From: MShernoff@aol.com Date: Wed, 14 May 1997 20:38:54 -0400 (EDT) Subject: drug & alcohol article Use or Abuse?: = Deciding When Drugs or Alcohol Become a Problem Michael Shernoff, MSW Published in LGNY, May 45, 1997 (c)1997 Michael Shernoff Permission is granted to copy or reproduce this article either in fu= ll or in part, without prior written authorization of the author on the sole condition that the author= is credited and notified of reproduction = One Friday afternoon last summer I received a desperate phone call from a= patient of mine who was on a week's vacation in The Pines. "I'm really terrified," he weepi= ngly told me. I've been partying since last night and realized I was in trouble when I came to th= is morning, could no longer pick up the vodka bottle because it was so greasy that it slipped = out of my hand and broke. = What's even worse, I'm alone, my butt is greased up, sore and there's no = condom wrapper anywhere. I have no idea what happened or who it happened with. I only = know that after last night I may very well not be HIV negative any longer. What should I do?"= = The call was not a surprise since for several months he and I had been ex= ploring his use of = "recreational" drugs and alcohol. I had often told him that his descript= ions made clear that the way he used and had come to rely on chemicals was causing problems. =0D "I would suggest that you get on the train, come back into the city and = go the beginner's AA meeting that is at the Episcopal Church on 9th Avenue and 28th Street at = 6:30 tonight. When you get there, walk up to whoever is running the meeting, tell him or her tha= t this is your first meeting and could they get you an interim sponsor who will guide you through your= entry into the program? Call me later and tomorrow so we can touch base." This was not= some flaky individual. He was a very well educated and sophisticated computer profes= sional. That phone call began his long hard journey to learn how live and enjoy himself free of = chemicals. = =0D Unfortunately, this man's story is all too familiar, and similar to that= of scores of other men who have consulted me for psychotherapy over the years. Most studies, includi= ng a highly regarded 1988 survey in San Francisco by Ron Stall and John Wiley have found that = the frequency and variety of drugs used by gay men is greater than that of heterosexual men= =2E But, gay men are not so different than the rest of society in using either alcohol or some oth= er drug to help them have a good time and to let off steam. For many people recreational use does not= pose a major difficulty. This article is intended to help you decide for yourself whether your use= of drugs has caused you to lose part of your life. = =0D How drug use can be problematic takes a variety of forms. Take Orlando, = for example. He is a thirty year old successful buyer in the woman's clothing industry. He is= HIV positive though asymptomatic and in excellent health, except for chronic active Hepatitis= B. Initially he told me that his drinking was moderate and happened only on weekends. But his wee= kend social life was based around heavy drinking. He admitted that while on a recent visit to= the Westside club he had engaged in unsafe sex. It was obvious that his drinking, combined with h= is antiretroviral drugs, was directly contributing to his elevated liver functions, a recent relap= se of Hepatitis and ultimately could result in his developing liver cancer and killing him. I= told him he had a serious drinking problem. He sat stunned, disbelieving and meekly asked, "a serio= usproblem with alcohol?" Orlando is a clear example of how powerful people's denial abou= t their drug use can be. While alcohol and drug use has always been fashionable in gay circles, th= e recent increase in "circuit parties" is one venue where wide spread drug use is accepted as = a norm. In his recently published book Life Outside, Michelangelo Signorile explores the relation= ship among the circuit, = drug use, and the wider gay male culture. Signorile provides numerous exa= mples of men who describe using drugs for a variety of reasons including: increasing their= energy and stamina in order to dance all night; reduce feelings of insecurity about their body = not measuring up to the current standard of gay male perfection; to become more uninhibited; and = to get out of their minds and escape their ordinary lives. While you may not frequent the ci= rcuit that Signorile describes, or even identify as a "party person," it is always a good idea= to honestly examine how often and how much you drink or use drugs. =0D Let's look at the spectrum of ways people can use drugs. Recreational, no= nproblematic use of drugs and alcohol is intended to enhance enjoyment of an event or occasio= n. The term implies infrequent and moderate usage. Can any drug be used safely without abuse,= in a recreational way? No one, not even experts, seem to agree. There is certainly a world of di= fference between wine with dinner and alcoholism, and occasional use of pot, coke or ecstacy to= party and using it all weekend every weekend. = =0D Do you have a problem with drugs if you occasionally get very drunk or st= oned? One certain indication that drugs or drinking has become problematic for you is if yo= u experience blackouts, periods of time about which you cannot remember any details of what was s= aid or done. The man +vacationing in the Pines called me only after he had awoken from a