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Lust, Men and Meth: Gay Recovery, Sexuality, and Intimacy SSSS Cleveland 2008

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Lust, Men and Meth: Gay Recovery, Sexuality, and Intimacy SSSS Cleveland 2008

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    1. David Fawcett, PhD, LCSW Lust, Men and Meth: Gay Recovery, Sexuality, and Intimacy SSSS Cleveland 2008

    2. David Fawcett, PhD, LCSW Topics Meth 101 Meth and the Gay Community The Logic of Meth Best Practices

    3. David Fawcett, PhD, LCSW What is Methamphetamine? “Tina”

    4. David Fawcett, PhD, LCSW Amphetamines Amphetamine Methamphetamine MDMA (ecstasy) Benzedrine Cocaine Ephedrine

    5. David Fawcett, PhD, LCSW History of Meth America’s love affair with speed Contained 1/3 gram meth

    6. David Fawcett, PhD, LCSW History of Meth America’s love affair with speed

    7. David Fawcett, PhD, LCSW Meth and Cocaine

    8. David Fawcett, PhD, LCSW Methods of Ingestion Smoke Snort Booty bump Slam

    9. David Fawcett, PhD, LCSW Reward Centers Food Sex Excitement Comfort Nurturing Reinforcement for pleasure, then neural pathway formed: creates tolerance

    10. David Fawcett, PhD, LCSW

    11. David Fawcett, PhD, LCSW

    12. David Fawcett, PhD, LCSW

    13. David Fawcett, PhD, LCSW Affected Brain Regions Mesolimbic Pathway Reward Emotions Frontal Lobe Higher level thinking Logic Judgment Decision Making

    14. David Fawcett, PhD, LCSW Two Neural Pleasure Systems Exciting “appetitive” pleasure Largely dopamine related Raises tension level Satisfying “consummatory” pleasure Largely endorphin related Calming, fulfilling

    15. David Fawcett, PhD, LCSW Meth and the Brain Dopamine levels in the brain

    16. David Fawcett, PhD, LCSW Meth and the Brain

    17. David Fawcett, PhD, LCSW Acute Physical Effects Increases Heart rate Blood pressure Pupil size Respiration Sensory acuity Energy Decreases Appetite Sleep Reaction time

    18. David Fawcett, PhD, LCSW Tremor Weakness Dry mouth Sore nose Sinus infection Cough Burned lips Impetigo & staph Scars Sweating Oily skin Headaches Diarrhea Weight loss Anorexia Erectile problems Chronic Physical Effects

    19. David Fawcett, PhD, LCSW Acute Psychological Effects Increases Mood Confidence Talkativeness Alertness Sex drive Decreases Boredom Loneliness Timidity

    20. David Fawcett, PhD, LCSW Chronic Psychological Effects Confusion Less concentration Insomnia Memory loss Irritability Paranoia Anger Psychosis Panic reactions Hallucinations Depression Formication

    21. David Fawcett, PhD, LCSW Tolerance Dopamine likes novelty Requires increasingly intense stimuli

    22. David Fawcett, PhD, LCSW Sensitization Less needed to create intense craving “I am an addict and it relieves the craving mostly. I do not enjoy the sex on it that much anymore. When I have it I flush the last bits down the toilet with self disgust.” Extends into peripheral cues ? Fos B (Eric Nestler, UT)

    23. David Fawcett, PhD, LCSW Meth and the Gay Community

    24. David Fawcett, PhD, LCSW “Remember when we only had black & white tv? Then came color tv-- it’s the same with methamphetamine and sex”

    25. David Fawcett, PhD, LCSW “[There are] very high prevalence rates of use of drugs but very comparatively low rates of addiction” in the gay community Ron Stall (U Pittsburgh)

    26. David Fawcett, PhD, LCSW 90% gay men never used meth 10% used in the last year 5% used handful of times, never used again 5% regular users 2-3% “use problematically” or with significant dependence Susan Kingston, Kings County Health Dept, Seattle

