Today’s episode features Dr. David Fawcett, therapist, author of Lust, Men and Meth, and expert in methamphetamines and stimulants in sexual behavior. David and Rob discuss trends in drug use among the gay male and female population, the frequent co-occurrence of both sex and drug addictions, risk factors and consequences of meth use, and the need for disruption in therapy to update training, assessment, and treatment.   David works hard to eliminates the stigma around addiction, and advocates to look at the whole picture of addiction rather than compartmentalizing it. He frequently presents workshops on LGBT health, addiction, HIV, and co-occurring disorders both in the US and internationally.   TAKEAWAYS: [2:25] We are in the middle of a dangerous trend. For about the last twenty years, we have seen a rise of stimulant abuse, particularly methamphetamines and cocaine in conjunction with sexual behavior. We have also seen a change in what kind of meth is coming in, as it’s much higher grade and leading to addiction in a quicker and more powerful way than ever before. [3:42] Meth and stimulants can be bonded with all types of behavior, not all sexually related. However, when used in conjunction with sexual behavior, people develop a dependence on the drug to perform in any capacity. David has noticed a trend with young gay men to skip over the pills and go right to the injectibles such as Trimix to treat erectile dysfunction. [5:36] The opioid crisis is certainly worth the mention and attention it has been getting in mainstream media, but meth overdoses are actually outpacing opioid-related ones. [6:39] Methamphetamine is a synthetic molecule that is neurotoxic and sits on the receptors for 9-10 hours, providing a surge and eventually the depletion of our “feel good” neurotransmitter dopamine. [7:44] Dopamine rewards behavior that helps us seek rewards in order to survive. The most natural way we release dopamine is through sex. [9:44] David sees many of his clients use meth to try and numb and dissociate negative feelings such as shame, isolation, and trauma. Over time, he has seen it most commonly in his clients that are gay men but is also now seeing it rise in the female population and eating disorder world as well. [10:50] There are a host of psychological and physiological severe consequences in meth use including brain damage, suicidal thoughts and actions, and cardiac issues. [12:53] Not all drug users become addicted. David discusses that although about 20% of drug users are led to addiction, the consequences are extremely severe. [13:05] David and Rob explain that meth and sexual addiction usually must be treated simultaneously. If one is a meth addict, chances addictions merge and work in tandem, creating a sex addiction as well. [15:57] Sexual addiction is often not addressed in drug treatment, left untreated may be a factor to lead the individual back to using. [18:20] There’s been a model of how we view addiction, and it’s been based on substances for 50 or 60 years, with a cultural resistance to natural occurring addiction such as sex and eating disorders. That model is changing, and more therapists and training programs are beginning to understand the repercussions and need for assessment of behavioral or process addictions. [21:38] Rob and David discuss the importance of finding a therapist that is well versed in the specialty one is seeking focused help. [25:45] David and Rob role play a typical call of someone seeking help for addiction and a potential therapist. [28:20] Therapists must do a more detailed assessment of sexual history as it related to addiction, and be hypersensitive to the level of shame, fear, trauma that their clients are bringing in to the treatment. It’s also important to help the client envision how sexuality is going to unfold in a healthy way in recovery.   RESOURCES Sex and Relationship Healing @RobWeissMSW Sex Addiction 101 David Fawcett @LustMenMeth Facebook @LustMenMeth Twitter