When a client of mine brought up his meth use, what I started to notice was that he seemed to avoid saying the word \u201cmeth.\u201d <\/p>\n
It was confusing at first, because he’d talk about \u201cacting out,\u201d but I’d have a hard time deciphering whether he meant sexual<\/a> behavior or meth use.<\/p>\n Whenever I would use the word to help clarify what he was saying, his affect would subtly change. <\/p>\n I reflected it to him and he said that if I’ve noticed he’s uncomfortable using the word, I’m right. He is.<\/p>\n He started to tell me how common it is in his industry and in many industries. He’s successful and high functioning, but uses meth about once per month.<\/p>\n He’s only bringing it up now in therapy<\/a> because it’s starting to become ego-dystonic. He’s recognizing that while his use is only once per month and he doesn’t view it as compulsive or an addiction<\/a>, meth keeps him from experiencing vulnerability and intimacy<\/a> in his connections with other gay men.<\/p>\n Meth use among gay and bisexual<\/a> men is documented as rising and is a silent epidemic among the gay community today.<\/p>\n Crystal meth prevalence among men who have sex with men has been estimated between 15% and 23% across studies in Europe, Canada, and the US, far above the general population.<\/p>\n When it comes to substance use, of any kind, there are many ways to change our relationship to it, and clients\u2019 goals<\/a> may vary, but there are common factors that contribute to why we drink and use.<\/p>\n Whenever I hear someone recognize that their substance use is starting to cause negative consequences, yet they have difficulty making any change, what I hear is that the pain they have outweighs the negative consequences. <\/p>\n Shame<\/a> on top of shame is just more shame and so for many gay men, we might drink or use drugs to numb the shame, conscious or unconscious<\/a>, and then we feel even more shame because we don\u2019t like where the drinking or drug use leads\u2014blacking out, avoiding intimacy, risky sexual behavior, feeling shame about sex, the list goes on.<\/p>\n I meet many gay men who feel unsure about their relationship with drugs and alcohol<\/a>, but think they have to wait until something dramatic happens before changing anything. That isn\u2019t true. We\u2019re allowed to question our relationship with drinking or using drugs long before it becomes a problem. We\u2019re also allowed to want a different relationship with ourselves without substances.<\/p>\n I want to invite clinicians, or anyone reading this post, to take a client-centered approach in meeting someone where they\u2019re at. For instance, my client helped me understand that sometimes, the very word for the substance can evoke feelings of shame. My client told me the word carries so much stigma<\/a>, even among other gay men, that for him to say it out loud sometimes causes him to shut down. <\/p>\n I was grateful<\/a> for what our work together taught me. So that my client could feel safe enough to even explore his meth use, we took the words meth, addiction, and abstinence off the table for now.<\/p>\n