Subject: drug & alcohol article
From: [email-masked]
Date: Wed, 14 May 1997 20:38:54 -0400 (EDT)

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 full 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 weepingly told me.  I've been
partying since last night and realized I was in trouble when I came to this 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 exploring his use of 
"recreational" drugs and alcohol.  I had often told him that his descriptions made clear  that the
way he used and had come to rely on chemicals was causing problems.

 "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 that 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 professional. That phone call
began his long hard journey to learn how live and enjoy himself  free of chemicals. 

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, including 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.  But, gay men are not
so different than the rest of society in using either alcohol or some other 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.  

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 weekend 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 his antiretroviral drugs,
was directly contributing to his elevated liver functions, a recent relapse 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 seriousproblem with
alcohol?" Orlando is a clear example of how powerful people's denial about their drug use can be.
While alcohol and drug use has always been fashionable in gay circles, the 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 relationship among the circuit, 
drug use, and the wider gay male culture. Signorile provides numerous examples 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 circuit 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.

Let's look at the spectrum of ways people can use drugs. Recreational, 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. There is certainly a world of difference between wine
with dinner and alcoholism, and occasional use of pot, coke or ecstacy to party and using it all
weekend every weekend. 

Do you have a problem with drugs if you occasionally get very drunk or stoned?  One certain
indication that drugs or drinking has become problematic for you is if you experience blackouts,
periods of time about which you cannot remember any details of what was said or done. The man
+vacationing in the Pines called me only after he had awoken from a blackout. A very simple way
of determining whether you have a problem with drugs is if your use of chemicals causes you
problems in any area of your life: work, family, social, emotional, physical 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, 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.  It is normal and understandable 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.

An individual is addicted when the body has built up a tolerance for a specific 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.  Alcohol is one of the drugs for
which people quickly acquire a tolerance and eventually a possible addiction. For instance if you
begin to shake if you don't have a drink for a certain amount of time, you are probably addicted to
alcohol. 

 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 of poppers, and then everything
is fine, wonderful, I feel like I belong.  And then, in a bit my second hit of Ecstacy kicks in,, and
I'm doing good for the night." But Walt's wonderful feelings are short lived.  Usually he winds up
home alone later and to cope with his loneliness he will spend hours on the phone sex lines,
snorting amphetamines, (a stimulant drug) to stay awake.  Walt told Signorile 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, taken in combination with
each other and with marijuana and alcohol do not become apparent until one or two days later
when at work you may feel hung over, or just dragged out, a bit muddled and 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 second job for repeatedly
missing work on Mondays due to how "fucked up" he got over the weekend.

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.

                  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 pot?
     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 invitation 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 inhaling 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 influence of chemicals?
     12. Have you ever behaved in an unsafe or irresponsible way especially regarding sex,
while under the influence of alcohol or drugs, that you would not have done had you been sober?
     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?
     14. Can you can only feel good about your self when you are high?

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 most likely are abusing 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 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? The answer is dependent upon whether there are any
ill effects to you related to your use of alcohol or drugs. But, no one but you can honestly answer
whether you have a problem with drugs. After all, people take drugs or drink 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.

        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!" 

Before stopping any drug suddenly, it is important to ask your doctor whether it is safe for you to
stop without medical supervision.  For example, full blown addiction to alcohol, barbiturates, and
a variety of tranquilizers should never be stopped "cold turkey." It is possible to have a seizure as
a result of suddenly stopping a drug that your body has grown dependent upon. Usually
detoxification occurs in a hospital.  Heroin, Demarol and the other opiates can be stopped cold
turkey. They do not require in-hospital detoxification, though I have often 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. 

Issues of substance abuse are routinely dealt with during the course of psychotherapy.  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 prospective therapist's experience
in helping people get off drugs.  In addition, ask if the therapist routinely refers chemically
dependent people to one of the twelve step programs like AA (Alcoholics Anonymous), NA
(Narcotics Anonymous), or CA (Cocaine Anonymous).  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. 

People who have been drinking or using drugs for many years very often can 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 process. 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. 

Numerous patients of mine have told me that had I not given them the phone number of someone
they could call to accompany them to their first AA meeting, they would never 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 does 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 problem.

Joining gay AA, NA, or CA has been a life saving step for tens of thousands of gay alcoholics and
drug addicts. These organizations are made up of people themselves recovering 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.  Information 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 mentioned above is a desire
to stop drinking or using drugs. 

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