Pilot Alcoholism-Treatment Program Targets Gays

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What gay man doesn't like a cocktail? Certainly, there are enough gay men who seem to drink too much. But 40 years after Stonewall — the birth of the gay liberation movement took place at a bar, let’s remember — Columbia University researchers have been trying to figure out if gay men can avoid giving up the nightlife just because they have a drinking problem.

Why? “It’s too socially debilitating to cut a gay man off from the bar and club scene,” said Jon Morgenstern, a clinical psychologist at Columbia University who is vice-president of the school’s National Center on Addiction and Substance Abuse and the director of the trial. “Gay men,” continued Dr. Morgenstern, a Dos Equis–swigging heterosexual, “have the minds of college students and teenagers when it comes to alcohol. It’s crucial to their socialization.” (Morgenstern makes it clear that the same conditions exist for other groups that tend to socialize around alcohol.) Unlike most accepted methods of managing alcoholism, the double-blind clinical trial does not demand abstinence; instead, alcoholics are taught to manage their addiction and moderate their drinking.

A treatment program specifically targeting gay men certainly makes sense. As a consequence of gay social life centering more on bars than straight social life often does, there's more of an opportunity to develop a drinking problem. “Proportionally, gay men struggle with addiction more than their straight counterparts,” said Benoit Denizet-Lewis, a gay author whose new book, America Anonymous: Eight Addicts in Search of a Life, includes his own addiction to sex. “It’s not surprising given that it’s traumatizing to grow up gay in this country; there’s a strong link between emotional trauma and addiction,” he added. “And growing up gay is often about shame, compartmentalizing, secret lives — all these habits that can easily work for addicts as well.”

Advertising in bars, bookstores, clinics, and even Craigslist personals, the Columbia program, named Project Smart, started in the spring of 2007. It is supposed to wind down this fall (though may go as late as next spring). Over three months, every patient receives seven generic counseling sessions as well as pills (either placebo or Naltrexone, an anti-craving drug); some also receive twelve 45-minute personalized psychotherapy sessions. Regardless of which group they fall into, everyone in the trial is given training on how to consume alcohol without bingeing on it, such as how to have alcohol in your apartment without going through the whole bottle, or how to go to an office party — or a bar — and not get drunk.

The scant research that exists on the subject suggests that alcoholics are rarely successful in trying to moderate their drinking, and Alcoholics Anonymous famously works through abstinence ("I hear a lot of people admit that periods of controlled drinking were more miserable than bingeing," AA spokesperson Irene Kontje told us). A 2005 report in the journal Addiction determined that, among alcoholics, those in full recovery were about evenly split between abstainers (18.2 percent) and so-called “low-risk drinkers” (17.7 percent). And Mark Willenbring, the director of the division of treatment and recovery research at the National Institute on Alcohol Abuse and Alcoholism, notes the emergence of a new term in the field: “non-abstinent recovery.” The national institute is financing the Columbia study.

Michael Levy, a lecturer at Harvard Medical School and author of 2007's Take Control of Your Drinking … And You May Not Need to Quit, offers his patients both abstinence and moderation-based treatments. “Just like with sex education or no-carbs dieting, abstinence doesn’t work for everyone,” he said. Moderation research is hampered, Dr. Levy added, because “we are heretics operating in a hostile field.” Even if he can show some success, Dr. Morgenstern noted that New York State health codes, like those in many states, forbid licensing treatment programs that have goals of moderation. Unless the rule is changed or he wins an exception, insurance companies will be unlikely to cover an unlicensed treatment program.

The bigger question might be definitional: Even in a big city like this one, is it really that difficult to be a homo sans mojitos? Will, 31, a gay art director from Brooklyn who joined Alcoholics Anonymous last year, says yes. He found it to be a segregating experience when he would socialize at bars. “Nobody wants you around because suddenly you’re the guy who remembers every drunken-mess thing they did or said, because you’re the one drinking ginger ale with a clear mind,” says Will, who, like other participants in the Columbia program, agreed to be identified by first name only. He left AA a few months ago. “It’s tough because, sure, as a New Yorker, drinking plays a role in going out. But it’s nothing compared to the role drinking plays in your life as a gay man.”