STIM Spotlight: Programs Need Concurrent Approach in Addressing Chemsex

Methamphetamine's resurgence has refocused attention to the needs of a group of users for whom meth use and compulsive sexual behavior become intertwined. At this November's Cocaine, Meth & Stimulant Summit in Miami, prominent interventionist and Breathe Life Healing Centers founder Brad Lamm, CIP, will offer clinical guidance for working with patients who have become immersed in a culture of “chemsex.”

Addiction Professional spoke with Lamm, whose California facility includes a Crystal Clear program for meth addiction, about the latest iteration of chemsex and the challenges that affected patients bring to treatment.

(Editor's note: These comments have been edited for length and clarity.)

Is today's chemsex phenomenon different from how it looked in the past?

In the last six months at Breathe, only one of our chemsex patients is not injecting meth. The majority were smoking or snorting the drug six years ago. It's really a different level of addiction. People will party for days and days and days, and this becomes more dangerous. The sex and the drugs are equally compelling them to stay in it. At Breathe, one of the biggest client populations we treat is gay male meth addicts. With the injecting, programs have seen HIV transmission go up. Rates of hepatitis C are also skyrocketing in the community.

What are some of the challenges involved in treating this group?

If you just treat the meth, it's pretty easy to keep someone off meth while they're in treatment. But as soon as they get out, they're back on their app and they're GPS'ing their way back to the party. One of the biggest headlines from my talk will be, “Here are ways you can adopt some treatment of both the sex and the meth concurrently.” An important goal is to establish the necessity of calling a “time out.” If you don't give both the sex and the meth a break by allowing the brain to heal, you're likely to go back into the cycle. Treatment will involve establishing a sexual recovery plan.

What are some important measures programs can take in treating this population?

If the patient is resistant to establishing real change with use of their mobile phone, what is involved is setting up an accountability path. At a minimum, they should let someone else control the content on their phone. Without that, they are likely to relapse shortly after discharge. The lure is so strong. There are sites for meth sex online, where you can watch people having sex and injecting each other.

Can programs that don't specialize in LGBT treatment reach the chemsex patient successfully?

Cultural competency is really important in treatment. If a program is able to establish the two basics of care, which are safety and stability, it can succeed. Those don't seem like high bars to set, but they are. You have to establish a safe place for the patient to stabilize. In mixed groups, that's hard to do. The patient is often paranoid, delusional.