Back from the brink: crystal meth has destroyed the lives of countless gay men. Yet the courageous survivors are fighting to stay clean and start new lives.

"I was always anti-drug," says Emory Etheridge, a 35-year-old gay man who lives in San Francisco. "I had separated from my partner [of two years] because he had a drug problem and I couldn't take it. That was a time that I was really down.

"It was a perfect storm of events."

During this perfect storm Etheridge started using crystal methamphetamine. He was living in Chicago then, and one night a guy he was having sex with introduced him to a "booty bump," inserting meth into Etheridge's rectum. "I had really, really great sex. It was amazing," he says.

The storm worsened. Etheridge tested positive for HIV. His partner--with whom he had exchanged rings and bought a condo--committed suicide. "I just started going to a bathhouse in Chicago, and every time I went there people would just give me crystal," he says. "I never even paid for it. I had no idea how much it cost."

Etheridge, 30 at the time, was soon frequenting a bathhouse every weekend. "Meth wasn't like alcohol. It was a euphoria. I could have sex for hours and hours and hours. I was dealing with so much pain, I didn't process that I was spiraling down," he says.

And no one knew. He kept his job at a tony restaurant. His best friend of 17 years, a veteran of rehab programs, failed to notice that Etheridge's body was quickly wearing down, exhausted from weekend meth binges. Etheridge recalls thinking that he was OK: "I wasn't using every day, and that's why, in my head, it was really easy for me to think that I didn't have a problem."

Nine months later he hit the wall. A guy gave him a drug--he has no idea what it was--and Etheridge threw up on top of the bar in a club. "At that point I knew that I had a problem," he says. After eight years in Chicago he moved back home to Texas to seek help. He's now three years' sober, living in San Francisco, and doing his utmost to convince other gay men not to follow in his footsteps.

For Emory Etheridge--and thousands of other gay men who've become addicted to meth--the journey to recovery has been the toughest of battles. Meth may be out of their systems, but the seductive memories always remain: mind-blowing sex, the blinding sense of confidence, the lightning energy to get through a day of work or weekend errands. For those who are infected with HIV, addiction provides a false comfort as they face their own mortality. Who cares if they take one more booty bump, snort one more line, inject one more needle? They're going to die anyway.

But survivors know that what meth gives, it quickly takes away. Coming down is a pure slice of hell. The intense depression can lead to suicide. For some, the paranoia has them thinking that their friends or dealers are out to kill them. The weight loss is drastic and quick. Others have experienced nighttime trips to the emergency room with hearts racing at dangerous speeds.

Yet there are the courageous survivors. One day at a time they are slowing rebuilding their lives, becoming productive members of society. They are holding jobs, finding new relationships, returning to the friends and family they discarded, and volunteering.

"Crystal has been a problem for gay men as far back as 15 years ago on the West Coast, when it was more of a speed-using area compared to the East Coast. Then we just saw crystal move from west to east," says George Ayala, director of the Institute for Gay Men's Health at Gay Men's Health Crisis in New York City. It was in the mid 1990s that meth's popularity began to spike nationwide among some gay men, thanks in part to the introduction of Viagra. The impotence drug finally gave meth users a way around "crystal dick," the erectile dysfunction typical with crystal.

To be clear: The vast majority of gay men-even in New York Los Angeles, and San Francisco--do not use meth. Most studies reporting meth's prevalence sample the most at-risk population--gay men who frequent bars, sex clubs, and Internet chat rooms for hooking up. [See "What We Don't Know," page 55.]

But whatever the statistical reality, it's clear that the media are hooked on meth in 2005. The volume of newspaper, magazine, and television features on the "poor man's cocaine" reeks of the hyped coverage given to inner-city crack problems of the 1980s or the terror over marijuana that swept the United States during the 1930s. Readers are awash in articles about users' rotting teeth and villages in the Midwest being destroyed by meth.

"I think that the fact that the gay community has been enlisted in this [media] hysteria around meth is really unfortunate," says Duncan Osborne, associate editor at Gay City News in New York. His book Suicide Tuesday: Gay Men and the Crystal Meth Scare is set to be released in November. "These moments are never useful from a public-health standpoint or a standpoint of organizing a reasonable and good response to a problem."

While the meth problem is very real, Ayala is concerned that users are being stigmatized as the "bad gays" who are infecting countless partners with HIV--a stigma that may cause them to use more and have more unsafe sex. "We just need more information," he says. "We just don't have a good sense of how prevalent crystal use is among gay men. We don't have a consensus about what constitutes addiction versus what constitutes occasional use."

