About.com Rating

Updated June 21, 2011.

Publisher's Site

A much-needed book for a vulnerable group of people with addiction and other substance use problems, Gay Men and Substance Use is a compassionate and informative guide for people trying to understand substance use among gay men. Written from the perspective of a gay male counselor with years of experience counseling gay men with substance use problems, this book speaks to gay men and the people involved with them in an encouraging and knowledgeable way.

However, I would hesitate to recommend this book to some potential readers, which I will explain later.

A Useful Starting Point for Addiction Counselors

Perhaps the best audience for this book is addiction counselors who have little or no experience with gay men, urban gay culture or substance use in these contexts. These readers will benefit from understanding some of the psychological struggles faced by gay men, which tend to worsen drug and alcohol abuse and addiction. Reading this empathetic account of how substance use problems develop in a specific sub-group of gay men, many counselors would gain a deeper understanding of the ambivalence many gay men face, both in terms of their sexuality and in terms of their substance use and recovery.

I think this book tries to cover a lot of ground by appealing to gay men with addictions and those who care about them, which actually includes partners, friends, counselors and family members. Each of these is a different audience, with different needs, and I don't feel this book is a good fit for every gay man and his family members.

Thinking about clients I've worked with who are gay men with substance use problems, and their families, I would hesitate to recommend this book to them.

Not Recommended Reading for All Gay Men

Why? Because a lot of the content is either obvious to them, unnecessary or potentially complicating to their situation.

Gay men who have been part of the gay scene described in this book -- including gay men seeking help for substance use problems, and their partners, will already be aware of the information on drugs and party and play. For them, it is redundant. The information on how to get help might be useful, but as the process of treatment and recovery is portrayed in a rather negative way, some may be put off getting help.

In contrast, the more naive, younger gay men who are going through the coming-out process and starting to experiment with sex and/or drugs may be intrigued by the details of casual sex and party and play, and the implication that drug use is a rite of passage in the gay community. This could potentially influence an 18 year old to try meth, even though he'd only tried marijuana when he picked up the book.

And there are many gay men, particularly those who are not part of a large, urban gay community, who would be alienated by the references to group sex and party and play, particularly those who have no interest in these activities. Research shows that it is a myth that meth is the drug of choice for gay men. The drug most commonly used by gay men, as with the straight community, is alcohol. Again, much of the book would be irrelevant to gay men who use alcohol but not other drugs.

May Help Couples, But Could Be Too Much Information for Parents and Families

Although the author acknowledges that family members may find the explicit nature of the book uncomfortable, the title does invite parents to read it as "those who care about" substance-using gay men. I think many of parents of gay men would find this difficult reading while they are trying to figure out how to support their sons. I don't think they want or need to read details of the extreme sex lives of some gay men. It may not even be relevant to their son's situation, and many would find this information embarrassing, upsetting and frightening.

On the other hand, there is some useful guidance on how to understand and communicate with a gay man struggling with substance problems. Therefore, partners might find this information helpful. There is also quite a bit of information on how to conduct an intervention, so friends and loved ones have some structure and guidance on how to set this up. However, interventions are not supported by research and can easily magnify problems for the individual and family, so this advice should be followed with caution.

Useful Resource on Treatment Services and Recovery

The book provides some useful information on treatment services and self help groups, and on the process of recovery, although it is 12 step oriented. The section on relapse may be particularly helpful for gay men, particularly if they are quitting alcohol or drugs without professional assistance. It is also important for partners and family members to know that quitting is often not a one-time deal, and relapse is frequently part of the recovery process -- it doesn't mean the person has failed or isn't serious about recovery.

The presence of homophobia within society, including among healthcare professionals, is certainly important to mention. Perhaps I have been particularly fortunate in working in places that emphasize acceptance, and have clients who are particularly tolerant and well informed about sexual minorities. My sense is that the culture has changed and is not as homophobic as it is portrayed here.

In my view, the description of ignorance about sexual minority issues in the context of treatment services is overstated, and unnecessarily negative. I have found the addictions-treatment community to be one of the safest and most accepting places for sexual minorities. Expressions of homophobia are unacceptable, whether from staff or other clients -- anyone exposed to this kind of abuse should report it to an authority immediately.

Self-help groups are another issue entirely, as they are unregulated and run by participants. Therefore, as the book warns, gay men who attend self-help groups run a higher risk of being judged if they are open about their sexuality.

Publisher's Site

Disclosure: A review copy of advance uncorrected proofs was provided by the publisher. For more information, please see our Ethics Policy.