A
Gay Man’s Guide to Sex and Recovery by David Fawcett
By
David Fawcett,
190
pages
Reviewed
by Sean McShee
This
book contributes to our understanding of meth addiction and sexual health among
gay and bi men. Fawcett identifies internalized shame and isolation as social
determinants that predispose some gay men to become meth addicts. A social
determinant refers to conditions that a group shares. It pre-disposes members
of that group to poor health outcomes.
Fawcett
rejects “shaming”, “shunning”, or “demonizing” meth users. If internalized
shame pre-disposes gay and bi men to all sorts of problems, continued shaming
will only make matters worse. Shamed people may become more rigid in their
behavior. Shame is counter-productive.
Fawcett
describes the current social context as a “perfect storm” for the meth epidemic.
The “culture wars”, lasting for almost 50 years consist largely of arguments
about shame and resistance to that shame. Meth, more than any other drug, has a
peculiar ability to fuse with sexual desire. This fusion occurs in the midst of
epidemics of multiple sexually transmitted diseases. While treatments have made
HIV a semi-manageable disease, the “HIV crisis” has now become the “HIV normal”.
Guys in their 20s have lived their entire lives thinking of HIV as a semi-manageable
disease. This “weather” pattern is ominous.
How psychoactive drugs work
Before delving into this book, here is a quick refresher on
how all psychoactive drugs, from caffeine to heroin, work.
Brain cells communicate exchanging chemicals called
neurotransmitters. This communication produces all of our perceptions,
thoughts, feelings, memories, and actions. Some neurotransmitters stimulate;
others relax. Some enhance mood. Still others disinhibit. We experience the
exchange of neurotransmitters as changes in mood, thought, perception, or
muscle movement.
Psychoactive drugs have the greatest effect in the reward system
of the brain. We experience exchange of neurotransmitters in this part of the
brain as pleasure or pain.
Psychoactive drugs have molecular structures similar enough
to neurotransmitters to “fool” a brain cell into reacting as if it had just
received an actual signal from another brain cell. That second brain cell then transmits
its misidentified message to other brain cells. This misidentification of the
psychoactive drug as a neurotransmitter causes the brain to reduce its
production of that neurotransmitter. When the psychoactive drug wears off, the
brain has less of that neurotransmitter available. This results in the opposite
effect of the high. For example, severe lethargy and depression follows an
energetic euphoric meth high, as the brain readjusts its chemical balance.
Psychoactive drugs change brain chemistry.
Part
I The Perfect Storm
This
part of this book concerns the effects of methamphetamine and the social
determinants of methamphetamine addiction among gay and bi men. People at all
stages of meth use and their significant others would find this section
valuable, as would people interested in social issues within gay male
communities.
Brain
cells misidentify meth as dopamine. They then transmit that misidentified
message throughout the reward system of the brain. On the physiological level,
two brain cells communicate by misidentifying meth as dopamine. On the
subjective level, we experience that misidentification as a sense of pleasure
and well-being. If a large number of brain cells simultaneously misidentify
meth as dopamine, we experience those misidentifications as a sense of euphoria
and invincibility. Despite its similar molecular structure, meth differs from
dopamine. While dopamine will be active for a short time, meth can last for up
to twelve hours. This extended presence of meth throws the entire reward system
off balance.
Meth
and sex “work” the reward system. Dopamine activates those brain cells that
process erotic information, desires, activities, and fantasies. When brain
cells communicate, they “lay down a path” between them. If these cells
communicate frequently, the path becomes stronger to facilitate that pattern. These
strengthened pathways allow us to perform familiar tasks by “going on
auto-pilot”. Two activities done at the same time will cause brain cells to simultaneously
communicate or fire. Meth and sex fuse (“what fires together, wires together”),
a double whammy to the reward system. Fawcett argues that meth “hijacks” the
reward system of the brain.
Fawcett
accepts the concept of “process addictions” whereby rewarding activities in
themselves can develop into addictions without the intake of any external
psychoactive drugs. In each case, the reward system becomes disturbed. The
presence of progression (becoming worse over time) and tolerance (needing a
bigger hit over time) justifies labeling the problem as an addiction rather
than a compulsion. Process addictions have generated controversy. Some people
feel the label “addiction” should be restricted to pharmacological
addiction.
Fawcett
argues that meth exploits key vulnerabilities among gay men. Some gay men lack
confidence, feel worthless, isolated, or feel a sense of shame. Meth allows
some guys to temporarily feel the opposite. Whether conscious or not,
internalized heterosexist values lead many gay and bi men to unacknowledged,
but felt shame. The extent of that shame influences the erotic lives of gay men
in ways that remain hidden from consciousness. Meth has great appeal for these
men.
According
to Fawcett, some gay and bi men reported that meth allowed them to experience
feeling defiantly gay for the first time in their lives. For some gay men,
their coming out process failed to deal with their internalized shame and
isolation. Meth filled this hole in their life.
Exploring
the Sexual Universe
The
second part concerns how we structure and organize erotic attractions and
relationships. This section would have value for many gay and bi men seeking to
improve their understanding of erotic patterns. Fawcett asserts, “Our society
has an overabundance of sexual images but also a simultaneous lack of deeper
sexual understanding.”
The first
part of the book focuses on the physiology of meth addiction, but we do not
just experience meth or sex on a physiological level. We experience meth and sex
on emotional, relational, and social levels as well.
