Crystal meth use among gay and bisexual men is above the general population, yet remains a silent epidemic.

The word "meth" itself can be stigmatizing, preventing clients from talking about their use.

We're allowed to question our relationship with substances long before it ever becomes a problem.

When a client of mine brought up his meth use, what I started to notice was that he seemed to avoid saying the word “meth.”

It was confusing at first, because he'd talk about “acting out,” but I'd have a hard time deciphering whether he meant sexual behavior or meth use.

Whenever I would use the word to help clarify what he was saying, his affect would subtly change.

I reflected it to him and he said that if I've noticed he's uncomfortable using the word, I'm right. He is.

He started to tell me how common it is in his industry and in many industries. He's successful and high functioning, but uses meth about once per month.

He's only bringing it up now in therapy because it's starting to become ego-dystonic. He's recognizing that while his use is only once per month and he doesn't view it as compulsive or an addiction, meth keeps him from experiencing vulnerability and intimacy in his connections with other........

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