Of Lust, Men, Meth & Healing
AIDS Activist David Fawcett, PhD, Explores the Intersection of Addiction and HIV Risk in a New Book
by Alina Oswald

Photo by Howard Zucker
Photo by Howard Zucker

First thing you notice when meeting Dr. David Fawcett face to face is his height. I certainly did when I attended one of his book events last December at the Lesbian, Gay, Bisexual & Transgender Community Center in New York City. Tall and slender, he gracefully moved around the room, shaking hands and welcoming people to the event that was about to start. His voice was warm and reassuring, as if to confirm that you’re in a safe space.

Many might be familiar with his work through his writings for TheBody.com or Positively Aware. Many more might be aware of the workshops and training the substance-abuse expert offers around the country and the world. Others might know him through his work in Florida, where his private psychology practice is located, and where, among others, he is the founder and chair of the South Florida Meth Task Force, and the director of the Pride Institute in Ft. Lauderdale.

The winner of several awards and recognitions, such as Broward Social Worker of the Year in both 2012 and 2015, David Fawcett, PhD, LCSW, is a certified sex therapist and clinical psychotherapist with thirty years of experience. After his HIV diagnosis in 1988, he became interested in mental health issues and HIV, in particular among gay men. Nowadays, he is a national trainer for the HIV Spectrum project of the National Association of Social Workers, and facilitates workshops for gay men and individuals living with HIV/AIDS at retreats and national events, such as Positive Living, the largest conference for people living with HIV/AIDS.

Dr. Fawcett is also the author of Lust, Men and Meth, his recently published book that he introduced at The Center, in New York City. The book is not a light read, but it’s a must-read for many people, especially those who are or know somebody who is struggling with drug addiction in general, or meth addiction in particular. With a foreword by longtime activist Mark S. King, Lust, Men, and Meth offers, as its subtitle states, A Gay Man’s Guide to Sex and Recovery and a unique, realistic look inside an individual’s struggle with issues such as drug use (methamphetamine in particular), sex, and recovery, while also providing vital tools for the professionals working with these individuals.

Divided in three parts, Lust, Men and Meth offers a survival guide that people can use not only as they go through the recovery process, but also as they try to remain clean of meth, of drugs in general, for the rest of their lives. Extensively documented with numerous case studies, the read not only provides much-needed information, but also solutions.

The first part, “The Perfect Storm,” examines the damaging effects of methamphetamine, on some gay men in particular; the dangers that lurk at the intersection of meth use and unprotected sex; and the strong connection between drug use and HIV transmission. “Remember when we only had black and white television and then came color TV—it’s the same with methamphetamine and sex,” a meth user is quoted as saying in Lust, Men and Meth. “Meth highjacks the brain’s reward system, which is designed to make activities essential to our survival highly pleasurable,” Dr. Fawcett writes in his book. “It intensifies sexual experiences to the point where the user feels that ‘meth-sex’ is the ultimate sexual experience, and expands personal sexual boundaries, resulting in riskier sexual interaction and a hightened interest in exploring more remote corners of sexual fantasies.”

The second part, “Exploring the Sexual Universe,” tells the meth addiction story from a sex therapist’sLust book perspective, taking on topics such as the role of dopamine and how its levels are dramatically triggered by meth use, the brain’s ability to change and adapt as a result to drug use and compulsive behaviors, and also drug recovery. Here, the author brings up the work of researchers like John Money and William Granzig, who “have made significant contributions to our understanding of sexual templates. This understanding of templates makes clear how a drug such as methamphetamine hijacks our brains and distorts our deepest fantasies into unrecognizable drives with supercharged and destructive erotic power.” Fawcett continues: “Once templates develop, they are, then, extremely resistant to change.”

The third and last part, “Restoring Your Life,” takes a closer look at the process of recovery in particular from methamphetamine, while rebuilding relationships with oneself and with others. “Everyone getting clean should have a complete physical examination,” Dr. Fawcett writes, referring to the life-threatening complications related to chronic meth use. “This is especially true for anyone living with HIV/AIDS, since meth use nearly always disrupts adherence to antiretroviral medication. Resistance to antiretroviral medications may have occurred due to inconsistent adherence routines, so laboratory tests to determine the effectiveness of the current regimen may be required.”

Maybe most importantly, Lust, Men and Meth offers a safe space for an open and honest conversation about sex, drugs, meth, and HIV; and sets the stage for people to talk freely about their own experiences, ask questions, and seek answers, as they did at the event I mentioned. After Dr. Fawcett presented and talked about his work in a room full of people, which included, among others, PrEP pioneer Damon L. Jacobs [A&U, December 2015] and Visual AIDS’ former programs manager, Ted Kerr, questions poured in, covering a wide range of topics—from triggers (that enable the use of meth) to neurotransmitters and dopamine, from brain neuroplasticity to the damaging fusion between methamphetamine, chem-sex and suicide Tuesday, unprotected sex and HIV, from using PrEP to finding a path to recovery. And the overall message that came through was loud and clear, and also promising: “There are solutions. People do recover.”

But the recovery process, especially recovery from meth use, is often a long and winding road. To find out more, I called Dr. Fawcett after the book event, to learn more.


[pull_quote_center]In my experience, what trips people up is that they think that [the negative effects] won’t happen to them. But there’s kind of a denial of their ability to control and handle [the drug]. And that kind of takes people by surprise.[/pull_quote_center]

During our phone conversation, he reminded me that the recovery rates, which, to an outsider, could seem quite disappointing, are slightly above ten percent for meth, sometimes as high as twenty to twenty-five percent for alcohol recovery. “It’s tricky,” he further explains, pointing out that recovery rates depend on the length of time during which an individual has been drug-free, and those lengths of time can vary drastically. “Sometimes it’s like comparing apples with oranges with those numbers,” he adds.

