Treatment and Peer Support for Men who have sex with Men and use Methamphetamines. Garth Parkhill

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1 Treatment and Peer Support for Men who have sex with Men and use Methamphetamines Garth Parkhill

2 Overview Introduction ReWired Therapeutic Group and 2.0: What are they? Why are they necessary? Why did we create them? How are they valuable?

3 ReWired: Therapeutic group and 2.0 What are they? What s the difference? Why have them both?

4 Why ReWired is necessary What we know National and international research reports that: Men who have sex with men are far more likely to experience problems associated with alcohol or recreational drug use than men who only have sex with women (Stall et. al., 2001) Members of the LGB communities show statistically significant elevated levels of use and dependence of non-medical drugs than their heterosexual counterparts (Cochran et. al, 2004) The use of illicit drugs is higher within the LGBTI population than in the heterosexual population (Ritter et. al., 2012) Members of the LGBTI are early adopters of emerging drug trends (Measham et. al., 2011) Members of the LGB community are more likely to inject drugs in their lifetime than their heterosexual counterparts (37% vs 12%) and previous 12 months (31% vs 6%) (Kellyet. al., 2015)

5 8 Meth use by sexuality, people aged 14 years or older, 2013 (age-standardised percentage) Ex-user Recent user Heterosexual Homosexual /Bisexual Not sure /Other Australia Meth use by sexuality, aged 14 or over, 2013 (age standardized percentage). AIHW National Drug Strategy Household Survey detailed report: Drug statistics series no. 28. Cat. no. PHE 183. Canberra: AIHW.

6 Recreational drug use amongst gay and heterosexual men over a 6 month period

7 Why ReWired is necessary What we know National and international research reports that: Members of the LGBTI population are reluctant to access AOD treatment services through fear of discrimination (McCann & Sharek, 2014) Feeling that clinicians do not understand the unique and specific needs of their community is an barrier for members of the LGBTI community in accessing medical services (Lombaardi, 2008) The Flux study reports that nearly one in ten (9.2%) respondents had ever injected illicit drugs in their lifetime, and 4.1% had injected illicit drugs in the previous six months, most commonly methamphetamine (The Flux Study: Annual Report 2015) About one in seven (15.4%) men who completed the Flux Study report having used illicit drugs in the previous six months and expressed a level of concern about their current drug use (7.8% of the sample) (The Flux Study: Annual Report 2015)

8 % of Amphetamine consumed in Crystal/Ice form in Victoria, persons 14 and older Crystal/Ice % of Amphetamine consumed in Crystal/Ice form in Victoria, persons aged 14 and over. AIHW National Drug Strategy Household Survey detailed report: Drug statistics series no. 28. Cat. no. PHE 183. Canberra: AIHW.

9 % Reasons Gay men use crystal N= I felt like I needed it To make it easier to get fucked For longer sex Someone else wanted me to use it To become less inhibited To party longer For a party and play (PNP) session To get a buzz To see what it was like For fun Reasons to use Crystal (The Flux Study: Annual Report 2015)

10 Why created ReWired While the overall methamphetamine prevalence of appears to have remained stable, there seems to be more frequent use within specific populations that already use drugs and a rapid shift within specific drug-using populations (i.e. gay men, men who have sex with men) towards use of methamphetamine in crystal form, with a related increase in harms (National Drug Research Institute, 2015) While methamphetamine use amongst gay men may contribute to risky sexual behaviour, there is little evidence of the increases in violence or other public order problems commonly attributed to methamphetamine use amongst gay communities (National Drug Research Institute, 2015) Research shows that the purity of crystal methamphetamine has increased from 21% in 2009 to 64% in 2013 (Scott, 2015) Increases in purity have influenced a range of contextual factors, such as risk taking, use within risky situations, and a persons ability to access treatment and services (National Drug Research Institute, 2015)

11 Why created ReWired Research evidence clearly suggests that perceived stigma and a fear of judgment is a major barrier for gay men when accessing health services (Sexual Exclusion Homophobia and health inequalities: a review, 2004 ) The data illustrates that many LGB people are likely to experience health inequalities or social exclusion as a result of prejudice and discrimination (Sexual Exclusion Homophobia and health inequalities: a review, 2004 ) Programs addressing problematic meth use for men who have sex with other men have been shown to be most effective when delivered within a community setting with appropriate community support and follow up (Shoptaw et. al., 2005)