Mike was not an occasional user. On a recent Saturday afternoon the 33-year-old gay man met up with The Advocate at a diner in Manhattan. He agreed to speak about his recovery from a six-year battle with meth on the condition that his hill name would not be used. Sober for 13 months, he spent that morning at a Crystal Meth Anonymous meeting.

The first time Mike tried meth, he and a trick were having a threesome. The trick had to leave, but Mike stayed with the other guy. "He'd just put a bump on his hand. I asked him what it was, and he said that it was crystal," Mike remembers. "I hesitated for a second, then I snorted it, and I proceeded to have sex like I've never had before."

The next morning, before work, he felt wired and out of control. He took another bump. "I had the most productive day at work that I've ever had."

Mike didn't become an instant addict. A year passed before an other sex partner offered him crystal. Monthly binges evolved into weekly binges. "It was fun for a while, and hot, and I wasn't experiencing any of the negative stuff," he says. "Of course, as time it was harder to recover from coming down."

Mike would try to stop using but a month later would pick it up again. In 2001 he had a serious boyfriend for the first time and tried to quit. He went to therapy, read books on spirituality, meditated, and tried to go cold turkey. "But it got continuously worse," he says. He began to have fevers; he woke up one night with a rash on his fingers and toes. "I went to the doctor, and they were asking me if I was using any new detergent, eating any different foods, and I said no," he remembers. "They took some blood work, and when they came back they brought an HIV counselor."

Testing positive kept Mike away from meth for only a month. When he went back to using, his boyfriend left him and moved to Florida, his family worried, and his true friends disappeared. Mike had lost 40 pounds. "I thought I looked great because I had six-pack abs," he says. "My skin was barely covering my bones."

In 2002 he tried attending Crystal Meth Anonymous meetings. It didn't take. "At that time I was afraid of people in general," he says. Two years later, on July 3, 2004, he gave the meetings one more shot. He has been sober since. He has gained the weight back. His finances are healthy. The company he started has flourished. He is a sponsor to another recovering addict in the program.

Crystal Meth Anonymous has seen its number of chapters skyrocket in recent years. In 2000 there was only one weekly CMA meeting in New York City, with about five members. Today it has 25 meetings per week and over 100 members. Nationwide, there are about 60 CMA chapters--in most big cities and such far-flung places as Bend, Ore., and Billings, Mont.

It's not the only option: The group experience and rigid dogma of a 12-step program is not for everyone. Others may benefit more from a private treatment facility or one-on-one therapy. "As we know, 12-step programs are problematic for many people," says Perry Halkitis, an associate professor of applied psychology at New York University and an expert on gay men, HIV/AIDS, and drug abuse.

He cautions that many rehab programs for crystal meth are still working out the kinks. "They're using models for heroin and cocaine, which are not the same thing. My belief is, the only model that is going to work is one that deals not only with the meth use but deals with meth use in conjunction with sex [or] in conjunction with depression and other mental health factors."

For Mike, the most telling changes are internal. "I remember a time when I couldn't walk up the street unless I was looking at the ground the whole time," he says. "I was painfully self-conscious and shy; it was a reflection of my self-esteem."

He now connects his drug use to internalized homophobia. "I made the relationships of my sexuality a source of shame," he says. "It became an intense burden over the years, and when I started using a drug that loosens inhibitions, it became a perfect match."

He has completed all 12 steps. "I'm more real with people, more honest. I don't care so much what people think of me. I'm not so self-absorbed. I can't catch myself thinking those old thoughts."

How to flip the switch that turns gay men from being hooked on meth to being determined to recover remains something of a mystery. Almost everyone in recovery has an story of an epiphany, the moment they knew they needed to stop using. But no recovery program has found the secret to inducing that conversion.

"Across the country, health care providers are just at a loss. They've never seen anything like it. They don't know how to treat these people," says Jim Peck, a clinical psychologist and researcher at the University of California, Los Angeles. "Look at the society that we live in. We're having to do more with less, with fewer resources. Everyone is being told that they have to work harder. Is it really a surprise that people are turning to stimulants?"

Peck is part of a team trying to figure out the best way to treat gay meth addicts, examining brain chemistry as well as psychological and behavioral interventions, searching for a medication that can ease withdrawal symptoms. "In terms of treatment, we know a few things," says Peck. "With meth, it's probably going to be longer and more frequent than for other substance abuse disorders."

