Perry Halkitis’ new book is Methamphetamine Addiction: Biological Foundations, Psychological Factors, and Social Consequences (American Psychological Association, 2009). Halkitis, who serves as professor of applied psychology and public health, as well as Steinhardt’s associate dean for research and doctoral studies, is the recipient of a $2.9 million NIH grant to study the development of young gay men and their specific risk factors for HIV infection. Debra Weinstein spoke to Halkitis about his book and research.
Your book is one of the most comprehensive books in print about methamphetamine addiction. Why does this drug interest you?
Methamphetamine interests me because its use transcends race, ethnicity, sexual orientation, economic status, and level of education. There is no stereotypical methamphetamine user. Soccer moms are users. Highly trained physicians are users. Disenfranchised individuals are users. Adolescents in indigent rural communities are users. Gay men in wealthy metropolitan areas are users. In the book I try to understand the common themes that connect all these users. While gay men and methamphetamine use are evident highly in behavioral studies because of the ‘meth-sex’ link, the vast majority of users of this drug are heterosexual, approximately 50% being women. However, I should note that the book focuses on all segments of the U.S. population.
Talk a little about the ‘meth-sex’ link.
My research has focused on the synergies that exist between illicit drug use, sexual risk taking and mental health burden. For more than a decade at my research center, the Center for Health, Identity, Behavior and Prevention Studies (CHIBPS), we have been examining these relations in large-scale studies. Of particular interest to us is the manner in which these overlapping epidemics manifest in the LGBT population. Methamphetamine is a drug that has a long history of use among gay and bisexual men. Moreover, because it is a drug that strongly reduces inhibitions, and exacerbates sexual arousal, its link to sexual risk taking is high. Among gay and bisexual men where HIV is concentrated this relation creates what I have coined ‘a dual epidemic.’ We are interested in determining why men are drawn to this drug and how we can effectively understand this link, and how we best translate our knowledge to empower clinicians and community based agencies to develop appropriate therapeutic interventions.
How did your early research and scholarship lead you to your current studies?
Throughout my career I have worked closely with many of the leading AIDS service organizations in New York City and nationally, as well as numerous departments of health. By them time I had completed my Ph.D. in 1995, many close to be me had died of AIDS. Although my formal training was that of an applied statistician, I tailored by skills and abilities to conduct HIV behavioral research, in part to help strengthen our scientific knowledge of risk taking, and in part as a memorial to those that I lost to the disease.
My team at CHIBPS and I have been conducting research on the health of gay men for over a decade. That being said the broader question for us is why gay and bisexual men experience such high rates of illicit drug use and mental health burden. We believe that a combination of factors, not least of which is the discrimination and stigmatization that gay men face from their families, non-gay peers, and our society at large are powerful factors that compromise the well being of these men. Using this lens of reasoning, we understand the HIV epidemic, drug use (including methamphetamine use), and mental health burden experienced by the LGBT community at large as socially produced ills that create this health disparity.
Who is most at risk for developing an addiction to methamphetamine?
There is no simple, linear path to methamphetamine addiction. Trajectories to addiction vary from person to person. But what we do know is that there are biological, psychological, and social vulnerabilities that may make some more susceptible to addiction—those who are depressed and/or who have ADHD and are untreated, those in poor economic situations, those who transact in venues and social circles where the drug is used. These and many other factors can lead one to the path of addiction. At the same time those who are resilient may protected against the development of addictions.
It is important to note that like all other risky behaviors, addiction to methamphetamine does not occur overnight. It is a lifelong process. The developmental experiences of childhood and adolescence provide strong indicators of the vulnerabilities that young adults will manifest. Family histories and psychopathologies cannot be ignored.
What is interesting about methamphetamine is that it appears to be more widely used among older (over age 30) gay men. Yet the trajectory that leads younger gay men to eventually be drawn to and use this drug is not fully understood.
In your research in prevention studies, what do you find are the most effective interventions in curtailing addictive behavior?
There is no full proof treatment for methamphetamine addiction. Currently there are behavioral, pharmacological, and 12-step treatments available. None have proven to be 100% effective. One promising treatment uses contingency management, a reward system for having ‘clean’ toxicology results. The ‘matrix model’ uses a combination of behavioral approaches. In addition there are approaches that address the ‘meth-sex’ link. In my view an approach that encompasses the totality a person’s life (biological, psychological, social) is the most beneficial—such approaches meet the person where he/she is, examines the realities of her/his life, and tries to understand why the addiction has developed and how to counter it.
What are you researching now? What are some questions that interest you?
For me, the most interesting and promising line of research focuses on the development of young adults. Our newly funded NIH project examines the development of risks and resiliencies in a cohort of 675, 18-year-old young men. This period of life is understudied, not completely understood, especially for sexual minority men. I would like to enact a similar study for young women who have sex with women. I believe that if we understand what places these young people at risk for drug use, mental health burden, HIV and other STIs we will be able to effectively translate these findings into practice and messaging that is relevant to a generation growing up in the 21st century. Another area for us is to explore the aging process of LGBT individuals, especially gay men living with HIV. We want our research to give voice to these aging men who have lived with and through the HIV epidemic and now are entering their later stages of life.
Another strand of research at our center involves partnerships with community-based agencies. We believe that randomized control trials of programs developed on the community level must be undertaken with, for and in the community. We are currently funded by the CDC and are working with Harlem United to examine the effectiveness of three different strategies for bring previously untested Black men into HIV testing and hope to begin a study that uses video production and peer education to educate and empower young men to reduce their HIV related risk.
Can you tell me one thing I don’t know about methamphetamine addiction?
Methamphetamine is the first true U.S. homegrown drug epidemic. For years methamphetamine was manufactured in the U.S. which is unlike many other drugs which are abused.