1. Addressing Crystal Methamphetamine Use Among Gay and Bisexual Men: A Treatment Center’s Response Joe Ruggiero, Ph.D. –Director, Outpatient Services The Addiction Institute of New York www.AddictionInstituteNY.org –(Formerly Smithers Treatment Center)

2. Overview There are many resources needed for gay and bisexual men who are using crystal methamphetamine. We tried to address what role a substance abuse center can play in providing support.

3. The Addiction Institute of New York Located in midtown Manhattan Part of St. Luke’s & Roosevelt Hospitals Outpatient: IOP, less intensive, specialty programs Inpatient: Detox, Rehab, Halfway House Gay friendly

4. Crystal and NYC Different history then out west Many studies indicate a rise in crystal use in NYC among gay and bisexual men (Halkitis & Parsons,2002; Stall et al,2001) Crystal ad campaigns Patient Zero Change in our admissions

6. Funding and support In 2004, we were visited by NYC council member Margarita Lopez and members of the DOHMH to discuss our experiences of crystal methamphetamine users. We were funded to create groups for gay and bisexual men who use crystal.

7. The Crystal Clear Project Outreach Education of staff Interventions (primarily OPD) Group Contingency Management

8. Outreach Colleagues Local gay magazines Gay organizations

10. Staff Education Biology of crystal Culture of crystal Discussion of sex and different comfort levels

11. The Crystal Clear Project The goal was to create an environment where gay and bisexual men can openly discuss issues of drug use, sex, sexuality, and identity Front-loading treatment: IOP Evening groups up to 3 days a week Individual counseling Contingency management

12. Friends Research Institute, Inc. CBT protocol that includes the issues we wanted to address and is culturally relevant Based on the MATRIX Model A research-based protocol Tom Freese, Ph.D., trained members of our staff throughout the system. 48 session manual

13. The protocol Basic CBT skills such as identifying triggers, coping strategies for cravings Incorporates gay venues in the text: clubs, bathhouses, etc. Aunt Tina Sex/HIV

14. Contingency Management Vouchers for attendance vs. use Build support for activities that don’t have to be associated with drug and alcohol use

15. Other services Inpatient Psychiatric Family Other addiction medications (buprenorphine, acamprosate, etc.) CMA

16. Research I Shoptaw et al (2005) randomly assigned 162 gay and bisexual men to one of 4 conditions: Matrix Model, CM, Matrix+ CM, Matrix Model-revised version for gay men. Measured use by urine testing and self- reported sexual risk behaviors.

17. Research II Statistically significant differences in retention and longest periods of consecutive methamphetamine-negative results in the CM group The revised version also significantly reduced unprotected receptive anal intercourse.

18. Research III At one year follow up, all groups maintained reductions from baseline in drug use and sexual risk.

19. Conclusions I We have provided a place where men can talk about these issues openly. Integrate men who want to be abstinent and men who want to address (e.g., cut down, examine, etc) their use.

20. Conclusions II We work with men who meet criteria for “dependency” but also men who are abusing drugs. The hope is that we can do prevention work as well. We can create more structure for men who need that level of support

21. Conclusions III GMHC Callen Lourde Private therapy A Community Center Self help