In one study, the researchers took a standard counseling intervention and tailored it to gay men who used crystal meth. They attended the program three times a week for 16 weeks. "We did see a significant reduction in both drug use and sexual risk behaviors," Peck says, adding that most of the men wanted to stay longer. That is probably why a group like Crystal Meth Anonymous has worked well men are encouraged to attend a meeting once a day for the first 90 days.

Another treatment that researchers have been experimenting with is contingency management. Used with other types of drug abusers, this method calls for meth users' urine to be tested three times a week. If they are clean, they are presented such incentives as retail gift cards. Eventually, having modified their behavior, they need neither the testing nor the rewards.

It a "very potent" approach, says Steven Shoptaw, a UCLA research psychologist who 12 years ago teamed up with sociologist Cathy Reback of the Van Ness Recovery House to study interventions with gay male meth addicts in Los Angeles. Shoptaw is the leader of Peck's team. "It gets people to change behaviors sufficiently so that they can begin to find resources in their community, being able to go to 12-step groups, being able to go to therapy. The idea is that the skills to go 48 to 72 hours without using meth is very complex. The idea of the contingency that is so powerful is that it pits money [against] drugs, and those are primate drives."

Alejandro Diesta knows what it's like to be in the grip of an addiction. "I didn't have the solutions or tools to stop," says the 33-year-old, who was HIV-positive before his 2 1/2-year meth binge began.

When he was younger he drank heavily. He favorite concoctions were blue Hawaiians and Long Island iced teas because both could be made with large amounts of booze yet were sweet. When he left the military in 1996 and settled in Los Angeles, he started experimenting with ecstasy and other drugs. "The one that really brought me to my knees was meth," says Diesta.

In 1999 he held a stressful job as an account manager for an insurance company. One night he came home at 2 A.M., exhausted. His roommate gave him meth as a pick-me-up. "It make me feel like I was up and I could do anything," Diesta remembers. "Next thing you knew, the drugs caught up with me and I was searching for more energy." Then he discovered sex on crystal. He was hooked.

The downside to meth use plagued him. "I would have paranoia, hopelessness, and I was feeling isolated," he says. "An incomprehensible demoralization set in."

He checked himself into a Veterans Affairs outpatient clinic and was sober for the first time in his adult life. But he relapsed. "I started picking up where I left off, and my life spiraled out of control completely," he says. He finally decided to try a 12-step program.

"I want to stay sober no matter what," says Diesta, who now lives in San Francisco and keeps himself busy with work, his meetings, and the gym. He has started running marathons. "I'm also a practicing Catholic," he says. "I'm active with my church and their programs." He and other members of the choir have already started rehearsing for the holiday season.

Perhaps most important, Diesta, who is Filipino, speaks to as many groups as be can about how being gay and Asian intersect as well as the connection between HIV/AIDS and meth. "I want to give people hope," he says. "I want to let them know that there is a solution."

But the solution cannot be mass-produced. Each gay man who dedicates himself to sobriety tailors recovery to his own needs. "I do a lot of both Western and Eastern medicine," says John Motter, a 44-year-old Portland, Ore., man who has been clean for four years. "Part of my treatment is acupuncture every week, Chinese herbs, and things like that. I'm doing pretty well now. My health has stabilized. I'm holding my own."

Motter began using meth in 1996. In April 1998 he learned that he had contracted hepatitis C due to surgeries he'd had as a child as well as HIV. When doctors placed him on a regimen of drugs, he became sick. He lost a drastic amount of weight, his joints ached, and his hair began to fall out. He was sleeping 14 to 20 hours per day. Nevertheless, he continued to use meth and to frequent his usual bathhouses and sex parties.

"I knew that meth would help with my energy," he says. "By snorting it, I could have fun. I was going to the bathhouse still, and even though I was sicker than a dog, I was still going to have fun. Eventually I ended up injecting it."

In 1998, because of his health problems, Motter had to go on disability, and he lost his $70,000-a-year job as a tax consultant for accounting firm Arthur Andersen. To his family, his body was a withering skeleton. He was left with nothing but a meth habit that he couldn't pay for.

Still, Motter didn't believe he was an addict. Addicts, he thought, were people who injected heroin.

He and friends conspired to steal mail and cash fraudulent checks. Motter was finally busted at a Costco store when a clerk refused a check. He would be sent to prison on a handful of charges, including identity theft. It wasn't until he stood in his cell that he had a moment of clarity.

