With a city’s increased awareness, many addicts seek ways to abate a drug’s ferocity
Gay men in New York City who are seeking treatment for a crystal meth problem may find that they have few options available to assist them in ending their crystal use, according to community health providers and activists. “We’re not licensed to do substance abuse treatment,” said Dr. Dawn Harbatkin, medical director at the Callen-Lorde Community Health Center, a gay health clinic. “Our goal is to assess someone, to stabilize them, and refer them to appropriate interventions. The difficulty we’ve been having is finding appropriate interventions.”
The choices are limited, in part, by money. Individuals who have private health insurance or who qualify for Medicaid, the government health insurance program for the poor or disabled, have the largest number of treatment options. Users who are uninsured have few.
“I’ve had many sad phone calls from friends who were trying to help friends,” said Peter Staley, a longtime AIDS activist and former crystal user. “These people had no insurance and therefore they can’t quit. They’re still on the drug. You just have to remove yourself completely from your surroundings when you’re that addicted.”
Staley quit after attending group and individual therapy sessions at the Realization Center for 16 months. He estimates that cost his private insurance provider thousands of dollars. “I used my insurance heavily by going to an outpatient center and that was for 16 months,” he said. “That’s outpatient. Inpatient is a thousand dollars a day or more.”
Marilyn J. White, director and CEO at the Realization Center, told Gay City News that they accept Medicaid, private insurance and patients can pay in cash with the fees charged on a sliding scale pegged to the ability to pay.
With doctors and psychiatrists on staff, the center can prescribe drugs to deal with the depression, anxiety or sleeping problems that can accompany getting off meth, but group therapy is the key. “The treatment here is group, group, group and group, the confrontation and the support of the groups,” White said. “They get to talk about what happened to them without being shamed. We talk about the sexual acting out.”
While the center only offers services on an outpatient basis, clients can spend whole days there. “If they need to be here all day long because they have no place to go they can do that,” White said. “What we try to do is get in between them and the crystal. It is really a support system that helps them on a daily basis to keep them off crystal and also we ask them to not act out sexually.”
Another choice for drug users is CenterCARE — for counseling, advocacy recovery and education — offered by the Lesbian, Gay, Bisexual and Transgender Community Center. Annually, the program serves some 2,000 people who are struggling with drug or alcohol problems free of charge or on a sliding fee scale and, at any given time, 1,000 people are participating in the group therapy sessions offered there, according to Dr. Barbara E. Warren, director of organizational development, planning and research at the gay center.
The gay center’s approach is “recovery readiness.” They do not insist that participants immediately abstain, but they do move people towards ending their drug or alcohol habit. “We really are about trying to get people to look at the costs of drug and alcohol use,” Warren said in a February 27 interview. The program saw its first crystal cases five years ago, but it is now contending with a dramatic increase in meth users seeking services.
“We are dancing as fast as we can, providing services,” Warren said at an April 22 City Council hearing on crystal. “This is the first time in our 16-year history that that we’ve had to wait-list people and it’s really due to crystal meth.”
The Pride Institute, which operates six drug treatment programs across the country, including an inpatient and an outpatient program in the New York area, is one more choice for meth users looking to get clean. The institute accepts private insurance and Medicaid.
“We have chemical dependency treatment that is inclusive of crystal meth,” said Marty Perry, the institute’s executive director. “We offer an abstinence-based program largely influenced by the twelve-step programs.”
All of these programs offer elements that activists say are essential to being able to deal specifically with, and getting off of, crystal meth. Other programs may put meth users in with people who use any kind of upper. “Most of the programs are putting them in with all the other amphetamine users,” Harbatkin said. That problem can be exacerbated because crystal and sex are linked for many gay men. They may not be comfortable talking about their sex lives among heterosexuals.
“When you ask around, that’s the real deficiency with a lot of the groups,” Harbatkin said. “Gay men feel uncomfortable in the groups and they can’t talk about their lives, their sex lives, and that’s a big part of crystal use.”
After all of these options, there is Crystal Meth Anonymous (CMA), a twelve-step program for users. While CMA is not a gay organization, the majority of its nearly 23 groups in New York City meet at the gay center, Callen-Lorde or the Gay Men’s Health Crisis (GMHC), which reflects the extent to which crystal use is concentrated in the city’s gay community. Keeping with the twelve-step tradition, CMA does not charge dues or fees and requires only a desire to stop using to be a member.
At the April 22 City Council hearing on meth, City Councilmember Margarita Lopez, chair of the mental health committee, sought information on where users can turn in the first days of quitting. While meth is generally not seen as physically addictive, like heroin, the first days of abstaining can result in severe symptoms.
“Crystal is much more psychologically addictive, but the complicating thing is that there are a lot of physical things that happen when you are getting off it,” said the Pride Institute’s Perry. These can include headaches, depression, sleep or skin problems, dehydration, and those who use a lot can experience paranoia to the point of being psychotic or delusional, according to Perry.
Because crystal is not physically addictive, insurers may not pay to treat those problems. “Insurance providers claim that meth does not have a medically dangerous detox,” Perry said. “Our belief is not that. We think that there are often medical dangers.”
While providers like the gay center, the Pride Institute and the Realization Center are applying therapy models to crystal that have been effective with other drugs, Harbatkin said part of the problem with crystal is that there is little science on how to best treat users.
Callen-Lorde has received funding from the state AIDS Institute to complete a small study on the most effective interventions for meth users. “We’re still in the process of defining what that treatment is going to look like,” Harbatkin said. “What we’re talking about doing is short-term, almost stop-gap interventions to get someone stabilized so we can refer them…The relapse rate for crystal is higher than with any other drug and I think it’s because we don’t have good treatment options for people.”