From: MShernoff@aol.com
Date: Thu, 20 Feb 1997 04:38:08 -0500 (EST)
Subject: gay men & "recreational drugs"

    So Many Drugs, So Little Time:
	When Recreation Becomes Dependence

Michael Shernoff, MSW

First Published in The New York Native, July 5, 1982 Revised and updated 
Feb., 1997

    Permission is granted to copy or reproduce this article either in full 
or in part, without prior written authorization of the author on the sole 
condition that the author is credited and notified of reproduction
Since the onset of AIDS, increased concerns about maintaining one's health
has contributed to many gay men beginning to reevaluate their use of 
"recreational" chemicals. The direct link between use of large quantities of
alcohol and/or illicit chemicals and immune impairment has been undeniably 
proven.  Thus for all people, but especially any person living with HIV or 
AIDS, use of recreational chemicals should be a serious concern.  Although 
statistics on the prevalence of chemical dependency in the gay community 
are imprecise, studies since 1973 have consistently found that approximately 
one third of the lesbians and gay men surveyed by different studies at 
various locations all around the United States reported being chemically 
dependent. One study conducted in San Francisco in 1988 by Stall and Wiley 
found that the frequency and variety of drugs used by gay men is greater 
than that of heterosexual men.

While alcohol and drug use has always been fashionable for many gay people
the recent increase in "circuit parties" is one venue where wide spread 
drug use is accepted as a norm.  Last summer the druggy nature of circuit 
parties was publicized by the public controversy generated in both the gay 
and mainstream press when the appropriateness of GMHC sponsoring a fund 
raising event where drugs were widely used was questioned. The fact remains 
that the taking of drugs is widespread and socially sanctioned within 
certain parts of the national gay community. 

As a psychotherapist I work with many gay men who are dependent upon some
type of drug. In general, substance abuse has not been the reason these 
men have given for seeking therapy. Only after careful questioning does 
it usually become apparent that the individual's life style use of alcohol
and/or other drugs is interfering with his life. For the purposes of this 
article, the term "chemical" refers to both alcohol and drugs.

DEFINITIONS
Webster's defines a drug as "a chemical substance administered to prevent
or cure disease or enhance physical or mental welfare...a substance 
affecting the structure or function of the body or mind." Attitudes towards 
the word "drug" can vary, depending on whether the drug under discussion 
is penicillin, prescribed to cure an infection, protease inhibitors to curb 
HIV replication, or whether it's alcohol, Valium, Ecstacy, Special K, Cocaine 
or Heroin.

Recreational and nonproblematic use of drugs and alcohol is intended to 
enhance enjoyment of an event or occasion. 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. Who determines how much is 
infrequent or modest usage? There is certainly a world of difference
between wine with dinner and alcoholism.

Another aspect of the question is polydrug use. A 1988 study found that 
gay men not only used drugs more often but used a greater variety of drugs 
than did heterosexual men. Many gay men who regularly party describe 
dropping some kind of illicit stimulant drug (Ecstacy and Special K are the 
current favorites) before they go dancing. If they are not sufficiently off 
in a couple of hours, they do another dose, snort cocaine or amphetamine, 
smoke marijuana and perhaps have a few beers or hard liquor drinks in
order to keep dancing until the party is over or the club closes.  Some 
sort of sedative or tranquilizer is taken before departing the club in 
order to come down and perhaps catch a few hours of sleep prior to returning 
to work.

Some effects of these drugs, taken in combination with each other and with 
marijuana and alcohol do not become apparent until one or two days later 
when at work the man feels dragged out, hung over, a bit muddled and unable 
to function at his normal level of performance.  Other more insidious 
effects are far from clear. Regular polydrug use is a serious problem for 
many gay men. Aside from individuals already in recovery themselves from 
drug abuse, AIDS prevention, mental health and substance abuse professionals, 
few people within the gay community care to discuss this issue.  