He traded a pair of headphones for a syringe from a fellow prisoner who was a diabetic. "I thought, This is so fucking pitiful," he remembers. "You're about to turn 40 and you're pitiful. It was like the lightbulb going off in my head, thinking that I needed to get my shit together."

Motter was released on August 8, 2002, after 13 months in prison, determined to change his life, to be a role model to gay men and--perhaps most important--to help the people he harmed. He began volunteering 10 to 15 hours a week, which he continues to do today. "You know, you go on disability, what purpose do you have?" he asks. "Doing the volunteer work is just a great way to be productive and give back to my community."

He paid restitution to his victims, to the tune of $33,000, by cashing in his retirement savings. Because of good behavior he was was released from probation on February 14, 2005. He goes to 12-step recovery programs and has a sponsor. "I seldom get actual cravings," he says. "It's one day at a time: It's going to meetings and talking to sponsors. I've always got the support of someone around me."

Emory Etheridge had no support network left in Chicago by 2002. His partner was dead, he had left his job, and he was a meth addict. As he made the decision to move back to his native Austin to seek help. He tried a 12-step program but found the structure too rigid. He went through a handful of therapists until he found one who worked. "I had to deal with my issues of grief and loss and dependence. That did it for me," he says. "It really took two solid, complete years. I started being productive in society and I started giving. I'm in a good place now."

Etheridge realized that being an HIV-positive man and a recovering addict gave him a voice and perspective he could share with others who were struggling. He moved to San Francisco and became involved with a local HIV/AIDS group. He allowed his sister, a sex education teacher in Texas, to use his story to educate her students.

"My life is pretty amazing now. It's wonderful," he says. "I'm healthy now and productive." Etheridge competed in the 2002 Gay Games in mountain biking. He also attends the outdoor Burning Man festival held annually in the Nevada desert and started meetings for attendees who are clean and sober.

"Every now and then I get cravings for meth," he admits. "I'm really careful not to block it out and pretend it's not there." On the other hand, he adds, "I am really careful not to surround myself with anyone who uses."

Motter sums up the daily life of a gay man in recovery from meth addiction: "I could easily go out and get meth. But if I just pause, take a minute to look at where it would take me, the craving will pass. I'm at a healthy weight. I know mentally how much better I feel. I cannot just use once. I can't drink just once. I know where it'd take me. It's just not worth it. It's just not worth the support of my family, my friends. It's just not worth dying for."

Photographed by Timothy Archibald for The Advocate

RELATED ARTICLE: Your brain on meth.

Methamphetamine is not a new drug or a new problem.

It has kicked around for decades under the names "speed," "crank," "tina," and "ice." In the 1930s it was used by doctors to treat nasal and bronchial ailments in addition to narcolepsy. During World War II the U.S. military gave it to soldiers to keep them alert in battle. In the 1950s and 1960s it was used legally by truckers to stay awake on long trips, and it was recommended as an antidepressant and weight loss solution. At its peak in 1967, 31 million Americans were using meth legally, according to data from UCLA. It was made illegal and taken completely off the market by 1971.

Like cocaine, meth is a stimulant, but it produces far more havoc in side the body. Cocaine produces a high that lasts between 20 and 30 minutes; half of the drug is removed from the body in one hour. In contrast, meth produces a high that lasts between eight and 24 hours, and half of the drug is removed from the body in 12 hours, according to the National Institute on Drug Abuse.

If smoked or injected, meth releases high levels of dopamine. The user experiences a "rush" or a "flash." The heart beats faster, blood pressure increases, and there can be stroke-producing damage to small blood vessels to the brain.

Prolonged use can permanently harm the central nervous system, causing irritability, insomnia, confusion, tremors, convulsions, anxiety, paranoia, and aggressiveness.

In some cases, hyperthermia (high body temperature) and convulsions can lead to death, according to NIDA.

"Let's do a scenario of being on the drug," says Perry Halkitis, an associate professor of applied psychology at New York University who is a nationally recognized expert on gay men, HIV/AIDS, and drug abuse. "You're doing the drug, you're having lots of sex, you're dancing all weekend long--you're experiencing weight loss right away. The grinding of the teeth, the picking of the skin develops after three to six months of chronic use."

In addition, once men have stopped abusing meth, their sex lives can suffer. "Psychologically, they're so used to having sex on this drug that it's very difficult for them to have a 'normal' sex life again without the substance," Halkitis adds.

That's true, says recovering meth user Emory Etheridge.

"I just admit to myself that sex is better on crystal meth," he says. "But I also realize that meth ruins your life, and it's not worth it."--C.G.

