Speed Limit: Substance Use Management

Welcome to Speed Limit, a new SPEEDOMETER feature on substance use management. This feature invites you to think about the ways you already manage your speed use and ways you might like to manage your use in the future. Check out the recommended books, local counseling/group options, practical worksheets and tools at the end of the article.

 

The feature will always include either an interview with a counseling program in the city that might be helpful or with a person or people who have life experience managing their speed use.  If you are someone who would like to be interviewed about how you manage your use for this feature, please call Terry at (415) 487-8043. 

 

Please enjoy this Interview with ALBIE, a counselor at the Stonewall Project.

 

SPEEDOMETER:  Albie, thanks so much for talking with speedometer today. What is Stonewall?

 

ALBIE:  Stonewall is a treatment program for men who have sex with men who use speed.  Most of the clients here identify as gay.

 

SPEEDOMETER:  Do you have to want to get into a drug recovery program?

 

ALBIE:  Folks who come here don't always walk in the door with a concrete goal like “I want to stop” or “I want to change my use” but most of the people who come are here because they know something's not right somehow.  In some ways, Stonewall is about addressing the quality of your life.  Sometimes folks come in here and they are really invested in seeing if they can improve the quality of their lives and maintain their speed use.  Sometimes people come in here and they're very adamant that they don't want to use speed ever again. So there's a broad range.

 

We have a walk in group every Wednesday at 6:30.  There are also individual walk in services here every day. If someone is interested in getting some help they can pretty much walk in and start without any problem.  You can always come to drop in services only if appointments are hard for you. There is a more formal intake process. I know that it can be weird to have an appointment if you're on speed because you can have a weird relationship with time.

 

I tell people from the get-go, for individual sessions with me, you do have to be able to at least show up. If I start working with you as a one-on-one client, I might call you a couple times if you don't show up. But generally I don't track people down because I respect people and their desire to show up or not show up.  People vote with their feet, and that's cool. If people disappear for awhile, there's no reason why they can't start up again at Stonewall.  Not everyone here, by the way, has to do groups.  It is certainly recommended, but sometimes people aren't ready for that.  Groups can be really stimulating and challenging sometimes, and it can be really hard for some people.

 

SPEEDOMETER:  What kind of stuff is talked about in group?

 

ALBIE:  Generally, drug use is a theme. Guys contemplate changes, think about goals, take steps and make progress towards goals. Folks talk about their relationships, about using, about regrets. What are those things outside of you that encourage you to use- like people, places and things. If your goal is to use less or not use at all, how can you negotiate those or remove those from your life to meet your goals?  The harder part is talking about internal triggers, the emotions that sometimes encourage you to use. For example, how anger is very possibly related, or feeling dirty or sexually inhibited. We talk about coping with those feelings and those environments.  Treatment helps people figure out what their value system is.

 

People like to use drugs for obvious reasons.  It makes them feel good, it makes them happy. It's a kind of a brilliant- you ingest a substance and it changes how you feel.  You actually get to choose how you feel depending on what substance and how much and the way you do it.  But I think that by the time folks come into treatment, the majority are no longer using because they want to have fun.  The old school therapy says that “If you are using, the work is useless!” Counselors at Stonewall don't agree with that. We don't believe that you can't do any work if you're using speed. 

 

Anecdotally, I'd say about 85 percent of the time when I am working with somebody who is using and they don't want to use, it's because something's happened in their lives and they've decided they just couldn't deal, you know?  They're just kind of like “fuck it”.  It hurts too much.  So they'll get high instead.          The other 10 or 15 percent of the time people are thinking to themselves “If I do my drug thing, this experience will be even better.”  Like when people talk about their early use and it was really fun all the time. 

 

SPEEDOMETER:  So what is substance use management? 

 

ALBIE: Substance use management is kind of a weird concept for folks because some people use drugs to not have to be conscious and aware. The challenge is, if you're going to manage, to ask yourself to be aware when you're using.  My job as a counselor is to help you think about it, to figure out what might be happening and tease out the why’s where’s and how’s with you.  Later, it's your job to tell me.  You need to have that frame of reference- that ability to pay attention to how things happen for you around your use. 