12 ReWired Assessment First session Last session

13 Outcomes ReWired therapeutic group September 2016 DUDIT, K10 and Personal Well Index (PWI) ReWired therapeutic group September 2016 DUDIT, K10 and Personal Well Index (PWI) Baseline Score (N=13) 40 Baseline Score (N=7) 30 Post-Program Score (N=7) 30 Post-Program Score (N=7) Mean DUDIT (/40) Mean K10 (/50) Mean PWI (/100) 0 Mean DUDIT (/40) Mean K10 (/50) Mean PWI (/100)

14 Outcomes Rewired therapeutic group June/July 2016 baseline and post-program Reediness to Change Questionnaire (RCQ) scores Rewired therapeutic group September 2016 baseline and post-program Reediness to Change Questionnaire (RCQ) scores Action 4 Action 4 Preparation Contemplation 3 Preparation Contemplation 3 Pre-Contemplation 2 Pre-Contemplation Baseline Scores (N=13) Post-Program Scores (N=7) Baseline Scores (N=7) Post-Program Scores (N=7)

15 Outcomes ReWired 2.0 Participants consistently report: ReWired 2.0 helps with reducing their meth use The ongoing support provided by ReWired 2.0 is essential to their recovery journey Felt supported by the peer facilitators Having a space where they can discuss their problematic meth use impacted other areas of their lives in a positive way

16 Outcomes Participants in both in both ReWired therapeutic group and 2.0 stated: Meth is a real and ongoing problem in the gay community Program reduce feelings of isolation Helped them see a life beyond meth Essential in building and developing skills for their recovery process

17 Knowing that the program was designed for their specific needs made it easier to access Accessing a community delivered service allowed them to be more open and share without fear of judgement The experience of ReWired was extremely positive

18 Questions? THANK YOU Garth Parkhill

19 References Cochran, S. D., Ackerman, D., Mays, V. M. and Ross, M. W. (2004), Prevalence of non-medical drug use and dependence among homosexually active men and women in the US population. Addiction, 99: doi: /j x Stall, R., Paul, J. P., Greenwood, G., Pollack, L. M., Bein, E., Crosby, G. M., Mills, T. C., Binson, D., Coates, T. J. and Catania, J. A. (2001), Alcohol use, drug use and alcohol related problems among men who have sex with men: the Urban Men's Health Study. Addiction, 96: doi: /j x Ritter, A., Matthew-Simmons, F., and Carragher, N. (2012), Prevalence of and interventions for mental health and alcohol and other drug problems amongst the gay, lesbian, bisexual and transgender community: A review of the literature. Measham, F., Wood, D. M., Dargan, P. I. And Moore, K. (2011), The rise in legal highs: prevalence and patterns in the use of illegal drugs and first- and second-generation legal highs in South London gay dance clubs. Journal of Substance, 16, 4. dx.doi.org/ / McCann, E. and Sharek, D. (2014), Survey of lesbian, gay, bisexual, and transgender people's experiences of mental health services in Ireland. Int J Ment Health Nurs, 23: doi: /inm Lombardi, E. (2008), Substance use treatment experiences of transgender/transsexual men and women. Journal of LGBT health research, 3, 2. dx.doi.org/ /j463v03n02_05

20 AIHW National Drug Strategy Household Survey detailed report: Drug statistics series no. 28. Cat. no. PHE 183. Canberra: AIHW. Hammoud M, Jin F, Degenhardt L, Lea T, Grierson J, Mackie B, Pastorelli M, Batrouney C, Bath N, Bradley J, Prestage G. (2016). Flux: Following Lives Undergoing Change, Gay community life, drug use, and taking care of ourselves and each other, Report Monograph, The Kirby Institute, UNSW Australia, Sydney Australia Douglas Scott, S., Pringle, A. and Lumsdaine, C. (2004). Sexual exclusion-homophobia and health inequalities: a review. UK Men s Health Network, England, UK. Shoptaw S., Reback C.J., Peck J.A., Yang X., Rotheram-Fuller E., Larkins S., Veniegas R.C., Freese T. E., Hucks-Ortiz C. Behavioral treatment approaches for methamphetamine dependence and HIV-related sexual risk behaviors among urban gay and bisexual men. Drug & Alcohol Dependence, Volume 78, Issue 2, dx.doi.org/ /j.drugalcdep Kelly, J., Davis, C. and Schlesinger, C. (2015), Substance use by same sex attracted young people: Prevalence, perceptions and homophobia. Drug Alcohol Rev, 34: doi: /dar National Drug Research Institute (NDRI) (2015), Responding to methamphetamine use and related harms in Australia: A submission to parliamentary joint committee on law enforcement s inquiry into crystal methamphetamine (Ice).

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