black= out. A very simple way of determining whether you have a problem with drugs is if your use of ch= emicals causes you problems in any area of your life: work, family, social, emotional, physi= cal or sexual. Another indication that you may have a problem with drugs is if you have = become dependent upon them to function in any way. For example, a reliance upon alcohol, t= ranquilizers or pot can develop as a necessary part of unwinding after a hard day. It can also t= ake the form of needing to be high in order to have fun and not become bored. It is normal and unde= rstandable that many men feel that they need a drink or joint in order to loosen up when in a = bar, cruising or on a date. = But if the only way you can talk with another man, or have sex, is to be = high, then you are dependent upon one or more drugs, and that can lead to trouble. =0D An individual is addicted when the body has built up a tolerance for a sp= ecific drug, and withdrawl symptoms are experienced if you suddenly stop taking it. Tolerance for a = particular drug means that increasing quantities are required to achieve the same effect. Alco= hol is one of the drugs for which people quickly acquire a tolerance and eventually a possible addict= ion. For instance if you begin to shake if you don't have a drink for a certain amount of time, yo= u are probably addicted to alcohol. = =0D An example provided by Signorile illustrates the "polydrug" use of many= men on "the circuit": = "In order to feel better, Walt hits the dance floor high on drugs. I'm on= Ecstasy, but still maybe I take another hit. But it'll be awhile before it works, so I take a hit o= f poppers, and then everything is fine, wonderful, I feel like I belong. And then, in a bit my second h= it of Ecstacy kicks in,, and I'm doing good for the night." But Walt's wonderful feelings are short li= ved. Usually he winds up home alone later and to cope with his loneliness he will spend hours on t= he phone sex lines, snorting amphetamines, (a stimulant drug) to stay awake. Walt told Signo= rile that he now uses amphetamines at work, to "get through the day." = Even if you do not use as many drugs as Walt, some effects of drugs, take= n in combination with each other and with marijuana and alcohol do not become apparent until on= e or two days later when at work you may feel hung over, or just dragged out, a bit muddled a= nd unable to function at your normal level of performance. I had one patient who accepted that= his weekend use of chemicals was interfering with his life only after he got fired from a se= cond job for repeatedly missing work on Mondays due to how "fucked up" he got over the weekend. =0D There is considerable difference of opinion about whether any nonprescrib= ed drug can be taken safely in a recreational way. When does occasional use of marijuana, Spec= ial K, Ecstacy, acid, = mescaline, ordinary cocaine or crack cocaine, a drink or one of those oth= er numerous "vague white powders" that are sold as speed, cocaine, MDA, MDM or Heroin that s= o many people casually inhale, and others inject, cross the line from recreational use= to abuse? There is no hard and fast answer to this question. =0D HOW ARE DRUGS AFFECTING YOU? When should you be concerned about the frequency and variety of your drug= intake? The answer is always. But at what point can you be considered chemically dependent? = How can you determine whether you're denying that you have a drug problem? Here is a= chemical use self-assessment tool for you to evaluate the impact that drugs is having = on your life. Try answering these questions. 1. Are you able to enjoy socializing without drinking or smoking po= t? 2. Are you able to flirt, cruise and talk with strangers if you're = not high? = 3. Are you able to ask someone on a date or to come home with you if= you're not high? 4. Are you able to go out on a first date or accept someone else's i= nvitation to go home with them if you are not high? 5. Are you able to enjoy dancing if you're not high? 6. Are you able to have sex without smoking, drinking, dropping or i= nhaling something?? 7. Are you able to achieve and/or enjoy orgasm without being under = the influence of any drug? 8. Do you respond to boredom by smoking a joint, taking a drink or = using some other drug? 9. Do you use alcohol or any other nonprescription drug every day? 10.Do you use any nonprescription drug more than once a day? 11. Have you ever gotten into trouble with the law while under the i= nfluence of chemicals? 12. Have you ever behaved in an unsafe or irresponsible way especial= ly regarding sex, while under the influence of alcohol or drugs, that you would not have do= ne had you been sober? 