Chad Upham had been the kind of kid any parent would be proud of -- an Eagle Scout, a good child who didn't cause problems in his fundamentalist Christian family. He didn't touch a beer until he was 21.
Jump forward to an early Monday morning this past July. Upham, now 27, had been up all night after another weekend of drugs and sexual hookups with strangers he met online.
But instead of pushing his limits for indulgence again, he made a different choice. Around 3 a.m., Upham sent an e-mail to his friends and family with some unexpected news.
"Over the past four months," he wrote, "I have become a regular user of crystal methamphetamine." He added, "I acknowledge, without shame, a concern for my mental, physical and emotional health."
While meth abuse is well-established in the U.S. heartland and increasing in New York and Los Angeles, it has had a low profile in the Washington area, where crack cocaine and marijuana are still the targets of most anti-drug programs run by law enforcement and public health agencies.
But meth use is increasing in portions of the gay community, according to local health officials, area addiction and mental health practitioners, and specialists in gay health issues. The District's Whitman-Walker Clinic, which provides HIV/AIDS and other health services to a largely gay clientele, reports that 75 percent of its new drug treatment clients list crystal meth as their primary drug of abuse. Five Crystal Meth Anonymous groups meet near Dupont Circle, a neighborhood with many gay residents. Two and a half years ago there were none. Suburban treatment centers report an increase in meth-related referrals, including some in teenagers. The D.C. government has just awarded its first grant for an anti-meth public education campaign, which will target the gay community.
The Post reported in July that police in Southern Maryland had found a small methamphetamine lab in the bathroom of a La Plata townhouse -- along with a cache of weapons, including grenades and seven rifles, some with bayonets. But that close-in lab is an exception. Federal drug authorities said in a 2002 report that the few meth labs in this region are located in the rural Shenandoah Valley.
Methamphetamine is a homemade, highly impure version of amphetamine, a stimulant that was widely abused in the 1950s through the 1970s. Its main ingredient is distilled from the pseudoepinephrine found in many over-the-counter cold and allergy medications.
Commonly known as crystal, crystal meth and Tina, meth is a potent, highly addictive drug that some experts say can cause long-term neurological and cardiovascular damage. The drug supercharges the central nervous system, causing the brain to churn out dopamine. This neurotransmitter affects brain processes that control movement, emotional response and the ability to feel pleasure and pain.
"Someone said [meth] is like smoking a cigarette, having an orgasm and eating chocolate all at the same time," said Amy Bullock-Smith, clinical program manager for the Whitman-Walker Clinic's addiction services, "and all that lasting about 12 hours."
Meth induces euphoria almost immediately after the odorless, bitter-tasting powder is smoked, the most common way meth is used. It takes a few minutes to feel the same rush from snorting, swallowing, injecting or, less commonly, dissolving it in water and taking it as an enema. This is followed by six to eight hours, and sometimes as much as 24 hours, of increased energy, suppressed appetite and other stimulating effects.
Meth labs can be set up in homes, motels, apartments, trailers, houseboats, cars -- anywhere that heat and basic lab tools can be used to cook down cold and allergy medications to extract their active ingredients. Other chemicals used to make meth -- according to news reports and numerous Web sites that offer "recipes" -- include iodine crystals, red phosphorous from the strike pad on matchbooks, muriatic acid, acetone, methanol and drain cleaner.
A Local View
Aside from its growing use in gay clubs, meth has made little impact in local jurisdictions, officials say.
In its most recent drug threat assessment report, published in 2002, the Department of Justice's National Drug Intelligence Center described meth abuse as "limited" in Maryland, "a low but increasing threat to Virginia," particularly southwestern Virginia, and "not yet a serious problem in the District."
The department said that most meth available in this area was produced in southwestern states or Mexico. It was distributed to users by teenagers and young adults, mostly at nightclubs and raves, large dance parties usually held in warehouses or open fields.
Over the past five years there has been a surge in the number of gay men in the Washington area seeking treatment for meth abuse. Kevin Shipman, manager for special populations in the District's Addiction Prevention and Recovery Administration, notes that the number of meth referrals to the Whitman-Walker Clinic's outpatient drug programs is five times higher this year than in 2000.
Local substance abuse treatment programs for adolescents report seeing small but growing numbers of youthful meth abusers.
At the Inova Kellar Center, senior case manager Mary Ellen Ruff said this mental health center in Fairfax is seeing a lot of adolescents who have experimented with meth, though she does not have specific figures. She blames the drug's accessibility, pointing out that teens "don't have to go downtown to get it, but can buy it from their neighbors." She said some teens who abuse attention-deficit hyperactivity disorder (ADHD) drugs -- kids without the disorder who get the drugs illegally and use them as stimulants -- move up to crystal meth.
Whitman-Walker's Bullock-Smith said the men turning to her clinic for help with meth addiction are typical of Washington's professional caste -- Type A personalities in fast-paced jobs that require a lot of mental energy. "It's not necessarily the folks who want to party all the time," she said.
She points out that people with untreated ADHD seem especially attracted to meth because, much like legally prescribed stimulants such as Ritalin (methylphenidate), the drug paradoxically calms and focuses them. Researchers have suggested that, like crystal meth, methylphenidate amplifies the brain's release of dopamine, thereby improving attention and focus in individuals who have weak dopamine signals.