Dr. Fawcett also reminds of the reason why recovery is so difficult nowadays. About a decade ago, when methamphetamine was considered the (then) new AIDS-like epidemic, as covered in Suicide Tuesday by Duncan Osborne, the drug itself was less pure, hence, less addictive. “I think it’s our job letting people know what’s out there,” he says. “Meth today is much more devastating than [it was years ago] because, instead of [using] the local mom-and-pop laboratories, [nowadays] they do it industrially, they got it down to a science. The purity is much higher than we’ve seen before. So, people who could maybe handle using meth a couple times a year, at a circuit party of some kind, have a little more of a hard time now, because now it’s sort of a different drug than it was before. We [still] call it meth, but the purity has increased.” He points out a very “scary” chart that shows the present purity level in the ninety percentiles. “It’s a dramatic bump in the purity in the last ten years. And, ironically, the purity goes up and the price goes down. It’s a pretty bad combination.”

Methamphetamine leads not only to more unprotected sex, which, in turn, could lead to more HIV infections, but the damage this particular drug can cause is multifaceted, and just plain scary. Meth leads to apathy; meth users interpret facial expressions as hostility. Also, while on meth, individuals are not eating, and not drinking water…hence they could end up in the hospital with kidney failure.

“In my experience, what trips people up is that they think that [the negative effects] won’t happen to them,” Dr. Fawcett explains. “But there’s kind of a denial of their ability to control and handle [the drug]. And that kind of takes people by surprise.”

Prevention messages about the dangers of methamphetamine need to be straightforward. A shaming approach doesn’t usually work.

“[We have to] do our best to appeal to people’s strengths that would give them what we call resistance skills,” he explains, “so that, if someone offers [meth] to them or if they encounter it somewhere by chance, they have more power to not pick it up.”

When it comes to prevention, HIV prevention also comes to mind. Dr. Fawcett endorses PrEP, but cautions that PrEP can only be used for HIV prevention, not any other STIs. “If somebody is informed enough to take PrEP, they generally have enough knowledge and self-awareness about things, and are more connected to the healthcare system,” he explains. “The big problem with PrEP is that [some believed] that people would go wild and not take any precautions. And what we see is that those [on PrEP] actually become more careful. But I always have to make sure,” he reiterates, “[to inform] that PrEP [prevents just] HIV. It doesn’t prevent anything else. [Whether you’re in] Ft. Lauderdale, L.A. or New York there’s always a high risk of other sexually transmitted infections that are out there, which people should be aware of. But PrEP is a wonderful tool, and I think it’s a great advantage for people, but it’s not the only answer.”

He further explains that people taking PrEP to prevent HIV often also try to prevent other health risks. What’s important is the mindset that comes with using this kind of prevention tools. Plus, those on PrEP go to see their doctor every several months, and that kind of care makes a big difference.


David Fawcett converses about his book, LUST, MEN AND METH at The Center in NYC. Photo courtesy D. Fawcett
David Fawcett converses about his book, LUST, MEN AND METH at The Center in NYC. Photo courtesy D. Fawcett

There are some interesting brain scans showing the changes happening in the brain, when an individual is using meth. “There are switches in the brain, and it really makes it difficult for these individuals to go back and use those substances without control,” Dr. Fawcett explains. “That’s a tough pill to swallow.” His goal for himself—he’s been through his own journey of recovering from alcohol addiction—and also for his patients is to really be completely abstinent, especially with meth, because it is such a powerful, addictive drug.

When it comes to recovery, the brain is capable of rewiring itself through a long process called neuroplasticity, which could last up to eighteen months. Scientists are not yet sure if, during this process, the brain can go back to what it was before the person began using drugs. That’s always a game. For some people it comes back, but that’s not always the case.

That being said, recovery is possible, and it’s a lifelong commitment. The first steps are usually the toughest, because, oftentimes, when using meth, people burn all their bridges, and so they don’t really have a support network to see them through their recovery. “That complicates the issue dramatically,” Dr. Fawcett comments. “But I think, if they can reach out to a friend or to their doctor, to anybody, and make a connection, [that’s] really the first step [they have to take], because the healing part about this is being connected.” And that connection better be a healthy one. “It’s so sad…sometimes [patients] meet people on Scruff or Grindr and don’t know [these people’s] last names,” he comments, explaining that that is not a support system.

Finding that support network, and that healthy connection could be tough, but it’s important to try to reach out. “That’s why the twelve-step groups are so important. You can just show up. Being connected to a larger group of people who have a shared experience is really important.” Dr. Fawcett further comments that a support group can be beneficial in many ways—it can help those in recovery stay on track, and rationalize. “There’s something magical about the group that really is very powerful.”

That human connection is important. “I think it’s something about being human,” Dr. Fawcett says, “I think we need that. It’s something reassuring and healing. That’s what I mean by connection, being there for each other. I’ve trained a lot of therapists. Ultimately, it’s [about] sitting there in a chair…you could be talking about the weather, and somehow that could be effective, because [as a therapist] you might be the only person that that person can talk to. And it’s something very profound about it.”

While February is the month of chocolates, flowers, love, romance and Valentines, when it comes to matters of love, Dr. Fawcett advises people, especially those in recovery from drug, meth abuse, to “give yourself a Valentine. I think we can’t love anybody until we love ourselves. That’s where the healing starts.”


For more information about the work of David Fawcett, meth addiction, and to purchase the book, visit www.david-fawcett.com. His website also features many resources for support, including Crystal Meth Anonymous: www.crystalmeth.org.


Alina Oswald is Arts Editor of A&U.