First published May 18, 2005, in the Chicago Free Press.
Recently, our fair city of Chicago issued a report by an ad hoc group calling itself The Chicago Task Force on LGBT Substance Use and Abuse.
The original advocates of the report deserve credit for wanting to address a long-standing problem in the gay community. But the final report, long-delayed and over-edited in order to offend no one, was so infected with drug treatment industry myths, mealy-mouthed social worker jargon and such feeble suggestions for dealing with the problem that it was almost useless.
The report called for a "safe, visible, sustained and supportive dialogue on the topic of substance use and abuse." It confidently asserted that "not all substance use is problematic." It preachily admonished us all to be "supportive and nonjudgmental about ... substance use and abuse" and urged us to "find common ground on which to define when substance use becomes abuse."
Well, no. I don't plan on being "supportive and nonjudgmental" or to regard "substance use" as non-problematic, or to try to "find common ground" with users who disagree. Here is what we know: Many drugs can and do cause long term physical and mental damage to the user, damage not immediately apparent. And some drugs increase a person's desire to engage in sexual behavior with high risk of HIV infection.
One recent study in the Journal of Urban Health as summarized by the Gay Men's Health Crisis newsletter found that "Drug use was significantly associated with higher numbers of sex partners, higher social isolation scores, and participation in unprotected receptive anal intercourse."
Another study found that people who used meth with other drugs such as cocaine and ketamine "reported more unprotected sex with more partners of ... unknown status. Heavy drug users also had higher scores on tests of impulsivity and negative self-perceptions."
A third study of meth and cocaine use concluded: "During periods of drug use, high risk sexual behavior increased along with the increasing frequency of drug use. ... To reduce and prevent risks of HIV, no level of use of these drugs should be considered 'safe.'"
What is the solution? There is no solution. Drug use is not going away. All we can do is promote strategies to limit the wider use of drugs. Clearly, we must find out what messages can best persuade current users to stop, discourage young people from starting and break the connection between drugs and the social aspects of being gay. Important steps to take include:
- Publicize - without exaggeration - the effects of the various drugs.This includes the biochemistry of how they work, the physical effects they produce, the behaviors they can lead to, and long term physical and mental impact. Drug dealers seldom provide that information.
- Be judgmental! Instead of being "supportive and nonjudgmental," be judgmental and non-supportive. The capacity for judgment is why God - and evolution - gave you a brain. Use it or lose it.
- Don't let people get away with the fiction that they are not responsible for their drug use. "Addiction" is a loaded word used to convince people that they are not responsible for their actions - that it is the drug's fault. But when we say people are "addicted" to a drug we only mean they like to use it and don't want to stop enough to actually stop. The same is true of the so-called "disease" of "alcoholism."*
In fact, people on their own can and do stop using drugs all the time. Cigarette smokers stop smoking, heavy drinkers cut down or stop drinking entirely, cocaine users stop using cocaine and meth users stop using meth. They just have to want to enough.
For many people, drug use as a way of avoiding coping with other problems in their lives: a hostile or unsatisfying home environment, stress at work, boredom due to a lack of any real interests or goals, personal fears or insecurities, a failure to develop enjoyable social contacts.
As psychologist Jeffrey Schaler pointed out five years ago in Addiction Is a Choice (Open Court, 2000), "I've witnessed over and over again that focusing on clients' drug-using behavior is no way to help them give up drugs. ... It's only by talking about their problems-in-living and encouraging them to confront and solve those ... that the drug use subsides."
Making this more widely known might encourage people to address their problems instead of using drugs as a coping or avoidance technique. The more that people understand their own motivations - and know that we are on to them - the more likely they are to act rationally.
Finally, young people have had too little time to learn from painful experience that the seeming benefits of drug use are immediate and the costs tend to be in the long run. And, of course, some adults never seem to learn. How we communicate that information effectively is a problem. But weak, permissive task force reports seem a counter-productive way to start.
*See, for elaboration, Herbert Fingarette, Heavy Drinking: The Myth of Alcoholism as a Disease (University of California Press, 1988).