David Fawcett, Ph.D., LCSW


Methamphetamine, also known as meth or crystal, is back with a vengeance. And due to higher purity and cheaper prices, it is more dangerous and addictive than ever before. Throughout its long history, meth has been used to instill feelings of confidence and strength, from individuals seeking to bolster their self-esteem to soldiers in World War II battles.

But chronic meth use today brings personal devastation and a host
of physical consequences. However, we now have a much better understanding of the drug and how to treat it. The impact of meth and a comprehensive guide to treatment are described in my book “Lust, Men, and Meth: A Gay Man’s Guide to Sex and Recovery,” which draws from thirteen years of patient sessions and personal research. I will share some key points of the book here.

In the United States there are dual meth epidemics: rural and urban. In states like West Virginia, Kentucky, Arkansas, and Montana, the drug appeals to men and women seeking to numb uncomfortable emotions related to poverty, unemployment, and feelings of hopelessness. In urban areas meth use is concentrated among gay men who have discovered the drug’s ability to heighten sexual desire. This results in high-risk sexual behavior often accompanied by high rates of HIV, hepatitis, and other sexually- transmitted infections.

Unlike cocaine, meth is a synthetic amphetamine; it is manufactured from acetone, pseudoephedrine, lithium, iodine, and other toxic chemicals. Meth therefore has particularly destructive properties; it flushes dopamine out of neurons while blocking receptors, resulting in a flood of euphoric feelings that instantly eliminate self-doubt, sadness, and unworthiness. It impacts the dopamine receptors for much longer than cocaine, resulting in a “high” that can last eight to ten hours. Because it is neurotoxic, meth literally destroys the dopamine transport system with chronic use, creating long-term brain impairment that requires up to 18 months to heal. While the brain “rewires” the dopamine transport system, a person can totally abstain from the drug but continue to experience muddled thinking, hopeless moods and, consequently, frequent relapses.

Meth can be smoked, snorted, inserted rectally, or injected or “slammed”. Usage quickly increases heart rate, blood pressure, respiration, energy, and sensory acuity. Psychologically, meth increases confidence and sex drive while decreasing boredom and timidity. When consistently used to enhance sex, meth commandeers sexual desire and ultimately results in arousal being only achieved by using the drug. Once a meth user is in recovery, this nonetheless creates persistent sexual dysfunction that is a contributing factor to relapse.

Through chronic use, meth users experience tremors, dry mouth, weight loss, sinus infections and skin problems, as well as confusion, insomnia, depression, irritability, paranoia, and even full-blown psychosis. Users quickly spiral downward into a devastating addiction. Partners, friends, and families distance themselves because of erratic behavior. Consequently, most users ultimately find their support system limited to their dealer and the men with whom they hook up for sex. Narcotics Anonymous and Crystal Meth Anonymous provide a safe harbor for those seeking help, although the physical and sexual effects of meth create a difficult recovery marked by frequent relapses. This dynamic has resulted in the erroneous belief that meth recovery is impossible. This is false. People recover from methamphetamine but it is a long process that requires support groups combined with in-depth psychological reflection that may require professional assistance.

When used for sex, methamphetamine quickly fuses with sexual desire, resulting in high-risk behavior indistinguishable from sex and porn addiction. There is a preoccupation with sexual hookups involving “PNP” (party and play – a desire to use drugs and sex), a gay male social trend facilitated by phone apps. Sex-drug episodes usually last several days and typically involve sexual contact with a number of individuals as well as the use of meth and other drugs such as GHB
(gamma hydroxibutyric acid). These long drug runs are followed by days dominated by extreme depression and hopelessness (“Suicide Tuesdays) resulting from the depletion of dopamine.

Because of the long period of brain recovery, meth users may not achieve full benefit from traditional inpatient programs. Although the drug doesn’t have the acute physical detox of opioids, meth users experience tremors, temperature fluctuations, and persistent low mood. Meth has other unique properties, as well. For example, it increases visual memory while impairing verbal memory. This means that meth users become highly sensitive to visual images which
can trigger drug cravings. Inadvertently seeing images of meth or a syringe, or simply walking into a CMA meeting and seeing other users, can be extremely triggering.

On the other hand, meth impairs verbal memory, resulting in limited abstract thoughts and comprehension. Because of this, concepts as straightforward as the Twelve-Step recovery program may be confusing and frustrating. Poor verbal memory has important implications for cognitive behavioral therapy (CBT), one of the standard modalities of psychotherapy. CBT teaches individuals to control feelings through awareness of one’s thoughts. Negative emotions can be limited by consciously changing intervening negative thoughts to those that are more positive and conducive to healthy emotions. With their limited attention span, however, meth users can find traditional CBT problematic. Many clinicians treating meth users adapt CBT materials to shorter, more concise exercises, casually referred to “CBT Lite.”

Impaired concentration by users has led to the development of best-practice models for methamphetamine recovery that accommodate these limitations. For example, treatment programs with brief, daily groups taking place over a very long period of time are highly effective, especially when combined with motivational interventions and support groups such as NA or CMA.

Recovery from meth’s damage to sexual functioning is more complicated; it requires a gradual process of eliminating compulsive use of sex or pornography, coupled with the development of a healthy sense of self. These become the foundation for both healthy sex and intimacy. This process for reclaiming health sexuality in sobriety is fully explained in my book .

The return of meth has created serious havoc in the lives of many Americans. Because of its unique characteristics, meth treatment and recovery require special knowledge and sensitivity. With a greater understanding, we can assist meth users along the path of recovery. As witnessed by thousands of case studies among men and women, there is indeed life after meth.

David Fawcett is a psychotherapist and sex therapist in Fort Lauderdale. He is the author of “Lust, Men, and Meth: A Gay Man’s Guide to Sex and Recovery” and is a highly-acclaimed trainer on addictions, mental health, and co-occurring HIV and mental health. For more information, visit