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).