Fawcett
distinguishes sexual orientation from sexual templates. Sexual orientation
refers to the sex of the people that one finds attractive. In slang terms, we
have a “type” to which we generally are attracted. In technical terms, we would
have a sexual template. This template refers to the physical image and general
erotic activities that a person finds attractive. People vary in how rigidly
they adhere to their template. Relatively fixed by the time of puberty, this
template structures our lifelong patterns of conscious and unconscious arousal.
While people can add factors to their template, most people find eliminating
factors from it extremely difficult.
Meth
interacts with templates in strange ways. It shatters them. Most of us have
“stuff“ buried beneath consciousness, ranging from internalized heterosexism to
leather fantasies and beyond. Meth tends to cause that “stuff” to break out
into consciousness but without conscious processing. Bringing this “stuff” out
of sub-consciousness leads to better mental health, but only if someone had
consciously processed it. This “stuff” has power and danger. If processed
consciously, someone can challenge the reasons why it was buried. They can then
integrate that “stuff” into consciousness. Without conscious processing,
unintegrated “stuff” explodes into behavior in dangerous ways.
Restoring
Your Life
The
third part of the book concerns recovery. This section would be useful for
someone with a significant other undergoing recovery, graduate students
studying addiction, or addiction professionals. A recovering addict in early
recovery would probably lack the concentration to read this book, however.
As
gay male meth users in recovery have fused meth and sex, Fawcett stresses that recovery
has to work these two tracks simultaneously. For the severely addicted, this
entails abstinence from drugs and sex to allow healing to occur. The recovering
addict has to learn new skills and acquire new tools to deal with the
underlying feelings that drove the drug use. People can recover, but recovery requires
resources.
According
to Fawcett, recovery has distinct stages in the recovery process. For the first
two weeks without meth, the former user will experience intense cravings,
depression, and paranoia. These tend to diminish relatively quickly.
The
next 90 days will involve unlearning old cues and establishing new routines. In
this period, the former user will have to become very aware of those
environmental events that trigger a desire to use. These triggers can be
sights, smells, sounds, people, neighborhoods, etc. The recovering addict has
to learn how to avoid these triggers. The
brain will take 18 months to rewire the neural pathways. Eventually, the
recovering addict can re-introduce sex into his life, but he can never
re-introduce meth.
While
this book focuses on meth addiction, Fawcett discusses ways of thinking about
sex and relationships that many would find valuable. Other parts can generate
community debate. Below are some areas
that could generate fruitful community debates and other areas that could use
improvements.
Areas
for Debate: Sexual Addiction, Sexual Compulsion, Anhedonia, and Treatment Differences
The
concept of “sexual addiction” will generate the most debate. Fawcett
acknowledges that this position engenders controversy. I do not find compelling
the argument that the label “addiction” best describes a type of compulsive
sexual behavior. I would imagine it would generate a good deal of resistance
and keep some people away from treatment.
While
the pharmacological addict can never again use the addictive substance, sex can
be reintroduced to the recovering sex “addict”. This difference in treatment
indicates a fundamental difference between pharmacological addiction and this
process “addiction”.
Process”
addictions” can be considered a type of compulsive behavior involving the
reward system. In a compulsive behavior, not involving the reward system, such
as handwashing, the hand can never become clean enough. In a functioning reward
system, rewarding activities lead to a sense of well-being and satiation,
rather than a need for more. According to Fawcett, a key feature of sex
addiction lies in its emphasis on anticipatory pleasure rather than orgasm.
Compulsive sexual behavior never is good enough to produce satisfaction.
Anhedonia,
another disturbance of the reward system, may be involved. This condition
refers to an inability to experience pleasure. Anhedonia frequently contributes
to depression and self-medicating depression contributes to stimulant use.
Compulsive sexual behavior may result from this pre-existing disturbance in the
reward system, rather than a psychoactive drug.
Areas
for Debate: Community vs clinical sample
Our
knowledge of substance use suffers from a major knowledge deficit. Most of what
we know about substance use comes from people in treatment programs, jails, and
hospitals. We primarily know about this end-stage drug use. We do not know
about drug users at earlier and less problematic stages. We have a knowledge
deficit about the varied “careers” of drug users. An unknown number may never
progress to addiction or may simply “mature out” of drug use. When people
generalize from end-stage drug use to all drug users, they risk overstating the
problem. This knowledge deficit should be acknowledged in all public
discussions of drug use.
This
knowledge would be particularly useful in answering the question: How does addiction differ from people frequently
doing what gives them pleasure? This question becomes particularly important
for groups of people, such as gay and bi men, with a history of victimization
by Puritanist ideology. Sensitivity to this history of victimization forms a key
component of cultural competence for health issues for gay and bi men.
Possible
Improvements: Resources Needed
Fawcett
states that people can recover from meth, but that recovery will take
resources. He never mentions the amount of resources it will take. Addiction
can leave people impoverished and homeless, but accessing services requires
money. Emotional recovery requires time. This deserves a place in a book about
addiction and recovery.
Possible
Improvements: Lack of a glossary
Fawcett
introduces many scientific terms in the course of a book intended for a
non-technical audience. As some people will encounter these terms for the first
time in this book, it would have benefitted from a glossary.
Good
books on public health issues work best when they generate debate. They fail to work when people treat them as
if they were sermons. This book should generate a good deal of debate about an
important issue.
Full
Disclosure: I have known and worked with
David Fawcett for over five years in various gay and bi men’s health
organizations.