Drug abuse fits into one of two categories.  An individual either disregards 
the specific instructions that a physician has written for a prescription, 
or has increased his use of recreational drugs to the extent that normal 
functioning becomes impaired. This interference can emerge in any one of a 
variety of areas: work, family, social, emotional, physical or sexual. 
One certain indication that drugs or drinking has entered the abuse
phase is if the individual experiences "blackouts." A blackout means that 
the person is unable to remember any details of what was said or done 
during the time they were under the influence of the substance in question

Drug dependence occurs when someone has come to rely upon a substance in 
order to function normally. For example, a reliance upon alcohol, 
tranquilizers or pot can develop as a necessary part of unwinding after a 
hard day.  It can also take the form of needing to be high in order to have 
fun and not become bored.

An individual is addicted when the body has built up a tolerance for a 
specific drug, and withdrawl symptoms are experienced if the individual 
suddenly stops taking it.  Tolerance for a particular drug means that 
increasing quantities are required to achieve the same effect.  Alcohol is 
one of the drugs for which people quickly acquire a tolerance and eventually 
a possible addiction.

Crack cocaine is one example of how an individual's curiosity about trying 
a powerful intoxicant can lead to a serious drug problem quickly.  The high 
produced when crack is smoked is described as being one of the most seductive 
and intense drug experiences, though it only lasts less than twenty minutes.  
I have worked with individuals who report that within a couple of weeks of 
first trying crack, they were so taken with it that they became addicted 
before they realized what had happened. 

Some people believe that if a drug is prescribed by their physician, it 
is safe.  Most of the time this is true providing the patient takes the 
drug exactly as it has been prescribed.  Even then, some people become 
unwittingly addicted to prescription pain killers, tranquilizers or 
sedatives following medical treatment. During the 1960s and early 1970s, 
before controls on certain prescription drugs were tightened, it was not 
uncommon to find physicians who routinely prescribed such recreational drugs 
as amyl nitrate (poppers), and quaaludes.

PARTY DRUGS
There is considerable difference of opinion about whether any nonprescribed 
drug can be taken safely in a recreational way. When does occasional use of 
marijuana, Special K, Ecstacy, acid,  mescaline, ordinary cocaine or crack 
cocaine, a drink or one of those other numerous "vague white powders" that 
are sold as speed, cocaine, MDA, MDM or Heroin that so 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.

In the 1970s, in the hey day of the large discos the drugs of choice were
marijuana, MDA, MDM, Cocaine, various halucinogenic drugs like Mescaline
or LSD, any variety of amphetamine, Ethyl Chloride and Amyl Nitrate (poppers). 
Today the drugs are often different with Ecstacy and Special K being the 
current favorites, along with marijuana, Cocaine and crack cocaine.

The issue is not which drugs are consumed, but the fact that chemicals are 
regularly and seemingly casually taken without any awareness of the possible 
negative ramifications of using them.  While today's younger set of party 
boys do not use poppers and Ethyl Chloride as frequently as did the dancing 
men of the 1970s and early 1980s, if you look around the dance floors of 
today's clubs, you will see men who are now noticeably older than the 
majority of revelers on the dance floor still doing poppers and Ethyl.

GYM DRUGS
The current trend for many gay men to have a well developed, gym toned body 
has produced an additional arena where drugs are used and abused.  For many 
years professional body builders would routinely use anabolic steroids to 
increase their muscle mass.  When steroids are taken in combination with 
regular gym work outs the results can produce rippled, well-muscled bodies 
like the ones routinely seen in muscle and body building magazines. These 
drugs have serious side effects in addition to the increase in muscle tissue. 
In order for them to be taken legally, they must be prescribed by a physician, 
and carefully monitored. Some gay men wanting to become "muscle queens" 
purchase and take nonprescribed steroids illegally.  

There are even some gyms where these drugs are sold on the black market by 
employees, trainers or other men who work out at that particular gym. Taking 
steroids without the supervision of a physician can be dangerous, especially 
for immune compromised individuals.  Steroids are capable of suppressing 
the immune system, and may cause extreme mood swings and possible 
determatological problems.    

