Drug Abuse in Gay Men Linked to Other Issues : Depression, partner abuse, and childhood sexual abuse are often intertwined with drug abuse.

ATLANTA — Substance abuse is pervasive among gay men and is so intricately intertwined with epidemics of depression, partner abuse, and childhood sexual abuse that adequately addressing one issue requires attention to the others as well, said Ronald Stall, Ph.D., chief of prevention research for the division of HIV/AIDS prevention at the Centers for Disease Control and Prevention, Atlanta.

A population-based telephone-survey of nearly 3,000 gay men living in urban areas across the United States showed that in the prior 6 months, 90% of respondents had used alcohol, 50% had smoked marijuana, nearly 20% had used cocaine, 10% had used crack cocaine, and 10% had used methamphetamine. About 1% of respondents were current intravenous drug users.

Gay men on the East and West Coasts favored different drugs. Those on the West Coast preferred methamphetamine; those on the East Coast were more likely to smoke marijuana. “But by and large, they were using [the drugs] for the same purposes,” Dr. Stall said at a conference jointly sponsored by the National Association of Addiction Treatment Providers and the Medical College of Georgia.

The survey findings debunk old, poorly constructed studies suggested that one in three was alcoholic, but that oft-quoted figure is inflated, Dr. Stall said.

Current alcoholism appears to be present in 10% of gay men, which is similar to the rate in a national sample of about 20,000 people from the general population.

About 1 in 10 gay men in the current study reported frequent heavy alcohol use (five or more drinks at one sitting at least once each week), and the same number reported three or more alcohol-related problems, which is diagnostic for problem drinking. Drug use was more prevalent. One in five reported drug use at least once each week or the use of three or more different drugs in the last 6 months, he said.

Compared with the general population sample, the gay male population sample had a 4-fold increase in marijuana use, a 7-fold increase in cocaine use, and a 10-fold increase in amphetamine use.

Data consistently show that drug use—particularly intravenous drug use—is associated with about a 40% increased risk of HIV infection. It appears that men who do not use intravenous drugs but who have high rates of other substance abuse have an equally high risk of HIV infection. Numerous studies have shown that substance use and high-risk sex are closely linked, he said.

In the current survey, substance use, childhood sex abuse, partner violence, and major depression emerged as interrelated issues that also are closely linked. Major depression and partner violence predicted multiple drug use and childhood sex abuse, and multiple drug use, childhood sex abuse, and partner violence were predictors of major depression.

“We have at least four epidemics going on among gay men that are associated with each other and making each other worse. Dealing with only one at a time may not be as effective as if we try to address them all,” he said.

In treating a patient with a substance use disorder, for example, the ability to achieve sobriety might be impaired if a history of childhood sexual abuse or major depression is not addressed simultaneously. Effectively addressing these matters in the gay male population requires teamwork on the part of organizations attempting to resolve each of these problems in isolation from the others.

The four epidemics should also be considered in the context of HIV risk. Two solid trials have suggested that substance abuse treatment is effective for reducing HIV risk-taking behaviors, which raises the possibility that substance abuse treatment equals HIV prevention.

ATLANTA — Substance abuse is pervasive among gay men and is so intricately intertwined with epidemics of depression, partner abuse, and childhood sexual abuse that adequately addressing one issue requires attention to the others as well, said Ronald Stall, Ph.D., chief of prevention research for the division of HIV/AIDS prevention at the Centers for Disease Control and Prevention, Atlanta.

A population-based telephone-survey of nearly 3,000 gay men living in urban areas across the United States showed that in the prior 6 months, 90% of respondents had used alcohol, 50% had smoked marijuana, nearly 20% had used cocaine, 10% had used crack cocaine, and 10% had used methamphetamine. About 1% of respondents were current intravenous drug users.

Gay men on the East and West Coasts favored different drugs. Those on the West Coast preferred methamphetamine; those on the East Coast were more likely to smoke marijuana. “But by and large, they were using [the drugs] for the same purposes,” Dr. Stall said at a conference jointly sponsored by the National Association of Addiction Treatment Providers and the Medical College of Georgia.

The survey findings debunk old, poorly constructed studies suggested that one in three was alcoholic, but that oft-quoted figure is inflated, Dr. Stall said.

Current alcoholism appears to be present in 10% of gay men, which is similar to the rate in a national sample of about 20,000 people from the general population.