13. Do you ever find yourself arriving late for work on Monday or mi= ssing work entirely because of feeling so poorly due to how hard you partied over the week en= d? 14. Can you can only feel good about your self when you are high? =0D Most people answer questions one through seven "yes"--- of course they're= able to hang out, have fun, cruise, dance and go home with someone without having to be high. T= he next question to ask yourself is when was the last time you chose to do any of these thing= s without being under the influence of alcohol or some other kind of drug? If you have difficulty r= emembering, the last time you did any of these activities drug free, then you most likely are abusi= ng drugs to some extent. What about people, like Orlando, who are never high during the work week = and are only rarely adversely affected by the previous night or weekend? These may also be pe= ople who take a hit of something to go out dancing. Is there anything wrong with blowing off som= e steam and using drugs to help shut off the mind's computer? The answer is dependent upon = whether there are any ill effects to you related to your use of alcohol or drugs. But, no one b= ut you can honestly answer whether you have a problem with drugs. After all, people take drugs or dr= ink because the effects usually feel good, and help disinhibit people so they can do things they = might be too uptight to do if they were sober. This can be good and bad. =0D WHAT TO DO IF YOU THINK YOU HAVE A DRUG PROBLEM The first thing to do is to try dealing with the problem directly. This = means cutting down or stopping your consumption of alcohol and recreational chemicals on your o= wn. If you're concerned about your use of a specific drug, try stopping taking this sub= stance entirely and without substituting anything else. Another way to assess whether you fe= el you have a drug or alcohol problem is to set a limit for yourself and see if you can stick t= o that predetermined amount. For instance, you decide that you will have only three drinks, = whether they be wine, alcohol or something stronger in any given day. Having one or two the da= y before does not mean that you can now have four or five in order to consume your quota. If yo= u are unable to stick to a self imposed limit, you probably have a problem. A patient of mine who i= s in recovery for alcoholism explained that after dinner with a friend he noticed that the = friend was leaving a glass of wine, largely untouched. "If that had been me when I was drinking I w= ould not have been able to have left that table without finishing off every drop of my own drink,= and very possible everyone else's as well!" = =0D Before stopping any drug suddenly, it is important to ask your doctor whe= ther it is safe for you to stop without medical supervision. For example, full blown addiction to a= lcohol, barbiturates, and a variety of tranquilizers should never be stopped "cold turkey." It is p= ossible to have a seizure as a result of suddenly stopping a drug that your body has grown dependent u= pon. Usually detoxification occurs in a hospital. Heroin, Demarol and the other opiat= es can be stopped cold turkey. They do not require in-hospital detoxification, though I have oft= en heard people who "cold turkeyed" heroin say that during the process they wanted to die. = A person detoxing from opiates therefore might also want to do so in a medical facility. = =0D Issues of substance abuse are routinely dealt with during the course of p= sychotherapy. Not all therapists are trained or experienced in working with the unique needs of= alcoholics and other chemically dependent individuals, so you should inquire about a prospecti= ve therapist's experience in helping people get off drugs. In addition, ask if the therapist routi= nely refers chemically dependent people to one of the twelve step programs like AA (Alcoholics A= nonymous), NA (Narcotics Anonymous), or CA (Cocaine Anonymous). If this professional d= oes not believe in the usefulness of AA or similar programs, do not begin treatment with this in= dividual. After almost twenty years of practicing psychotherapy, I know that there is no way tha= t I can effectively help a chemically dependent individual who refuses to go to one of these program= s. = =0D People who have been drinking or using drugs for many years very often ca= n not even imagine stopping, or what their life would be like if they did no longer drink or= drug. Very often the most difficult part of giving up alcohol or drugs is beginning the recovery pr= ocess. The first step in addressing the problem is admitting to yourself that you do indeed have a= problem and that you need help. The next step is finding the right kind of help. = =0D Numerous patients of mine have told me that had I not given them the phon= e number of someone they could call to accompany them to their first AA meeting, they would n= ever have gotten there. = Asking for help is very hard, especially for men. But so many people in = our community have gotten sober, that it is a rare gay or lesbian person in New York who doe= s not know someone who is in "The Program,"and who would be happy to be of assistance during= the difficult and trying period of beginning to face the reality of a drug or alcohol probl= em. =0D Joining gay AA, NA, or CA has been a life saving step for tens of thousan= ds of gay alcoholics and drug addicts. These organizations are made up of people themselves recove= ring from addiction to one or more substances. They provide support for people at any stage of = identifying the nature of their drug or drinking problem. There are now special interest meetings,= ranging from people living with HIV/AIDS to men into the leather and s/m lifestyles. Informa= tion about how to locate the all gay meetings can be obtained anonymously by calling either the AA= office at 212 870-3400, or the Alcoholism Council Fellowship Center of New York Hotline= (212 979-1010). The only requirement for attending one of the twelve step programs mentio= ned above is a desire to stop drinking or using drugs. = =0D Michael Shernoff, MSW is a psychotherapist and author in private practice= in Manhattan. He can be reached via e mail at mshernoff@aol.com or at his home page http://members.aol.com/therapysvc=