    27. David Fawcett, PhD, LCSW A Gay Morality Tale Use of disease as terror Supervirus 2005 MRSA 2007 Equates gay men with disease and pathology “complacency at best, depravity at worst” Need to resist the narrative of pathology

    28. David Fawcett, PhD, LCSW Circuit Parties

    29. David Fawcett, PhD, LCSW 7

    30. David Fawcett, PhD, LCSW Bathhouses

    31. David Fawcett, PhD, LCSW Impact of the computer

    32. David Fawcett, PhD, LCSW

    33. David Fawcett, PhD, LCSW Gay Men, Meth and Sex Meth (among HIV positive men) was associated with: High rates of anal sex Low rates of condom use Multiple sex partners Sexual marathons Anonymous sex Semple, Patterson and Grant (2002)

    34. David Fawcett, PhD, LCSW Meth + STDs Studies from San Francisco and New York show that MSMs who use meth vs. non users are: 2-3X more likely to have HIV 6x more likely to have syphilis 2X more likely to have gonorrhea

    35. David Fawcett, PhD, LCSW Meth and HIV Long term MACS (Multicenter AIDS Cohort Study) MSM using meth had 46% greater risk of becoming infected with HIV MSM using poppers (93%) and meth had 3x risk Plankey MW, Ostrow et.al. The relationship between methamphetamine and popper use with HIV seroconversion in the Multicenter AIDS Cohort Study. J.Acquir Immune Defic Syndr. (published online ahead of print (March 29, 2007)

    36. David Fawcett, PhD, LCSW Meth and HIV Drug Interactions The effect of methamphetamine [is] two or three times greater for individuals on combination therapy, especially combinations including ritonavir (Norvir)* CYP2D6 – liver enzyme *Halkitis, Parsons, and Stirrat (2001)

    37. David Fawcett, PhD, LCSW Meth and HIV Meds “an acceptable compromise” Unplanned nonadherence Planned nonadherence Reback, Larkins, Shoptaw (2003)

    38. David Fawcett, PhD, LCSW HIV and HAART Drug Resistence Tumor Necrosis Factor Metabolic Rates Medical Adherence Ghaziani, A. Crystal methamphetamine and antiretrovial drug resistance: IAPAC Monthly, Oct. 2005.

    39. David Fawcett, PhD, LCSW Straight Men, Meth and Sex Sexually active w/ casual or anonymous female partner Multiple female partners Anal sex with female partner Sex with IDU Received drugs or money for sex Forced into sex Methamphetamine use and HIV risk behaviors among heterosexual men; MMWR, 55(10) 3/17/2006,

    40. David Fawcett, PhD, LCSW The Logic of Meth

    41. David Fawcett, PhD, LCSW The cart in front of the horse? “Crystal meth isn’t fueling unprotected sex and hence HIV transmissions. Gay men’s desire to have good old-fashioned sex the way it’s supposed to be is what fuels crystal use.” Susan Kingston, Kings County Health Dept, Seattle

    42. David Fawcett, PhD, LCSW Popular Framing of Gay Issues Why is there continued risk? Skills deficit Knowledge gap Something wrong with how gay men view themselves as gay or sexual people

    43. David Fawcett, PhD, LCSW Just say no? Complex relationship

    44. David Fawcett, PhD, LCSW Desire “I was a sex maniac on the drug…” “I never wanted the sex to end…ever”

    45. David Fawcett, PhD, LCSW Desire Sexual Risk Not using condoms Orgasm doesn’t relieve desire

    46. David Fawcett, PhD, LCSW Duration “I was uninhibited, horny, insatiable.” “I never fucked for 36 hours straight before using methamphetamine.” “No one in their right mind would have sex the way I did on meth.”