About 1 in 10 gay men in the current study reported frequent heavy alcohol use (five or more drinks at one sitting at least once each week), and the same number reported three or more alcohol-related problems, which is diagnostic for problem drinking. Drug use was more prevalent. One in five reported drug use at least once each week or the use of three or more different drugs in the last 6 months, he said.

Compared with the general population sample, the gay male population sample had a 4-fold increase in marijuana use, a 7-fold increase in cocaine use, and a 10-fold increase in amphetamine use.

Data consistently show that drug use—particularly intravenous drug use—is associated with about a 40% increased risk of HIV infection. It appears that men who do not use intravenous drugs but who have high rates of other substance abuse have an equally high risk of HIV infection. Numerous studies have shown that substance use and high-risk sex are closely linked, he said.

In the current survey, substance use, childhood sex abuse, partner violence, and major depression emerged as interrelated issues that also are closely linked. Major depression and partner violence predicted multiple drug use and childhood sex abuse, and multiple drug use, childhood sex abuse, and partner violence were predictors of major depression.

“We have at least four epidemics going on among gay men that are associated with each other and making each other worse. Dealing with only one at a time may not be as effective as if we try to address them all,” he said.

In treating a patient with a substance use disorder, for example, the ability to achieve sobriety might be impaired if a history of childhood sexual abuse or major depression is not addressed simultaneously. Effectively addressing these matters in the gay male population requires teamwork on the part of organizations attempting to resolve each of these problems in isolation from the others.

The four epidemics should also be considered in the context of HIV risk. Two solid trials have suggested that substance abuse treatment is effective for reducing HIV risk-taking behaviors, which raises the possibility that substance abuse treatment equals HIV prevention.

ATLANTA — Substance abuse is pervasive among gay men and is so intricately intertwined with epidemics of depression, partner abuse, and childhood sexual abuse that adequately addressing one issue requires attention to the others as well, said Ronald Stall, Ph.D., chief of prevention research for the division of HIV/AIDS prevention at the Centers for Disease Control and Prevention, Atlanta.

A population-based telephone-survey of nearly 3,000 gay men living in urban areas across the United States showed that in the prior 6 months, 90% of respondents had used alcohol, 50% had smoked marijuana, nearly 20% had used cocaine, 10% had used crack cocaine, and 10% had used methamphetamine. About 1% of respondents were current intravenous drug users.

Gay men on the East and West Coasts favored different drugs. Those on the West Coast preferred methamphetamine; those on the East Coast were more likely to smoke marijuana. “But by and large, they were using [the drugs] for the same purposes,” Dr. Stall said at a conference jointly sponsored by the National Association of Addiction Treatment Providers and the Medical College of Georgia.

The survey findings debunk old, poorly constructed studies suggested that one in three was alcoholic, but that oft-quoted figure is inflated, Dr. Stall said.

Current alcoholism appears to be present in 10% of gay men, which is similar to the rate in a national sample of about 20,000 people from the general population.

About 1 in 10 gay men in the current study reported frequent heavy alcohol use (five or more drinks at one sitting at least once each week), and the same number reported three or more alcohol-related problems, which is diagnostic for problem drinking. Drug use was more prevalent. One in five reported drug use at least once each week or the use of three or more different drugs in the last 6 months, he said.

Compared with the general population sample, the gay male population sample had a 4-fold increase in marijuana use, a 7-fold increase in cocaine use, and a 10-fold increase in amphetamine use.

Data consistently show that drug use—particularly intravenous drug use—is associated with about a 40% increased risk of HIV infection. It appears that men who do not use intravenous drugs but who have high rates of other substance abuse have an equally high risk of HIV infection. Numerous studies have shown that substance use and high-risk sex are closely linked, he said.

In the current survey, substance use, childhood sex abuse, partner violence, and major depression emerged as interrelated issues that also are closely linked. Major depression and partner violence predicted multiple drug use and childhood sex abuse, and multiple drug use, childhood sex abuse, and partner violence were predictors of major depression.

“We have at least four epidemics going on among gay men that are associated with each other and making each other worse. Dealing with only one at a time may not be as effective as if we try to address them all,” he said.

In treating a patient with a substance use disorder, for example, the ability to achieve sobriety might be impaired if a history of childhood sexual abuse or major depression is not addressed simultaneously. Effectively addressing these matters in the gay male population requires teamwork on the part of organizations attempting to resolve each of these problems in isolation from the others.

The four epidemics should also be considered in the context of HIV risk. Two solid trials have suggested that substance abuse treatment is effective for reducing HIV risk-taking behaviors, which raises the possibility that substance abuse treatment equals HIV prevention.