1. The UK’s only LGBT Substance Misuse Service 10 year history serving the Substance Use needs of London’s LGBTQ community 8,000 contacts, 700+ people in treatment each year

2. “Club Drugs” are Problematic Drugs

3. 3 Our scene highly sexualised

4. 4 Normalised Drug/Alcohol use on our Bar and Club Scene

5. 5 From “Huggy” to Hardcore”

6. 6 72 hour clubbing, sex-on- premises venues, On-line hook- ups, Crystal sex parties…

7. 7 24 HOUR SAUNAS…

8. 8 The popularity of BareBacking

9. Shame around sex, intimacy anxiety, internalised homophobia Sexual SHAME

10. 10 Crystal Methamphetamine, Crystal, Tina. Crystal Methamphetamine, Crystal, Tina. 3, 4 + day “benders” of speedy, unboundaried chaotic sexual marathons. 3, 4 + day “benders” of speedy, unboundaried chaotic sexual marathons. Effects managed with GBL use. Effects managed with GBL use. Repetitive GUM presentations. Repetitive GUM presentations. Increased HIV/Hep C infections. Increased HIV/Hep C infections. Drug-induced psychosis very common. Drug-induced psychosis very common. High likelihood of psychological dependence. High likelihood of psychological dependence.

11. 11 MANY more people now injecting..

12. 12 2 Distinct Issues Toxicity/Overdose Dependency/

13. 13 Overdosing in clubs/saunas/ sex- parties. Large numbers of people forming dangerous addictions, using hourly every day, just to avoid unmanageable and dangerous withdrawal symptoms.

14. 14 HOW dependence begins, progresses Used to sleep after a big weekend of continual use, Used to sleep after a big weekend of continual use, leading to.. leading to.. using to manage the comedown during the week, using to manage the comedown during the week, leading to.. leading to.. using to aid sleep at bedtime, using to aid sleep at bedtime, leading to.. leading to.. using for any stress or discomfort, using for any stress or discomfort, leading to.. leading to.. regular use/dependence regular use/dependence

15. 15 “Keyworking” tools Identifying “Contemplation” or “Action” Identifying “Contemplation” or “Action” Setting Goals Setting Goals Recognising Triggers Recognising Triggers (Places, situations, people, emotional states, stress, sexual arousal..) (Places, situations, people, emotional states, stress, sexual arousal..) List of Pro’s and Con’s List of Pro’s and Con’s Managing Cravings Managing Cravings Recognise and anticipate triggers/associated situations Recognise and anticipate triggers/associated situations Acupuncture, breathing, meditation Acupuncture, breathing, meditation Remove yourself from situation “Time Out” Remove yourself from situation “Time Out” Delay, Distract, Decide Delay, Distract, Decide

16. 16 MORE TOOLS Make a list Make a list Saying “no” confidently/setting boundaries Saying “no” confidently/setting boundaries Anticipating certain invitations/situations Anticipating certain invitations/situations Encouraging other interests Encouraging other interests Communication skills. Communication skills. Honesty/support from appropriate friends/family Honesty/support from appropriate friends/family Harm Reduction Harm Reduction Referrals Referrals Listening is Support Listening is Support

17. 20052011 Crystal Meth 0%39% GHB GBL 3.2%27% Mephedrone 0%14% Referrals from GUM clinics, A&E or statutory drug services 8%63% 17

18. 18STATS Of the Crystal Meth, GBL and Mephedrone users at Antidote; 95% are using to facilitate sex 95% are using to facilitate sex 80% are injecting (Meth and Meph) 80% are injecting (Meth and Meph) 70% report having shared needles to inject (Meth and Meph) 70% report having shared needles to inject (Meth and Meph) Prefer to use “Bareback” sites to find sexual partners Prefer to use “Bareback” sites to find sexual partners Report an average of 5 sexual partners per “episode” Report an average of 5 sexual partners per “episode” 75% are HIV positive; of these, 60% report being non-compliant with ARV’s while “high” 60% report being non-compliant with ARV’s while “high” 90% attribute their diagnosis to the use of drugs and alcohol 90% attribute their diagnosis to the use of drugs and alcohol Of the HIV Negative clients, more than half have had one or more courses of PEP in the last year

19. 19 Domestic Violence

20. 20 Thank you for listening. Questions, discussion…