    47. David Fawcett, PhD, LCSW Duration “I found it impossible to obtain an erection. I would be impossibly horny but unable to cum unless I beat my dick to the point of blistering.”

    48. David Fawcett, PhD, LCSW Physical Capability (Personal Best) Increased anal sensation Instant bottoms “I could take bigger cocks” “I could suck for hours” “Fuck me harder”

    49. David Fawcett, PhD, LCSW Physical capability Increased risk of injury Increased risk of disease transmission Crystal dick

    50. David Fawcett, PhD, LCSW Quantity “I used to walk in to a hotel room with ten guys I never met, throw them the rope, and say, 'take me however you want me boys.‘” “I was once fucked without condoms by over 20 guys in one night in a rather long S/M session.”

    51. David Fawcett, PhD, LCSW Quality Judgment Would you say “hi” in public? Careless in choice of partner

    52. David Fawcett, PhD, LCSW Sensation “Sex on crystal shouldn't even be called 'sex'. The universe never intended for us to experience sex THAT good, because it can not be replicated without crystal.”

    53. David Fawcett, PhD, LCSW Sensation “Since I've quit using I've been practically impotent. Sadly I don’t know [how sex could be better without crystal].”

    54. David Fawcett, PhD, LCSW Group Identity Clubkids Tribe Slammers Social Leveler

    55. David Fawcett, PhD, LCSW Group Identity Polarization “It has created a polarized community of PNPers versus those who are sober and safe.” “d/d free – ub2” Stigma “I think some of the community sees it as yet one more tragedy to make us look bad.”

    56. David Fawcett, PhD, LCSW Self Image Overcome negative social meanings of gay Reinforce and intensify concepts of selves as sexual males “Where other drugs (alcohol, cocaine, LSD) used to help me hide from my sexuality, meth finally made it be ok to be gay.”

    57. David Fawcett, PhD, LCSW Self Image “I feel hot!” “I’m invincible!” “I’m visible” “At 50 I don’t exist socially in the gay community anymore. Having a ‘connection’ has made me ‘cool’ albeit temporarily. But it’s better than being invisible when I want to get laid.”

    58. David Fawcett, PhD, LCSW Self Image Internalized Homophobia Relationship with self “No fats, no fems” “No fakes, no flakes, no fruity-cakes” “Str8 acting” Wreckage of addiction

    59. David Fawcett, PhD, LCSW Disinhibits Breaking Taboos “It's sleazy! It's so dangerously addictive and leads to such reckless sexual behavior, more so than other drugs.”

    60. David Fawcett, PhD, LCSW Disinhibits “I've become a bigger freak - a pig, a fetishist -- however you want to put it.” “It made me more receptive to scenes outside my normal activities.” “It pushed my personal boundaries and changed preferences of the type of sex (rough, more adventurous, etc.)”

    61. David Fawcett, PhD, LCSW Intimacy “I have never been so connected to another men – it was so intense.” “It gave me permission to really touch.”

    62. David Fawcett, PhD, LCSW Intimacy Disrupts Love/Lust Balance Increased narcissism Increased partner objectification Decreased empathy Aggression/violence (gay-style?) “He became selfish on the drug…sex with him was one way…his way.”

    63. David Fawcett, PhD, LCSW Fusion of Meth and Sex Neurons that “fire together wire together” Focused attention Reinforced through fantasy New cognitive maps increase at expense of old ones (“vanilla” sex replaced by darker sex)

    64. David Fawcett, PhD, LCSW Fusion of Meth and Sex “I can't think of a way that sober sex could ever hope to be as passionate, as driven and hungry as speed sex. And please don't give me that ‘Oh it's so much more intense with someone you truly, deeply care for... crap. Gimme a break, huh? Save it for the greeting card companies.”