HOW ARE DRUGS AFFECTING YOU?
The guidelines I offer here are only suggestions to help you decide if your 
drug use has become a problem.  

    Do you need a drink, joint, pill or a few lines of something to make it
through the work day?.
    Do you ever have a problem remembering certain periods of time--what you
did or said or how you got home on any sort of a regular basis? 
    Is your work performance ever directly impaired and negatively effected
because of the night before, or previous weekend? 
    Can you can only feel good about your self when you are high?

If you answered any of the above questions "yes," then you may in fact have 
a problem with alcohol and/or drugs.  The more of these questions that
you answered affirmatively the greater the likelihood is that your use of 
chemicals is negatively effecting you.. What about people who are never
high during the work week and are only rarely adversely affected by the 
previous night or weekend? These may also be people who take a hit of 
something to go out dancing. Is there anything wrong with blowing off some 
steam and using drugs to help shut off the mind's computer? No one but the
individual himself can honestly answer that question. After all, people 
take party drugs or drink because the effects usually feel good.

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? If you are drug dependent, what if you don't see the 
problem because your drug or alcohol consumption does not appear to be out 
of control to you? 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 pot?
    2.  Are you able to have sex without smoking, drinking, dropping or 
inhaling something?
    3.  Are you able to flirt, cruise and talk with strangers if you're not
high?
    4.  Are you able to ask someone on a date or to come home with you if 
you're not high?
    5.  Are you able to go out on a first date or accept someone else's 
invitation to go home with them if you are not high?
 	6.  Are you able to enjoy dancing if you're not high?
    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 
influence of chemicals? e.g. (Have you ever been arrested for drunk driving 
or drunk and disorderly conduct?)
    12. Have you ever behaved in an unsafe or irresponsible way while 
under the influence of alcohol or drugs, that you would not have done had 
you been sober? (e.g. Engaged in high risk sexual activity)
    13. Do you ever find yourself arriving late for work on Monday or 
missing work entirely because of feeling so poorly due to how hard you 
partied over the week end?

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.  The next question to ask yourself is when was 
the last time you chose to do any of these things without being under the 
influence of alcohol or some other kind of drug? If you have difficulty 
remembering, the last time you did any of these activities drug free, then 
you are most likely chemically dependent to some extent. When questions about 
nicotine and caffeine consumption are added to this list, most Americans 
would have to be classified as chemically dependent individuals. 

CHEMICALS AND THE GAY COMMUNITY
A question that needs to be addressed by all members of the gay community
is why so many people need drugs to be able to relax and have a good 
time.  The high incidence of alcoholism and drug abuse within the lesbian 
and gay community is probably related to the repressiveness of the highly 
homophobic society we live in. Until the past two decades bars were 
practically the only safe places for gay people to meet and socialize. 
Pervasive homophobia and the resulting internalized bad feelings is another 
reason why so many of us choose to anesthesize ourselves so often with such 
a variety of chemicals. The results can be tragic, including accidental 
death from an overdose.
Societal homophobia is impossible to ignore or escape, and the degree 
to which an individual can withstand his experience of the pervasive 
homophobia is directly related to that individual's sense of self worth. I 
often hear men discussing their fear of approaching someone in a bar, club 
or gym in order to ask them out, or even to make eye contact or smile at 
another man.  My assessment is that so much of the obnoxious, but ever 
present "Attitude" that abounds within our community is really a self 
defensive posture meant to protect a truly insecure man.  The multiple ways 
we intimidate each other needs to be looked at and ameliorated. It is 
important to remember too, that these fears and anxieties are often experienced 
by some of the most attractive, successful and well built of men. It is 
not uncommon to hear men say: "Only after I have a drink or two, or if I 
am high, am I able to go over and begin to chat up someone I find hot."
Many people use drugs to mask feelings of anxiety and insecurity, not 
only about approaching people, but about how they are perceived by others 
on many levels. Over the past twenty five years, alternatives to meeting 
other gay people only in the highly charged sexual arenas have developed 
and blossomed.  Gay professional, social, political, religious and 
athletic organizations all provide places for gay people to meet others with 
similar interests and to participate in activities that are not primarily 
sexual, and where alcohol or drug consumption are minimal.

