CRYSTAL METH: ITS GRIP IS RELENTLESS

One by one, the clients at the 28-day rehab facility introduced
themselves and their addictions, the way participants in another
group venue might identify their alma maters or employers. "I'm Joe,
I'm an alcoholic." "I'm Sarah, I'm an addict, methamphetamine."

The counselor turned to the friends and family members of the dozen
or so clients who were there for a two-hour session. He asked: "Who
wants to start?" No one volunteered. He then gazed at a woman of
about 20, who had placed her left hand on the knee of her younger sister.

"I'm angry, and I really don't want to be here," she began, without
a trace of emotion in her voice. "But I am here, because I love my father."

She proceeded to catalog the devastation her father's addiction to
crystal meth had wreaked on the family: the wild mood swings, the
abrupt absences for days at a time, the financial ruin, his physical
and mental deterioration. She spoke of the anxiety inflicted on her
mother, who was getting tested monthly after learning recently that
her husband had become HIV-positive.

The father fidgeted in his seat as his daughters, rigid and
resolute, talked about how the lies and suspicions that pervaded the
household were finally explained when their mother found his stash
of meth. They remained calm as their fidgeting father, under
unrelenting questioning from the counselor, filled in the details of
his plunge into methamphetamine addiction and sexual recklessness.

What was striking about the meth addicts was the commonality of
their stories and the magnitude of their collapse, despite their
variation in age and socioeconomic circumstances. Each talked of the
drug's seductive effects - endowing them with almost superhuman
focus and the ability to stay up for up to 72 hours, enhancing their
performance on the job and in the bedroom - and their ultimately
futile attempts to continue at a "maintenance level" of use. They
described how their lives contracted into a world of meth users that
revolved around their dealers, providing them with "a family" to
support an addiction that was destroying their real ones. And they
all spiraled into an existence of depravity, despair - and a level
of denial that rehab had yet to exorcise.

As I heard these searing accounts of methamphetamine's toll, I
reflected on an October 2005 panel on "Crystal Meth and HIV: One
Pandemic or Two?" that I moderated at the Commonwealth Club. At the
time, media attention was focused on the pervasiveness of crystal
meth use in the gay community, particularly in the San Francisco
club scene, and its connection with high-risk sex. I recall being
struck by the sensitivity, among both the panelists and the audience
members, about the effect of media coverage in "stigmatizing" gay
men who use meth. I worried that such sensitivity - or political
correctness - would make it difficult to confront what was,
indisputably, a serious public-health problem.

Besides, I wondered, what was the problem with stigmatizing behavior
that was so obviously destructive to self and society? After all,
the stigmatization of drunk driving and cigarette smoking helped
reduce its occurrence and thus save lives.

So what has happened since 2005?

Health officials and community leaders suggest that attitudes toward
crystal meth are changing.

"There was a a norm that it was accepted in certain parts of the
community," said Supervisor Bevan Dufty, who said he encountered
"nasty messages and ridicule" from "some of my brothers in the
community" when he helped spearhead a task force on crystal meth. "I
think we've brought it out of the closet."

The city and state have poured more resources into prevention and
treatment. The price of meth has risen, partly a result of
pharmacies exerting tighter control over precursor substances.
Public health officials in San Francisco said they have gained a
better understanding of meth-use patterns, which has allowed them to
develop more effective treatment strategies. For example, about 90
percent of meth users are also abusing alcohol or another drug.

"There is a little evidence that the peak of the crystal meth
epidemic has subsided," said Grant Colfax, director of prevention
for the city Department of Public Health. "But I think it's too
early to declare victory."

One encouraging sign, he said, is a slight reduction in meth-related
admissions to San Francisco General Hospital. Colfax was heartened
that crystal meth was no longer "quote-unquote cool in some
quarters," though it remained "a major problem."

As the personal stories at the rehab session show, there are many
routes to ruination. Alcohol had at least a supporting role in every
single one. But there was something distinctly insidious about meth,
in the force of its grip and its power to steal a user's need to
eat, sleep and care about others.

"It's like a wrecking ball," Dufty said.

As I left the rehab center that Saturday afternoon, a driving rain
forced visiting family members to pull their coats over their heads
as they sprinted to their cars. Many had promised the counselor they
would return for the next week's session; some had seen their loved
one go through the 28-day drill before. For them, addiction is the
cloud that never lifts.