This image shows a crack/crystal meth pipe
“You’re too well put together to be an addict.” I beamed at Jake’s comment, overwhelmed with relief. He squirmed as he disclosed his struggles with addiction, pushing aside the wine list as we both opted for water. The restaurant was dimly lit. I hoped it would soften the twitches in my face and limbs.
Jake and I had exchanged messages on Grindr, and this was our first time meeting face-to-face. As I got ready for the date, I was overcome by nervousness, my mind racing with insecurities.
Too paralyzed to leave my apartment, I turned to what had over the past few months become my new source of courage: a glass pipe, the swirling vapor of crystal meth easing my anxieties and bathing me in the confidence I needed. It also meant jumping muscles and awkward movements, and anxiety about concealing my track marks as occasional smoking shifted to frequent injecting.
Dinner was cordial, but we reached an unspoken agreement that we wouldn’t meet up again. An investment banker, Jake’s schedule was tight. Between my exploration of methamphetamine and the rigors of a PhD program, I was inclined to protect my time, too.
For a while at least, meth seemed to aid me in just about all aspects of my life.
I had moved to New York City for a doctoral program in social work. Most of my professional work had been in mental health and addiction; I was particularly committed to providing compassionate services to people who use drugs, even though I wasn’t one of them at the time. Then, a few months after I moved to the city, I went to a party and tried “Tina.” The taste was nauseating. The euphoria was life-changing.
Crystal meth fit me well. As I navigated the stressors of a new academic program, I found that meth helped me better articulate complex ideas in my writing and in class discussions. It eased lingering memories of a painful childhood. It even gave me a boost before a workout. Later, I learned that I’d been living with undiagnosed mental health concerns, and came to see that meth had been my “street” substitute for psychiatric medication. But for a while at least, it seemed to aid me in just about all aspects of my life.
The social group I quickly developed was with guys who used Tina to party. Using it along with them dissipated my underlying social anxiety, helping me make friends. Over time, I’ve learned that many people are able to use methamphetamine simply for pleasure, without a chaotic impact on their life. I simply wasn’t one of them.
Over the next few months, my time shifted more toward the necessities of acquiring, using and recovering. That summer was sweaty and unbearable. I was rapidly draining of energy. I needed meth to function.
As the new academic year approached, I wasn’t sure I had the physical or emotional strength to continue with my education. Recovery seemed impossible. I could not imagine how I’d manage the impending responsibilities of the new academic year. As things deteriorated, I could see only one solution.
For hours, I tried to summon the energy to jump.
Hands shaking, I checked hotel specials online and found that I had just enough money in my squandered savings to check into a hotel on the Upper East Side of Manhattan. I booked a room on the top floor. I wrote a short letter to loved ones.
For hours, I tried to summon the energy to jump. Body tiny from months of lost appetite, I stared out into the humid night from my awkward perch on the ledge of the single window. I was devoid of thought; unable to pray. On a terrace across the street, construction workers began to repair a patio. Gradually, the rush of morning traffic appeared. Pedestrians below me hustled on their way to work.
I clumsily stepped back inside the room. It was time to check out of the hotel, but I had no idea where to go. I had neither the energy to end my life nor return to it.
The moment I stepped out the lobby door, I became frozen, unable to merge into the churn of human life. As I stood there, I was shocked to recognize one familiar face: my Grindr date and fellow substance user, Jake.
He was clean-shaven, decked out in a tailored suit. My reflex was to hide, ashamed to be seen in that state. But I didn’t. Legs wobbling, I ran down York Avenue to catch up with him.
“Jeff! You’re a mess! What happened, honey?”
We flagged a taxi and headed to a nearby hospital. Tears flowed as I took comfort in his presence. I was no longer alone.
Change is incremental. What followed that taxi ride was the first of several inpatient stays. I continued to use meth. Jake was my sponsor for a while. We frequently butted heads—he had saved me, but we couldn’t find a way to forge an ongoing relationship.
It’s been a decade since I saw Jake on York Avenue. In that time, I’ve discovered that New York City has a vibrant community of drug users and professionals—and drug-using professionals—engaged in the clinical and practical application of harm reduction tools to stay safe and use with reduced risk.
Abstinence-based providers would drop me if I had a “slip,” but I was fortunate to have help from a group of psychologists who have published extensively about their development of harm reduction approaches to psychotherapy. I maintained relationships with these folks for years, and through them learned helpful strategies—like mindfulness meditation and urge surfing— that are utilized in harm reduction and recovery settings alike.
While often framed as opposites, harm reduction and recovery can often benefit the same person.
I also benefited from strategies that were exclusively, undeniably harm reduction, even though my personal goal was recovery. I learned to notify a friend whenever I was about to use. I learned the importance of not sharing syringes, and of testing my drugs for fentanyl. I participated in a weekly harm reduction therapy group, a safe space for me to have frank discussions about meth and the ambivalence I often felt around using it.
There is strong evidence of the benefits of implementing harm reduction in social work. But many in my field continue to discredit harm reduction’s legitimacy in favor of an abstinence-only approach.
At low doses, methamphetamine can have various medical benefits, and can serve a similar function as prescription medication for people with conditions like ADHD. For me, any short-term gains in cognitive functioning were overshadowed by my patterns of bingeing. But that does not mean abstinence is the most suitable path for everyone—just that it was, and still is, the most suitable path for me.
As a social worker, I’ve practiced in settings based in recovery as well as others based in harm reduction. While often framed as opposites, these two philosophies can benefit the same person.
Combining harm reduction tools with a 12-step recovery plan was what allowed me to complete my doctorate. That, and a chance encounter on a sidewalk with someone who was willing to be kind to me—someone who understood.
Photograph via United States Drug Enforcement Administration