 

Most traditional treatment centers give up before a person actually is able to make a change.  They see it as a failure if people can’t achieve the only acceptable goal in their eyes- abstinence. Our approach- inviting people to make their own goals- results in folks making miraculous changes…but some of them learn really slow.  I find as a provider, it's more work to help somebody learn how to manage because there's so many different things to ask questions about, to wonder about and to explore with somebody.  If somebody's just quits using altogether and says “I'm just not going to go there” that’s a pretty easy treatment plan! Abstinence might be easier than substance use management. It’s easier to be really concrete about a lot of things in life. But it may not be what works for you. There's a lot of support in the United States to be abstinent. 

 

Most of the clients at Stonewall are here to address their speed use. So for instance, folks don't want to be abstinent from alcohol because they don't drink very often. Or they want to do ecstasy even though it might be cut with speed- but it's a different kind of thing for them that is not problematic.  They’re not worried about ecstasy.  What I hear from people is that they've done everything- every which way- and speed brought them to their knees. 

 

To my mind, substance use management is acknowledging, realizing, and beginning to notice what's not working in terms of your drug use and how it is impacting the quality of your life.  As a for instance, say you're somebody who's employed and it's really clear to you that something's not right. You're starting to miss work on Mondays. Your weekends are no longer starting on Friday, they’re starting on Thursday or they're no longer ending on Sunday but extending until Tuesday.  So the management could look a lot of different ways depending on the person:  It could be that your goal is to not use on certain days, or to snort instead of shoot because the high isn't as intense- snorting enables you to both get high AND to come down a little bit faster. 

 

SPEEDOMETER:  What do people's substance use management plans usually have in common? 

 

ALBIE:  While a lot of people talk about getting high because it's so much fun, there are a lot of people in treatment who will tell you that the first time they used speed was also the first time they actually felt normal. Which implies to me some mental health stuff is going on.  Often times, but not always- and it is certainly not required, folks at least examine whether or not they need to be on psychiatric medications, which are helpful for a lot of people. 

 

A person doing substance use management is looking at frequency, amount, duration, and method.  A goal around any of those areas is the beginning of management.  It requires a certain degree of insight and thought.  And for a lot of people, that's just not realistic- they're high and they don't want to do it.  And I don't blame them.  It takes a lot of thought to make goals and a plan. To decide, “Okay, I don't want to use any old time.  I only want to use under these conditions.” Or “I will only cop in a safe place and buy amounts that won’t get me a possession with intent to distribute charge.”  Say your goal is to use less, if you have speed on hand- you're going to do it.  If you only want to use for a weekend- don't buy enough for a week-long binge, you know?  Stuff like that.  I'm not trying to push abstinence on them. I try to be honest with people looking at this.  Doing speed takes up a lot of time.

 

I've talked to a lot of people who shoot and are getting abscesses- they don't like how they are getting treated when they go to the doctor, they’re sick of wearing the long sleeves, they are starting to shoot up in veins they wouldn't normally. There is something about using needles that's intense and wonderful feeling and they like the whole process of shooting up- but they also realize that process is getting them into trouble. But they like to get high, right?   So I ask them, “What do you need to do?” Their plan might be about better hygiene. It might be to spend some time thinking and talking about switching methods and what that would be like for them. It’s all about what makes sense for them.

 

SPEEDOMETER:  When people don't achieve their goals, how do you help them reframe the experience and keep trying?

 

ALBIE:  I think treatment is really hard work. I have immense respect for people who try to do this because it's really hard work.  I remind people-the truth is- that every person who has ever achieved their goals when they're in an addictive, impulse-driven process, has never stopped trying.  Every single person who has achieved their goals has never stopped trying.  That includes people who say “I'm going to stop” and just stop, it includes people who get a few days and then start again. Every single person doesn't stop trying.  That's it.  I think more than anything else, that's the foundation of making any kind of change.

 

For some people, even having a goal is very hard because that automatically leads them to this expectation of failure. So it really depends on how they experience not achieving their goals. If it's somebody who shows up for individual sessions consistently and I have a relationship with them- then often times when they don’t meet a goal it’s an opportunity to really get down to the nitty gritty of what dealing with this drug is really about. 

 

If you really do this work- on the other end of it you'll realize that you don't have a right to judge anybody else. And if you have that understanding it’s a foundational element for compassion.  If you really do this work, you have the potential to become one of the most compassionate people that anybody is going to meet.

