David Fawcett, Ph.D., L.C.S.W., is a substance abuse expert, certified sex therapist and clinical psychotherapist in private practice in Ft. Lauderdale, Florida specializing in gay men’s health. He has worked in the areas of mental health and substance abuse for more than 30 years in numerous settings, including inpatient and outpatient programs. He currently maintains a private psychotherapy practice and consults with numerous agencies, including the Broward County Health Department and Sunserve, an LGBT social services agency. He frequently presents workshops on issues concerning substance abuse, mental health and chronic illness, both nationally and internationally.
In his book, “Lust, Men, and Meth: A Gay Man’s Guide to Sex and Recovery,” Dr. Fawcett outlines the seductive appeal of methamphetamine and its impact on high-risk behaviors and sexual desire, resulting in the fusion of meth and sex in the brain. The book outlines a path toward healing, describing the phases of physical, emotional, and sexual recovery and provides a broad range for supportive tools from managing triggers to mindfulness.
We had the pleasure of chatting with Dr. Fawcett by phone to get his insight on drug use and sex, harm reduction, the road to recovery, and his plans to open residential treatment centers for substance abuse and sexual behaviors.
KC: First, please tell us more about yourself and your background.
Dr. F: Out of college my first career was in anthropology working in a museum in New York and doing field work among the Pueblo Indians. Once I got into my own recovery from alcohol, I became interested in addiction treatment and mental health and went back and got a Masters in Social Work and later completed my PhD in clinical sexology. For nearly 3 decades I’ve worked in substance abuse treatment and community mental health in every possible level. I also work a great deal with persons living with HIV. I was diagnosed with HIV in 1988 and consequently approach this work from both a personal and professional viewpoint. I work especially with co-occurring mental health issues for persons living with HIV, especially those who are aging, such as depression anxiety and PTSD.
KC: In regards to meth use and sex, have you noticed any surprising trends?
Dr. F: There are several trends that have been surprising to me as an addiction professional. Drug epidemics usually come and go over a period of 5 to 10 years, but the current methamphetamine epidemic is different. It started around the year 2000 and is going strong largely because of the new production methods created by the cartels resulting in high-purity meth, along with the effectiveness of their distribution networks. The second surprising trend is that most of the new chemsex users are racial and ethnic minorities. Young black and Latinx men are using meth in greater numbers and are really driving the current chemsex epidemic. This has created a perfect storm as their drug use merges with the HIV epidemic in those communities, further creating complications such as higher risk of seroconversion and undermining success in achieving viral suppression.
KC: In your opinion, what are the three major inhibitors people face while in recovery?
Dr. F: #1 The apps such as Grindr and Scruff are really problematic for people trying to recover from chemsex. These apps trigger processes in the brain that really sets up a drug craving. Medical scans show that when someone starts looking at an app, or even pick up their phone, their brain reacts as if they’ve taken the drug and the craving begins.
#2 Sex itself. Sex can be a real trigger for someone in recovery from chemsex. In most cases people lose their sexual desire early in recovery because the drugs and sex have become so fused. When someone gives up the drugs, sex often goes out the window with it. Another problem is trying to re-engage in healthy sex without being triggered for drug use. This can be done but it takes a longer period of time than recovery from other drugs.
#3 The long recovery period . Recovery from chemsex takes longer than recovery from other drugs in terms of both physical and psychological recovery period because methamphetamine, a key component of chemsex, is neurotoxic to dopamine receptors basically creating a functional brain injury. The good news is that these dopamine pathways do regenerate but the bad news is that it can take up to 2 years during which time someone may feel depressed, unable to experience pleasure, and can be impulsive. This obviously complicates recovery.
KC: In conjunction with your friend and colleague, Dr. Robert Weiss, you have designed and plan to open two residential treatment centers for substance abuse and sexual behaviors. Can you explain the type of services that will be offered to patients at these residential treatment centers?
Dr. F: It has really been a great privilege to work with Dr. Rob Weiss in the creation of the country’s first true chemsex treatment program. Dr. Weiss is a very well-known therapist, author and trainer on sex addiction. We have presented at conferences together and realized that we were approaching the same problem from two different directions. Sex addiction is related to chemsex in many ways and much of the therapeutic processes for healing are the same. The program we created in Los Angeles views these addictive behaviors as intimacy and attachment disorders. These are problems specific to how one relates to other people and often involves a history of trauma. The program starts with a 2 week intensive with the option of an additional 2 weeks. Our unit is small: only 8 clients go through the program at a time. Dr. Rob and I both personally created the program and remain involved either in person or through extensive use of video conferencing. We believe that Seeking Integrity will have at least two other locations in the United States by the end of the year. You can find more information at www.seekingintegrity.com.
KC: What are some advantages you’ve seen to harm reduction?
Dr. F: Harm reduction is gradually gaining favor in the United States and I think that is long overdue. I believe that harm reduction has a role to play in earlier stages of addictive behavior when someone may have more control over limiting their behavior or making it safer. Unfortunately the people that I usually see in my level of practice are those for whom chemsex has become problematic. That is, they’ve gone past the point where there is anything resembling “social using.” For those people I believe abstinence is absolutely necessary. But for those who may be questioning their use or who need more information I believe that harm reduction programs such as the Recharge Program in New York City and Austin Harm Reduction Coalition offer a non-judgmental access points to both information and care. I do hope that we continue to integrate harm reduction models into our treatment systems.
KC: Lastly, what are some ways our community can support both those in recovery and those who use drugs?
Dr. F: I believe the single biggest contribution a community can make to support persons in recovery is to really be conscious of the extreme impact of stigma and how the shame that addicts feel only makes that worse. I see a lot of judgment about chemsex, for example, by people who clearly have an issue with alcohol or other drugs. I think we all need to understand the nature of addiction and the underlying root causes that are fueling it in our society. Only by embracing each other through support and understanding can we move people into recovery at far greater numbers.
We would like to express our deepest appreciation to Dr. Fawcett for lending his expertise to our fourth installment of our Kind Talk series, “Kind Talk: Sex & Substance Use.” Hear more from Dr. Fawcett at Friday’s event by registering for tickets using this link: www.facebook.com/events/846586792406650