The Mental Health Aspects of Crystal Meth Recovery
Perhaps no issue is hotter in the gay community these days than that of Crystal Meth. It seems everyone is either doing it themselves, or knows someone who uses regularly, and almost everyone knows someone who “has a problem” with it – from problem use that affects their job or relationships, to full-on addiction that has the same effect as a major medical illness. In my work as a psychotherapist, nearly one-third of my practice consists of gay men who are trying to get off, and stay off, using crystal. While various drug treatment centers exist (including the promising and innovative Prometa Center), and while AA and CMA are vital resources in the community, the mental health aspects of crystal use deserve more attention and discussion in the community.
While it is true that some guys – some would even say many – use crystal occasionally without much negative impact, it’s also true that for many users, their casual use has unintentionally grown into addiction. Part of the insidious nature of crystal is that it’s hard to tell at the beginning which “casual users” will become “addicts,” and how soon. For guys whose crystal use has become problematic – or catastrophic – it’s important to realize that you’re not alone. In the community of medical and mental health providers whose job it is to help people in this position, we’re still looking for the “ideal” treatment method. But I’ve learned some important points from my clients facing this struggle and from the academic and medical literature, and certain consistent points have emerged from this work. Here are some of the common steps I see that guys have used to become successful in addressing their use:
1. Think about what the problem is.
If you have feelings about your use, what are they? Guilt that you’re hiding something? Confusion about how the use has grown? Fear that it’s out of control? Worry that you won’t have good sex – or any sex – if you stopped? What harm results from using? Is it that you’ve received warnings from work about absenteeism? Have you been neglecting taking care of yourself or completing projects? Do you feel guilty when you party-and-play and ignore playing with your dog? Has using had an impact on your finances? How has it affected your relationships with coworkers, neighbors, or friends? Have you begun to feel anxious that are you being watched or persecuted? Have there been changes in your skin, your body, or your teeth? What makes you want to reduce or stop using?
2. Realize you have options.
So many guys feel “stuck” and isolated when facing problem crystal use, without realizing that there are many other people out there who feel just the same. If you feel badly about how things are going, realize that you have options. You could always visit a Crystal Meth Anonymous or an Alcoholics Anonymous meeting. If you are embarrassed about going, don’t be – everyone is there for the same reason, and they are there to support you, not judge you. One way to reduce the isolation is to go out and meet guys who feel the same way – they were probably at one time just as scared as you – and while they felt the same fear, they went anyway. Some hand out business cards (free from www.vistaprint.com) with their name, phone number, and email address on them, and receive supportive communications from other guys in the same situation right away. For some others who aren’t ready to stop yet, adopting some Harm Reduction techniques can help – learning safer injection techniques, not sharing needles, having condoms handy, remembering to stay hydrated, and taking HIV medications on time can all be steps to “buy time” until you’re really ready to stop using.
Educating yourself by talking to your doctor and other helpful professionals about crystal can be helpful. So can reading the material on crystal-related websites like www.tweaker.org, or www.crystalneon.org, or www.knowcrystal.org. There is also the option of going to a professional treatment program. Gay-friendly programs like Matrix, Alternatives, Friends La Brea, Being Alive’s “Get Off Now” program, and programs at the LA Gay & Lesbian Center, UCLA, and AIDS Project Los Angeles, as well as others in our community, are funded either by your health insurance or your tax dollars just to help with this problem. So since you’ve really partially paid for them already, you might as well use them. New resources are being developed often — an associate in my office, Michael Kaltenbach, MSW (323-646-1139) is offering the first private, confidential psychotherapy support group in West Hollywood that specifically addresses these issues, called “Crystal Clear,” held on Saturday mornings, which is intended for gay male professionals who work Monday through Friday and want a very private setting to discuss crystal issues. There is also the option of private individual psychotherapy to learn what addiction is and how to manage it through cognitive-behavioral therapy, and also to learn what underlying feelings are driving your use (more on this below). Rather than feeling isolated and helpless, learning what resources exist in our community to help can empower you and reduce your anxiety.
3. Evaluate your options.
Not every approach is right for everyone. You might not be able to take 30 days off from work to attend a full-time rehab program. Or you might have to only visit AA or CMA meetings that take place in the morning or evening, before or after work. But there are enough resources that one of them should help, and it’s just a matter of evaluating your options and then choosing one that’s best for you. Once you do, be brave and act on it: set a day and time when you’re going to call or visit one of the resources.
4. Understand the science.
Most guys I work with who use crystal heavily report feeling depressed or paranoid, and they don’t know why. Often, they don’t understand that crystal is a powerful chemical that affects the neurotransmitters in the brain that affect mood and other mental functions. The depletion of neurotransmitters (chemicals) in the brain such as dopamine can affect mood, appetite, and other subjective feelings. Side-effects such as paranoia are also the result of changes in brain chemistry. PET scan pictures of a person’s brain who has used crystal heavily will look different for about a year even after stopping all use. Some of my patients who are in recovery from crystal need assistance from a psychiatrist (a specialist kind of MD) who can prescribe antidepressant or other medication to help in the healing process. Getting off crystal involves understanding the combination of the art – and science – of recovery. The Prometa Center in Santa Monica offers an amazing new medical treatment protocol that can get rid of cravings for crystal (as well as alcohol and cocaine).
5. Understand the psychology.
Perhaps the most important aspect of crystal meth recovery that I work with my clients on is the psychological part. Part of the work of a recovery program is deciding when, or if, you want to quit using completely (abstinence) or “ease into” that by reducing the negative things that come from using (Harm Reduction). Another part is learning to understand what gets in the way of abstinence – learning about “external” triggers, like people, places, and situations that lead to using, and about “internal” triggers, such as feeling states like loneliness, low self-esteem, anger, stress, poor body image, or the desire to overcome guilt about having sex. Still another component is reversing the isolation and developing a supportive “cast of characters” who can be a support in the recovery process – from professional providers like a doctor, therapist, psychiatrist, or other supportive community resources – to personal supports, such as a CMA program sponsor, partner, friends, family, or peers in various groups.
6. Think about the big picture.
One of the things that strikes me about guys who are beginning to be in recovery from crystal is how relatively young they are. The life expectancy in the United States for men is about 80 now. That means that there is a lot of life ahead of you, even if you’re an “older” user in his 50’s or 60’s. What is the “big picture” of what you want your life to look like? What kind of career goals do you have? What kind of role in the community do you want to play? What was important to you before crystal became such a focus of your life? People in recovery can find hope in remembering that the old dreams and goals still apply, and there is still time to make many of those happen.
For everyone who begins to address problem use of crystal, there is a way out that is somewhat different for everyone. Following this path can give life hope and meaning, when they were beginning to erode. The decision to take some form of self-nurturing action is probably the most important step. During the early days of the Great Depression in the 1930’s, President Franklin D. Roosevelt was asked what to do about the massive unemployment and despair that gripped the country during this time. “Do something,” was his reply, just before he developed the elaborate plan for economic recovery called the New Deal. The longest journey begins with the first step: What’s your New Deal?