Because the drug's effects can include a supercharged libido, extended periods of high energy and sleeplessness and a much-reduced ability to make sound judgments, unprotected and promiscuous sex is a high risk. Recent studies from San Francisco and Chicago confirm that gay meth abusers are at significantly heightened risk for becoming infected with HIV and other sexually transmitted infections.
A 2003 study in the American Journal of Drug and Alcohol Abuse found that meth users are likely to experience increased respiration and blood pressure, irregular heartbeat and insomnia.
A report in Psychological Medicine in 2003 said that long-term users may experience paranoia, hallucinations, tremors, mood disturbances, repetitive motor activities, homicidal or suicidal thoughts and irreversible damage to small blood vessels that increase the risk of stroke. Children of meth users frequently are at risk for neglect and abuse, the authors found.
Researchers reported in the American Journal of Psychiatry in 2001 that prolonged exposure to even low doses of meth can damage up to 50 percent of the brain's dopamine-producing cells.
Those who overdose on meth experience hyperthermia and convulsions that, if not treated, can result in death.
"While some people enjoy the short-term benefits," said Bullock-Smith, "it's the long-term effects, like the psychosis, that bring them to me."
Breaking Tina's Spell
The National Institute on Drug Abuse says the only treatment known to be effective for methamphetamine addiction is cognitive behavioral therapy to modify thinking and behaviors and to increase skills in coping with stressors. The agency says that meth recovery groups, such as Crystal Meth Anonymous, appear to help sustain drug-free recovery, though relapse rates are high.
As for the brain damage meth causes, researchers Gene-Jack Wang and colleagues at the Brookhaven National Laboratory in Upton, N.Y., have offered evidence that some areas of the brain begin to heal after abstaining for as little as two months. Other damage is longer-lasting.
George Kolodner, a board-certified addiction psychiatrist and medical director of the Kolmac Clinic in Silver Spring, said his clinic saw an increase in crystal meth users beginning about two years ago, but the trend has not accelerated since then. He said meth users are the most difficult patients to treat because there is no medication to prevent craving or treat the protracted post-use symptoms, such as dysphoria, or depressed mood.
"With other substances," said Kolodner, "we can help people get off and keep off by decreasing their cravings. With meth and cocaine, we don't have that."
Randy Pumphrey, executive director of the Washington Psychiatric Institute's Lambda Center, which provides substance abuse services to gay people, said that in the past four years meth has increased from being "something we saw every once in a while" to the third most commonly abused substance, after alcohol and crack, among new clients.
If someone is dependent, said Pumphrey, "they are going to need a period apart from their environment -- and also need hospitalization" to deal with the paranoia, severe depression or even homicidal feelings that can accompany the detox process.
After this acute phase, Pumphrey said, patients usually participate in a daytime treatment program for several weeks before joining an extended support program such as Whitman-Walker's six-month evening program for recovering addicts.
Kolodner said the relative newness of meth-specific support groups is a challenge to treatment because few have been in recovery long enough to serve as mentors.
Bullock-Smith explains that Whitman-Walker's three-phase addiction recovery program requires a substantial commitment. To graduate, clients must attend one to three meetings a week at the clinic, participate in an outside 12-step group, have a sponsor, undergo breathalyzer and urinalysis tests to verify that they are not using, see a therapist, have a psychiatric evaluation and complete "lots of homework."
Let's Talk About It
A committee including the police department and other District agencies, substance abuse professionals, youth organizations, nightclub owners and recovering addicts began to meet this summer to plan a response to what they view as a growing meth crisis.
Like community-level anti-meth efforts in other cities, the D.C. Crystal Meth Working Group is planning a campaign aimed at educating the nonusing public, preventing meth abuse among gay men and offering treatment referrals to current users. The District health department has provided a $42,000 grant for the group to work with Whitman-Walker on the campaign.
This is a good start, said group member Bruce Weiss, executive director of the Sexual Minority Youth Assistance League, which serves gay, lesbian, bisexual and transgendered youth. The group will seek $1 million from the D.C. government and try to ensure that fighting meth is included in the five-year plan of the task force advising the mayor on anti-drug priorities.
Community activist Christopher Dyer, who chairs the group's social marketing campaign subcommittee, said the campaign's slogans, "Let's Talk About Crystal Meth" and "Crystal Meth Sucks," will be launched in nightclubs with posters, pins and T-shirts.
Another group member, Ed Bailey, co-owner of Nation, a Southeast Washington dance club, said major club owners across the country support anti-meth campaigns like this one. The drug has cut into their business because people typically do not drink alcohol when they are using meth, he said. Over time they also become increasingly isolated and don't go to clubs.
Since deciding to live meth-free after one too many sleepless, drug-driven weekends, Chad Upham said he depends mainly on Crystal Meth Anonymous groups and constructive activities with family and friends to support his recovery. Although he saw a doctor for a standard checkup, he -- unlike some of his recovering friends -- isn't taking any medications to treat anxiety or depression.
Upham is discovering that Tina continues to tempt.
"I am thinking desirously about the people, places and things that were associated with my using," he said. Running into a person he knew from those "hot days and nights" revives thoughts of "all that fun."
But he pulls himself back to his new reality -- denying the drug, listening to his family, co-workers and new friends in the support groups he attends several nights a week.
They have "embraced me in my weakness," said Upham, "continually saying that I am brave, courageous and strong for taking the steps to get and stay healthy and live independent of drugs for satisfaction."
John-Manuel Andriote, author of "Victory Deferred: How AIDS Changed Gay Life in America," is a Washington journalist. To comment on this article, send e-mail to email@example.com.