WHAT WE DON'T KNOW

How bad is it? Researchers don't know for sure. With limited funds to study crystal meth use among gay men, researchers don't know for certain how many are chronic abusers. They can't be certain whether some gay men can use meth occasionally and not be hooked. They're not sure whether anti-meth advertising campaigns are effective. "We have some sense of what the relative use is among gay men, but no exact estimate," says Perry Halkitis, a New York University associate professor of applied psychology who is an expert on how HIV/AIDS and drug abuse link to gay men.

Much of the research that has been funded by the marijuana-obsessed Bush administration has been limited to surveying gay men in gyms, bathhouses, or clubs. Or researchers skip directly to those already seeking help for meth addiction, which tells them nothing about prevalence among all gay men. And the few federally funded surveys that do exist typically ask only about meth use "in the past 12 months"--meaning a gay man who tried crystal once registers equally with a hard-core addict.

"The best estimate that I have from New York City right now is that in a general sample of men who were recruiting at gyms, it's about 20% active use in the last few months," Halkitis says. "I can't tell you if they're using chronically or if they're using once and again from that study."--CG.

Here's what researchers do know:

* Crystal meth users are at least three times as likely as nonusers to be HIV-positive.

Source: a San Francisco study in the August issue of AIDS, which surveyed nearly 3,000 men who have sex with men and who were tested anonymously for HIV in 2000 and 2001

* More than 10% of men who have sex with men who were tested at the Los Angeles Gay and Lesbian Center in 2004 said they had used meth, almost double the rate from 2001.

* Gay men in recovery in West Hollywood, Calif., reported an average of eight years of meth use, with three years of heavy use. Mostly in their 30s, these men averaged 10 sex partners in the past month, 44 in the past six months. Source: a UCLA survey

evaluating 162 gay and bisexual men in a clinical treatment setting in West Hollywood between 1996 and 2001. "It's a small sample," admits researcher Jim Peck. "It's easy to find guys who are using. It's not so easy to find guys who are looking for treatment."

* Meth abuse combined with HIV causes alterations in the size of brain structures, leading to difficulties in learning, solving problems, maintaining attention, and processing information. Source: The August issue of The American Journal of Psychiatry.

THE ADVOCATE POLL

sponsored by SUBARU

Can crystal meth be used responsibly as an occasional recreational drug by some gay men?

Sign on to The Advocate's Web site before September 27 to cast your vote and leave your comments. Results will appear in the October 25 issue.

www.advocate.com

Fighting back

Resources to get help and get involved

Crystal Meth Anonymous * chapters nationwide www.crystalmeth.org * [phone]

The first CMA San Francisco Bay area retreat, intended to be an annual event is scheduled October 21-23 in Healdsburg, Calif., near the Russian River. Cost is $130, and limited scholarships are available. For more info e-mail Dan C. at [e-mail].

Gay Men's Health Crisis * New York City www.gmhc.org * [phone]

The group says its 2004 anti-meth banner ads on Manhunt.net were viewed by 886,061 people, Its continuing Task Force on Crystal Meth, Syphilis, and HIV works with LGBT organizations, community leaders, and government officials.

New York City LGBT Community Center www.gaycenter.org * [phone]

The center launched its "Getting Clear About Crystal Meth" education and survey project in March 2004. It is scheduling the meth forum "Breaking Up With Tina: A Guide to Kicking Meth for Users and Their Friends" for September 29 at 7 P.M.

Los Angeles Gay and Lesbian Center www.laglc.org * [phone]

In addition to a therapy group that meets Mondays, an all-day summit scheduled for October 29 will bring together policy makers, service and treatment providers, and researchers to discuss meth abuse in the Los Angeles area and its connection to the spread of HIV and other sexually transmitted diseases.

Chicago Crystal Meth Task Force www.crystalbreaks.org * [phone]

The AIDS Foundation of Chicago launched a new public-awareness campaign on August 6 (including an ad in this issue of The Advocate) to educate gay men on the risks of using crystal meth. The campaign's "Crystal Breaks" slogan emphasizes the health risks associated with meth use.

The Stonewall Project * San Francisco www.tweaker.org * [phone]

Social marketing messages sponsored by Tweaker.org appear in gay media, bars, and clubs as well as on poster ads in gay neighborhoods. The "Tweak Team" also distributes info and posters at LGBT events and others.

Your Group Here www.advocate.com * [e-mail]

Help The Advocate to include your work against crystal meth addiction in our online version of this story. E-mail us the details and contact info today.