A typical weekend for many gay men goes something like this.  Early 
Friday evening, there is a dinner with friends or a date where alcohol and 
marijuana is consumed.  The later part of the night is spent in the bars 
or at home "doing the deed,"continuing to drink, or take some other 
substance.  Still later, if one has not met "Mr. Right" the evening 
continues at one of the after hours sex or dance clubs where even more 
chemicals are consumed.  After waking up on Saturday there will be an 
obligatory visit to the gym for a work out.  If time allows perhaps there 
will be a nap.  If people are going to go to one of the late night dance 
clubs, they often gather at a friend's house for a pre-club cocktail party 
where communal drug taking is de rigeur.  Once at the club, alcohol and 
more drugs may or may not be consumed.  Early Sunday morning one returns 
home to either play with a new found friend or sleep.  If due to the 
consumption of stimulant drugs, sleep does not come easily, then perhaps 
a sedative will be taken to knock the person out.  Sunday afternoon may 
or may not be spent with friends at brunch where more cocktails are consumed, 
and the evening winds down in one of the bars or bath houses.

If this combination of events and drugs seems exaggerated to you than 
either you are not what is commonly referred to as "a circuit queen," or 
you don't use drugs heavily in order to party.  For large numbers of gay 
men, the above is a fairly routine weekend.  The combination of chemicals 
and socializing is regularly experienced by gay men in large urban 
centers.

If you're not sure whether or not you can enjoy the bar, club, dinner, 
baths, party or sex without some kind of artificial stimulant, perhaps it 
is time for you to try doing anything you would regularly do, but 
without the drugs.  If you don't enjoy yourself  as much, perhaps it would be 
in your best interest to ask yourself  why that might be?

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 own.  If you're concerned about your use of 
a specific drug, try stopping taking this substance entirely and without 
substituting anything else.  Another way to assess whether you feel you 
have a drug or alcohol problem is to set a limit for yourself and see if 
you can stick to 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 day before does not mean 
that you can now have four or five in order to consume your quota.  If 
you are unable to stick to a self imposed limit, you probably have a 
problem.

A patient of mine who is 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 
would 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!" 

If you are using drugs, before stopping any drug suddenly, it is 
important to consult with your doctor and ask him or her whether it is safe for 
you to stop any particular drug without medical supervision.  For 
example, full blown addiction to alcohol, barbiturates, and a variety of 
tranquilizers should never be stopped "cold turkey." Usually detoxification 
occurs in a hospital.  Heroin, Demarol and the other opiates can be stopped 
cold turkey and do not require in-hospital detoxification.  Suddenly 
stopping these drugs can be quite an unnerving experience and usually results 
in the individual becoming quite ill, but not to a life threatening 
extent.

Detoxification from opiates is therefore most comfortably and safely 
accomplished in a medical facility specifically geared to this procedure.

If you are not certain about what you require in order to get help for your 
problem with either drugs or alcoholism try calling either the 
Smithers Alcoholism and Treatment Center at 212 523-6491 or the Greenwich 
House Counseling Center at 212 691- 2900. Either of these agencies will 
be able to set up an appointment for you where a complete assessment of 
what is the best way to begin dealing with your problem will be formulated, 
and suggestions offered for how best to proceed in order to begin to 
obtain help.

