S., Reback, C. J., Peck, J. A., Yang, X., Rotheram-Fuller, E., Larkins, S., . . .
Hucks-Ortiz, C. (2005). Behavioral treatment approaches for methamphetamine
dependence and HIV-related sexual risk behaviors among urban gay and bisexual men.
Drug and Alcohol Dependence, 78(2), 125-134.
15
16 Shoptaw,
S., Reback, C. J., Larkins, S., Wang, P., Rotheram-Fuller, E., Dang, J., & Yang,
X. (2008). Outcomes using two tailored behavioral treatments for substance abuse in
urban gay and bisexual men. Journal of Substance Abuse Treatment, 35(3), 285-293.
Retrieved March 17, 2016, from
http://www.sciencedirect.com.ezproxy.usd.edu/science/article/pii/S07405472070035
10
OTHER SOURCES
Nakamura, N., Mausbach, B. T., Ulibarri, M. D., Semple, S. J., & Patterson, T. L. (2009).
Methamphetamine Use, Attitudes About Condoms, and Sexual Risk Behavior Among HIV-Positive
Men Who Have Sex with Men. Arch Sex Behav Archives of Sexual Behavior, 40(2), 267-272.
The Matrix Model (Stimulants). (2012, December). Retrieved March 14, 2016, from
https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-basedguide-third-edition/evidence-based-approaches-to-drug-addiction-treatment/behavioral-3
Substance Abuse and Mental Health Services Administration (SAMHSA). (2006). Substance abuse:
Clinical issues in intensive outpatient treatment (Treatment Improvement Protocol (TIP) No. 47).
Retrieved March 15, 2016, from http://www.ncbi.nlm.nih.gov/books/NBK64102/
Substance Abuse and Mental Health Services Administration (SAMHSA). (2003). A provider's
introduction to substance abuse treatment for lesbian, gay, bisexual and transgender individuals.
Rockville, MD: The Center.
Nakamura, N., Semple, S. J., Strathdee, S. A., & Patterson, T. L. (2009). Methamphetamine
initiation among HIV-positive gay and bisexual men. AIDS Care, 21(9), 1176-1184.
Foundation for a Drug-Free World. (n.d.). The Stages of the meth "experience" Retrieved
November, 2015, from http://www.drugfreeworld.org/drugfacts/crystalmeth/the-stages-of-themeth-experience.html
ACKNOWLEDGEMENT
Center for Brain and Behavior Research
NIDA Grant Number R25-DA033674
Link to survey: https://www.psychdata.com/s.asp?SID=166301