In 1997, when Anthony Snyder was 31, he tested positive for HIV and left the air force. Snyder's next move: He started snorting crystal methamphetamine, a highly addictive form of speed. By 2000, he was smoking daily. Crystal, Snyder says, helped him escape his issues with being gay and positive--and from "feeling like I was going to die soon" from HIV. Until 2001, that is, when he’d begun shooting up (crystal is most commonly snorted or smoked, although injecting, or "slamming," is becoming popular too), become homeless, then got arrested for dealing--and decided it was time to quit.
Crystal (aka meth, ice, T or Tina) is not just a gay phenomenon, though urban gay communities have been hit especially hard. Crystal has hooked a wide cross section—from hard-core junkies to overachieving students and desperate housewives. Nearly 12 million Americans have tried the drug, according to the 2004 National Survey on Drug Use and Health. However, research at the intersection of HIV and crystal has focused on gay men.
As crystal meth use has swept the country over the past 20 years, the media have repeatedly linked its euphoric and energy-boosting effects to lowered inhibitions and increased HIV risk. But studies show that many users, especially gay male users, already have the virus. So how does the drug affect a positive person like Snyder?
Studies show that one of meth's first casualties is HIV-med adherence. "With crystal," says Steven Lee, MD, a New York City psychiatrist who treats many meth users, "the drive to use the drug becomes so strong that it overcomes the drive to do other important things, like taking medicine." All 23 HIV-positive meth users in a 2003 study, for example, reported missing doses, which can spark drug resistance. Recent San Francisco research found that positive meth users were more likely to develop resistance to non-nukes. What's more, in one San Diego study, active meth users taking HIV meds had higher viral loads than nonusers or former users, though the disparity vanished in folks who weren’t taking meds. In both studies, poor adherence seemed responsible for the differences in response to treatment.
Meth may also interact with common medications, including several HIV drugs. The same liver pathway that processes protease inhibitors (PIs) handles meth. Using crystal with PIs floods the brain with extra meth, increasing the likelihood of addiction—and brain damage. Meth mimics some of HIV's brain-busting effects (even without med interactions). Over time, both HIV and methamphetamine can impair concentration, heighten risk of dementia and promote short-term memory loss. Snyder says that after he'd been using crystal for a while, "I'd be carrying on a conversation and completely forget what I was talking about. I couldn't remember things I'd done the day before; I couldn't remember people's names." These changes can hobble other functions, such as learning new information and solving problems, says research psychologist Steve Shoptaw, PhD, of UCLA’s psychiatry department: "Methamphetamine causes major deficits in the 'working memory,' which allows you to grasp a concept and return to it when needed."
But the most perilous brain damage may occur in the area called the prefrontal cortex, where meth attacks a user's ability to make logical judgments and resist cravings. That's why the drug is so tough to quit (for help, see "Kicking Crystal to the Curb"). Lee adds, "Meth is the most powerful known stimulator--even more than crack cocaine--of the 'brain reward circuit,' which causes people to repeat a behavior." This and some other brain functions seem to recover gradually if you stop using crystal. Indeed, Snyder says his memory began rebounding about a year after he quit.
It's the waiting that's the problem, Shoptaw says. Quitters often become impatient because "they have trouble holding on to the idea that by not using meth, they're going to recover their function," he says--and that can trigger a relapse.
Support, consistency and length of recovery are key, says Kathy Watt of Van Ness Recovery House, a Los Angeles rehab program. "Right away, people need to be told that their mood is going to fluctuate wildly for about 18 months," she says, and most people will need programs lasting at least that long.
Snyder says that in his first months of recovery, "the depression was huge. Just trying to deal with everything and stay sober was overwhelming at times." But he's managed with the help of a drug rehab program and a 12-step group. "What's worked," he says, "is going at a slow pace and giving my brain time to take in what it needs to take in." He calls it quitting time.
KICKING CRYSTAL TO THE CURB
Ditching meth is tough, but with the help and support, it can be done. If you don't have a therapist, ask your physician to help you find one--some specialize in addiction counseling. Try these tips from Steven Lee, MD, too:
1. Learn everything you can about crystal meth and how it affects your body and mind. That way, you'll really understand all the reasons why you need to quit.
2. Examine closely the role that crystal plays in your life: what it’s replacing; what pleasures it provides (better body image, fewer inhibitions, etc.). You’ll need to be realistic about what you’re giving up in order to regain health and control.
3. Don’t keep your crystal use a secret--discuss it with someone sober. This will help you stay grounded when meth tries to trick your brain into thinking everything is OK.
4. Where possible, avoid your personal triggers for crystal use; develop plans for managing those you can't escape.
5. Whatever holes in your life crystal may be filling--loneliness, depression, internalized homophobia, HIV burnout--you can address them through various forms of therapy.
6. You will need a sturdy, consistent support network of sober people, both former meth users and folks who've never used, to help you through the long months to recovery.
For more, check out Lee's "Overcoming Crystal Meth Addiction: An Essential Guide to Getting Clean" (www.knowmoremeth.com). Most AIDS service organizations (you can find one in the ASO directory at www.poz.com) can help you locate a drug treatment program. For a local chapter of the recovery group Crystal Meth Anonymous, go to www.crystalmeth.org; for more, try www.tweaker.org.