Addiction, trauma, and resilience in LGBTQ people’s lives: my experience as an integrated behavioral health services provider

By Frank Busconi

When invited to write about substance use in the LGBTQ community I flashed back to 2001, when I first came to work at Fenway Health and Boston was just beginning to grapple with the extent of methamphetamine use among gay men. I was hired to manage a small HIV and STD prevention program that included community outreach, group prevention activities and community forums. In 2002 I helped organize a community dialogue about methamphetamine. Clearly we’d struck a nerve, as we packed the relatively tight confines of Fenway Health’s former home on Haviland Street. There was curiosity, concern and outright fear among the attendees, a combination of community members, prevention workers and behavioral health professionals. I was all three: a gay man living in Boston, working in a prevention program, and providing behavioral health and addiction therapy. I’ve spent the many years since then providing and managing behavioral health and addiction recovery services at Fenway Health.

Through a focus on methamphetamine, my aim here is to shed light on issues that may not reflect the diversity of all substance use experiences in the LGBTQ community, yet nonetheless highlight key themes. This perspective reflects lessons gleaned from many kind mentors who have contributed over the years to my understanding of the nuances of health behavior, effective intervention, human nature, and the need for empathy. I’d specifically like to recognize and credit Gail Beverley, Doug Hein, Michael Shernoff, Eric Rofes, and Patricia Case.

Methamphetamine has been around for 100 years and amphetamines have been in pharmaceutical and recreational use for about as long. Where methamphetamine intersects with the lives of gay men is around sexual behaviors (increasing drive and the quality of the experience) and what I’ve come to think of as managing internalized homophobia and fear of sex and HIV. My understanding about methamphetamine is inextricably linked to the impact of HIV/AIDS on our community. There were twelve short years between Stonewall in 1969, a pivotal moment in the LGBTQ rights movement, and the first cases of HIV that were diagnosed in 1981. By the time I moved to Boston in 1984 to attend college, an entire generation of the LGBTQ community was traumatized, grief-stricken, emotionally exhausted, and facing high levels of AIDS-related stigma and fear from mainstream America. This is where the writing of Eric Rofes is so helpful. He eloquently described how generations of gay men grew up and struggled to form healthy identities and negotiate everyday life under the significant burden of homophobia, only to encounter the additional lethal threat and stigma of HIV.