    65. David Fawcett, PhD, LCSW Best Practices

    66. David Fawcett, PhD, LCSW

    67. David Fawcett, PhD, LCSW Gay Men’s Health Movement Emphasis on wellness Move away from pathology focus Less HIV-centric Roots in feminist movement

    68. David Fawcett, PhD, LCSW Gay Men’s Health Movement Strength, resilience, and support Not disease Gay men know how to play Sex is valued Most men practice safer sex Most men value personal health Most men share responsibility for health

    69. David Fawcett, PhD, LCSW Villain, victim, or hero? Move beyond simplistic dialogue Become aware of Resilience Conscientiousness Body Mind Spirit Helping others

    70. David Fawcett, PhD, LCSW Motivation to Stop Stages of Change Prochaska and DiClemente Precontemplation Contemplation Determination Action Maintenance Permanent Exit

    71. David Fawcett, PhD, LCSW Motivation to Stop “All I wanted was my hard-on back and quitting gave that to me.”

    72. David Fawcett, PhD, LCSW Meth Withdrawal Depression Difficulty concentrating Severe Cravings Paranoia Exhaustion Confusion

    73. David Fawcett, PhD, LCSW Meth Withdrawal “I constantly have nightmares. Right before I push the syringe in I'll wake up in a cold sweat and depressed that it was only a dream. I miss it very much.”

    74. David Fawcett, PhD, LCSW Best Practices Treatment approaches Non-judgmental Empowering Supportive Collaborative

    75. David Fawcett, PhD, LCSW Best Practices Matrix Model Phases Withdrawal Day 1-15 Honeymoon Day 16-45 The Wall Day 46 – 120 Adjustment Day 120-180 Resolution Day 180 +

    76. David Fawcett, PhD, LCSW Best Practices Most valuable modalities Cognitive Behavioral Therapy Motivational Enhancement Contingency Management

    77. David Fawcett, PhD, LCSW Meth-Specific Sexual Interventions

    78. David Fawcett, PhD, LCSW Realities Speed sex is gone Seek alternative non-sexual exhilaration Avoid high risk situations

    79. David Fawcett, PhD, LCSW Sex Define safe sex boundaries Masturbation Celibacy What is good sex? Lose the porn and Manhunt profile Have planned sex

    80. David Fawcett, PhD, LCSW Intimacy Importance of touch Massage Tantra Sensate focus

    81. David Fawcett, PhD, LCSW Learning/Unlearning The plastic brain “Brain traps” Stop behavior to weaken map Must learn to redifferentiate sex and meth Relearn sexual feelings without drug state What turns me on when I’m feeling good?

    82. David Fawcett, PhD, LCSW Awareness Recognizing mode of thought Meditation Processing vs Free Flowing

    83. David Fawcett, PhD, LCSW Self care Get tested Sleep Eat Work out Connect with others

    84. David Fawcett, PhD, LCSW Other Important Interventions

    85. David Fawcett, PhD, LCSW Therapy Shame (Internalized Homophobia) The Penis Project, Magnet, SF Affect regulation Trauma versus trauma

    86. David Fawcett, PhD, LCSW Sexual Recovery Relationship with Self “I no longer have the shame that used to dampen the satisfaction. It used to be that drugs took me away from the pain for a few more minutes.” Relationship with Others “When I was off it and in love the sex was the best thing in the world” “Good sex without crystal? Have an emotional connection prior to sex”

    87. David Fawcett, PhD, LCSW Recovery Support 12 step programs CMA, NA, AA SAA, SCA, SLAA COA, CODA Harm reduction approaches (not dichotomous with abstinence) Psychotherapy Medical intervention

    88. David Fawcett, PhD, LCSW Sexual Recovery “Make it “un-cool” to be a ‘friend of Tina’ – like wearing plaid or polyester.”

    89. David Fawcett, PhD, LCSW Contact David Fawcett, PhD, LCSW 915 South Middle River Drive Suite 520 Fort Lauderdale, FL 33304 954.776.3639 davidfawcett@earthlink.net www.fortlauderdalecounseling.com

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