 

Part of that is learning how to forgive yourself.  Many of the folks who come in here live such chaotic lives.  The hardest part is learning forgiveness. Listening to the stories that I've heard here at Stonewall, when folks are really doing the work and willing to cultivate their own compassion and learn again what it means to care about somebody and to understand that when they do something that it actually affects the people around them- those people- when they fall on their faces- understand a few things.  One of which is this, “It’s okay.” A lot of this is about refueling resilience. 

 

I meet people and I know that their spirits are broken, not that they're shattered and they can't be rebuilt, what is broken is their resilience- their ability to source and resource themselves is not there.  You have to learn that again.  And that's part of learning to deal with failures. 

 

SPEEDOMETER:  For a guy reading this in a hotel room, an apartment, a shelter or whatever-  if he never wants to come in to see a counselor and he never wants to go to a support group- what would you recommend he does- if he does want to manage his substance use?

 

ALBIE:  I have talked with Michael Siever Stonewall’s director a lot about this. Michael's always makes the point that most people do this on their own.   Michael says that this is lot like being part of this giant science experiment. So when you do use and you don’t want to or you didn’t do it how you planned, that's fine, but learn from it.  Think about things like who were you with?  What were you feeling?  Where were you?  If you keep a record of it, you'll probably find patterns.  You may find you're using a lot because you're angry or sad or whatever- it’s different for everybody.  But you can figure it out.  If you can't figure it out yourself- do a walk in at Stonewall- kick it with somebody and see what insights you get.

 

If your goal is reducing your use you really have to understand to change that means to change your life. You have to really figure out what supports make you change and which don’t- including where you go and who you hang with. You’ll figure out who is just showing up because you've got a baggy.  That is really good information to have. You have to really pay attention to what's going on around you, ask yourself and learn. 

And don't give up. Just don't give up.

 

For anyone whose reading this or thinking about changing their behavior is, my main message is that change is do-able.  Don't listen to anybody who says that you can't or that you're useless because you use speed. At the same time, do not underestimate how horrible speed can be. If you're at a place in your life where your self esteem is so bad that you don't respect yourself anymore- at least respect your drug. Tina's a bitch.

 

My investment in doing harm reduction work is not to make people change.  It's not to force that.  Doing harm reduction work is really about being part of this giant experiment to see how loving I can be. It’s a process that really demands patience. 

SPEEDOMETER: Right on.  Thank you so much.

ALBIE: You’re welcome.

 

Resources:

1) The Stonewall Project is a harm reduction counseling program for men who have sex with men (meaning queer, gay, bisexual, transgender, questioning, or no label) who have questions about speed, want information about speed, want help dealing with speed etc. There's no requirement that you be clean and sober, or even want to be, to join us. 

Drop in One on One Counseling is Available! 

Mon-Friday 4PM-5PM at 3180 18^th Street, Suite 202 (near Folsom)

Wed. 5:30-7PM and Sat. 2PM-4:30PM at Magnet 4122 18th Street (near Castro)

Stonewall Drop In groups  

Wednesday at 6:30PM-8PM, 3180 18th Street, Suite 202 (near Folsom Street)

Stonewall (415) 487-3100

Magnet (415)  581-1600

2) The Harm Reduction Therapy Center is a non-judgmental approach to helping substance users reduce the negative impact of drugs and alcohol have on their lives. It respects that people use drugs for a variety of reasons.  Want more info? http://www.harmreductiontherapy.org/

Drop in One on One Counseling is Available!

HRTC offers sub use/mental health services 5 days a week at Tenderloin Health (187 golden gate), Monday through Friday from 9 to noon and appointments in the afternoon.  The best way to have someone come to us is to come through one of our drop-in times. The closer you show up to 9AM the less time you will have to wait around. HRTC also offers drop in mental health counseling at Hospitality House (290 Turk) is available on Mondays and Tuesdays from 1 to 5pm.

 Harm Reduction Therapy Center Drop In groups

Mon-Thurs. 1:30-2:30PM  at the Self Help Center 288 Turk at Leavenworth

Wed 9:30-10:30AM & Thurs. 2PM-3PM at Tenderloin Health 187 Golden Gate