Issues of substance abuse are routinely dealt with during the course of 
psychotherapy.  Not all therapists are trained to or are experienced in 
working with the unique needs of alcoholics and other chemically dependent 
individuals.  If you are thinking of beginning counseling or therapy to 
get help with a drug or alcohol problem be sure to inquire from the 
prospective therapist whether he or she has worked with large numbers of 
other people around this problem. A therapist skilled in the area of 
substance abuse can be very helpful in deciding which course of treatment seems 
most appropriate. In addition, ask him or her if they routinely refer 
chemically dependent people to one of the twelve step programs like AA, NA or 
CA.  If this professional does not believe in the usefulness of AA or 
similar programs, do not begin treatment with this individual.  After 
almost twenty years of practicing psychotherapy I know that there is no way 
that I can effectively help a chemically dependent individual who refuses 
to go to one of these programs. 

Joining gay AA (Alcoholics Anonymous), NA (Narcotics Anonymous), or CA 
(Cocaine Anonymous has been a life saving step for tens of thousands of 
gay alcoholics and drug addicts. These are organizations of people who are 
themselves recovering from addiction to one or more substances.  They 
provide support for people who are at any stage of identifying the nature 
of their drug or drinking problem.  There are now special interest 
meetings for people living with HIV/AIDS and men into the leather and s/m 
lifestyles.  Information about how to locate the all gay meetings can be 
obtained anonymously by calling either the AA office at 212 870-3400, the 
Alcoholism Council Fellowship Center of New York Hotline (212 979-1010), or 
the 24 hour Alcohol Abuse Action Help Line (1-800-888-9383). 

The only requirement for attending one of the twelve step programs 
mentioned above is a desire to stop drinking or using drugs.  There are now 
drug treatment programs where a desire to stop using is not a requirement 
in order to get help with looking at the impact of drugs on your life.  
These counseling programs are the newest and for some individuals in 
recovery as well as drug treatment professionals, the most controversial 
approach to helping people with drug and alcohol problems.  The approach is 
called the "harm reduction model" and it began in England in the mid 1980s 
as a response to the spread of HIV/AIDS among people who used drugs and 
shared needles. Harm reduction has gained popularity both in Europe and 
around North America. Though originally developed to work with people who 
shoot up, harm reduction has now been expanded to become a method of 
reaching and serving a wide variety of people who use all kinds of drugs with 
AIDS prevention and education messages without requiring that they stop 
using.  Needle exchange programs are one example of a harm reduction 
approach to working with street addicts.

Prior to the development of Harm Reduction all alcohol and drug treatment 
programs had complete and life long abstinence from substances as the 
only acceptable goal of treatment.  Proponents of harm reduction believe 
that abstinence from drugs should not be the only objective of services 
to drug users because it excludes a large proportion of the people who are 
committed to a lifestyle of long term drug use. The SUCE (substance use 
counseling and education) program at GMHC is one example of a harm 
reduction model that offers counseling to people who want to talk about their 
drug use without feeling a pressure to stop.  While opponents of harm 
reduction feel that harm reduction condones drug use, advocates of the model 
view it as simply a realistic way of providing needed AIDS information to 
people who have no desire to stop their usage, increasing their access 
to abstinence models if they ever want to go that route.

When I showed a draft of this article to friends, they were disturbed 
that they "failed" the drug dependency questionnaire.  These are 
successful, professional men, most of whom I would not classify as having a 
serious problem with drugs.  Yet they admitted that they routinely relied upon 
some kind of chemical as part of their recreational patterns.  At least 
after reading this article they are asking themselves certain difficult 
questions. If we want our community to continue to develop and grow as a 
healthy and vibrant entity, then we must address all threats to our health 
and well being including the misuse of alcohol and drugs. Drug addiction 
and alcoholism have resulted in the needless deaths of tens of thousands 
of gay people.  These are preventable tragedies with the correct treatment.    

Key Words: Drugs, Drugs, Drugs, Drugs, substance abuse, substance 
abuse, substance abuse, substance abuse, chemical dependency, chemical 
dependency, chemical dependency, chemical dependency, chemical dependency, 
alcoholism, alcoholism, alcoholism, 

Michael Shernoff, MSW is a psychotherapist and author in private 
practice in Manhattan. He can be reached via e mail at mshernoff@aolo.com 
or at his home page http://members.aol.com/therapysvc