Gay men and Sex(uality) and drug use
Drugs are people substitutes – People are drug substitutes 1

When most people talk about drug use and sex, they think of addiction. So I should preface my comments on this subject with my take on “addiction”. First of all “addiction” is not a word I use. I believe that when people use the word addiction they are only describing what they see as “bad behaviour”. We have many repetitive behaviours that we do daily and perhaps compulsively but the word addiction would not be used to describe these behaviours. Some examples of such behaviours may be: I may wish to kiss my partner every day or a few times a day and have a negative feeling if it does not happen, I may like to cuddled daily, I may enjoy a few glasses of cold water daily etc. Often when the term “addiction” is used it seems to only provide a way of describing behaviour one is critical of, the label of addiction is not helpful and does not add to understanding.
Beginning a counselling relationship without acceptance and disempowering (http://www.pearsoned.ca/highered/showcase/shebib/pdf/samplechapter_ch07.pdf) an individual is a poor way to begin a counselling relationship. (http://www.ccpa-accp.ca/blog/?p=2996 ) One of the main characteristics of counselling is acceptance without judgment. (http://infed.org/mobi/helping-relationships-principles-theory-and-practice/) Starting counselling with a label describing the person as engaging in bad behaviour can be counterproductive. This is especially true when it is implied that “the person has no control over their behaviour.
People use drugs for a reason. There is an emotional need that is being met by the drug that is being used. Given this, the best way to begin to help an individual is to explore what they get out of using the drug. The next step is to help them to find other ways of meeting those emotional needs that more fully rewarding.
One drug that is popular with many gay men is Chrystal Meth. (http://www.wehoville.com/2013/12/02/crystal-meth-gay-men-start-load-road-addiction/ ) For some of those gay men crystal meth use can be problematic. Therefore without judgment I begin to explore with gay men what emotional needs does crystal meth allow him to satisfy. It often becomes apparent that most gay guys will use crystal meth to allow them to be the “sex pig” (http://cbrc.net/resources/2013/desire-and-defiance-pig-sex-project) that they would like to be, but do not allow themselves to explore without drugs. I was once asked to do a workshop on “Pig Sex” (http://www.realjock.com/gayforums/16537 ) . (Pig sex, is like pigging out at a Christmas dinner – that is eating too much, and a bit of everything.) The main point that came out of this workshop was: “We may not have the same kinks, but I know I will not be judged”. This lack of judgment allowed for a freedom in “pigging out”. Many gay guys have sexual needs/fantasies that they cannot fulfill without crystal meth. The use of that drug allows a person to explore many aspects of sexuality that may not be explored without some drug use, due to of internal and/or external inhibitions. It follows then that part of the motivation for crystal meth use may be because of sexual inhibition, and fear of judgment. If this true, than the goal is to help him to become less sexually inhibited, and be free to explore his sexual desires, without the problems caused by drug use. (I would suggest the therapist also must NOT be sexually inhibited.)
In addition many gay guys who use crystal meth are often looking for a feeling of being emotionally connected (at least for the moment) with the other guy(s). Many gay men grow up denying their sexual and emotional feelings. This denial of sexual and emotional feelings often happens because as the gay guy is growing up he will often have feeling of being different than other boys, of “not belonging”, and also questioning if they are lovable if parents and others knew they were gay. This sense of separation, being different, and questioning if they are lovable has a profound on most gay men.
Given that crystal meth allows a gay man to achieve feelings of connectedness, sexual openness and a feeling of freedom from judgment, it is not surprising that many gay men would be attracted to use crystal meth. Many gay men find great pleasure in what crystal meth can bring them. It is only because crystal meth is meeting these deep personal needs of a gay man that he uses this drug again and again and again. Often crystal meth users do not know of another way to feel sexually free and emotionally connected. Therefore, the goal is not, to stop crystal meth use, but to find ways to be sexually uninhibited and emotionally connected with other gay men. Stopping or reducing crystal meth use may be a byproduct of a happier more fulfilled life.
Craig Sloane reports that “By using gay affirmative treatment,” and “Promote self-acceptance, create safe and non-judgmental environments. We have to set up treatments that don’t pathologize gay sex.” (http://www.addictionpro.com/article/crystal-meth-and-its-use-among-gay-men )
Counsellors need to begin laying the foundations of a nurturing therapeutic relationship that refrains from labels and judgments that disempower a person. The therapist must recognize that drug use is meeting a person needs. Explore those needs and seek alternative ways of meeting those needs if drug use if problematic.

1. (Blachly, 1970) Seduction: A Conceptual Model in the Drug Dependencies and Other Contagious Ills, Paul H. Blachly, M.D., 1970, Charles C. Thomas, Springfield, Illinois

Most of my career has been working with criminals, and much of that with sexual criminals, I also work in the area of sexual health.  Much of my work has been with gay men at BC Centre for Disease Control, and in private practice.  I wrote a column in the local gay newspaper, Xtra, on gay men and health.  I tend to see the “problem behaviour that is presented” as the symptom,  (for example:  Sex, drug use, violence etc.) the goal is to discover what are the many facets that are pushing that behaviour.  Gay men have generally grown up emotionally alone, afraid of discovery, being taunted-bullied or teased with a constant fear of rejection from parents, family, friends, and classmates, this provides a unique obstacles later in life. (For more info: www.bcoleman.ca)